Organization and overall job satisfaction among publicly employed, salaried dentists in Sweden and Denmark.

BACKGROUND: In Sweden and Denmark, clinical dentistry is changing and public dentistry is in transition towards more market orientation. Dentists' overall job satisfaction is important for how public dentistry can fulfil the new expectations from patients, the public and politicians. OBJECTIVES: The aim of this study was to investigate what organizational factors were important for publicly employed salaried dentists' overall job satisfaction. METHODS: A random sample of active, general dental practitioners (private and publicly employed) was selected in Denmark and in Sweden, and they received a postal questionnaire. The number of questionnaires was 1835 and the response rate was 68% (n = 1226). This study analysed only the publicly employed dentists. The sampling frame for the Swedish dentists was 431, response rate 68.9% (n = 297) and for the Danish ones 194, response rate 81.9% (n = 159). Multivariate regression was used with overall job satisfaction as a dependent variable. RESULTS: Common organizational variables were important. The used model explained between 32% (Sweden) and 39% (Denmark) of the variance in overall job satisfaction. The only significant individual factor was less job satisfaction for Swedish dentists born outside Sweden. An organizational climate characterized by a focus on professional values was associated with job satisfaction in both countries. Among the Swedish dentists, number of colleagues and degree of influence were also important and among the Danish ones sufficient time for patients. CONCLUSIONS: Organizational factors had an impact on salaried publicly employed dentists' overall job satisfaction in both countries. The findings may have implications for other Human Service Organizations with employed professionals.

Collegial Support and Community with Trust in Swedish and Danish dentistry.

OBJECTIVES: The aim of the study was to better understand the associations between work factors and professional support among dentists (Collegial Support) as well as the sense of being part of a work community characterized by trust (Community with Trust). METHODS: A questionnaire was sent to 1835 general dental practitioners, randomly selected from the members of dental associations in Sweden and Denmark in 2008. The response rate was 68%. Two models with the outcome variables Collegial Support and being part of a Community with Trust were built using multiple hierarchical linear regression. Demographic background factors, work factors, managerial factors and factors relating to objectives and to values characterizing climate of the practice were all introduced as blocks into the models. RESULTS: A different pattern emerged for Collegial Support than for Community with Trust, indicating different underlying mechanisms. The main results were: (I) Female, married/cohabitant, collegial network outside the practice, common breaks, formalized managerial education of leader and a climate characterized by professional values, which were positively associated with Collegial Support, while number of years as a dentist and being managerially responsible were negatively associated. (II) Common breaks, decision authority and a climate characterized by professional values were positively associated with Community with Trust. CONCLUSION: A professionally-oriented practice climate and having common breaks at work were strongly associated with both outcome variables. The study underlined the importance of managing dentistry in a way which respects the professional ethos of dentists.

Overall job satisfaction among dentists in Sweden and Denmark: A comparative study, measuring positive aspects of work.

OBJECTIVE: Human service work differs from industrial work, which should be considered when organizing work. Previous research has shown organizational differences in the perceptions of work, often with a focus on negative aspects. The aim of this study was to analyse the overall job satisfaction among private- and public-practising dentists in Sweden and Denmark. This also implied a description of the questionnaire Swedish and Danish Dentists' Perceptions of Good Work about opportunities and positive and rewarding aspects of work. MATERIAL AND METHODS: A questionnaire covering the multidimensional concept of good work was developed. A total of 1835 dentists randomly sampled from the dental associations were sent a questionnaire in November 2008. A special non-response study was performed. Principal components analysis (PCA) was used to create a measure of overall job satisfaction, comparing four organizational subgroups. RESULTS: The average net response rate was 68% (n = 1226). The special non-response study of the Danish private practitioners showed more males, managers and dentists with more working hours than the respondents. PCA of three satisfaction questions showed a stable one-factor solution. There were differences in job satisfaction, with Danish public dentists ranked highest in overall job satisfaction and Swedish public dentists lowest. CONCLUSIONS: There were organizational differences in the perception of job satisfaction. Further analysis of how the human service is organized in the different groups is needed.

Good Work for dentists - a qualitative analysis.

OBJECTIVE: This study explores dentists' perceptions of Good Work in the meaning of positive and rewarding aspects in their work in contrast to a traditional problem-centred focus on work life. METHODS: Nine informants were selected among Danish and Swedish general dental practitioners to obtain variation as to country of origin, gender, age and clinical work experience. Semi-structured, in-depth interviews were audio-recorded and transcribed verbatim in the original language. Statements concerning positive aspects of work were used for systematic text condensation according to the principles of Giorgi's phenomenological analysis, as modified by Malterud, generalizing descriptions reflecting aspects of Good Work. Selection of participants continued until saturation of the emerging categories was achieved. RESULTS: The core of Good Work emanates from the clinical encounter: from the relation with the patient and from the opportunity to carry out high quality odontological handicraft. Social relations at the workplace, as well as organizational values and conditions were perceived as influencing the opportunities to achieve the rewarding aspects from the clinical encounter. CONCLUSIONS: The results implicate a need for developing a work-environmental model with intrinsic as well as extrinsic rewards when dealing with human service organizations. At policy level it is necessary to address the professional culture.

Work environment factors affecting quality work in Swedish oral and maxillofacial surgery.

The aim of this study was to investigate how work environment influenced attitudes to and knowledge of quality among employees of Oral and Maxillofacial Surgery (OMFS) clinics in Sweden. Data were collected with a questionnaire of 67 questions, related to quality management at the clinic, working situation, content of "good work", physical environment and health. 22 clinics with 297 employees responded, 65% of the clinics and 86% of the employees. A multiple regression analysis with the dependent variable "Attitude towards quality work" showed that only "work environment" (p = 0.010) revealed a significant association (p < 0.05). The personnel will have a more favourable attitude to quality work if they regard work environment to be important. Dental nurses and assistant nurses had more than four times more knowledge of the used quality management system than had the maxillo-facial surgeons. Women had nearly four times more knowledge of quality management than men. Clinic size was important, with better knowledge of quality management in bigger clinics. Soft demands were defined as demands for "flexibility, creativity, quality, service, engagement/commitment and ability to work together, and competence". Hard demands included economy as important, and emphasis on efficiency and productivity. There was a weak association with knowledge of quality management systems if soft demands increased, but negative if hard demands increased. In conclusion, mainly work environment was of significance for the attitude towards quality work among the employees of OMFS clinics in Sweden. Profession, gender, clinic size, and the hard demands were significantly associated with knowledge of the quality management system used.

Psychosocial work environment related health in Swedish oral and maxillofacial surgery in comparison with other human service workers.

The aims of this study were to describe how the employees of OMFS clinics in Sweden perceive their health, to compare with female unpromoted general practice dentists and other human service groups and to explore the dimensionality of the health measure. Data were collected by way of a questionnaire with 67 questions, related to quality management at the clinic, working situation, questions about the content of "good work", the connection between physical environment and health, emphasis on physical environment. 22 clinics with 297 employees responded, 65% of the clinics and 86% of the employees. The results showed that employees of OMFS clinics in Sweden perceived their health as rather problematic. In comparison, the present study group placed itself between general practice dentists and other human service groups as to their health. Three factors explained more than half of the variance of symptoms. They were interpreted as (1) psychosomatic troubles, (2) somatic troubles, and (3) muscle and joint troubles. These factors were almost the same as previously reported, confirming the basic dimensionality of the question battery. This study has shown that OMFS employees are feeling unhealthy, but no worse than other high-risk-groups in human service working situation and better than female general practice dentists. The women among OMFS employees felt worse than the men. Three factors of symptoms could be established, i.e. psychosomatic troubles, somatic troubles, and muscle and joint troubles.

Perceived social support in relation to work among Danish general dental practitioners in private practices.

Social support is an important phenomenon in the psychosocial work environment. The aim of this study was to assess the extent to which Danish general dental practitioners perceived support from colleagues and to relate perceived support to demographic and work related background factors. A questionnaire was sent to a random sample of 300 Danish dentists. The response rate was 80% after one reminder. Factor analyses and multiple regression analyses were carried out. The results showed that clinic size was the overall most important variable explaining perceived support among dentists. Gender differences were found in perceived emotional and practical support, and women perceived more emotional support (e.g. discussing problematic patients with peers) than their male colleagues. A similar gender difference was not found for the perception of practical support, such as helping each other in the event of falling behind schedule. Dentists from small and large practices did not differ in the extent of peer contact outside the clinical environment. This study emphasized the importance of the organizational setting for a professional and personal supportive psychosocial working environment in dentistry.

Dimensions of good work for employees in oral and maxillofacial surgery in Sweden.

The aims of this study were to describe how the employees of Oral and Maxillofacial Surgery (OMFS) clinics in Sweden perceive "good work", i.e. their image of the good dimensions that the profession should contain and to investigate if there is a discrepancy between ideal and reality for this group. The study was based on a questionnaire with 67 questions, related to quality management at the clinic, health and the content of good work in two sections, one with the headline "defines good work" and the other "fulfilled 'in my present work' ". Each section was subdivided into 12 parts covering aspects of good work. The maxillo-facial surgeons rated "intellectually stimulating work" as most important (91%), and the "hazard-free work environment" as least important (48%). The nurses rated "stimulating fellowship" as most important (84%), and the "opportunity for career advancement" as least important (27%). The percentage unit differences between the ideal and the reality were largest for the item "the work provides opportunities to have an influence on important decisions". Maxillo-facial surgeons had the greatest differences for that question and nurses had the greatest differences in "the work is well paid". A principal components analysis was performed and three factors explained more than half of the variance (52%). The factors were interpreted as (1) aiming at moral values and possibilities for skill discretion, as (2) career development, and as (3) work environment. The employees of OMFS clinics in Sweden emphasized free, influential, and intellectually stimulating work, but the discrepancy between ideal and reality was rather wide. Three factors of work environment could be established.

Moral values and career: factors shaping the image of healthy work for female dentists.

OBJECTIVE: Female unpromoted general practice dentists (GPDs) constitute about one-quarter of all dentists in Sweden. These female dentists suffer from many problems relating to their psychosocial working conditions. There are wide discrepancies between their perception of the ideal job situation and reality. Previously, three factors were found to constitute the ideal job situation. The aim of this study was to analyze patterns in two of these factors, i.e. the moral and the career factors, for understanding how ideal circumstances are conceived, i.e. how "good work" for the dentists could be obtained. MATERIAL AND METHODS: In the year 2000, all female unpromoted GPDs (183 persons) within the Public Dental Health Service (PDHS) in a region in Sweden received a questionnaire; response rate 94%. Four multiple regression models were constructed for two factors of good work and for the differences between the ideal job situation and reality concerning these factors. RESULTS: In all models, the explained variance was high. Those dentists who were committed to moral issues perceived large differences between the ideal and reality concerning moral values. Dentists committed to career issues experienced large differences between the ideal and reality concerning career development. Those dentists - about 60% - who would not want to be a dentist if they were to choose today, perceived large discrepancies concerning moral and career issues. CONCLUSIONS: The PDHS organization has failed to convince or engage those whom it ought to engage, that is those with the highest level of commitment. Dentists' emphasis on moral values confirms the character of dentistry as primarily a human service work.

Good work for dentists--ideal and reality for female unpromoted general practice dentists in a region of Sweden.

Female unpromoted general practice dentists (GPDs) in the Public Dental Health Service (PDHS) constitute about one fourth of all working dentists in Sweden. Unpromoted means that the position is without managerial functions. According to many reports, they have a problematic psychosocial work situation. THIS THESIS AIMED TO: Describe the perceived health for these GPDs, in comparison with others with a similar work situation. Analyse their sense of support in comparison with others. Describe how they perceived "good work", i.e. both the healthy and socially responsible work, and whether there was a difference between their ideal and their reality. Analyse patterns in two aspects - the moral and the career aspects - of "good work" for dentists. In zooo, questionnaires were sent to all female unpromoted GPDs in the PDHS in a region of Sweden. The response rate was 94%. RESULTS: The dentists felt unwell, worse than other compared groups. There was little support from the management. There was little inter-colleague contact. There was no cross-sectional assciation between collegial neworks and support, but the qualitative investigation showed that collegial networks were perceived as positive. There was a great difference between ideal and reality concerning good work. The dentists felt a lack of influence, and this was the greatest difference of all. Three components of good work - "moral values and skill discretion", "career development" and "work environment" were found. The dentists emphasized the moral basis of their work, confirming the character of dentistry as primarily human service work. IN CONCLUSION: There were serious work environmental problems among these dentists. The dentists felt unwell and felt a great lack of influence on important decisions. There was little inter-colleague contact, but collegial networks were perceived as positive. There was little support from the management, indicating a clear weakness in the relations between employers and female unpromoted GPDs in the PDHS. Three components of good work were found, where the moral component was the most important but it also showed the greatest difference between ideal and reality. Thus, the dentists emphasized the moral basis of their work, confirming the character of dentistry as primarily human service work and not industrial work. The dentists with the highest level of commitment perceived the largest differences. The PDHS organization has therefore failed to convince or engage those whom it ought to engage, i.e. those with the greatest commitment. The way to improve the female unpromoted GPDs' work situation would be through increased influence and support, bridging the gap between ideal and reality.

Network participation for unpromoted female dentists in relation to psychosocial support.

Studies have shown that female unpromoted general practice (GP) dentists have a taxing work situation with many problems related to their psychosocial work environment. This study aims to describe: 1) the participation of this group in organized network activity (support groups) in a region (Scania) in Sweden, 2) the sense of support compared with another organization and with a nationwide sample of GP dentists, and 3) the covariation of network participation with support. All unpromoted female dentists within the Public Dental Health Service (PDHS) in Scania received a questionnaire and 94% responded. Those participating in network activity < or =4 times a year constituted 12% of respondents. Cooperation between colleagues was lower than in the nationwide sample. Support from the PDHS was experienced as weak. It was not possible to explain why female unpromoted GP dentists participated < or =4 times a year, while those who felt lonely in their work were to a higher degree participants in a network. Almost 9 out of 10 reported being strengthened by the network both as a person and in a professional role. The female dentist was three times more likely to participate in a network if she had a male head of clinic. The main findings are a paucity of inter-colleague contact and a lack of association between support and network participation. The many affirmative comments indicated that network participation might be a good coping strategy for unpromoted female GP dentists.

Healthy work for female unpromoted general practice dentists.

This study describes how female unpromoted general practice dentists (GPDs) in a region in Sweden perceive 'healthy work', i.e. their image of the dimensions that the dentistry profession should contain if it is to be really healthy work. The study also investigates whether there is a gulf between ideal and reality for this group. All unpromoted GPDs within the Public Dental Health Service's general practice in a region in Sweden received a questionnaire, and 94% responded. The data were collected during July and August 2000 and the question about healthy work was taken from work environment studies. A principal components analysis was performed. Three factors explaining more than half the variance (53%) formed three well-defined vector clusters: 1) a factor for moral values and possibilities for skill discretion, i.e. properties specific for human services, 2) a factor for career development, and 3) a factor for work environment. We found that factor 1 alone explained a greater proportion of the variance (28%) for the respondents. The main results were that the female unpromoted GPDs emphasized free and intellectually stimulating work and that the gulf between ideal and reality was wide, especially concerning the dentist's influence on important decisions. A salutogenetic approach built on good communication and democracy at work, and based on freedom and the employees' influence, could bring ideal and reality closer.

Psychosomatic symptoms among female unpromoted general practice dentists.

Unpromoted female general practice dentists have a working situation with hard work conditions. The aim of the present study was to describe the perceived health for unpromoted female general practice dentists in comparison with others having a somewhat similar working situation. Questionnaires were sent to all unpromoted female general practice dentists (n = 183) within the Public Dental Health Service in a region in Sweden. The response rate was 94%. Comparisons have been done with personnel in the Social Insurance Organization in Sweden and Children Clinics in the Public Health Care in a region in Sweden. The dentists in this study suffered from many physical and mental troubles and also linked them to the working situation. They reported high prevalences of tiredness (70%) and back, neck and shoulder pain (76%) and related these symptoms to the job situation in 83% and 95%, respectively. The study showed statistically significant differences (p < or = 0.0001) in the comparison between all the samples that were investigated. In conclusion, the results show problems concerning self-perceived health for the unpromoted female dentists. We have shown that they are feeling unhealthy, worse than other high-risk-groups in a human service working situation, and they suffer from a multitude of problems also connected to their working environment.