Increased parental satisfaction by unrestricted visiting hours and developmentally supportive care in NICUs - results of a German multicenter study.

Purpose: This study aims to provide insights into the impact of organizational family-centered care characteristics at German neonatal intensive care units (NICUs) on the satisfaction of parents of very low birthweight (VLBW) infants.Materials and methods: Using multilevel modeling, this study analyzed whether organizational characteristics of NICUs fostering parent-infant interaction (by way of the existence of a recreation room, possibility of rooming in, existence of unrestricted visiting hours for parents, existence of parental classes, and the connection to parent associations as well as the existence of standards on developmentally supportive care) increase the satisfaction of parents after the infants' high-intensive care phase within the NICU.Results: Nine hundred and twenty-three VLBW infants from 66 NICUs in Germany born between May and October 2013 were enrolled in this multicenter study. We retrieved 1493 questionnaires completed by 1277 parents. The existence of unrestricted visiting hours (adjusted odds ratio (AOR): 1.967; 95% CI [1.118, 3.459]) and standardized procedures for developmentally supportive care (AOR: 1.775; 95% CI [1.166, 2.704]) were positively associated with parental satisfaction.Conclusions: Fostering the parent-infant interaction through the provision of developmentally supportive care and unrestricted visiting hours for parents whose infants are hospitalized within an NICU significantly contributes to the satisfaction of parents.

Health literacy of commercial industry managers: an exploratory qualitative study in Germany.

Managers have been neglected in health literacy research. There still is little known about the health-literacy status and needs of commercial industry managers. This article reduces the existing knowledge gap by presenting findings of an exploratory qualitative study. We conducted 23 separate semi-structured interviews of managers from all management levels (low, middle and top) and experts in the field of health management and/or personnel management. The qualitative interviews were analysed according to Mayring's content analytic approach using MAXQDA. The findings indicate that managers do have considerable information levels about existing health topics and relevant problems but have difficulties of discernment as to which sources of information can be activated or accessed in a timely fashion due to work and information overload. Even those who devise strategies often fail in implementing health-literate behavior. Experts and managers had fairly consistent views on the importance of health literacy among managers. Most agreed that mental health was neglected and that company conditions were important in influencing the ability to act in a way that promoted health literacy. The findings also show that strengthening of managerial self-perception, self-regulation and self-control, raising awareness and ability to take personal responsibility for one's own health, developing skills in handling large amounts of information and fostering open and trusting communication are all essential.

Exploring the differential impact of individual and organizational factors on organizational commitment of physicians and nurses.

BACKGROUND: Physician and nursing shortages in acute and critical care settings require research on factors which might drive their commitment, an important predictor of absenteeism and turnover. However, the degree to which the commitment of a physician or a nurse is driven by individual or organizational characteristics in hospitals remains unclear. In addition, there is a need for a greater understanding of how antecedent-commitment relationships differ between both occupational groups. Based on recent findings in the literature and the results of a pilot study, we investigate the degree to which selected individual and organizational characteristics might enhance an employee's affective commitment working in the field of neonatal intensive care. Moreover, our aim is to examine the different antecedent-commitment relationships across the occupational groups of nurses and physicians. METHODS: Information about individual factors affecting organizational commitment was derived from self-administered staff questionnaires, while additional information about organizational structures was taken from hospital quality reports and a self-administered survey completed by hospital department heads. Overall, 1486 nurses and 540 physicians from 66 Neonatal Intensive Care Units participated in the study. We used multilevel modeling to account for different levels of analysis. RESULTS: Although organizational characteristics can explain differences in an employee's commitment, the differences can be largely explained by his or her individual characteristics and work experiences. Regarding occupational differences, individual support by leaders and colleagues was shown to influence organizational commitment more strongly in the physicians' group. In contrast, the degree of autonomy in the units and perceived quality of care had a larger impact on the nurses' organizational commitment. CONCLUSIONS: With the growing number of hospitals facing an acute shortage of highly-skilled labor, effective strategies on the individual and organizational levels have to be considered to enhance an employee's commitment to his or her organization. Regarding occupational differences in antecedent-commitment relationships, more specific management actions should be undertaken to correspond to different needs and aspirations of nurses and physicians. TRIAL REGISTRATION: German Clinical Trials Register ( DRKS00004589 , date of trial registration: 15.05.2013).

Volume, size, professionals' specialization and nutrition management of NICUs and their association with treatment quality in VLBW infants.

OBJECTIVE: To assess the association of volume, size, the availability of highly-specialized professionals and nutrition management of NICUs with treatment quality among VLBW infants. STUDY DESIGN: A prospective multicenter study of 923 VLBW infants in 66 German NICUs, born between May and October 2013. Using multilevel modeling, we examined the association between the aforementioned organizational characteristics and treatment quality, measured via major morbidities (severe IVH, PVL, BPD, NEC, FIP, ROP, and discharge without severe complications) and medical process measures of VLBW infants. RESULTS: After risk-adjustment and accounting for other NICU characteristics, infants in low-volume NICUs were at higher risk of IVH, ROP and PVL. However, the initial effect of volume on process measures (growth velocity, administration of antenatal steroids) disappeared. CONCLUSION: Volume can only partially explain differences in the treatment quality of VLBWs. The underlying organizational mechanisms should be considered to improve the quality of care.

Staff working in hospital units with greater social capital experience less work-home conflict: Secondary analysis of a cross-sectional study.

BACKGROUND: When the interplay between work and private life does not function correctly (work-home conflict), this constitutes a well-known risk factor for poorer health, increased absenteeism and lower work performance. Information about influencing factors of work-home conflict is therefore indispensable in order to avoid it. In this study, we analyse whether a good working atmosphere that fosters mutual trust, support and a 'sense of unity' (organizational social capital) can reduce an employee's conflict between work and private life. OBJECTIVE: This study investigates the link between organizational social capital and work-home conflict in health professionals. DESIGN: This issue was investigated using a cross-sectional study conducted in 2013. PARTICIPANTS AND SETTING: Data from questionnaires completed by physicians and nurses (n=1733) were linked with structural data from 66 neonatal intensive care units in Germany. METHODS: Using multi-level analyses, we investigated associations between organizational social capital at the ward level and work-home conflict at the level of individual employees, taking into account additional structural and individual characteristics. RESULTS: Employees on wards with greater social capital reported significantly less work-home conflict. Our results support the hypothesis that organizational social capital is an important collective resource. CONCLUSION: As such, more attention should be given to establishing a good working atmosphere that fosters mutual trust, support and a 'sense of unity', and this should be encouraged in a targeted fashion.

Patients' Trust in Physician, Patient Enablement, and Health-Related Quality of Life During Colon Cancer Treatment.

In cancer care, where patients and their families experience significant emotional distress and patients have to deal with complex medical information, patient centeredness is an important aspect of quality of care. The aim of this study is to examine the impact of patients' trust in their oncologists and patients' enablement on changes in health-related quality of life of colon cancer patients during follow-up care. We conducted a prospective study in a representative sample of private practices of German oncologists (N = 44). Patients (N = 131) filled out a standardized questionnaire prior to their first consultation (T0), directly after the first consultation (T1) and after two months (T2). Data were analyzed by structural equation modeling. Significant associations were found between trust in physician and changes in physical functioning between T1 and T2, and between trust in physician and patient enablement. Patient enablement is significantly associated with changes in physical functioning between T1 and T2. The results underline the importance of building a close and trustful patient-physician relationship in the oncology encounter. A central mechanism of the association between the quality of the relationship and health outcomes seems to be patient enablement. To enable patients to cope with their situation by making them understand their diagnosis, treatments, and side effects can impact health-related quality of life in physical domains.

Recovery opportunities, work-home conflict, and emotional exhaustion among hematologists and oncologists in private practice.

Hematologists and oncologists in private practice play a central role in the care provided for cancer patients. The present study analyzes stress and relaxation aspects in the work of hematologists and oncologists in private practice in Germany in relation to emotional exhaustion, as a core dimension of burnout syndrome. The study focuses on the opportunities for internal recovery using breaks and time out during the working day, the frequency of working on weekends and on vacation, and the physician's work-home and home-work conflict. Postulated associations between the constructs were analyzed using a structural equation model. If work leads to conflicts in private life (work-home conflict), it is associated with greater emotional exhaustion. Working frequently at the weekend is associated with greater work-home conflict and indirectly with greater emotional exhaustion. By contrast, the availability of opportunities to relax and recover during the working day is associated with less work-home conflict and indirectly with less emotional exhaustion. These results underline the importance of internal recovery opportunities during the working day and a successful interplay between working and private life for the health of outpatient hematologists and oncologists.

The initial clinical interview--can it reduce cancer patients' fear?

PURPOSE: A common phenomenon among cancer patients is a fear of cancer recurrence or cancer progression (FOP). The aim of the present study was to analyze whether the oncologist is able to reduce patients' FOP at the initial clinical interview. METHOD: A prospective, longitudinal study included patients who were consulting private-practice oncologists in Germany for the first time. Recruitment was carried out by 44 members of the Professional Organization of Office-Based Hematologists and Oncologists. In the patient surveys, data on colon cancer patients' perceptions of communications with their oncologist and on patient-reported outcomes were collected over a period of 6 months. The present study analyzed the patients' data before their first consultation (T 0) and within 3 days after the first consultation (T 1). RESULTS: A total of 169 patients agreed to participate in the study. Backwards multiple regression analysis was conducted to determine whether the change (T 0-T 1) in FOP is associated with demographic, medical, or psychosocial determinants, or with the physician-patient communication. A significant association was found between the change in FOP and interruptions to the conversation, the comprehensibility of the information provided, the extent of perceived empathy from the physician, and the patient's social support and family status. CONCLUSION: Private social support and the initial medical encounter can help reduce FOP. Particularly, oncologists should ensure that they facilitate the presentation of information in a comprehensible way while avoiding interruptions and that they take particular care of patients with poor social support.

Validation of the Work-Life Balance Culture Scale (WLBCS).

OBJECTIVE: The purpose of this paper is to describe the theoretical development and initial validation of the newly developed Work-Life Balance Culture Scale (WLBCS), an instrument for measuring an organizational culture that promotes the work-life balance of employees. METHODS: In Study 1 (N=498), the scale was developed and its factorial validity tested through exploratory factor analyses. In Study 2 (N=513), confirmatory factor analysis (CFA) was performed to examine model fit and retest the dimensional structure of the instrument. To assess construct validity, a priori hypotheses were formulated and subsequently tested using correlation analyses. RESULTS: Exploratory and confirmatory factor analyses revealed a one-factor model. Results of the bivariate correlation analyses may be interpreted as preliminary evidence of the scale's construct validity. CONCLUSION: The five-item WLBCS is a new and efficient instrument with good overall quality. Its conciseness makes it particularly suitable for use in employee surveys to gain initial insight into a company's perceived work-life balance culture.

The influence of transformational leadership on employee well-being: results from a survey of companies in the information and communication technology sector in Germany.

OBJECTIVE: The aim of this study was to investigate the impact of a transformational leadership style on employee well-being. METHODS: Data for the study were taken from an on-line survey of all employees from six German companies in the information and communication technology sector. The data obtained were analyzed using multiple logistic regressions. RESULTS: Analysis of data from a total of 318 employees (response rate 58.4%) revealed a significant relationship between transformational leadership and employee well-being (P = 0.00; OR = 1.13; 95% CI = 1.05 to 1.22). A higher degree of perceived transformational leadership is associated with greater well-being. CONCLUSIONS: The results of this study suggest that a transformational leadership style, which both conveys a sense of trust and meaningfulness and individually challenges and develops employees, also has a positive effect on employee well-being.

Employees' negative and positive work-home interaction and their association with depressive symptoms.

BACKGROUND: Depression is the leading cause of disability and high costs worldwide. One possibility for preventing depression in the workplace, which has received little consideration so far, is the promotion of a successful balance between work and personal life. The aim of this study was to investigate employees' negative and positive work-home interaction and their association with depressive symptoms. METHODS: A cross-sectional study was conducted in the micro- and nanotechnology sector in Germany. A stepwise multivariate logistic regression analysis was performed using data from N = 213 employees. RESULTS: The results suggest that while negative work-home interaction is associated with an increased risk for depressive symptoms, positive work-home interaction is correlated with a lower risk. Neither positive nor negative interaction in the home-to-work direction demonstrated a significant association with depressive symptoms. CONCLUSION: When attempting to prevent mental illnesses, such as depression, it is important to develop strategies aimed at reducing conflict between work and personal life and promoting a positive exchange between these two domains.

Work-life balance culture, work-home interaction, and emotional exhaustion: a structural equation modeling approach.

OBJECTIVE: To examine the relationships among employees' emotional exhaustion, positive and negative work-home interaction, and perceived work-life balance culture in companies. METHODS: Data for this study were collected through online surveys of employees from companies in the micro- and nanotechnology sectors (N = 509). A structural equation modeling analysis was performed. RESULTS: A company culture perceived by employees as supportive of their work-life balance was found to have both a direct negative effect on emotional exhaustion and an indirect negative effect meditated by negative work-home interaction. In addition, whereas negative work-home interaction associated positively with emotional exhaustion, positive work-home interaction had no significant effect. CONCLUSIONS: The direct and indirect relationship between work-life balance culture and emotional exhaustion has practical implications for health promotion in companies.

Exploring the association between social capital and depressive symptoms: results of a survey in German information and communication technology companies.

OBJECTIVE: This study examines the association between social capital at work and depressive symptoms in employees. METHODS: Data for this cross-sectional study were collected through an online survey with the full population of employees from six companies in the German information and communication technology sector (response rate: 58.4%). A multivariate logistic regression analysis was performed. RESULTS: Results of data from a total of 328 employees suggest that, after controlling for sociodemographic factors, health awareness, and job strain, lower levels of perceived social capital at work are associated with the experience of depressive symptoms (OR = 0.76; 95% CI: 0.64-0.90). CONCLUSIONS: Our findings suggest that characteristics of high social capital at work, such as an established environment of trust and a sense of common values and convictions, could be an essential resource for preventing depressive disorders.

Organizational factors and the attitude toward health promotion in German ICT-companies.

This study takes a first step toward examining the relationship between organizational characteristics and the perceived attitude toward health promotion in companies from the perspective of chief executive officers (CEOs). Data for the cross-sectional study were collected through telephone interviews with one CEO from randomly selected companies within the German information and communication technology (ICT) sector. Multivariate logistic regression analysis (LRA) was performed, and further LRA was conducted after stratifying on company size. LRA of data from a total of n = 522 interviews found significant associations between the attitude toward health promotion and the company's market position, its number of hierarchical levels, the percentage of permanent positions and the percentage of employees with an academic education. After stratification on company size, the association between the attitude toward health promotion and both market position and the percentage of employees with an academic education was still present in small companies. There were no significant relationships between the attitude toward health promotion and the structural characteristics of medium-sized and large companies. The preliminary results of the study indicate that a perceived attitude toward health promotion in companies can be explained, to a certain degree, by the intraorganizational characteristics analyzed. Our key findings highlight that efforts toward establishing a positive attitude toward health promotion should focus on small companies with a lower market position and a greater number of employees with a lower education level.

The relationship between perceived social capital and the health promotion willingness of companies: a systematic telephone survey with chief executive officers in the information and communication technology sector.

OBJECTIVE: This study examines the association between perceived social capital and health promotion willingness (HPW) of companies from a chief executive officer's perspective. METHODS: Data for the cross-sectional study were collected through telephone interviews with one chief executive officer from randomly selected companies within the German information and communication technology sector. A hierarchical multivariate logistic regression analysis was performed. RESULTS: Results of the logistic regression analysis of data from a total of n = 522 interviews suggest that higher values of perceived social capital are associated with pronounced HPW in companies (odds ratio = 3.78; 95% confidence intervals, 2.24 to 6.37). CONCLUSIONS: Our findings suggest that characteristics of high social capital, such as an established environment of trust as well as a feeling of common values and convictions could help promote HPW.

The Worksite Health Promotion Capacity Instrument (WHPCI): development, validation and approaches for determining companies' levels of health promotion capacity.

BACKGROUND: The Worksite Health Promotion Capacity Instrument (WHPCI) was developed to assess two key factors for effective worksite health promotion: collective willingness and the systematic implementation of health promotion activities in companies. This study evaluates the diagnostic qualities of the WHPCI based on its subscales Health Promotion Willingness and Health Promotion Management, which can be used to place companies into four different categories based on their level of health promotion capacity. METHODS: Psychometric evaluation was conducted using exploratory factor and reliability analyses with data taken from a random sample of managers from n = 522 German information and communication technology (ICT) companies. Receiver operating characteristic (ROC) analyses were conducted to determine further diagnostic qualities of the instrument and to establish the cut-off scores used to determine each company's level of health promotion capacity. RESULTS: The instrument's subscales, Health Promotion Willingness and Health Promotion Management, are based on one-dimensional constructs, each with very good reliability (Cronbach's alpha = 0.83/0.91). ROC analyses demonstrated satisfactory diagnostic accuracy with an area under the curve (AUC) of 0.76 (SE = 0.021; 95% CI 0.72-0.80) for the Health Promotion Willingness scale and 0.81 (SE = 0.021; 95% CI 0.77-0.86) for the Health Promotion Management scale. A cut-off score with good sensitivity (71%/76%) and specificity (69%/75%) was determined for each scale. Both scales were found to have good predictive power and exhibited good efficiency. CONCLUSIONS: Our findings indicate preliminary evidence for the validity and reliability of both subscales of the WHPCI. The goodness of each cut-off score suggests that the scales are appropriate for determining companies' levels of health promotion capacity. Support in implementing (systematic) worksite health promotion can then be tailored to each company's needs based on their current capacity level.

Breast cancer patients' trust in physicians: the impact of patients' perception of physicians' communication behaviors and hospital organizational climate.

OBJECTIVE: To examine whether patients' perception of a hospital's organizational climate has an impact on their trust in physicians after accounting for physicians' communication behaviors as perceived by the patients and patient characteristics. METHODS: Patients undergoing treatment in breast centers in the German state of North Rhein-Westphalia in 2006 were asked to complete a standardized postal questionnaire. Disease characteristics were then added by the medical personnel. Multiple linear regressions were performed. RESULTS: 80.5% of the patients responded to the survey. 37% of the variance in patients' trust in physicians can be explained by the variables included in our final model (N=2226; R(2) adj.=0.372; p<0.001). Breast cancer patients' trust in their physicians is strongly associated with their perception of a hospital's organizational climate. The impact of their perception of physicians' communication behaviors persists after introducing hospital organizational characteristics. Perceived physician accessibility shows the strongest association with trust. CONCLUSIONS: A trusting physician-patient relationship among breast cancer patients is associated with both the perceived quality of the hospital organizational climate and perceived physicians' communication behaviors. PRACTICE IMPLICATIONS: With regard to clinical organization, efforts should be put into improving the organizational climate and making physicians more accessible to patients.