Association of Patient and System-Level Factors With Social Determinants of Health Screening.

BACKGROUND: Health systems are increasingly recognizing the importance of collecting social determinants of health (SDoH) data. However, gaps remain in our understanding of facilitators or barriers to collection. To address these gaps, we evaluated a real-world implementation of a SDoH screening tool. METHODS: We conducted a retrospective analysis of the implementation of the SDoH screening tool at Mayo Clinic in 2019. The outcomes are: (1) completion of screening and (2) the modality used (MyChart: filled out on patient portal; WelcomeTablet: filled out by patient on a PC-tablet; EpicCare: data obtained directly by provider and entered in chart). We conducted logistic regression for completion and multinomial logistic regression for modality. The factors of interest included race and ethnicity, use of an interpreter, and whether the visit was for primary care. RESULTS: Overall, 58.7% (293,668/499,931) of screenings were completed. Patients using interpreters and racial/ethnic minorities were less likely to complete the screening. Primary care visits were associated with an increase in completion compared with specialty care visits. Patients who used an interpreter, racial and ethnic minorities, and primary care visits were all associated with greater WelcomeTablet and lower MyChart use. CONCLUSION: Patient and system-level factors were associated with completion and modality. The lower completion and greater WelcomeTablet use among patients who use interpreters and racial and ethnic minorities points to the need to improve screening in these groups and that the availability of the WelcomeTablet may have prevented greater differences. The higher completion in primary care visits may mean more outreach is needed for specialists.

Involuntary vs. Voluntary Flexible Work: Insights for Scholars and Stakeholders.

Building on insights from the early stages of our research partnership with a U.S. Fortune 500 organization, we came to differentiate between voluntary and involuntary schedule variability and remote work. This differentiation underscores the complexity behind flexible schedules and remote work, especially among white-collar, salaried professionals. We collected survey data among the partner firm's information technology (IT) workforce to evaluate whether these forms of flexibility had different implications for workers, as part of the larger Work, Family, and Health Network Study. We find that a significant minority of these employees report working variable schedules and working at home involuntarily. Additionally, involuntary variable schedules are associated with greater work-to-family conflict, stress, burnout, turnover intentions, and lower job satisfaction in models that adjust for personal characteristics, type of job, work hours, family demands, and other factors. Voluntary remote work, in contrast, is protective and more common in this professional sample. Employees working at least 20% of their hours at home and reporting moderate or high choice over where they work have lower stress and intentions to leave the firm (as well as higher job satisfaction in some models). These findings point to the importance of both stakeholders and scholars distinguishing between voluntary and involuntary forms of flexibility, even in a relatively advantaged professional and technical workforce.

Edificando sobre la base de conocimientos que resultaron de las fases iniciales de nuestra colaboración con una empresa estadounidense de la Fortune 500, hemos diferenciado entre el trabajo a distancia o variabilidad de horario voluntaria e involuntaria. Esta diferenciación destaca la complejidad tras los horarios flexibles y el trabajo a distancia, particularmente para oficinistas y profesionales asalariados. Como parte del estudio más amplio "Work, Family, and Health Network Study," lanzamos una encuesta a los empleados especializados en las tecnologías de la información (TI) de esta empresa, con fines de evaluar si dichas formas de flexibilidad laboral tienen distintas implicaciones para los funcionarios de esta empresa. Se observa que una minoría importante de los empleados declara haber experimentado variabilidad de horarios y haber trabajado desde casa de forma involuntaria. Adicionalmente, se observa que la variabilidad de horario involuntaria se asocia con mayores incidencias de conflicto entre trabajo y familia, estrés, agotamiento, intenciones de rotación laboral, y otros factores. En cambio, el trabajo a distancia voluntario protege a los empleados y es más frecuente entre esta muestra de profesionales. Aquellos funcionarios que realizan 20% o más de sus horas laborales desde casa y que declaran tener moderadas o amplias opciones de empleador presentan menos estrés y menores intenciones de renunciar (algunos modelos indican que éstos también presentan mayor satisfacción laboral). Estas conclusiones demuestran la importancia para académicos e interesados de distinguir entre la flexibilidad laboral voluntaria e involuntaria, incluso en una fuerza laboral técnica, profesional, y relativamente aventajada.

IS WORK-FAMILY CONFLICT A MULTILEVEL STRESSOR LINKING JOB CONDITIONS TO MENTAL HEALTH? EVIDENCE FROM THE WORK, FAMILY AND HEALTH NETWORK.

PURPOSE: Most research on the work conditions and family responsibilities associated with work-family conflict and other measures of mental health uses the individual employee as the unit of analysis. We argue that work conditions are both individual psychosocial assessments and objective characteristics of the proximal work environment, necessitating multilevel analyses of both individual- and team-level work conditions on mental health. METHODOLOGY/APPROACH: This study uses multilevel data on 748 high-tech professionals in 120 teams to investigate relationships between team- and individual-level job conditions, work-family conflict, and four mental health outcomes (job satisfaction, emotional exhaustion, perceived stress, and psychological distress). FINDINGS: We find that work-to-family conflict is socially patterned across teams, as are job satisfaction and emotional exhaustion. Team-level job conditions predict team-level outcomes, while individuals' perceptions of their job conditions are better predictors of individuals' work-to-family conflict and mental health. Work-to-family conflict operates as a partial mediator between job demands and mental health outcomes. PRACTICAL IMPLICATIONS: Our findings suggest that organizational leaders concerned about presenteeism, sickness absences, and productivity would do well to focus on changing job conditions in ways that reduce job demands and work-to-family conflict in order to promote employees' mental health. ORIGINALITY/VALUE OF THE CHAPTER: We show that both work-to-family conflict and job conditions can be fruitfully framed as team characteristics, shared appraisals held in common by team members. This challenges the framing of work-to-family conflict as a "private trouble" and provides support for work-to-family conflict as a structural mismatch grounded in the social and temporal organization of work.