Caring work environments and clinician emotional exhaustion: Empirical test of an exploratory model.

BACKGROUND: Burnout has been a chronic problem in the workplace, especially in health care. Although the literature has examined many antecedents to burnout, specific workplace practices to reduce burnout remain elusive. Nascent research has begun to examine how health care work places can become more caring for workers. Although psychological safety has been proposed as an important predictor of burnout, relations have not yet been comprehensively examined. PURPOSE: Underpinned by conservation of resources theory, we argue that a caring work environment, in which compassion and interpersonal support are key priorities, provides resources for workers, which should increase psychological safety and in turn help reduce emotional exhaustion. METHOD: To explore our proposed model, we conducted a paper-and-pencil survey of clinical health care providers working in medical units of a large acute care hospital. Response rate was 44% (n = 631). RESULTS: Analysis found support for a moderated-mediation model in which psychological safety partially mediated relations between caring climate and emotional exhaustion, and this effect was stronger for those who were less empowered in their jobs. CONCLUSION: Our findings suggest that a caring work environment holds psychological resources that may help buffer against resource losses through increased psychological safety. PRACTICAL IMPLICATIONS: Although health care work environments will continue to experience constraints on key resources, worker emotional exhaustion may be mitigated through a focus on systematically increasing caring and compassion in the work environment, as opposed to relying on individual workers to support one another in an uncaring workplace.

Patient perceptions of patient-centred care: empirical test of a theoretical model.

AIM: Patient perception measures are gaining increasing interest among scholars and practitioners. The aim of this study was to empirically examine a conceptual model of patient-centred care using patient perception survey data. BACKGROUND: Patient-centred care is one of the Institute of Medicine's objectives for improving health care in the 21st century. Patient interviews conducted by the Picker Institute/Commonwealth Fund in the 1980s resulted in a theoretical model and survey questions with dimensions and attributes patients defined as patient-centered. METHOD: The present study used survey data from patients with overnight visits at 142 U.S. hospitals. RESULTS: Regression analysis found significant support for the theoretical model. Perceptions of emotional support had the strongest relationship with overall care ratings. Coordination of care, and physical comfort were strongly related as well. CONCLUSION: Understanding how patients experience their care can help improve understanding of what patients believe is patient-centred, and of how care processes relate to important patient outcomes.

Improving work environments in health care: test of a theoretical framework.

BACKGROUND: In light of high levels of staff turnover and variability in the quality of health care, much attention is currently being paid to the health care work environment and how it potentially relates to staff, patient, and organizational outcomes. Although some attention has been paid to staffing variables, more attention must be paid to improving the work environment for patient care. PURPOSES: The purpose of this study was to empirically explore a theoretical model linking the work environment in the health care setting and how it might relate to work engagement, organizational commitment, and patient safety. This study also explored how the work environment influences staff psychological safety, which has been show to influence several variables important in health care. METHODOLOGY: Clinical care providers at a large metropolitan hospital were surveyed using a mail methodology. The overall response rate was 42%. This study analyzed perceptions of staff who provided direct care to patients. FINDINGS: Using structural equation modeling, we found that different dimensions of the work environment were related to different outcome variables. For example, a climate for continuous quality improvement was positively related to organizational commitment and patient safety, and psychological safety partially mediated these relationships. Patient-centered care was positively related to commitment but negatively related to engagement. PRACTICE IMPLICATIONS: Health care managers need to examine how organizational policies and practices are translated into the work environment and how these influence practices on the front lines of care. It appears that care provider perceptions of their work environments may be useful to consider for improvement efforts.