1. AG Krankenhausforschung Alf Trojan, Stefan Nickel, Silke Werner University Medical Center Hamburg-Eppendorf Center of Psycho-Social Medicine Department of Medical Sociology The 13th International Conference on Health Promoting Hospitals (HPH) Dublin, May 18-20, 2005 Staff surveys: An empowering intervention for improving staff health and patient care quality?

2. AG Krankenhausforschung AT/SN 2005 2 Objective and method  Goal: To test the short and medium term effects of new working hours arrangements (including shift work) in one hospital  Tool: Standardised medical staff survey in written form administered at two points in time t1: about 7 months after implementation (incl. measurement of remembered situation at t0) t2: about 17 months after implementation

3. AG Krankenhausforschung AT/SN 2005 3 Characteristics of the responders at t2  Response rate of 48% (n=35 of 73 doctors)  77% were already working in hospital unit before conversion of stand-by-for emergency duties into shift work  72% were or are currently employed in shift work (compared with t1: 58%)  Comparison of responders with all doctors in unit shows substantial similarity in: function age sex

4. AG Krankenhausforschung AT/SN 2005 4 Scope of the questionnaire Organisational view Individual view Compatibility with “normal“ family life  Recreational activities  Family / child care  Income equity Abiding by legal norms  Maximum hours of work  Recreation time and breaks  Transparency / documentation Job strains  Psychophysical strains  Communication and cooperation Organisational procedures  Effectivity and efficiency of work  Flexibility of staff roster Patient orientation  Daily activities of patients  Doctor-patient communication Working hours preferences  Actual working hours  Wishes for future working hours Participation Staff‘s job satisfaction and health

5. AG Krankenhausforschung AT/SN 2005 5 Statistical evaluation  Describing the changes in respect to their practical significance and imputability  Topics to be dealt with: Working hours strains and preferences Working conditions and staff health changes over time (quality scales) Comparison of groups with / without shift work Relevance of the changes measured

6. AG Krankenhausforschung AT/SN 2005 6 Actual, requested und contracted hours of work Means in hours per week

7. AG Krankenhausforschung AT/SN 2005 7 Working hours preferences (only measured at t1) 6 most mentioned wishes in % of respondents

8. AG Krankenhausforschung AT/SN 2005 8 Working conditions changes over time Means of our 6 quality scales (Effect sizes [ES] t0-t1 and t0-t2 in brackets°) Best score ° ES .20 „small“; . 50 „medium“; .80 „large“ effect

9. AG Krankenhausforschung AT/SN 2005 9 Staff health changes over time Means of Zerssen‘s list of complaints (B-L): Best score = 0, worst = 3 (Effect sizes t0-t1 and t0-t2 in brackets°) Norm (1976) = ° ES .20 „small“; . 50 „medium“; .80 „large“ effect

10. AG Krankenhausforschung AT/SN 2005 10 Quality of working hours arrangements from t0 to t2 Frequency of ratings in % of respondents

11. AG Krankenhausforschung AT/SN 2005 11 Effects of the new arrangement t0-t1 comparing groups with and without experience of shift work Quality scalesChanges t0-t1 (Effect sizes) Doing shift work (n=18) Doing no shift work (n=13) Total (n=31) Abiding by legal norms.47.73*.60** Compatibility with family life-.66*.93**.12 Psychophysical strains.31.42.37* Communication and cooperation.19.30.25 Organisational procedures-.18-.23.05 Patient orientation.16.22.18 Staff health-.12-.39.20 * p<.05, ** p<.01 (t-test)

12. AG Krankenhausforschung AT/SN 2005 12 Effects of the new arrangement t0-t2 comparing groups with and without experience of shift work Quality scalesChanges t0-t2 (Effect sizes) Yes, but cur- rently not (n=5) Yes, cur- rently in rota- tion (n=10) Yes, perma- nently (n=10) No (n=10) Total (n=35) Abiding by legal normsn/a -.68*.10.47.35 Compatibility with family lifen/a-1.46*-1.41-.27 -.21- Psychophysical strainsn/a -1.38** -.06-.19.09 Communication and cooperationn/a.03.77*.21.20 Organisational proceduresn/a -.60-.03.28 -.12- Patient orientationn/a-1.10* -.20-.16 -.38- Staff healthn/a -.71- -.20--.03-.00 n/a = not analysed; * p<.05, ** p<.01 (t-test)

13. AG Krankenhausforschung AT/SN 2005 13 Relevance of new working hours arrangements (staff‘s view)  New working hours arrangements play a major role in the process of innovation in hospitals.  Ranking of the most important factors for quality of working conditions in the last 2 years (at t2): 1.Implementation of new working hours arrangements 2.General changes in work organisation 3.Other internal changes in hospital unit 4.Collateral arrangements for working hours 5.Other  Pre-post-results correspond to self-perceived changes reported by the doctors.

14. AG Krankenhausforschung AT/SN 2005 14 Summary and discussion  As intended, the surveys yielded data suitable for intervention aimed at improving staff and patient well- being.  For a short time some improvements were found (e.g. increased abiding by legal norms), but for doctors doing shift work most areas worsened.  In the medium term (about 17 months after implemen- tation) the overall situation worsened. Particularly negative impact was reported on “normal“ family life, and on patient care (in the staff‘s view).  In the staff‘s view the deterioration is a result of too few doctors.  The hospital management emphazises the difficult economic situation of the hospital.

15. AG Krankenhausforschung AT/SN 2005 15 Are staff surveys an empowering intervention for improving staff health and patient care quality?  In principle yes, because they can show critical developments and specific areas of concern;  in practice no, because alerting results at t0 did not lead to measures for improvement (the effects of the t2-results are as yet unclear).  From qualitative research results we conclude that economic values dominate, even when staff health is severely endangered by working hours arrangements.