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PubMed2005

Nurses' work environment perceptions when employed in states with and without mandatory staffing ratios and/or mandatory staffing plans.

Multiple stakeholders have sought regulatory and nonregulatory strategies to address nursing workforce and patient safety concerns. This study examines differences in nurses' work environment perceptions. Approximately 4,000 nurses employed in 10 states provided their perceptions of key characteristics of their work environment using the Individual Workload Perception Scale. Univariate statistics were used to characterize mean values of the nurses' work environment perceptions by state of employment and whether these perceptions changed if employed in states with versus without mandatory staffing ratios and/or mandatory staffing plans. This study provides preliminary evidence that mandatory staffing plan legislation may be linked with the most positive nurse work environment perceptions when compared with implementation of mandatory staffing ratios or no workforce regulation. Based on this preliminary observation, further analysis comparing the relative benefits and costs of workforce regulation may be warranted.

Adult↗

PubMed2006

Similar support for three different life course socioeconomic models on predicting premature cardiovascular mortality and all-cause mortality.

BACKGROUND: There are at least three broad conceptual models for the impact of the social environment on adult disease: the critical period, social mobility, and cumulative life course models. Several studies have shown an association between each of these models and mortality. However, few studies have investigated the importance of the different models within the same setting and none has been performed in samples of the whole population. The purpose of the present study was to study the relation between socioeconomic position (SEP) and mortality using different conceptual models in the whole population of Scania. METHODS: In the present investigation we use socioeconomic information on all men (N = 48,909) and women (N = 47,688) born between 1945 and 1950, alive on January, 1st,1990, and living in the Region of Scania, in Sweden. Focusing on three specific life periods (i.e., ages 10-15, 30-35 and 40-45), we examined the association between SEP and the 12-year risk of premature cardiovascular mortality and all-cause mortality. RESULTS: There was a strong relation between SEP and mortality among those inside the workforce, irrespective of the conceptual model used. There was a clear upward trend in the mortality hazard rate ratios (HRR) with accumulated exposure to manual SEP in both men (p for trend < 0.001 for both cardiovascular and all-cause mortality) and women (p for trend = 0.01 for cardiovascular mortality) and (p for trend = 0.003 for all-cause mortality). Inter- and intragenerational downward social mobility was associated with an increased mortality risk. When applying similar conceptual models based on workforce participation, it was shown that mortality was affected by the accumulated exposure to being outside the workforce. CONCLUSION: There was a strong relation between SEP and cardiovascular and all-cause mortality, irrespective of the conceptual model used. The critical period, social mobility, and cumulative life course models, showed the same fit to the data. That is, one model could not be pointed out as "the best" model and even in this large unselected sample it was not possible to adjudicate which theories best describe the links between life course SEP and mortality risk.

Adolescent↗

PubMed2006

Contribution of main causes of death to social inequalities in mortality in the whole population of Scania, Sweden.

BACKGROUND: To more efficiently reduce social inequalities in mortality, it is important to establish which causes of death contribute the most to socioeconomic mortality differentials. Few studies have investigated which diseases contribute to existing socioeconomic mortality differences in specific age groups and none were in samples of the whole population, where selection bias is minimized. The aim of the present study was to determine which causes of death contribute the most to social inequalities in mortality in each age group in the whole population of Scania, Sweden. METHODS: Data from LOMAS (Longitudinal Multilevel Analysis in Skåne) were used to estimate 12-year follow-up mortality rates across levels of socioeconomic position (SEP) and workforce participation in 975,938 men and women aged 0 to 80 years, during 1991-2002. RESULTS: The results generally showed increasing absolute mortality differences between those holding manual and non-manual occupations with increasing age, while there were inverted u-shaped associations when using relative inequality measures. Cardiovascular diseases (CVD) contributed to 52% of the male socioeconomic difference in overall mortality, cancer to 18%, external causes to 4% and psychiatric disorders to 3%. The corresponding contributions in women were 55%, 21%, 2% and 3%. Additionally, those outside the workforce (i.e., students, housewives, disability pensioners, and the unemployed) showed a strongly increased risk of future mortality in all age groups compared to those inside the workforce. Even though coronary heart disease (CHD) played a major contributing role to the mortality differences seen, stroke and other types of cardiovascular diseases also made substantial contributions. Furthermore, while the most common types of cancers made substantial contributions to the socioeconomic mortality differences, in some age groups more than half of the differences in cancer mortality could be attributed to rarer cancers. CONCLUSION: CHD made a major contribution to the socioeconomic differences in overall mortality. However, there were also important contributions from diseases with less well understood mechanistic links with SEP such as stroke and less-common cancers. Thus, an increased understanding of the mechanisms connecting SEP with more rare causes of disease might be important to be able to more successfully intervene on socioeconomic differences in health.

Adolescent↗

PubMed2005

Human resources: the Cinderella of health sector reform in Latin America.

Human resources are the most important assets of any health system, and health workforce problems have for decades limited the efficiency and quality of Latin America health systems. World Bank-led reforms aimed at increasing equity, efficiency, quality of care and user satisfaction did not attempt to resolve the human resources problems that had been identified in multiple health sector assessments. However, the two most important reform policies - decentralization and privatization - have had a negative impact on the conditions of employment and prompted opposition from organized professionals and unions. In several countries of the region, the workforce became the most important obstacle to successful reform.This article is based on fieldwork and a review of the literature. It discusses the reasons that led health workers to oppose reform; the institutional and legal constraints to implementing reform as originally designed; the mismatch between the types of personnel needed for reform and the availability of professionals; the deficiencies of the reform implementation process; and the regulatory weaknesses of the region.The discussion presents workforce strategies that the reforms could have included to achieve the intended goals, and the need to take into account the values and political realities of the countries. The authors suggest that autochthonous solutions are more likely to succeed than solutions imported from the outside.

Journal Article↗

PubMed2005

"There's no place like home" a pilot study of perspectives of international health and social care professionals working in the UK.

BACKGROUND: Many countries are reporting health workforce shortages across a range of professions at a time of relatively high workforce mobility. Utilising the global market to supply shortage health skills is now a common recruitment strategy in many developed countries. At the same time a number of countries report a 'brain drain' resulting from professional people leaving home to work overseas. Many health and social care professionals make their way to the UK from other countries. This pilot study utilises a novel 'e-survey' approach to explore the motives, experiences and perspectives of non-UK health and social care professionals who were working or had worked in the UK. The study aims to understand the contributions of international health and social care workers to the UK and their 'home' countries. The purpose of the pilot study is also in part to test the appropriateness of this methodology for undertaking a wider study. RESULTS: A 24-item questionnaire with open-ended and multiple choice questions was circulated via email to 10 contacts who were from a country outside the UK, had trained outside the UK and had email access. These contacts were requested to forward the email to other contacts who met these criteria (and so on). The email was circulated over a one month pilot period to 34 contacts. Responses were from physiotherapists (n = 11), speech therapists (n = 4), social workers (n = 10), an occupational therapist (n = 1), podiatrists (n = 5), and others (n = 3). Participants were from Australia (n = 20), South Africa (n = 10), New Zealand (n = 3) and the Republic of Ireland (n = 1). Motives for relocating to the UK included travel, money and career opportunities. Participants identified a number of advantages and disadvantages of working in the UK compared to working in their home country health system. Respondents generally reported that by working in the UK, they had accumulated skills and knowledge that would allow them to contribute more to their profession and health system on their return home. CONCLUSION: This pilot study highlights a range of issues and future research questions for international learning and comparison for the health and social care professions as a result of international workforce mobility. The study also highlights the usefulness of an e-survey technique for capturing information from a geographically diverse and mobile group of professionals.

Journal Article↗

PubMed2005

Human resource management strategies and the retention of older RNs.

This study investigated the human resource management strategies that are most important in retaining older RNs in the workforce and the extent to which hospitals are currently engaging in these practices. The participants (n=361) were RNs aged 50 and over employed in hospitals across Ontario. Along with flexible work schedules, the human resource practices rated as most important in the decision of these RNs to remain in the workforce involved compensation (improving benefits; offering incentives for continued employment), recognition and respect (showing appreciation for a job well done; recognizing the experience, knowledge, skill and expertise of older nurses; ensuring that older nurses are treated with respect by others in the organization) and pre- and post-retirement arrangements (retirement with callback; partial or phased retirement options). There were significant differences between the importance that RNs attributed to the 34 human resource practices and the extent to which their hospitals are currently engaged in each practice, with the largest discrepancies occurring for those practices that RNs indicated were most important in their decision to remain in the workforce. While some hospitals may have difficulty in implementing strategies that have budgetary implications, all could implement recognition and respect with minimal financial consequences.

Age Factors↗

PubMedDate not supplied

Adding more specialists is not likely to improve population health: is anybody listening?

Before a shortage of physicians, and particularly subspecialists, in the United States is declared, it is worth reviewing the considerable evidence that calls into question whether further specialization automatically improves health. Barbara Starfield and colleagues' latest research reveals, again, that having more specialists may not be a good thing. The current workforce functions well as an economic engine, but continued emphasis on market demand will likely widen disparities in workforce distribution and population health. The resurgence of interest in shaping the future physician workforce should lead to purposeful choices about what we want them to do and the outcomes we expect.

Health Status↗

PubMed1997

The true rates of injury among workers in New Zealand: comparing 1986 and 1991.

This study has established true injury rates in New Zealand in 1986 and 1991 for the general and working populations. The general population grew by 3% between the two censuses, while the injury rate increased by 23%. The workforce decreased by 7% while the workforce injury rate rose by 11%. The numbers of salary earners and wage earners fell by 10% and the number of self-employed workers rose by 4%, the injury rates in the former rising by 16% and falling by 7% in the latter group. This suggests either a lower injury rate or a lower claim rate among these latter workers. Young males have the highest injury rates in the general and workforce population. Women have half the injury rate of men, suggesting that women should pay lower insurance premiums. Detailed analysis revealed 'high injury rate/high cost' groups in whom targeted intervention strategies should be cost-effective. This study gives a baseline against which changes can be measured. We recommend that this study be repeated.

Accidents, Occupational↗

PubMedDate not supplied

Workplace practices with mental health implications impacting on recruitment and retention of overseas nurses in the context of nursing shortages.

In response to nursing workforce shortages, health agencies in Australia and elsewhere have sought to meet the demand for nursing services by recruiting nurses internationally. While there is a major focus on recruitment, little attention is given to factors that could enhance retention of overseas qualified nurses. There are a host of factors reported in the literature that impact upon retention of overseas nurses in the workforce, including: impact of re-settlement experiences in the new country; discriminatory practices in accessing employment and negative experiences in the work place. For the benefit of long term retention of overseas nurse graduates in the workforce in Australia and globally, these experiences are major issues needing urgent attention. This discussion paper reviews the literature to explore the impact of aggression and discriminatory practices in nursing as evidence for nurses leaving the profession, and discusses the mental health implications and consequences of such practices relating to overseas nurse graduates.

Acculturation↗

PubMed1992

General practitioner databases in Australia.

OBJECTIVE: General practitioner-based research has been hampered by the poorly defined database and the cost of continuous updating of lists of practitioners. Little is known about the general practitioner workforce. Fresh awareness by health planners of the serious maldistribution of general practitioners has heightened the need for workforce planning. Integral to this is the availability of an accurate listing of general practitioners. DATA SOURCES: A CD-ROM Medline review of all surveys involving general practitioners which were conducted in Australia in the period 1983-1990 was performed. All general practitioner listings still existing at the end of the decade were identified. STUDY SELECTION: Nine listings considered for use as general practitioner databases. DATA EXTRACTION: Each listing was assessed in six ways--quality of information provided, availability for research purposes, cost, potential to provide the correct postal address, ability to identify general practitioners in active practice and comparative advantage over other lists. DATA SYNTHESIS: Each listing has limitations and advantages, with individual peculiarities and variable information relating to identifying characteristics of general practitioners. None was specifically created for research or workforce planning purposes. The Medical Provider File (formerly called the Central Register of Medical Practitioners) was the most used list. CONCLUSIONS: We propose a framework for the ideal database and avenues for its development.

Australia↗

PubMed2007

Impact of race on the professional lives of physicians of African descent.

BACKGROUND: Increasing the racial and ethnic diversity of the physician workforce is a national priority. However, insight into the professional experiences of minority physicians is limited. This knowledge is fundamental to developing effective strategies to recruit, retain, and support a diverse physician workforce. OBJECTIVE: To characterize how physicians of African descent experience race in the workplace. DESIGN: Qualitative study based on in-person and in-depth racially concordant interviews using a standard discussion guide. SETTING: The 6 New England states in the United States. PARTICIPANTS: 25 practicing physicians of African descent representing a diverse range of primary practice settings, specialties, and ages. MEASUREMENTS: Professional experiences of physicians of African descent. RESULTS: 1) Awareness of race permeates the experience of physicians of African descent in the health care workplace; 2) race-related experiences shape interpersonal interactions and define the institutional climate; 3) responses to perceived racism at work vary along a spectrum from minimization to confrontation; 4) the health care workplace is often silent on issues of race; and 5) collective race-related experiences can result in "racial fatigue," with personal and professional consequences for physicians. LIMITATIONS: The study was restricted to New England and may not reflect the experiences of physicians in other geographic regions. The findings are meant to be hypothesis-generating and require additional follow-up studies. CONCLUSIONS: The issue of race remains a pervasive influence in the work lives of physicians of African descent. Without sufficient attention to the specific ways in which race shapes physicians' work experiences, health care organizations are unlikely to create environments that successfully foster and sustain a diverse physician workforce.

Adult↗

PubMed1994

Managing diversity in health services organizations.

The changing ethnic, racial, and gender workforce characteristics require innovations in management philosophy and practice. Valuing employees' differences is believed to be a competitive advantage in many modern corporations. This article offers recommendations to health care managers for rethinking and improving the management of their heterogeneous workforces. A conceptual framework and evaluative criteria are developed in an attempt to better understand the factors that influence effective diversity management. The experiences of health services institutions in the Southwest (already a multicultural region) are studied to illustrate various approaches to diversity management. Leader philosophy and support, organizational policies and programs, workforce composition, structural integration, and organizational type constitute the main elements in this study. As the nation debates restructuring the health industry, it should also take the opportunity to integrate a management philosophy that values diversity and its practice.

Ethnicity↗

PubMed1999

Recruitment and retention of general practitioners in the UK: what are the problems and solutions?

Recruitment and retention of general practitioners (GPs) has become an issue of major concern in recent years. However, much of the evidence is anecdotal and some commentators continue to question the scale of workforce problems. Hence, there is a need to establish a clear picture of those instabilities (i.e. imbalances between demand and supply) that do exist in the GP labour market in the UK. Based on a review of the published literature, we identify problems that stem from: (i) the changing social composition of the workforce and the fact that a large proportion of qualified GPs are significantly underutilized within traditional career structures; and (ii) the considerable differences in the ability of local areas to match labour demand and supply. We argue that one way to address these problems would be to encourage greater flexibility in a number of areas highlighted in the literature: (i) time commitment across the working day and week; (ii) long-term career paths; (iii) training and education; and (iv) remuneration and contract conditions. Overall, although the evidence suggests that the predicted 'crisis' has not yet occurred in the GP labour market as a whole, there is no room for lack of imagination in planning terms. Workforce planners continue to emphasize national changes to the medical school intake as the means to balance labour demand and supply between the specialities; however, better retention and deployment of existing GP labour would arguably produce more effective supply-side solutions. In this context, current policy and practice developments (e.g. Primary Care Groups and Primary Care Act Pilot Sites) offer a unique learning base upon which to move forward.

Attitude of Health Personnel↗

PubMed1999

Work stress and alcohol use.

Employees who drink heavily or who abuse or are dependent on alcohol can undermine a workforce's overall health and productivity. To better understand the reasons behind employee abusive drinking and to develop more effective ways of preventing problem drinking in the workforce, researchers have developed a number of paradigms that guide their research. One such paradigm is the alienation/stress paradigm, which suggests that employee alcohol use may be a direct or indirect response to physical and psychosocial qualities of the work environment. Although in the alcohol literature, work alienation and work stress traditionally have been treated as separate paradigms, compelling reasons support subsuming the work-alienation paradigm under a general work-stress paradigm. Researchers have developed several models to explain the relationship between work stress and alcohol consumption: the simple cause-effect model, the mediation model, the moderation model, and the moderated mediation model. Of these, the moderated mediation model particularly stands out, because it simultaneously addresses the two fundamental issues of how and when work stressors are related to alcohol use. Recent research supports a relation of work-related stressors to elevated alcohol consumption and problem drinking. Future research should focus on the relation between work stressors and alcohol use among adolescents and young adults, because they are just entering the workforce and are the most likely to engage in heavy drinking. Longitudinal studies also are needed to better explain the relation between work stress and alcohol use.

Adult↗

PubMed2001

Occupational health in European member states: a road to organizational health.

After an introduction, giving a short historical perspective on European Health and Safety legislation, the first experiences and opportunities for occupational physicians regarding international co-operation are described, with the first result in a form of a Position Paper on Occupational Health, adopted by the Standing Committee of European Doctors and presented to the European Commission. Since the ultimate shared goal for occupational physicians should be to contribute to the promotion of healthy workforce in safe and sound working conditions, the characteristics of a healthy organization are described with the possible activities to reach these characteristics, with particular attention drawn to the role of different disciplines. The growing importance of the management responsibility for health and safety in their enterprises is stressed and the possible benefits elucidated. The implications and consequences of such an extensive and ambitious program are pointed out with special regard to the challenge to contribute pro-actively to ensuring a healthy workforce in safe and sound working conditions for the benefit of employees, hereby clarifying the role and improving the general perception and position of occupational physicians. The importance of speaking with one voice and sharing ideas with colleagues, employers, employees and governments is essential, if the mission "to contribute to the realization of a healthy workforce in safe and sound working conditions" is to be reached.

European Union↗

PubMed2002

Health promotion programme in the private workplaces in Singapore: a prevalence survey.

A postal survey was conducted in 4,479 private companies with at least 50 employees in 1998 to determine the prevalence and the scope of workplace health promotion programme in these companies in Singapore. The self-administered questionnaire mailed to the study population covered five areas viz, organisational details, workplace health policies, health promotion and related activities, workplace health facilities and the source of assistance for the programme. The overall response was 49.5%. Parkinson's definition of workplace health promotion was used in the analysis to determine the prevalence of the programme. The data was collated on DBase IV and analysed using SPSS computer programmes. About one third of the respondents covering an estimated 26% of the private sector workforce had a comprehensive workplace health promotion programme as defined by Parkinson. This prevalence was a function of workforce size and industry type. Workplaces with larger workforce size (p<0.001) and those from the manufacturing and human/health service sectors (p<0.001) were more likely to have such programmes compared to their smaller counterparts and other industries respectively. The management remained the main driver behind these programmes. Many of the programmes were centred around health promoting policies and facilities with emphasis on occupational healthl safety and smoking issues. A significant proportion of workplaces surveyed had in place a comprehensive workplace health promotion programme. However, more could still be done to encourage its uptake such as training for facilitators, consultation, grant provision etc. Small workplaces remained an untapped market for such programmes.

Chi-Square Distribution↗

PubMedDate not supplied

[The World Health Organization and the development of human resources of the health system].

Health workforce is among the main components of the health care system. The performance of the latter depends on the knowledge, competence and motivations of the various categories of health workers. The task of the World Health Organization is to analyze the main problems related to health workforce and to help member-states overcome these problems. An other task is to facilitate intercountry comparisons. To attain these objectives, WHO has developed a conceptual framework, taking into account elements such as the labour market, the health care system, the policies and macro-factors (economic, socio-demographic). Among the main issues related today to health workforce, one can quote: the numbers and distribution of health workers, their migration, their involvement into the field of public health, the contents of their training, and, finally, the increased risk factors they are challenging.

Career Mobility↗

PubMed2004

Doctors' perspectives on the viability of rural practice.

INTRODUCTION: Private practitioners play a vital role in meeting the health needs of rural communities. However, the prospect of operating a private practice business in rural Australia seems to be increasingly unattractive, because many communities are forced to recruit salaried or overseas-trained doctors. This study focuses on rural practices as businesses whose viability influences their attractiveness for the recruitment and retention of practitioners. The specific objectives are to ascertain which factors contribute to or threaten practice viability in rural areas, and whether they vary according to the degree of rurality or geographical remoteness. METHODS: This study is based on data collected from a national study into the viability of rural general practice undertaken jointly by the Rural Doctors Association of Australia and Monash University School of Rural Health Bendigo. The Rural Remote and Metropolitan Area (RRMA) classification was used as the indicator of rurality. The study surveyed all general practitioners practising in rural or remote regions of Australia (RRMAs 3 to 7). Only practitioners with some financial interest in the practice were selected for this analysis. Free-text responses to the two questions 'What are the key factors contributing to the viability of your practice?' and 'What factors would put the viability of your practice at risk?' were analysed using qualitative content analysis. Factors were derived iteratively through higher-level aggregation of responses. Chi-square tests were used to make comparisons across the RRMA categories. RESULTS: The national survey achieved a response rate of 35% of the entire population of GPs practising in RRMA 3 to 7 regions. Of these, 1050 respondents were relevant to this analysis. Seven major factors were identified by practitioners as the main contributors to practice viability. 'Practice characteristics' was nominated by 59% of respondents, followed by 'Income' (31%), 'Personal circumstances', 'Workforce' and 'Community characteristics' (all approximately 23%), 'GP activities and workload' (16%) and 'Professional support' (12%). Eight main factors were identified by practitioners as threats to viability. 'Workforce' was nominated by 57% of respondents, followed by 'Financial' (44%), 'Medico-legal' (33%), 'Administration-political' (16%), 'Community characteristics' (15%), 'GP-practice characteristics' and 'Personal circumstances' (10%) and 'Family circumstances' (3%). Across RRMA 3 to 5 the order of the percentage of respondents identifying each factor was generally consistent, with significant differences in the magnitude of the percentages for three contributing factors and four risk factors. While respondent numbers in RRMA 6 and 7 communities were low, significance testing did reveal differences between them and the rural communities on two contributing and one risk factor. CONCLUSIONS: Practice viability is a major factor affecting the attractiveness of rural and remote practice for intending and existing GPs. Initiatives designed to contribute to viability will not be successful unless measures are also adopted to address perceived threats. This study highlights the systemic nature of the factors which contribute to and threaten practice viability. Although a primary component of practice viability is economic, with income from consultations being critical, the importance of the interrelationships between the main viability factors should not be underestimated. Clearly a multifaceted systemic response is required to overcome problems associated with rural workforce recruitment of future and burnout of current rural GPs.

Journal Article↗