Effects of work conditions on provider mental well-being and quality of care: a mixed-methods intervention study in the emergency department

• DOI: 10.1186/s12873-018-0218-x
• Publication Date: 2019-01-03T06:55:49Z
• Authors: Anna Schneider; Markus Wehler; Matthias Weigl
• Keywords: Male; Work conditions; Mental well-being; Health Personnel; Personnel Staffing and Scheduling; Nurses; Intervention; Observation; Job Satisfaction; Interviews as Topic; Occupational Stress; 03 medical and health sciences; 0302 clinical medicine; Physicians; Surveys and Questionnaires; Humans; Professional Autonomy; Prospective Studies; Quality of Health Care; ddc:610; Emergency department; RC86-88.9; RC952-1245; Social Support; Medical emergencies. Critical care. Intensive care. First aid; Interrupted Time Series Analysis; 3. Good health; Mental Health; Special situations and conditions; Controlled Before-After Studies; Patient Satisfaction; Depersonalization; 8. Economic growth; Female; Emergency Service, Hospital; Research Article

Emergency departments (EDs) are highly dynamic and stressful care environments that affect provider patient outcomes. Yet, effective interventions missing. This study evaluated prospective effects of a multi-professional organizational-level intervention on changes in ED providers’ work conditions well-being (primary outcomes) patient-perceived quality (secondary outcome). A before after including an interrupted time-series (ITS) design over 1 year was established the multidisciplinary tertiary referral hospital Southern Germany. Our mixed-methods approach included standardized surveys, expert observations, register data. Stakeholder interviews were conducted for qualitative process evaluation. ITS data available 20 days pre- post-intervention (Dec15/Jan16; Dec16/Jan17). The comprised ten meetings which physicians nurses developed solutions to stressors systematic moderated process. Most consecutively implemented. Changes outcomes assessed with paired t-tests segmented regression analyses controlling daily workload. One hundred forty-nine surveys returned at baseline follow-up (response baseline: 76 out 170; follow-up: 73 157). Forty-one providers participated both waves. sixty observations comprising 240 observation hours 156 subsequent stress reports. thousand four eighteen patients surveyed. Considering primary outcomes, respondents reported more job control less overtime follow-up. Social support, satisfaction, depersonalization deteriorated while respondents’ turnover intentions inter-professional interruptions increased. secondary outcome, reports indicated improvements organization waiting times. Interviews revealed facilitators (e.g., comprehensive approach, employee participation) barriers understaffing, organizational constraints) implementation. To best our knowledge, this is first report system care. We found inconsistent results partial perceptions However, aspects mental deteriorated. Given lack research EDs, findings provide valuable insights into feasibility participatory setting.