Evaluation of an intervention programme based on empowerment for eldercare nursing staff

Abstract

This study evaluated the impact of an intervention programme at individual, worksite, and organizational level, for eldercare nursing staff at 12 eldercare units. The project aimed at empowering auxiliary nurses and nursing assistants, thus promoting good working conditions, health and well-being of eldercare staff, and improving their evaluation of the quality of nursing care. Questionnaire responses from the nursing staff (n=200) before and after an 18-month intervention programme evaluated the effects using ANOVA, repeated measures for the statistical analyses. Although the improvements were limited, the intervention seemed to impact on work conditions and on the perceived quality of nursing rather than on the health and well-being of staff. Work at nursing homes or at home-care was shown to modify the outcome due to different needs and priorities for work unit improvements. Staff turnover and multiple reorganizations are discussed as inhibiting factors for performance as well as for the evaluation of workplace interventions. The sharing of power between occupational groups or organizational levels must be carefully considered. The study emphasizes the importance of involving the middle management in early project planning and decisions.     

Organizational interventions: A research-based framework for the evaluation of both process and effects

Abstract

Organizational interventions are often recommended when organizations want to improve employee psychological health and well-being. Research, however, has revealed inconsistent results and reviewers have called for research on why interventions either bring about desired change or fail to do so. Answering the “how” and “why” of intervention outcomes requires a close examination of the elements that hinder or facilitate desired outcomes, thus moving beyond evaluation of only the overall effects. In this paper, we present an evaluation framework based on recent intervention research and process-oriented organization theory. The framework offers suggestions for which elements to include when evaluating organizational interventions. Within the framework, elements crucial to intervention evaluation are grouped into four overarching categories that we argue are crucial to evaluation over the five phases of an intervention programme. These categories are: the organizational “actors”; the mental models of those actors; the context of the intervention; and intervention design and process. Evaluation during the process as well as of the overall effects, as recommended by this framework, should throw light on what works for whom, why, how and under which circumstances.     

In sickness and in health: An exploration of spousal support and occupational similarity

Abstract

While many studies of interventions have focused on their content and immediate effects, less research has focused on the processes that may explain these effects. The purpose of this study was to show how process evaluation can be used to interpret the results of an intervention study in four industrial canteens in Denmark. Two canteens acted as intervention groups and two as comparison groups. Effects were measured by surveys before and after interventions, and observations and interviews were conducted to provide an in-depth understanding of processes. Analyses were conducted based on the responses from 118 employees. Results showed, contrary to expectations, improvements in working conditions and well-being in one intervention group and in one comparison group, whereas no improvements were found in the two remaining groups. Data from the process evaluation enabled a meaningful interpretation of these results, raising the possibility programme failure rather than theory failure, and thereby constituting an example of how process evaluation can shed light over the factors that may influence outcomes in controlled intervention studies.     

Success or failure? Interpreting and understanding the impact of interventions in four similar worksites

While many studies of interventions have focused on their content and immediate effects, less research has focused on the processes that may explain these effects. The purpose of this study was to show how process evaluation can be used to interpret the results of an intervention study in four industrial canteens in Denmark. Two canteens acted as intervention groups and two as comparison groups. Effects were measured by surveys before and after interventions, and observations and interviews were conducted to provide an in-depth understanding of processes. Analyses were conducted based on the responses from 118 employees. Results showed, contrary to expectations, improvements in working conditions and well-being in one intervention group and in one comparison group, whereas no improvements were found in the two remaining groups. Data from the process evaluation enabled a meaningful interpretation of these results, raising the possibility programme failure rather than theory failure, and thereby constituting an example of how process evaluation can shed light over the factors that may influence outcomes in controlled intervention studies.     

Personality and organizational health: the role of conscientiousness

Organizational health research identifies processes through which the work environment and individual differences combine to influence both individual and organizational outcomes. This study investigated the contribution of conscientiousness to organizational health. Research in the areas of occupational stress, work performance, and organizational climate was used to develop a framework for integrating different elements of organizational health. Within this framework, the work environment was assessed by perceptions of workload and role clarity ; individual well-being was assessed by psychological distress and job satisfaction ; and behaviour important for organizational success was assessed by contextual performance. Conscientiousness was investigated within the framework using self-reports from a sample of 104 Australian employees. Conscientiousness directly influenced contextual performance but did not influence well-being or perceptions of the work environment. Conscientiousness also reduced the impact of role clarity on both psychological distress and job satisfaction. The role of conscientiousness in a comprehensive model of organizational health is discussed.     

The health of health care organizations

Abstract

This paper explores the nature and development of health care organizations in terms of a model of organizational healthiness. The model places particular emphasis on the psychosocial subsystems which describe the subjective organization. These represent the perceived internal functioning of the organization in terms of task completion, problem solving and staff development. The implications of such a model for the well-being of health care staff and for the evaluation of service delivery are discussed.     

The Intervention Project on Absence and Well-being (IPAW): Design and results from the baseline of a 5-year study

This paper presents the background, design and baseline results of the Intervention Project on Absence and Well-being (IPAW). IPAW is a 5-year psychosocial work environment intervention study including 22 intervention and 30 control work-sites from three different types of work-site (a large pharmaceutical company, municipal technical services, and municipal nursing homes) in Copenhagen, Denmark. The baseline survey reported in this paper was conducted in 1996-97, and the cohort was followed until 2002. Interventions took place during 1996-98 at the organizational and interpersonal level and focused on psychological demands, social support, control, meaning of work, and predictability. The main end-points are self-rated health, perceived stress, absence from work, job satisfaction, and labour turnover. Analyses of the baseline data show good reliability of the psychosocial scales and a number of clear associations between psychosocial work environment factors and health indicators. The baseline data also demonstrate several discrepancies between the planned design of the study and the actual implementation of the project in practice.     

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.     

Beyond demand and control: The contribution of organizational risk factors in assessing the psychological well-being of health care employees

Abstract

The job demand–control(–support) model is frequently used as a theoretical framework in studies on determinants of psychological well-being. Consequently, these studies are confined to the impact of job characteristics on worker outcomes. In the present study the relation between work conditions and outcomes (job satisfaction, emotional exhaustion, psychological distress, and somatic complaints) is examined from a broader organizational perspective. This paper reports on an analysis that examines both the unique and the additional contribution of organizational characteristics to well-being indicators, beyond those attributed to job characteristics. A total of 706 care staff from three public residential institutions for people with mental or physical disabilities in the Netherlands took part in this research. To assess organizational risk factors a measurement instrument was developed, the organizational Risk Factors Questionnaire (ORFQ), based on the safety-critical factors of the Tripod accident causation model. Factor analyses and reliability testing resulted in a 52-item scale consisting of six reliable sub-scales: staffing resources, communication, social hindrance, training opportunities, job skills, and material resources. These organizational risk factors explained important parts of the variance in each of the outcome measures, beyond that accounted for by demographic variables and job demand–control–support (JDCS) measures. Communication and training opportunities were of central importance to carers’ job satisfaction. Social hindrance, job skills, and material resources explained a substantial amount of unique variance on the negative outcomes investigated.     

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.     

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.     

The impact of restructuring on employee well-being: a systematic review of longitudinal studies

This is a review of published longitudinal empirical research on the impact of restructuring on employee well-being. We investigated whether restructuring accompanied by staff reductions impacts differently on worker well-being than restructuring without staff reductions, and the differences between short- and long-term effects of restructuring. Furthermore, we investigated the mechanisms that explain these effects. We conducted a literature search on longitudinal, peer-reviewed, English-written studies from the period 2000–2012. Thirty-nine papers fulfilled the inclusion criteria. We found that restructuring events, with and without staff reductions, mainly have a negative impact on the well-being of employees. The majority of studies showed negative changes over time, in the short and the long term. Some groups of workers reacted less negatively: for example, workers with a high organizational status before a merger and workers who underwent a change in workgroup. Variables that intervened in the relationship between restructuring and well-being were physical demands, job control, communication, provision of information, training, procedural justice, job insecurity and change acceptance. Further high-quality longitudinal research is needed to get more insight into the impact of restructuring over time and into the part played by intervening variables.     

Using a stress audit: The construction site manager experience in the UK

The aim of this study was to conduct a stress audit among construction industry site managers in the UK as a precursor to a stress management intervention programme. Qualitative data were obtained from in-dept interviews with a total of 36 male middle and senior construction site managers; and aquantitative data were obtained by questionnaire. Based on the analysis of 561 postal quenstionnaires, eight stressor factors were identified, most significantly, ambiguity (i.e. role and task). Job satisfaction levels were low compared to a normative population and influenced by grade level. Measures of mental health were similar to the norm for males, but both grade of management and type of contract affected mental health. Anxiety levels were signficantly high, independent of managerial grade. The stress of work overload and role insecurity (fear of failure) were associated with reduced mental health and high anxiety, and the stress of the organizational culture and climate was the strongest predictor of job dissatisfaction. There was some cause for concern for the vulnerable high-risk groups, i.e. the extreme type A and those working overtime. Medical data from a small subset of managers (n = 78) revealed that this group evidenced a better quality of psychological health than the group in total; but a high percentage of personnel had high levels of triglycerides and cholesterol. Recommendations for action focused on the needs of specific subgroups, and guided the organization on the acceptability of possible interventions at individual, interpersonal and organizational levels.     

Strategies for growth: Intervention in a church

This article is a case study of a small, local congregation, and reports the results of an intervention aimed at evaluation and change of existing organizational strategy. It presents both a summary of one applicable business model, and the techniques and procedures employed in assisting both the general membership and church leaders in self-evaluation and long-range planning. The intervention resulted in increased awareness of organizational problems and needs, and provided a basis for future choices involving pastoral leadership, programme development and institutional needs. The events occured while the author served as temporary, interim pastor during 1980 and 1981.     

Functional Assessment and Intervention for Organizational Behavior Change: Improving the Timeliness of Staff Meetings at a Human Services Organization

We implemented functional behavioral assessment (FBA) at a human services organization to reduce the tardiness of scheduled staff meetings. Following baseline, FBA focused on antecedent and consequence conditions that affected staff arriving on time to scheduled meetings. These data were subsequently presented at a staff meeting in which staff planned an intervention to improve the timeliness of meetings. The intervention, composed of premeeting reminders, positive reinforcement for arriving on time, and meeting termination criteria (to facilitate meeting-to-meeting transitions), was implemented in a multiple baseline design across 3 types of meetings. As a result of the intervention, the number of minutes late that meetings started decreased. We discuss FBA within organizational behavior management that targets performance improvement objectives.     

Effects of vacation from work on health and well-being: Lots of fun,quickly gone

Abstract

Although vacation from work provides a valuable opportunity for recovery, few studies have met the requirements for assessing its effects. These include taking measurements well ahead of the vacation, during the vacation and at several points in time afterwards. Our study on vacation (after-) effects focused on two related questions: (1) Do health and well-being of working individuals improve during a vacation? and (2) How long does a vacation effect last after resumption of work? In a longitudinal study covering seven weeks, 96 Dutch workers reported their health and well-being levels two weeks before a winter sports vacation, during vacation and one week, two weeks and four weeks after vacation on seven indicators. Participants' health and well-being improved during vacation on five indicators: health status, mood, tension, energy level and satisfaction. However, during the first week of work resumption, health and well-being had generally returned to pre-vacation levels. In conclusion, a winter sports vacation is associated with improvements in self-reported health and well-being among working individuals. However, these effects fade out rapidly after work resumption. We propose a framework for future vacation research and suggest investigating the role of vacation type, duration and means to prolong vacation relief.     

Using a stress audit: The construction site manager experience in the UK

Abstract

The aim of this study was to conduct a stress audit among construction industry site managers in the UK as a precursor to a stress management intervention programme. Qualitative data were obtained from in-dept interviews with a total of 36 male middle and senior construction site managers; and aquantitative data were obtained by questionnaire. Based on the analysis of 561 postal quenstionnaires, eight stressor factors were identified, most significantly, ambiguity (i.e. role and task). Job satisfaction levels were low compared to a normative population and influenced by grade level. Measures of mental health were similar to the norm for males, but both grade of management and type of contract affected mental health. Anxiety levels were signficantly high, independent of managerial grade. The stress of work overload and role insecurity (fear of failure) were associated with reduced mental health and high anxiety, and the stress of the organizational culture and climate was the strongest predictor of job dissatisfaction. There was some cause for concern for the vulnerable high-risk groups, i.e. the extreme type A and those working overtime. Medical data from a small subset of managers (n = 78) revealed that this group evidenced a better quality of psychological health than the group in total; but a high percentage of personnel had high levels of triglycerides and cholesterol. Recommendations for action focused on the needs of specific subgroups, and guided the organization on the acceptability of possible interventions at individual, interpersonal and organizational levels.     

The Job Demands-Resources Model in emergency service volunteers: Examining the mediating roles of exhaustion,work engagement and organizational connectedness

Using a sample of 887 volunteer emergency service workers in South Australia, we conducted a study based on the JD-R framework to examine the roles of three mediators in the relationship between job characteristics and volunteer well-being. These were (i) exhaustion as a mediator in the relationships between job demands and both poor mental health and turnover intentions; and (ii) work engagement and organizational connectedness as mediators in the relationships of job resources (training and organizational support) with happiness and turnover intentions. Organizational connectedness, a relatively new construct, is a positive state of well-being that involves an emotional connection with other workers, with service recipients and with aspects of the task and the organization's values. Results indicated that all three mediators were important in explaining volunteer well-being. Specifically, job demands were positively related to exhaustion, which, in turn, was linked to ill-health and turnover intentions. Job resources were positively related to work engagement and organizational connectedness, which were, in turn, negatively related to turnover intentions. However, while organizational connectedness mediated the relationship between job resources and happiness, this was not the case for work engagement. The roles of these variables in future research in paid and voluntary work are discussed.     

Supporting staff through stressful organizational change

Support from various sources inside and outside the organization helps employees cope with the stress of work. Support becomes even more necessary when the processes and outcomes of organizational change undermine staff well-being. This paper presents and explores a model of support though different phases of stressful organizational change. The findings of a qualitative study of 31 participants in a public healthcare authority in New Zealand reveal that support took various forms (emotional, instrumental, informational, and appraisal) and was sourced internally through supervisors and colleagues and externally through partners, family, and friends, at different stages of the change. However, for some participants it was either denied to them or they were reluctant to mobilize it. Implications for research and human resource development (HRD) practice focus on the provision of forms and sources of support that enhance individual well-being and the likelihood of successful change. Barriers to providing and accessing support need further exploration. HRD professionals have the insights and skills to deliver supervisory, mentorship, and peer support programmes that mitigate stressful change within the context of a supportive organizational culture.