Unlocking the benefits of diversity among healthcare workforces: a holistic view.

PURPOSE: The increasing diversity among workforces - as well as the increasing diversity among patient populations served - offers a variety of opportunities and potential pitfalls for healthcare organizations and leaders. To unravel this complexity, the authors aim to holistically understand how to maximize provider and patient experiences regardless of (1) the degree to which diversity is present or lacking, and (2) the type(s) of diversity under consideration. DESIGN/METHODOLOGY/APPROACH: This conceptual paper develops a framework that combines three organizational behavior theories - emotional labor theory, similarity-attraction theory and climate theory - with evidence from the broader healthcare literature. FINDINGS: Authentic interactions yield positive outcomes for providers (i.e. improved job attitudes and work-related well-being) and patients (i.e. patient satisfaction) and acts as a mediator between demographic diversity and positive outcomes. Demographic similarity facilitates authentic interactions, whereas demographic diversity creates an initial barrier to engaging authentically with others. However, the presence of a positive diversity climate eliminates this barrier. ORIGINALITY/VALUE: The authors offer a conceptual model to unlock positive outcomes - including reduced absenteeism, better morale and improved patient satisfaction - regardless of the level and types of diversity present within the workforce. In addition to deriving an agenda for future research, the authors offer practical applications regarding how diversity can be more effectively managed and promoted within healthcare organizations.

Work-family culture within hospitals: An interdepartmental analysis of employee engagement and retention.

BACKGROUND: Helping employees balance their work and family needs is increasingly pivotal for attracting, engaging, and retaining key talent in health care. Yet, emerging theory and anecdotal evidence suggest that, within organizations, there is considerable variation between departments or units regarding how employees' lives outside work are supported. Despite top management's efforts to develop a unified organizational work-family culture, departments have a tendency to take on their own culture, norms, and traditions such that some are more supportive than others. PURPOSE: We investigate whether more positive work-family cultures improve functioning within hospital departments. METHODOLOGY/APPROACH: We surveyed 680 hospital employees nested within 60 departments at a hospital located in the southeastern United States. RESULTS: Departments with a more (vs. less) positive work-family culture tend to have higher levels of (a) employee engagement, (b) pride in their organization, (c) confidence in management and leadership, and (d) intention to remain with the organization. Our analyses were robust when splitting the sample between clinical (e.g., nurses and physicians) and nonclinical (e.g., office, clerical, and support services) roles. CONCLUSION: Our study sheds further light on the importance of a positive work-family culture within hospitals. The key to instilling a positive, organization-wide work-family culture may be through a department-by-department focus. PRACTICE IMPLICATIONS: Benefits of positive work-family cultures within departments can extend beyond job-related attitudes and can potentially enhance recruitment strategies, improve a hospital's external image to the public, and lead to improvements in patient care and more positive patient experiences.

Caring for the elderly at work and home: Can a randomized organizational intervention improve psychological health?

Although job stress models suggest that changing the work social environment to increase job resources improves psychological health, many intervention studies have weak designs and overlook influences of family caregiving demands. We tested the effects of an organizational intervention designed to increase supervisor social support for work and nonwork roles, and job control in a results-oriented work environment on the stress and psychological distress of health care employees who care for the elderly, while simultaneously considering their own family caregiving responsibilities. Using a group-randomized organizational field trial with an intent-to-treat design, 420 caregivers in 15 intervention extended-care nursing facilities were compared with 511 caregivers in 15 control facilities at 4 measurement times: preintervention and 6, 12, and 18 months. There were no main intervention effects showing improvements in stress and psychological distress when comparing intervention with control sites. Moderation analyses indicate that the intervention was more effective in reducing stress and psychological distress for caregivers who were also caring for other family members off the job (those with elders and those "sandwiched" with both child and elder caregiving responsibilities) compared with employees without caregiving demands. These findings extend previous studies by showing that the effect of organizational interventions designed to increase job resources to improve psychological health varies according to differences in nonwork caregiving demands. This research suggests that caregivers, especially those with "double-duty" elder caregiving at home and work and "triple-duty" responsibilities, including child care, may benefit from interventions designed to increase work-nonwork social support and job control. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Lasting Impression: Transformational Leadership and Family Supportive Supervision as Resources for Well-being and Performance.

Although evidence is growing in the occupational health field that supervisors are a critical influence on subordinates' reports of family supportive supervisor behaviors (FSSB), our understanding is limited regarding the antecedents of employee's FSSB perceptions and their lagged effects on future health and work outcomes. Drawing on a positive job resource perspective, we argue that supervisors who report that they use transformational leadership (TL) styles are more likely to have subordinates with higher FSSB perceptions. We theorize that these enhanced perceptions of work-family specific support increase access to personal and social resources (objectively and subjectively) that buffer work-nonwork demands and enhance health (mental, physical) and job outcomes (performance appraisal ratings, job satisfaction, turnover intentions, work-family conflict). Time-lagged multi-source survey data collected in a field study from retail employees and their supervisors and archival performance ratings data collected a year later support our proposed relationships (with the exception that for health, only mental health and not physical health was significant). Post hoc analyses showed that employees' FSSB perceptions play a mediating role between supervisor TL and job satisfaction and work-family conflict, but no other outcomes studied. Overall, this study answers calls in the occupational health literature to use stronger designs to determine linkages between leadership-related workplace phenomena as antecedents of health, work-family, and job outcomes. Our results demonstrate that employees with supervisors who report that they use transformational leadership styles are more likely to perceive higher levels of family supportive supervision, which are positive job resources that enhance occupational health.

Age Differences and the Acceptance of Infusion Pump Technology.

Previous studies demonstrate that age and receptiveness to new technologies tend to be negatively correlated. Using data from a sample of 311 nurses in a large teaching hospital in the midwestern United States, this study sought to determine whether age predicted satisfaction perceptions of infusion pump technology. Hierarchical regression indicated that the relationship between age and infusion pump satisfaction was not statistically significant, but it also revealed interesting moderation effects. When perceived support for infusion pump use was low, age was negatively related to infusion pump satisfaction. However, when perceived support was high, age was positively related to infusion pump satisfaction.

Organizational, Cultural, and Psychological Determinants of Smart Infusion Pump Work Arounds: A Study of 3 U.S. Health Systems.

OBJECTIVES: We investigated nurse perceptions of smart infusion medication pumps to provide evidence-based insights on how to help reduce work around and improve compliance with patient safety policies. Specifically, we investigated the following 3 research questions: (1) What are nurses' current attitudes about smart infusion pumps? (2) What do nurses think are the causes of smart infusion pump work arounds? and (3) To whom do nurses turn for smart infusion pump training and troubleshooting? METHODS: We surveyed a large number of nurses (N = 818) in 3 U.S.-based health care systems to address the research questions above. We assessed nurses' opinions about smart infusion pumps, organizational perceptions, and the reasons for work arounds using a voluntary and anonymous Web-based survey. Using qualitative research methods, we coded open-ended responses to questions about the reasons for work arounds to organize responses into useful categories. RESULTS: The nurses reported widespread satisfaction with smart infusion pumps. However, they reported numerous organizational, cultural, and psychological causes of smart pump work arounds. Of 1029 open-ended responses to the question "why do smart pump work arounds occur?" approximately 44% of the causes were technology related, 47% were organization related, and 9% were related to individual factors. Finally, an overwhelming majority of nurses reported seeking solutions to smart pump problems from coworkers and being trained primarily on the job. DISCUSSION AND CONCLUSIONS: Hospitals may significantly improve adherence to smart pump safety features by addressing the nontechnical causes of work arounds and by providing more leadership and formalized training for resolving smart pump-related problems.

Taking Another View: How Nurses Perceive Infusion Pumps as Demanding for Both Themselves and Their Patients.

Based on an organization theory perspective, this study proposes that nurses not only consider how infusion pumps place demands on themselves but also consider how infusion pumps place demands on patients. Results from a sample of nurses in a large, public authority, nonprofit teaching hospital located in the midwestern United States indicate that "demanding formalization for nurses" and "demanding formalization for patients" are 2 empirically distinct constructs. Demanding formalization for patients was a stronger predictor of infusion pump-related attitudes, in addition to trust and pay satisfaction. Demanding formalization for nurses was a stronger predictor of job satisfaction, turnover intention, and burnout.

The unique effects of general and specific support in health care technology: An empirical examination of the principle of compatibility.

BACKGROUND: The principle of compatibility suggests that specific attitudes should target specific behaviors. The attitude-behavior relationship is contingent upon the consistency between the two. PURPOSE: This aim of this study was to examine the strength of relationships involving general versus specific support perceptions and attitudes regarding smart pump technology in hospitals. Specifically, we hypothesized that organizational support perceptions would be more strongly related to general positive work attitudes than it would to smart pump satisfaction. We also hypothesized that smart pump-specific support would be more strongly related to smart pump satisfaction than it would to general positive work attitudes. METHODOLOGY: Data were collected in a cross-sectional field study via online surveys at two large, public hospital systems in the Midwestern United States, one in Iowa (n = 311 nurses) and one in Wisconsin (n = 346 nurses). Because nurses in one system had more experience with smart pump technology than nurses in the other system, analyses were run separately to compare results across the two sites. FINDINGS: Consistent with the principle of compatibility, hierarchical regression revealed across both sites that smart pump support had a stronger relationship with smart pump satisfaction whereas general organizational support perceptions had a stronger relationship with general positive work attitudes. In addition, moderation effects were present in one sample where high levels of the noncompatible support (e.g., smart pump-specific support on positive workplace attitudes) buffered low levels of compatible support. PRACTICE IMPLICATIONS: Our findings highlight the contextual importance of support in regard to the growing technological transformations that health care systems currently experience. When specific forms of support are provided for specific technologies, end-users will generally respond more favorably compared to when general support is the only available resource.