Quality management and work environment in Swedish oral and maxillofacial surgery.

This thesis attempts to describe the opinion of the work with quality, quality management, and work environment among the employees at Oral and Maxillofacial Surgery (OMFS) clinics in Sweden. THIS THESIS AIMED TO: Analyse if the OMFS clinics in Sweden actively work with quality development and if so which systems they use. Explore the opinion of the employees about quality work. Describe how the employees of OMFS clinics in Sweden perceive good work, i.e., their image of the dimensions that the profession should contain to be really good work. Investigate whether there is a discrepancy between ideal and reality for this group. Describe how the employees of OMFS clinics in Sweden perceive their health. Analyse how work environment influenced attitudes to and knowledge of quality among employees of OMFS clinics in Sweden. The study was based on self-report questionnaires which in 2003 were sent to all OMFS clinics in Sweden. The response rate was 86%. Only at two clinics did all the respondents agree on their system. Surgeons rated intellectually stimulating work as most important, and the hazard-free work environment as least important. The nurses rated stimulating fellowship as most important, and the opportunity for career advancement as least important. The percentage unit differences between the ideal and the reality were largest for the item the work provides opportunities to have an influence on important decisions. There were significant differences between maxillofacial. surgeons and dental nurses and assistant nurses as to muscle- and joint trouble. The differences were also significant between men and women both as to muscle- and joint troubles and somatic trouble. Only work environment was significant for attitude towards quality work. Profession, gender, clinic size, and a factor for hard demand had significant associations to quality management system used or not. IN CONCLUSION: More than half of the respondents stated that they worked with a quality system. The dental nurses and assistant nurses had a much more positive view on the potential of quality work as a means to improve their work than had the maxillo-facial surgeons. For a majority of the dental nurses the working situation concerning the physical environment was more important than for the maxillo-facial surgeons. The employees emphasized free, influential, and intellectually stimulating work, but the dissonance between ideal and reality was rather wide concerning good work. OMFS employees are feeling unhealthy, but no worse than other high-risk-groups in human service working and better than female general practice dentists. The women of OMFS employees feel worse than the men.

Work environment factors affecting quality work in Swedish oral and maxillofacial surgery.

The aim of this study was to investigate how work environment influenced attitudes to and knowledge of quality among employees of Oral and Maxillofacial Surgery (OMFS) clinics in Sweden. Data were collected with a questionnaire of 67 questions, related to quality management at the clinic, working situation, content of "good work", physical environment and health. 22 clinics with 297 employees responded, 65% of the clinics and 86% of the employees. A multiple regression analysis with the dependent variable "Attitude towards quality work" showed that only "work environment" (p = 0.010) revealed a significant association (p < 0.05). The personnel will have a more favourable attitude to quality work if they regard work environment to be important. Dental nurses and assistant nurses had more than four times more knowledge of the used quality management system than had the maxillo-facial surgeons. Women had nearly four times more knowledge of quality management than men. Clinic size was important, with better knowledge of quality management in bigger clinics. Soft demands were defined as demands for "flexibility, creativity, quality, service, engagement/commitment and ability to work together, and competence". Hard demands included economy as important, and emphasis on efficiency and productivity. There was a weak association with knowledge of quality management systems if soft demands increased, but negative if hard demands increased. In conclusion, mainly work environment was of significance for the attitude towards quality work among the employees of OMFS clinics in Sweden. Profession, gender, clinic size, and the hard demands were significantly associated with knowledge of the quality management system used.

Psychosocial work environment related health in Swedish oral and maxillofacial surgery in comparison with other human service workers.

The aims of this study were to describe how the employees of OMFS clinics in Sweden perceive their health, to compare with female unpromoted general practice dentists and other human service groups and to explore the dimensionality of the health measure. Data were collected by way of a questionnaire with 67 questions, related to quality management at the clinic, working situation, questions about the content of "good work", the connection between physical environment and health, emphasis on physical environment. 22 clinics with 297 employees responded, 65% of the clinics and 86% of the employees. The results showed that employees of OMFS clinics in Sweden perceived their health as rather problematic. In comparison, the present study group placed itself between general practice dentists and other human service groups as to their health. Three factors explained more than half of the variance of symptoms. They were interpreted as (1) psychosomatic troubles, (2) somatic troubles, and (3) muscle and joint troubles. These factors were almost the same as previously reported, confirming the basic dimensionality of the question battery. This study has shown that OMFS employees are feeling unhealthy, but no worse than other high-risk-groups in human service working situation and better than female general practice dentists. The women among OMFS employees felt worse than the men. Three factors of symptoms could be established, i.e. psychosomatic troubles, somatic troubles, and muscle and joint troubles.

Dimensions of good work for employees in oral and maxillofacial surgery in Sweden.

The aims of this study were to describe how the employees of Oral and Maxillofacial Surgery (OMFS) clinics in Sweden perceive "good work", i.e. their image of the good dimensions that the profession should contain and to investigate if there is a discrepancy between ideal and reality for this group. The study was based on a questionnaire with 67 questions, related to quality management at the clinic, health and the content of good work in two sections, one with the headline "defines good work" and the other "fulfilled 'in my present work' ". Each section was subdivided into 12 parts covering aspects of good work. The maxillo-facial surgeons rated "intellectually stimulating work" as most important (91%), and the "hazard-free work environment" as least important (48%). The nurses rated "stimulating fellowship" as most important (84%), and the "opportunity for career advancement" as least important (27%). The percentage unit differences between the ideal and the reality were largest for the item "the work provides opportunities to have an influence on important decisions". Maxillo-facial surgeons had the greatest differences for that question and nurses had the greatest differences in "the work is well paid". A principal components analysis was performed and three factors explained more than half of the variance (52%). The factors were interpreted as (1) aiming at moral values and possibilities for skill discretion, as (2) career development, and as (3) work environment. The employees of OMFS clinics in Sweden emphasized free, influential, and intellectually stimulating work, but the discrepancy between ideal and reality was rather wide. Three factors of work environment could be established.

Quality managements and work environment in oral and maxillofacial surgery in Sweden.

The aim of this study was to investigate if the Oral and Maxillofacial Surgery (OMFS) clinics in Sweden actively work with quality development and if so, which systems they use. A further aim was to explore the opinion of the employees about quality work. Data were collected by way of a questionnaire with 67 questions, related to quality management at the clinic and to the content of healthy work. 22 clinics with 297 employees responded, 65% of the clinics and 86% of the employees. More than half of the respondents stated that they worked with a management system, but there was uncertainty as to the type of a quality system. Only at two clinics, all the respondents agreed on the system. This showed that one of the most important aspects in a quality system, i.e. to inform everyone, was unsatisfactory. The study showed that dental nurses and assistant nurses were more appreciative of quality as a tool for improvement than the maxillo-facial surgeons. There was no such difference concerning the importance of quality work. Dental nurses thought that the quality was more important for the working situation concerning the physical environment than did the maxillo-facial surgeons.