Let's be PALS: User‐Driven Organizational Change in Healthcare*

This paper explores user‐driven organizational change in the National Health Service (NHS). The NHS Plan ( Department of Health, 2000 ) created Patient Advice and Liaison Services (PALS) to provide information, solve problems and drive user‐led change. Evidence is drawn from a study of PALS in London acute, primary care, mental health and specialist trusts, drawing on discussion forums, interviews with PALS officers and documentation. From context and role profiles, two conclusions are evident. First, organizational instability, boundary disputes, variable management support, resource limitations, financial insecurity and multi‐site working characterize the context in which PALS operate, and the officer role is characterized by problem diversity, overlap with complaints systems, monitoring problems, relationship building and ‘serial users’. Second, these context and role attributes restrict PALS to ‘repair and maintenance’, ensuring that established systems work correctly. While PALS sit on the bottom rung of a ‘participation ladder’, their contribution is more than tokenistic. However, a processual perspective demonstrates how a fluid, networked, and diversified context isolates PALS structures from management decision‐making, constraining their power base, and inhibiting the promotion of substantive change agendas.     

Direct and Indirect Links Between Organizational Work–Home Culture and Employee Well‐being

The extent to which an organization's culture exhibits support for its employees' efforts to balance work and personal responsibilities has been shown to influence a number of work‐ and home‐related outcomes. This study tests a model with a mix of mediated and moderated relationships to investigate direct and indirect routes by which work–home culture may affect employee well‐being. Sex differences in these relationships are also explored. Data collected from public sector employees in the UK indicate that a supportive work–home culture is significantly associated with lower levels of psychosomatic strain among employees. For women, this relationship is mediated by reduced levels of work–home interference. Different types of support demonstrate different effects for men and for women: managerial support has a more beneficial impact on women's well‐being, and organizational time demands have a more detrimental impact on men's well‐being. Recommendations for managers to boost employee well‐being include shifting the focus away from presenteeism and toward work outputs in order to reduce gender stereotypes and improve attitudes toward those using flexible work practices and family‐friendly initiatives, incorporating work–home supportiveness into the managerial performance appraisal process, and compensating or otherwise recognizing employees taking on absent colleagues' workloads.     

How Plant Managers' Experiences and Attitudes Toward Sustainability Relate to Operational Performance

Managers are increasingly faced with pressure to think not just about profits, but also about their organization's environmental and social performance. This research provides a first examination of operational managers' experiences with and attitudes about employee well‐being and environmental issues, how these factors impact employee well‐being and environmental performance, and how the three performance measures interrelate. We use violations of Occupational Safety and Health Administration regulations and Toxic Release Inventory reports of emissions as proxies for employee well‐being and environmental performance. Our findings suggest that operational managers do not (yet) think in sustainability terms. However, employee well‐being and environmental performance do interact in a significant way with operational performance. Hence, operational managers would benefit from a more complete understanding of the relationships among the elements of the triple bottom line.     

The relationship between perceived employability and subsequent health

Being capable of getting new employment may enable an employee to cope with turbulent situations or deteriorating job conditions. Individuals who have higher perceived employability are likely to appraise a situation at work more favourably, and consequently experience better health and well-being. The aim of the present study was to investigate the relationship between perceived employability and subsequent health, while controlling for baseline health, background factors, and work environment exposures. The study is based on 53 items in the National Working Life Cohort in Sweden from two data collections (2004 and 2005), comprising 1918 individuals. Forced entry hierarchical regression analysis showed that, after controlling for demographics, psychological demands, control, and ergonomic exposures, perceived employability was positively associated with global health and mental well-being, but unrelated to physical complaints. When baseline health status was added, perceived employability was still a significant predictor of two out of three outcome variables. Individuals with higher perceived employability had a tendency to report better health and well-being a year later. It is concluded that how an employee perceives his or her possibilities in regard to acquiring new employment is relevant for well-being at a later stage. Perceived employability, which has been little studied before, is therefore a useful concept in health promotion, both at the individual and at the organizational level.     

Employee Well‐being and the HRM–Organizational Performance Relationship: A Review of Quantitative Studies

There is a lack of consensus on the role of employee well‐being in the human resource management–organizational performance relationship. This review examines which of the competing perspectives –‘mutual gains’ or ‘conflicting outcomes’– is more appropriate for describing this role of employee well‐being. In addition, this review examines whether study attributes such as the measurement of key variables, the level of analysis and the study design affect a study's outcomes. The review covers 36 quantitative studies published from 1995 to May 2010. Employee well‐being is described here using three dimensions: happiness, health and relationship. The main findings are that employee well‐being in terms of happiness and relationship is congruent with organizational performance (mutual gains perspective), but that health‐related well‐being appears to function as a conflicting outcome. Directions for future research and theoretical development are suggested.     

The relationship between perceived employability and subsequent health

Abstract

Being capable of getting new employment may enable an employee to cope with turbulent situations or deteriorating job conditions. Individuals who have higher perceived employability are likely to appraise a situation at work more favourably, and consequently experience better health and well-being. The aim of the present study was to investigate the relationship between perceived employability and subsequent health, while controlling for baseline health, background factors, and work environment exposures. The study is based on 53 items in the National Working Life Cohort in Sweden from two data collections (2004 and 2005), comprising 1918 individuals. Forced entry hierarchical regression analysis showed that, after controlling for demographics, psychological demands, control, and ergonomic exposures, perceived employability was positively associated with global health and mental well-being, but unrelated to physical complaints. When baseline health status was added, perceived employability was still a significant predictor of two out of three outcome variables. Individuals with higher perceived employability had a tendency to report better health and well-being a year later. It is concluded that how an employee perceives his or her possibilities in regard to acquiring new employment is relevant for well-being at a later stage. Perceived employability, which has been little studied before, is therefore a useful concept in health promotion, both at the individual and at the organizational level.     

Organizational change, health, and sick leave among health care employees: A longitudinal study measuring stress markers, individual, and work site factors

This controlled longitudinal study was conducted to investigate the effects of organizational change on employees' self-reported health, work satisfaction, work-related exhaustion, stress, and sick leave. The population consisted of 226 employees at T1 and 198 at T2, divided into a study group affected by organizational changes, and a reference group not affected by them. Group differences for the outcome measures self-rated health (SRH), work satisfaction, work-related exhaustion, and hormones associated with stress were analysed using a two-factor ANOVA design for repeated measurements. Our findings showed no significant differences, either across time or between groups for SRH, work satisfaction, and work-related exhaustion. However, we did find significant change across time and between groups for the recovery hormone DHEA-S. Days of sick leave increased by 7% for employees in the study group and by 2% in the reference group. Serum cortisol showed significantly decreased levels across time but not between groups. The decreased recovery potential in the study group might have long-term health implications. The study points to the importance of looking at the impact of organizational change on employee well-being from a number of perspectives, such as self-reported health parameters, registered sick-leave data, and biological stress markers.     

Organizational change,health, and sick leave among health care employees: A longitudinal study measuring stress markers,individual, and work site factors

Abstract

This controlled longitudinal study was conducted to investigate the effects of organizational change on employees’ self-reported health, work satisfaction, work-related exhaustion, stress, and sick leave. The population consisted of 226 employees at T1 and 198 at T2, divided into a study group affected by organizational changes, and a reference group not affected by them. Group differences for the outcome measures self-rated health (SRH), work satisfaction, work-related exhaustion, and hormones associated with stress were analysed using a two-factor ANOVA design for repeated measurements. Our findings showed no significant differences, either across time or between groups for SRH, work satisfaction, and work-related exhaustion. However, we did find significant change across time and between groups for the recovery hormone DHEA-S. Days of sick leave increased by 7% for employees in the study group and by 2% in the reference group. Serum cortisol showed significantly decreased levels across time but not between groups. The decreased recovery potential in the study group might have long-term health implications. The study points to the importance of looking at the impact of organizational change on employee well-being from a number of perspectives, such as self-reported health parameters, registered sick-leave data, and biological stress markers.     

Signs of struggle (SOS): The development and validation of a behavioural mental health checklist for the workplace

ABSTRACT

For managers to successfully support employee access to mental health resources, they must first be able to recognise if and when an employee may need help. To manage employees effectively, managers must be able to recognise changes in employees’ work behaviour that may indicate when an employee is struggling at work. In study 1, we develop and establish the structure of the 20-item Signs of Struggle (SOS) checklist as comprising five factors that describe the warning signs of health impairment at work (i.e. distress, withdrawal, reduced attendance, degradations in performance, extreme behaviours). In study 2, we show that manager-rated signs of struggle correlated substantially (r?=?.72) with participant-reported strain. The SOS tool provides managers a way to recognise when employees may be struggling and could benefit from workplace resources. We recommend that for maximal benefit, managers also receive training on how to use the SOS, and also on how to approach and assist employees who are displaying warning signs.     

Adverse psychosocial working conditions and subjective health in freelance media workers

In recent years there has been a steady growth of non-standard work contracts in advanced societies. These contracts are characterized by increased flexibility of work arrangements and increased job instability, which holds particularly true for the media industry. This pilot study analyses associations of work stress with subjective health in a group of German freelancers (N = 290) working in the media industry. The measurement of work stress is based on the effort-reward imbalance model. Results of logistic regression analyses indicate significant effects of high effort in combination with low reward (money, esteem, promotion prospects, job security) on subjective health in men and women, with the effects being higher in men. Moreover, among men a critical pattern of coping with work stress enhanced the reported effect. In conclusion, the preliminary evidence from this study indicates an elevated risk of poor subjective health among freelance workers who are exposed to adverse psychosocial work conditions.     

Leader-Member Exchange across two hierarchical levels of leadership: concurrent influences on work characteristics and employee psychological health

Leader-Member Exchange (LMX) theory suggests that the quality of the leader–employee relationship is linked to employee psychological health. Leaders who reside at different hierarchical levels have unique roles and spheres of influence and potentially affect employees' work experiences in different ways. Nevertheless, research on the impact of leadership on employee psychological health has largely viewed leaders as a homogeneous group. Expanding on LMX theory, we argue that (1) LMX sourced at the levels of the line manager (LM) and senior management (SM) team will be differentially linked to employee psychological health (assessed as worn-out) and that (2) these relationships will be mediated by perceived work characteristics (reward and recognition, workload management, quality of relationships with colleagues and physical environment). Structural equation modelling on data from 337 manual workers partially supported the hypotheses. Perceptions of the physical environment mediated the relationship between LMX at the LM level and employee psychological health, whereas perceptions of workload management mediated the relationship between LMX at the SM level and psychological health. These findings corroborate arguments that leaders are not a uniform group and as such the effects of LMX on employees will depend on leadership hierarchy. Implications for expanding leadership theory are discussed.     

Leaders as role models: Effects of leader presenteeism on employee presenteeism and sick leave

ABSTRACT

There is a broad consensus that associations exist between leadership behaviour and employee health. However, much less is known about potential mediating processes underlying links between specific leader behaviours, for instance presenteeism (i.e. working while being ill), and indicators of employee health, such as sick leave. Integrating theories of social information processing, social learning, and the allostatic load hypothesis, we propose that employee presenteeism mediates the positive association between leader presenteeism and employee sick leave. This hypothesis was tested with a multilevel mediation model using three-wave longitudinal data from 74 leaders and their 412 team members across a time period of 22 months. As hypothesised, leader presenteeism had a positive effect on employee presenteeism which, in turn, had a positive effect on employee sick leave, controlling for baseline measures of employee presenteeism and sick leave, as well as employee general health status, shared workload and job autonomy, and demographic characteristics. Additionally, leader presenteeism had a positive indirect effect on employee sick leave through employee presenteeism. These results contribute to the occupational health psychology literature by suggesting that leader health-related behaviour can have consequences for employee health-related behaviour and employee health.     

效忠主管与员工工作绩效的关系:反馈寻求行为和权力距离的影响

效忠主管一直是华人组织经久不衰的议题,尽管已有文献认为员工效忠主管有助于提升其工作绩效,然而关于效忠主管通过怎样的具体机制来影响员工工作绩效却并未得到系统的阐释。本文以14家企业的360名员工为样本,探讨了效忠主管对工作绩效的影响机制,尤其是研究员工反馈寻求行为在其中的中介作用及员工权力距离的调节作用。分析结果表明,效忠主管对员工工作绩效、反馈寻求行为都有显著的正向影响;反馈寻求行为在效忠主管与工作绩效关系中起完全中介作用。另外,员工的权力距离负向调节了效忠主管与反馈寻求行为的正相关关系,即员工的权力距离越低,两者的正向相关关系越强。     

Demanding work schedules and mental health in nursing assistants working in nursing homes

Nursing home assistants have physically and emotionally challenging jobs, and they often work demanding schedules in order to provide 24-h care. While the physical effects of demanding work schedules have been studied, little is known about the impact on mental health. This study explored the relationship between demanding scheduling variables and mental health indicators of depression, anxiety and somatization. A cross-section of 473 US female nursing assistants working in nursing homes was surveyed. Work schedule characteristics included shiftwork, hours per day and week, days per week, number of weekends per month, number of double shifts per month, breaks, and number of jobs worked. Working two or more double-shifts per month was associated with increased risk for all mental health indicators, and working 6-7 days per week was associated with depression and somatization. There was a trend for increasing odds of adverse mental health with increased numbers of demanding work schedule factors. The odds of depression was increased four-fold when working 50+ h/week, more than two weekends/month and more than two double shifts/month. Providing work schedules that are less unhealthy may have implications for both worker retention and the quality of care delivered to nursing home residents.     

Demanding work schedules and mental health in nursing assistants working in nursing homes

Nursing home assistants have physically and emotionally challenging jobs, and they often work demanding schedules in order to provide 24-h care. While the physical effects of demanding work schedules have been studied, little is known about the impact on mental health. This study explored the relationship between demanding scheduling variables and mental health indicators of depression, anxiety and somatization. A cross-section of 473 US female nursing assistants working in nursing homes was surveyed. Work schedule characteristics included shiftwork, hours per day and week, days per week, number of weekends per month, number of double shifts per month, breaks, and number of jobs worked. Working two or more double-shifts per month was associated with increased risk for all mental health indicators, and working 6–7 days per week was associated with depression and somatization. There was a trend for increasing odds of adverse mental health with increased numbers of demanding work schedule factors. The odds of depression was increased four-fold when working 50+ h/week, more than two weekends/month and more than two double shifts/month. Providing work schedules that are less unhealthy may have implications for both worker retention and the quality of care delivered to nursing home residents.     

“These Power Lines Make Me Ill”: A Typology of Residents’ Health Responses to a New High‐Voltage Power Line

Little attention has been devoted to the potential diversity in residents’ health responses when exposed to an uncertain environmental health risk. The present study explores whether subgroups of residents respond differently to a new high‐voltage power line (HVPL) being put into operation. We used a quasi‐experimental prospective field study design with two pretests during the construction of a new HVPL, and two posttests after it was put into operation. Residents living nearby (0–300 m, n = 229) filled out questionnaires about their health and their perception of the environment. We applied latent class growth models to investigate heterogeneity in the belief that health complaints were caused by a power line. Classes were compared on a wide range of variables relating to negative‐oriented personality traits, perceived physical and mental health, and perceptions of the environment. We identified five distinct classes of residents, of which the largest (49%) could be described as emotionally stable and healthy with weak responses to the introduction of a new power line. A considerable minority (9%) responded more strongly to the new line being activated. Residents in this class had heard more about the health effects of power lines beforehand, were more aware of the activation of the new line, and reported a decrease in perceived health afterwards. Based on our findings we can conclude that there is a considerable heterogeneity in health responses to a new HVPL. Health risk perceptions appear to play an important role in this typology, which has implications for risk management.     

Subjective Perceptions of Organizational Change and Employee Resistance to Change: Direct and Mediated Relationships with Employee Well‐being

Researchers have focused on linking objective measures of change exposure, such as the number of downsizing activities implemented, with employee well‐being. This has meant that less attention has been paid to employees’ subjective experience of change. The authors examine relationships between employees’ perceptions of the extent of change and the frequency of change and insomnia and psychological well‐being. They propose direct and indirect relationships via resistance to change between employees’ subjective experience of change and well‐being. Data were collected from 260 employees from a range of different organizations and industries. Respondents completed surveys at two time points, separated by four months. Results revealed significant indirect relationships between subjective perceptions of change and insomnia and employee well‐being via affective resistance to change at Time 1 and Time 2. In addition, employees’ subjective reports that change was very frequent were initially positively associated with T1 behavioral resistance to change but also were negatively associated with T2 behavioral resistance to change. Discussion focuses on the importance of managing employees’ perceptions of change. Practically, the authors consider the difficult choices that confront managers when seeking to implement and ‘sell’ change within their organization.     

The impact of a participatory organizational intervention on job stress in community health care institutions

The aim of the present study was to investigate the effect of a short-term participatory intervention in health care institutions in Norway on workers' control, other job characteristics, job stress, subjective health and job satisfaction. Participants (including managers and supervisors) were randomly allocated to intervention groups and to a control group. Actions to solve problems based on the employees' own perceptions of the main problems were seen as the key motivators for organizational improvement and increased control at the task and office level in the work situation. The main stressors identified by the participants in this study were lack of information, communication and respect between professions, as well as the need for professional and personal development. The participatory intervention had a positive, but limited effect on work-related stress, job characteristics, learning climate and management style, and seemed to have started a beneficial change process. There were no negative short-term effects on work-related stress and job demands. Organizational interventions may be a potential training ground for acquiring participatory skills and resources, and if sustained after the intervention period, they can have long-term effects on problem solving, job stress and employee satisfaction.     

EMPLOYEE DEVELOPMENT: AN EXAMINATION OF SERVICE STRATEGY IN A HIGH‐CONTACT SERVICE ENVIRONMENT

A critical component of service strategy in high‐contact environments is service encounter management. Effective service encounters are a result of the quality of employee development, including systems for work and job design, training and development, and attention to employee well being. Results of empirical analysis indicate that service strategies reflecting the dimensions of employee development drive employee outcomes such as productivity and satisfaction. Employee outcomes are significantly associated with customer satisfaction, but only some linkages to financial performance are significant. This study illustrates the importance of employee development in service strategy design for managing service encounters in high contact service environments.     

WHAT GOOD IS WEALTH WITHOUT HEALTH? THE EFFECT OF HEALTH ON THE MARGINAL UTILITY OF CONSUMPTION

We estimate how the marginal utility of consumption varies with health. To do so, we develop a simple model in which the impact of health on the marginal utility of consumption can be estimated from data on permanent income, health, and utility proxies. We estimate the model using the Health and Retirement Study's panel data on the elderly and near‐elderly, and proxy for utility with measures of subjective well‐being. Across a wide range of alternative specifications and assumptions, we find that the marginal utility of consumption declines as health deteriorates, and we are able to clearly reject the null of no state dependence. Our point estimates indicate that a one‐standard‐deviation increase in the number of chronic diseases is associated with a 10%–25% decline in the marginal utility of consumption relative to this marginal utility when the individual has no chronic diseases. We present some simple, illustrative calibration results that suggest that state dependence of the magnitude we estimate can have a substantial effect on important economic problems such as the optimal level of health insurance benefits and the optimal level of life‐cycle savings.