The effects of improving hospital physicians working conditions on patient care: a prospective, controlled intervention study
1 Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, Ludwig-Maximilians-University Munich, Ziemssenstrasse 1, D-80336 Munich, Germany
2 Institute of Psychology, University of Innsbruck, Innsbruck, Austria
3 Institute for Occupational Medicine and Social Medicine, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
4 Institute of Medical Sociology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
BMC Health Services Research 2013, 13:401 doi:10.1186/1472-6963-13-401Published: 9 October 2013
Physicians, particularly in hospitals, suffer from adverse working conditions. There is a close link between physicians’ psychosocial work environment and the quality of the work they deliver. Our study aimed to explore whether a participatory work-design intervention involving hospital physicians is effective in improving working conditions and quality of patient care.
A prospective, controlled intervention study was conducted in two surgical and two internal departments. Participants were 57 hospital physicians and 1581 inpatients. The intervention was a structured, participatory intervention based on continuous group meetings. Physicians actively analyzed problematic working conditions, developed solutions, and initiated their implementation. Physicians’ working conditions and patients’ perceived quality of care were outcome criteria. These variables were assessed by standardized questionnaires. Additional data on implementation status were gathered through interviews.
Over the course of ten months, several work-related problems were identified, categorized, and ten solutions were implemented. Post-intervention, physicians in the intervention departments reported substantially less conflicting demands and enhanced quality of cooperation with patients’ relatives, compared to control group physicians. Moreover, positive changes in enhanced colleague support could be attributed to the intervention. Regarding patient reports of care quality of care, patient ratings of physicians organization of care improved for physicians in the intervention group. Five interviews with involved physicians confirm the plausibility of obtained results, provide information on implementation status and sustainability of the solutions, and highlight process-related factors for re-design interventions to improve hospital physicians work.
This study demonstrates that participatory work design for hospital physicians is a promising intervention for improving working conditions and promoting patient quality of care.