Systematic Violence Monitoring to Reduce Underreporting and to Better Inform Workplace Violence Prevention Among Health Care Workers: Before-and-After Prospective Study.

BACKGROUND: Monitoring workplace violence (WPV) against health care workers (HCWs) through incident reporting is crucial to drive prevention, but the actual implementation is spotty and experiences underreporting. OBJECTIVE: This study aims to introduce a systematic WPV surveillance in 2 public referral hospitals in Italy and assess underreporting, WPV annual rates, and attributes "before" (2016-2020) and "after" its implementation (November 2021 to 2022). METHODS: During 2016-2020, incident reporting was based on procedures and data collection forms that were neither standardized between hospitals nor specific for aggressions. We planned and implemented a standardized WPV surveillance based on (1) an incident report form for immediate and systematic event notification, adopting international standards for violence definitions; (2) second-level root cause analysis with a dedicated psychologist, assessing violence determinants and impacts and offering psychological counseling; (3) a web-based platform for centralized data collection; and (4) periodic training for workforce coordinators and newly hired workers. We used data from incident reports to estimate underreporting, defined as an observed-to-expected (from literature and the "before" period) WPV ratio less than 1, and the 12-month WPV rates (per 100 HCWs) in the "before" and "after" periods. During the latter period, we separately estimated WPV rates for first and recurrent events. RESULTS: In the "before" period, the yearly observed-to-expected ratios were consistently below 1 and as low as 0.27, suggesting substantial violence underreporting of up to 73%. WPV annual rates declined in 1 hospital (from 1.92 in 2016 to 0.57 in 2020) and rose in the other (from 0.52 to 1.0), with the divergence being attributable to trends in underreporting. Available data were poorly informative to identify at-risk HCW subgroups. In the "after" period, the observed-to-expected ratio rose to 1.14 compared to literature and 1.91 compared to the "before" period, consistently in both hospitals. The 12-month WPV rate was 2.08 (95% CI 1.79-2.42; 1.52 and 2.35 in the 2 hospitals); one-fifth (0.41/2.08, 19.7%) was due to recurrences. Among HCWs, the youngest group (3.79; P<.001), nurses (3.19; P<.001), and male HCWs (2.62; P=.008) reported the highest rates. Emergency departments and psychiatric wards were the 2 areas at increased risk. Physical assaults were more likely in male than female HWCs (45/67, 67.2% vs 62/130, 47.7%; P=.01), but the latter experienced more mental health consequences (46/130, 35.4% vs 13/67, 19.4%; P=.02). Overall, 40.8% (53/130) of female HWCs recognized sociocultural (eg, linguistic or cultural) barriers as contributing factors for the aggression, and 30.8% (40/130) of WPV against female HCWs involved visitors as perpetrators. CONCLUSIONS: A systematic WPV surveillance reduced underreporting. The identification of high-risk workers and characterization of violence patterns and attributes can better inform priorities and contents of preventive policies. Our evaluation provides useful information for the large-scale implementation of standardized WPV-monitoring programs.

Implementing Smart Working in Public Administration: a follow up study.

BACKGROUND: Starting from February 2020, in Italy most organizations have had a forced transition to flexible working practice - called "smart working in emergency" - due to the Covid-19 epidemic outbreak. This allowed to continue work activities and services and contributed to contain the risk of infection in different sectors, particularly in the public administration. OBJECTIVES: This follow up study focussed on a panel of 187 workers from the Italian Workers' Compensation Authority taking part to a pilot project "Smart Working in INAIL" from January 2019 to December 2019. The aim was to investigate the effects of work organization on work attitudes, work-life balance and health outcomes before and after the introduction of the smart working. METHODS: The data were collected at two time points through a web-based questionnaire. The first wave aimed to collect information up to one month before the implementation of the smart working. The second wave aimed to collect information about potential changes occurred after one year of smart working. RESULTS: This study showed that high demands, low control and low social support might lead to reduced well-being and less satisfaction with work, and have an effect on work engagement and work-life balance. Particularly, improving social support can moderate the negative impact of high strain on well-being, preventing work-life imbalance and risk of isolation. DISCUSSION: Findings and future perspectives are discussed to support stakeholders in defining policies and practices concerning health and wellbeing at work while preserving productivity, for a successful implementation of smart working in the public administration.

Improving Working Conditions and Job Satisfaction in Healthcare: A Study Concept Design on a Participatory Organizational Level Intervention in Psychosocial Risks Management.

This paper contributes to the literature on organizational interventions on occupational health by presenting a concept study design to test the efficacy of a Participatory Organizational-level Intervention to improve working conditions and job satisfaction in Healthcare. The Participatory Organizational-level Intervention is developed using the Italian methodology to assess and manage psychosocial risks tailored to Healthcare. We added an additional step: evaluation, aiming to examine how the intervention works, what worked for whom and in which circumstances. This ongoing study is conducted in collaboration with two large Italian hospitals (more than 7000 employees). The study design comprises a quasi-experimental approach consisting of five phases and surveys distributed pre- and post-intervention aiming to capture improvements in working conditions and job satisfaction. Moreover, to evaluate the efficacy of the Intervention in terms of process and content, we use a realist evaluation to test Context-Mechanisms-Outcome (CMO) configurations. We collect contextual factors at baseline and during and post-intervention process data on the key principles of line manager support and employees participation. This study is expected to provide insights on methods and strategies to improve working conditions and employees' job satisfaction and on national policies in the occupational health framework.

Assessing Objective and Verifiable Indicators Associated With Work-Related Stress: Validation of a Structured Checklist for the Assessment and Management of Work-Related Stress.

Risk assessment represents an essential part of any successful intervention in health and safety at work. The most prominent European methodologies propose multi-method approaches for identifying the risks associated with work-related stress. Nevertheless, the most widely used method is the self-administered questionnaire. By adapting the UK Management Standards approach, the Italian National Workers Compensation Authority (INAIL) developed a checklist for the assessment of objective and verifiable indicators of work-related stress. This checklist is filled in by a steering group composed of homogenous groups of workers. Through a web-platform developed by INAIL, a considerable amount of data over the last 5 years has been collected throughout Italy. The aims of this study are to examine the psychometric properties as well as the practical validity of the checklist in a wide sample of Italian companies. The sample comprised 5,301 homogeneous groups of workers nested within 1,631 organizations. The checklist measures two main areas: (1) the organizational indicators of work-related stress (sentinel events) and (2) four and six factors related respectively to content and context of work. Multilevel and multivariate analyses revealed that the checklist shows adequate factor structure and criterion validity. Results also demonstrate that small companies and the public and healthcare sector show higher risk levels. These results support the use of the checklist as a structured and generalizable tool for assessing and monitoring the risks associated with work-related stress.

The psychological distress and care needs of mesothelioma patients and asbestos-exposed subjects: A systematic review of published studies.

BACKGROUND: The purpose of this study is to present the results of a systematic review of published research that focuses on psychological aspects of malignant mesothelioma patients and asbestos-exposed people. METHODS: Our research includes primary studies published between 1980 and 2016, using information from the Cochrane Library, the Psychology Behavioral Sciences Collection, PsychINFO, PubMed, PubGet, PubPsych, and Scopus, in compliance with PRISMA guidelines. RESULTS: We identified 12 papers that investigated the psychological distress and care needs of mesothelioma patients, and nine papers for asbestos-exposed subjects. CONCLUSIONS: This paper highlights the paucity of studies on the psychological distress and care needs of mesothelioma patients and asbestos-exposed subjects. It confirms that malignant mesothelioma is associated with the physical, emotional, and social functioning of patients, while also suggesting that the risk of developing asbestos-related diseases among asbestos-exposed subjects is associated with high levels of psychological distress, despair, and mental health difficulties.

Do Italian Companies Manage Work-Related Stress Effectively? A Process Evaluation in Implementing the INAIL Methodology.

Studies on Intervention Process Evaluation are attracting growing attention in the literature on interventions linked to stress and the wellbeing of workers. There is evidence that some elements relating to the process and content of an intervention may have a decisive role in implementing it by facilitating or hindering the effectiveness of the results. This study aimed to provide a process evaluation on interventions to assess and manage risks related to work-related stress using a methodological path offered by INAIL. The final sample is composed of 124 companies participating to an interview on aspects relating to each phase of the INAIL methodological path put in place to implement the intervention. INAIL methodology has been defined as useful in the process of assessing and managing the risks related to work-related stress. Some factors related to the process (e.g., implementation of a preliminary phase, workers' involvement, and use of external consultants) showed a role in significant differences that emerged in the levels of risk, particularly in relation to findings from the preliminary assessment. Main findings provide information on the key aspects of process and content that are useful in implementing an intervention for assessing and managing risks related to work-related stress.

[A review of measures taken to improve organizational wellbeing in Italy]. / Rassegna di interventi realizzati per il miglioramento del benessere organizzativo in Italia.

INTRODUCTION: The Italian Decree Law D. Lgs. no. 81 dated 9 April 2008, dealing with the implementation of Article 1 of Law No. 123 dated 3 August 2007, on the topic of health and safety in the workplace, indicated that work-related stress (art. 28, section 1) was to be assessed in accordance with the European Agreement of 8 October 2004. It recalled the employer's legal obligation to safeguard workers' health and safety, and included psychosocial risk, in order to improve their wellbeing at work. The Decree Law specified that when risks had been assessed the employer could take all necessary measures, with reference to the "good practice", defined in the Law as organizational or procedural solutions coherent with current regulations and good technical rules, adopted voluntarily with the aim of promoting safety and health in the workplace by reducing risk and improving working conditions [...]" (art. 2, section 1 v); the practical solutions identified were to aim at eliminating, or at least reducing, psychosocial risk in the enterprise. METHOD: On the basis of the studies most widely accepted in Europe and the indications issued by the European Agency for Safety and Health at Work, we identified the good practice measures adopted by companies in Italy and other countries. The aim was to make known some of the practical solutions regarding psychosocial risk that companies can put in place with a view to improving their workers' health and wellbeing. RESULTS: We examined measures related to the content and context of work. Measures affecting the work content mainly involved the workplace itself and equipment, work planning and working hours. For the work context the measures centered mostly on organizational function and culture, career progress, and home/work interface. CONCLUSIONS: In accordance with good safety practice, the practical measures taken by the enterprises examined cantered on some potentially stressful features of work, indicating the growing attention being paid to workers' wellbeing. However, organizational wellbeing is a multifaceted concept and the European Agency points out that measures taken must cover all the aspects of the work that appear particularly critical in risk assessment; from the primary prevention viewpoint, this means all the organizational aspects that might affect a person's wellbeing. As we become increasingly aware of the problems, and of the measures that have proved successful, it is to be hoped that further solutions will be identified and developed in organizations.