Workplace ostracism in healthcare: Association with job satisfaction, stress, and perceived health.

AIMS: To examine (1) the association between healthcare workers' workplace ostracism and job satisfaction, stress and perceived health, and (2) whether this relationship is mediated by loneliness and self-esteem. DESIGN: A cross-sectional study. METHODS: Healthcare (N = 569) managers and employees (nurses, practical nurses, doctors and social workers) in Finland responded to a semi-structured survey in January 2021 and evaluated their experiences of workplace ostracism, job satisfaction, stress, perceived health, loneliness and self-esteem during the last year. To examine the association of these variables, linear regression and mediator model tests were performed. RESULTS: Workplace ostracism had a clear direct association with job satisfaction, stress and perceived health. Loneliness fully mediated the relationship between workplace ostracism, stress and perceived health, and partly mediated the association between workplace ostracism and job satisfaction. Self-esteem partly mediated the association between workplace ostracism, stress, job satisfaction and perceived health. CONCLUSION: The experience of workplace ostracism in organizations is a significant factor in job satisfaction, stress and perceived health. Healthcare organizations could strengthen job satisfaction and increase workers' well-being by strengthening social relationships in the organization and, via that, reducing turnover intention. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: This study gives understanding and information to the healthcare profession on how workplace ostracism affects work well-being and workplace relationships. Workplace ostracism decreases interaction, which can also endanger patient care if information is not openly exchanged. IMPACT: This study indicated that workplace ostracism weakened job satisfaction more than loneliness. More commonality and consideration for others at work are needed because these factors may help increase work well-being and decrease exits from working life. Further research is needed on why workplace ostracism occurs in healthcare workplaces. REPORTING METHOD: STROBE. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Physical activity as an investment or consumption good-a mixed methods approach.

Studying individuals' motivation to engage in physical activity raises the question of whether physical activity is a consumption good (enjoyment) or an investment good (a health investment). The aims of the study were: (i) What kind of motivational background is it possible to identify for different forms of physical activity among adults, and (ii) Is there an association between different motivational factors and the form and amount of physical activity among adults. A mixed methods approach was applied using interviews (n = 20) and a questionnaire (n = 156). The qualitative data was analysed using content analysis. The quantitative data were analysed using factor and regression analysis. Among the interviewees, different types of motivation were found: 'enjoyment', 'health reasons' and 'mixed motivations', and from the quantitative data: (i) mixed motivation, a combination of enjoyment and investment, (ii) dislike of physical activity, (iii) social, (iv) goal focused, (v) appearance focused and (vi) exercising only within the comfort zone. Mixed-motivational background, with both enjoyment and investment in health, increased weekly physical activity hours significantly (ß = 1.733; p = 0.001). Personal appearance-based motivation increased weekly muscle training (ß = 0.540; p = 0.000) and brisk physical activity hours (ß = 0651; p = 0.014). Conducting such physical activity which provides enjoyment during the performance of the activity, increased weekly balance-focused exercise hours (ß = 0.224; p = 0.034). People have different kind of motivational backgrounds for engaging in physical activity. Mixed motivational background, including enjoyment and investment in health, yielded more physical activity in hours than if the person had only one of these motivations.

Pairing physical activity with pleasant associations could be a direction for effective physical activity promotion. It is important to enable people to test different physical activity types in order to find the type of physical activity which gives them most joy and pleasure. If one is conducting physical activity purely as an investment in health, the amount of activity is less than when the activity is combined with enjoyment. Getting pleasure from physical activity should be the main target when we try to increase physical activity among people who have previously not enjoyed physical activity.

The dynamic nature of leader-member exchange relationships in health-care organizations.

PURPOSE: This study aims to make visible the dynamic nature of leader-member exchange (LMX) in the changing realm of health-care leadership. DESIGN/METHODOLOGY/APPROACH: The qualitative study used an open questionnaire, which was distributed amongst nursing staff and managers at a Finnish public university hospital. FINDINGS: The participants described partly LMX theory, but the leader-member relationship was also influenced by the organizational culture and the existing management practices. Nursing staff were found to have a more variable and dynamic role in the LMX relationship than has previously been reported. The research therefore provided novel information for the field of health-care research. RESEARCH LIMITATIONS/IMPLICATIONS: The presented research was limited by the content of the data, as the collected single narratives were rather short; however, the fact that a large number of narratives were collected from diverse participants strengthened the ability to reliably answer the research questions. PRACTICAL IMPLICATIONS: Although the participants described partly LMX theory, the leader-member relationship is also influenced by the organizational culture and existing management practices; the finding that nurses have more variable roles in LMX relationships in the health-care context was new insight in this field. Therefore, the presented findings can help decision-makers change the current, perhaps antiquated, leadership practices at health-care organizations. ORIGINALITY/VALUE: This study provides new insight into the field of LMX research in terms of the important role of nursing staff, the organizational factors that influence the LMX relationship and the dynamic nature of LMX relationships.

Trust as a multidimensional phenomenon in LMX relationships.

PURPOSE: The purpose of this study is to address the construction of trust in leader member exchange (LMX) relationships as a multidimensional phenomenon and identify the importance of emotional and collective factors contributing to this phenomenon. DESIGN/METHODOLOGY/APPROACH: Ten health care professionals (five leaders and five members) were interviewed to subject to qualitative thematic analysis. FINDINGS: Four main themes in the data were identified (work roles, collectivity, interaction and participation) and linked to two main elements of LMX trust relations: core and contextual. The results extend understanding of the construction and maintenance of trust in LMX relationships, indicating that it is a more complex and socially constructed phenomenon than previously described. RESEARCH LIMITATIONS/IMPLICATIONS: Despite identified limitations of the study (the small amount of empirical material, interpretive research method and purposive sampling of participants), the findings reveal that constructing trust in LMX relationships is more multidimensional than generally portrayed in traditional LMX theory and its three-stage continuum. This study suggests that a broader perspective should be adopted in LMX research, treating it not only as a collective phenomenon but also considering leaders and members as emotional individuals. PRACTICAL IMPLICATIONS: Understanding the multidimensional nature of LMX relationships is helpful for developing interpersonal relationships in organizations and leadership practices through recognition of the importance of the transparency, practices and adequacy of mutual interaction. The results presented here may contribute to such understanding and help leaders to relate to members as both subjective individuals and parts of a complex social network. The results may also increase members' awareness of possible ways that they can promote the development of good LMX relationships in organizations. ORIGINALITY/VALUE: The novelty of the study relates to the identification of the collective, emotional and multidimensional nature of LMX relationships.

Powerless positions, silenced voices? - critical views on health and social care management.

PURPOSE: The purpose of this paper is to provide background to this special issue and consider how critically oriented research can be applied to health and social care management. DESIGN/METHODOLOGY/APPROACH: Basic principles of critical management studies are introduced briefly to frame subsequent papers in this issue. FINDINGS: In order to identify the wicked problems and darker sides of the care field, there is a need to study things in alternative ways through critical lenses. Giving a voice to those in less powerful positions may result in redefinition and redesign of conventional roles and agency of patients, volunteers and professionals and call into question the taken-for-granted understanding of health and social care management. ORIGINALITY/VALUE: The special issue as a whole was designed to enhance critical approaches to the discussion in the field of health and social care. This editorial hopefully raises awareness of CMS and serves as an opening for further discussion on critical views in the research on management and organization in this field.

People with multimorbidity: forgotten outsiders or dynamic self-managers?

PURPOSE: The purpose of this paper is to draw attention to the discursive construction of multimorbidity. The study illustrates how the social reality of multimorbidity and the agency of patients are discursively constructed in scientific articles addressing care for people with multiple chronic conditions. DESIGN/METHODOLOGY/APPROACH: The study is based on the postmodern assumptions about the power of talk and language in the construction of reality. Totally 20, scientific articles were analysed by critically oriented discourse analysis. The interpretations of the findings draw on the agency theories and principals of critical management studies. FINDINGS: Four discourses were identified: medical, technical, collaborative and individual. The individual discourse challenges patients to become self-managers of their health. It may, however, go too far in the pursuit of patients' active agency. The potential restrictions and consequences of a "business-like" orientation must be paid careful attention when dealing with patients with multimorbidity. RESEARCH LIMITATIONS/IMPLICATIONS: The data consisted solely of scientific texts and findings therefore serve as limited illustrations of the discursive construction of multimorbidity. In future, research focusing for example on political documents and practice talk of professionals and patients is needed. Social implications - The findings highlight the power of talk and importance of ethical considerations in the development of care for challenging patient groups. ORIGINALITY/VALUE: By identifying the prevailing discourses the study attempts to cast doubt on the taken-for-granted understandings about the agency of patients with multimorbidity.