1. AG Hospital Research Alf Trojan, Stefan Nickel University Hospital Hamburg Centre of Psychosocial Medicine Institute for Medical Sociology 12th International Conference Investing in health for the future Positioning health promotion in health care provision & supporting effective implementation May 26-28, 2004, Moscow Staff health surveys as a prerequisite for monitoring healthy hospitals

2. AG Hospital Research IMS/AT 2004 2 Staff surveys: identifying workloads with regard to health promotion in hospitals and staff health Patient surveys: 'boom' in quality management (in spite of methodological and practical problems) Combined surveys: rarely used so far  Aim: increasing the effectivity and efficiency of quality assessment in hospitals, particularly improvements in patient - and staff-orientation Background & objectives

3. AG Hospital Research IMS/AT 2004 3 Methods Research-Setting: internal and surgical departments of two hospitals (A and B) General surveys among both the medical and nursing staff and the patients (>18 years old, at least 1 night stay)  Staff: all personnel of the departments studied (79 doctors : 55% response rate; 175 nursing staff : 56% response rate)  Patients: representative sample by postal survey 1-2 weeks after discharge (1,235 patients : 35% response rate)

4. AG Hospital Research IMS/AT 2004 4 Scope of the questionnaires dimensions in staff‘s and patients‘ view of quality dimensions in staff‘s view of quality

5. AG Hospital Research IMS/AT 2004 5 Example of Type of Question " Over and over again, there are conflicts between the heavy demands on patient care and my other duties of work. " (0) don't agree (1) agree less (2) agree partly (3) agree fairly (4) agree totally

6. AG Hospital Research IMS/AT 2004 6 Results presented here Health problems of staff Doctors' view of working conditions (overview) Focus: quality culture Focus: staff- and patient-orientation Additional results from 2 other studies Challenges

7. AG Hospital Research IMS/AT 2004 7 General health complaints (means by Zerssen‘s B-L; best = 0, worst = 3) The differences between the groups for each hospital are highly significant: p<0.001 in hospitals A und B (t-test for independent samples).

8. AG Hospital Research IMS/AT 2004 8 Ranking of health complaints Complaints of medical and nursing staff are very similar: First and foremost, the staff complain about pain from physical strains (back, neck, shoulder). Second, a complex of psychomental complaints follows (exessive need of sleep, brooding, irritability, uneasiness, fatigue). Finally, symptoms of the digestive system dominate the more rare complaints.

9. AG Hospital Research IMS/AT 2004 9 Quality of working conditions: doctor`s view (means of the 6 quality scales, converted into a 100-point-scale; 100 = best quality) Quality culture

10. AG Hospital Research IMS/AT 2004 10 Specific items of quality culture (frequency of the two positive ratings in %) importance of staff orientation

11. AG Hospital Research IMS/AT 2004 11 Main problems of working conditions The most notable workloads (doctors and nurses) (frequency of the two positive ratings < 10%) : little attention paid to staff orientation (hospital A und B) working overtime (A und B) no breaks (B) few qualified personnel (B) conflicts between patient care and other duties (B) Additional working loads of nursing staff: insufficient opportunities for further professional training(B) frequent interruptions of work (A) physical obstacles by lifting and loading (A) inadequate pay (A)

12. AG Hospital Research IMS/AT 2004 12 Conclusions of this survey 1.There are considerable health problems of hospital staff. 2.Surveys can differentiate between hospitals. 3.Surveys can give specific information for improvements. 4.Consideration of staff and patient orientation is rated very low. 5.There is a conflict between patient care and other duties.

13. AG Hospital Research IMS/AT 2004 13 Additional Study 1: Impact of new doctor's working hours (new shift system) on patient-orientation and staff health Impact on researched units Patient communication and patient care Doctors' health negativepositiveno effectnegativepositiveno effect hospital I (n=13 =26%) 36% 27%36%45%18% hospital II (n=31 =42%) 28%64%10%33%43%23%

14. AG Hospital Research IMS/AT 2004 14 Additional Study 2: 824 (56%) doctors in hospitals Do you have enough time apart from the purely medical services to give personal care to your patients? Source: Medical Chamber Thüringen, 2002 Survey amongst doctors in hospitals

15. AG Hospital Research IMS/AT 2004 15 Challenges for health promoting hospitals  to monitor not only patient- but also staff- orientation  to improve the "quality culture"  to strengthen health promotion policies for doctors and nurses  to strike a balance between the interests of the two most important target groups in the hospital: patients and staff! Thank you!