Psychosocial work conditions, perceived stress, perceived muscular tension, and neck/shoulder symptoms among medical secretaries.

PURPOSE: Unfavorable psychosocial working conditions are hypothesized to lead to perceived stress, which, in turn, can be related to an increased risk of development of neck/shoulder symptoms through increased and sustained muscle activation. The aim of the present study was to test this hypothesized process model among medical secretaries, a female-dominated profession characterized by a high amount of visual display unit use and a high prevalence of neck/shoulder symptoms. METHODS: In this cross-sectional study, a questionnaire survey was conducted among medical secretaries (n = 200). The proposed process model was tested using a path model framework. RESULTS: The results indicate that high work demands were related to high perceived stress, which in turn was related to a high perceived muscle tension and neck/shoulder symptoms. Low influence at work was not related to perceived stress, but was directly related to a high perceived muscle tension. CONCLUSIONS: In general, these cross-sectional results lend tentative support for the hypothesis that adverse psychosocial work conditions (high work demands) may contribute to the development of neck/shoulder symptoms through the mechanism of stress-induced sustained muscular activation. This process model needs to be further tested in longitudinal studies.

Is the job satisfaction of primary care team members associated with patient satisfaction?

BACKGROUND Previous research has shown a correlation between physician job satisfaction and patient satisfaction with quality of care, but the connection between job satisfaction of other primary care team members and patient satisfaction is yet unclear. OBJECTIVE To evaluate whether there is an association between patient satisfaction and job satisfaction of the members of patient care teams. DESIGN The study was based on data from the European Practice Assessment and used an observational design. SETTING 676 primary care practices in Germany. PARTICIPANTS 47 168 patients, 676 general practitioners (practice principals), 305 physician colleagues (trainees and permanently employed physicians) and 3011 non-physician practice members (nurses, secretaries). MAIN OUTCOME MEASURES Patient evaluation was measured using the 23-item EUROPEP questionnaire. Job satisfaction was measured using the 10-item Warr-Cook-Wall job satisfaction scale and further items relating to practice structure. Bivariate correlations were applied in which factors of patient satisfaction and practice structure were compared with physicians and non-physicians satisfaction. RESULTS Patient satisfaction correlates positively with the general job satisfaction of the non-physician (r=0.25, p<0.01) and no significant correlation was found for the general job satisfaction of practice principals and physician colleagues. Patients' satisfaction with the practice organisation correlates positively with the general job satisfaction of the non-physicians (r=0.30, p<0.01) and their view of practice structure (r=0.29, p<0.01). CONCLUSIONS The correlation between non-physician team member satisfaction and patient satisfaction was higher than the correlation between satisfaction of physicians and patients. Patients seem to be sensitive to aspects of practice structure.

An intervention to enhance nursing staff teamwork and engagement.

Numerous studies have concluded that work group teamwork leads to higher staff job satisfaction, increased patient safety, improved quality of care, and greater patient satisfaction. Although there have been studies on the impact of multidisciplinary teamwork in healthcare, the teamwork among nursing staff on a patient care unit has received very little attention from researchers. In this study, an intervention to enhance teamwork and staff engagement was tested on a medical unit in an acute care hospital. The results showed that the intervention resulted in a significantly lower patient fall rate, staff ratings of improved teamwork on the unit, and lower staff turnover and vacancy rates. Patient satisfaction ratings approached, but did not reach, statistical significance.

Nurses information-processing patterns: impact on change and innovation.

This descriptive study, based on the Organizational Engineering conceptual framework, investigates the information-processing styles of nursing staff (RNs, LPNs, nursing assistants, and unit secretaries) that impact how they accept and deal with change and innovation. The study sample was made up of 578 nursing staff and nurse managers. The major finding is that both nursing staff overall and RNs as a separate group are clustered in the "Conservator" (Logical Process--Hypothetical Analyzer) quadrant of the Organizational Engineering Model. In contrast, the nurse managers were significantly more likely to be in the "Changer" (Reactive Stimulator--Relational Innovator) quadrant.

Social networks and best practices in public health: the example of regional billing groups.

OBJECTIVE: Rising health care costs, increased demand for clinical services, and reimbursement difficulties created a funding shortage among local health departments in the state of Kansas. This intervention established regional billing groups to provide professional support and increase third-party reimbursement. DESIGN: Through feedback sessions, billing clerks provided qualitative responses about training needs. These informed the process of establishing billing groups in each state health district. SAMPLE: All billing clerks in the state's 6 regional health districts were invited to participate, as were insurance and billing software representatives. INTERVENTION: Between April 2002 and September 2004, 6 collaborative groups were established. Billing clerks received professional support and training from peers, insurance representatives, and software providers. An interagency billing advisory team was established to coordinate training activities between groups. RESULTS: These groups have allowed local health departments to increase reimbursement revenue by 50%-75%, allowing for the provision of expanded health services to client populations. CONCLUSIONS: These methods can serve as a model for other states, particularly those with considerable rural populations or decentralized health care systems. Still, funding shortages persist, and public health billing clerks will continue to need ongoing training in the most current and effective billing methods.

Attitude changes among emergency department triage staff after conducting routine alcohol screening.

Excessive alcohol consumption is common among injury patients, but routine alcohol interventions seem to be difficult to implement in emergency departments. An obstacle seen in previous studies is the limited time available in a real-world setting for staff to participate in routine alcohol screening and interventions. In the present study, ordinary staff participated in a simple alcohol screening procedure. The aim of the study was to evaluate the feasibility of this procedure and if there was any change in attitudes and practices among triage staff after the implementation. We analyzed interviews with six staff members and questionnaires completed by 29 nurses and medical secretaries before and after a period of systematic routine screening. The staff reported that the routine worked well and that few patients reacted negatively. A positive change was seen in attitudes towards alcohol preventive measures in general. However, this seems not to be sufficient for the staff to spontaneously engage more actively. In fact, more of the staff were uncertain after the study period whether the emergency department is an appropriate place for alcohol screening and intervention despite an increased role legitimacy and perceived competence. There is a need for further development of alcohol prevention models that are acceptable for the staff to implement as part of the daily routine.

Unlicensed staff members' experiences with patients' pain on an inpatient oncology unit: implications for redesigning the care delivery system.

Although unlicensed staff have routine contact with patients in pain, little research relates to their role with these patients. The purpose of this study was to describe the experiences of unlicensed inpatient hospital staff caring for cancer patients in pain. We sought to understand pain identification and communication practices, describe common practice situations, and identify training needs. We conducted 4 focus groups with unit secretaries, nurses' aides, and housekeepers (N = 24) on 2 inpatient oncology units at an urban, northeastern teaching hospital. Group processes were tape-recorded, transcribed, and analyzed using Atlas/ti software and content analysis. Analysis generated 5 issues related to pain in the daily practice of unlicensed staff: perceived function with pain, building relationships with patients, interpreting patients' pain, system issues, and job challenges and coping strategies. Unlicensed staff reported performing important functions related to pain, including alerting nursing staff to patients' pain, and providing psychosocial support. Participants shared difficulties of working with patients in pain and expressed interest in education on pain identification and course of illness. Findings provide insight into the role of unlicensed staff, and have implications for the educational preparation of this group as well as the nature of their participation in the care delivery system.

Wireless technology improves nursing workflow and communications.

Inpatient healthcare delivery involves complex processes that require interdisciplinary teamwork and frequent communication among physicians, nurses, unit secretaries, and ancillary staff. Often, these interactions are not at a nursing unit, or near a phone. In an effort to address the inefficiencies of these workflow processes and communications, St. Agnes HealthCare, Baltimore, MD, installed a new hands-free communications system that uses a wireless network, voice recognition, and a small wearable badge. Developed by Vocera, the communications system permits one-button access to others on the system or connects to outside phones through PBX integration. While many agree that today's technology has the potential to positively impact nursing care delivery, St. Agnes HealthCare and Vocera, with assistance from First Consulting Group, decided to conduct a comprehensive benefits study in December 2003 to quantify the impact of this communications system on workflow and communications. The results identified a number of significant findings that demonstrate its value from a quantitative and qualitative standpoint. The following article describes this study and its findings.

Use of and attitudes to a hospital information system by medical secretaries, nurses and physicians deprived of the paper-based medical record: a case report.

BACKGROUND: Most hospitals keep and update their paper-based medical records after introducing an electronic medical record or a hospital information system (HIS). This case report describes a HIS in a hospital where the paper-based medical records are scanned and eliminated. To evaluate the HIS comprehensively, the perspectives of medical secretaries and nurses are described as well as that of physicians. METHODS: We have used questionnaires and interviews to assess and compare frequency of use of the HIS for essential tasks, task performance and user satisfaction among medical secretaries, nurses and physicians. RESULTS: The medical secretaries use the HIS much more than the nurses and the physicians, and they consider that the electronic HIS greatly has simplified their work. The work of nurses and physicians has also become simplified, but they find less satisfaction with the system, particularly with the use of scanned document images. CONCLUSIONS: Although the basis for reference is limited, the results support the assertion that replacing the paper-based medical record primarily benefits the medical secretaries, and to a lesser degree the nurses and the physicians. The varying results in the different employee groups emphasize the need for a multidisciplinary approach when evaluating a HIS.

Rationing access to care to the medically uninsured: the role of bureaucratic front-line discretion at large healthcare institutions.

BACKGROUND: Medically uninsured patients seeking nonemergency care are not guaranteed access to services at most healthcare institutions. They must first register with a clerk who could require a deposit and/or payment on an outstanding debt. OBJECTIVES: This study examines the factors that influence whether nonmedical bureaucratic staff sign in or turn away uninsured patients who cannot meet prepayment requirements. RESEARCH DESIGN: The study was conducted at a for-profit, a not-for-profit, and a public healthcare institution in a metropolitan area. The authors explored the relevant policy environment through interviews with senior administrators and a review of documents pertaining to the management of self-pay patients. Then they examined how policies affecting access were implemented through in-depth, semistructured, audiotaped interviews with 55 front-line clerical personnel. RESULTS: At all 3 institutions, policies were ambiguous about what to do when uninsured patients cannot afford required prepayments. Seventy-one percent of staff reported they do not turn patients away; the remainder stated that on occasion they do. A variety of rationales were provided for how decisions are made. Those with the lowest-level positions were significantly more likely to be sympathetic to indigent patients and less likely to report turning patients away. CONCLUSIONS: Consistent with other studies of front-line bureaucracies indicating that low-level personnel who interface with clients make discretionary decisions, particularly when organizations pursue potentially conflicting priorities, this preliminary investigation found that nonmedical personnel play a significant role in decisions affecting access to care for medically indigent patients.

Personnel reductions and structural changes in health care: work-life experiences of medical secretaries.

OBJECTIVE: To explore the experiential aspects of 'psychosocial stressors and motivators' for medical secretaries, following a period of personnel reductions and structural changes in Swedish health care. The focus was to understand and describe work-life experiences for this specific group of women and how they managed in what can be presumed to be a more demanding work situation. METHOD: A descriptive qualitative study with repeated in-depth interviews of six medical secretaries (mean age: 45 years) in a large hospital in Sweden. The first interview took place in the autumn of 1997 (in connection with the last round of the 20% staff redundancies), 1998 and 2000. Thematic content analysis from audiotaped and transcribed interviews was used to obtain understanding. RESULTS: The study provided three main themes from the women's perceived stressors, motivators and coping options. The descriptions of their stressors provided the metaphor, 'energy thieves' with three underlying subthemes: 'too much work,' 'lack of recognition' and 'the dilemma of health, family and finances.' Experienced motivators, labeled as 'energy givers' had two subthemes: 'professional pride' and 'the comprehensive whole.' The women's descriptions about managing increasing demands were thematized as altering between 'being submissive and taking actions' with three subthemes: 'unequal communication,' 'resigned and passive reactions' versus 'cautious and solution-oriented coping.' Expressions concerned mainly 'energy thieves,' inclusively worries about 'lacking energy' (intrinsic stressor), combined with passive and cautious coping behavior. However, the descriptions became somewhat more varied and balanced with enriching and solution oriented factors in the follow-up interviews. CONCLUSIONS: There is an evident contrast between a demanding reality of work, described by medical secretaries in this study, and their expressed desire to have a more reasonable work environment that allowed them to be able to complete their work. They also wanted to be heard regarding their requests about work options and decent salaries. This study demonstrates the importance of making feelings of inferiority and injustice visible as well as to support professional pride and more assertive coping behavior. This is also valid for the need to enhance equal/congruent communication between interdependent workers. The study has implications for managers and health workers supporting and empowering women, providing administrative service in a clinical health care context. The subthemes being identified within the metaphor 'energy thieves,' in relation to resigned/passive reactions and cautious coping styles, could be used in stress prevention, while the understanding of 'energy givers' and the support of active and solution-oriented coping conducts could be used in health promotion work.

A job analysis of selected health workers in a district health system in KwaZulu-Natal. Part three: Other categories of health workers.

This article described the third part of a study aimed at doing a job analysis of nurses and non-professional health workers in a district health system. This article describes the tasks of five categories of workers, their training and their work-load over an ordinary week. Interviews were done with 52 workers from three hospitals and five clinics, of whom 14 were men and 38 women. The three PHC guards had a much more varied job than the hospital security staff (also three). All of them have had specific task related training. The six General Assistants in Primary Health Care settings were almost exclusively involved in cleaning, while the 23 in hospitals added food and drink management and running errands to their work. Only one had training pertaining to the specific tasks. All three clerks were found in the PHC setting, and their tasks were mainly that of receptionist. None had specific task related training. The three Ground's Men worked at gardening and cleaning at PHC clinics, but a range of other tasks were added from time to time. Porters, of whom ten were interviewed, did mainly transporting of patients and running errands. GA's and security staff were also used to control violent patients and visitors, something for which none of them have had training. Recommendations were made about training and work redesign in the district.

Organizational cultures, strategies, and commitments in health care organizations.

Cultural elements called norms and values affect organizational commitment and job satisfaction of managers and executive secretaries in this study of 13 health care organizations. Results also show that organizations pursuing a consistent strategy possess strong cultures, while organizations with an inconsistent strategy exhibit weak cultures.

Experiences of women clerical workers in patient care areas.

Nurse managers at all levels have a stake in the well-being and job satisfaction of clerical workers in patient care areas. The authors discuss the results of a qualitative interview study of 46 women employed as unit clerks and clinic clerks. As these women described their work experiences, they identified interactional dynamics in the workplace, issues of relative powerlessness, stresses involved in dealing with ill clients, organizational problems, and occupational hazards.

Neck and shoulder disorders in medical secretaries. Part I. Pain prevalence and risk factors.

420 medical secretaries took part in a cross-sectional study at examining the prevalence of musculoskeletal disorders as well as the relationship between neck and shoulder pain and possible risk factors. Sixty-three percent had experienced neck pain sometime during the previous year and while 15% had suffered almost constant pain 32% had experienced neck pain only occasionally. Shoulder pain during the previous year had been experienced by 62%, 17% had suffered almost constant pain while 29% experienced pain only occasionally. Fifty-one percent had experienced low back pain. Age and length of employment were significantly related to neck and shoulder pain. Furthermore, working with office machines 5 hours or more per day was associated with a significantly increased risk for neck pain (OR 1.7), shoulder pain (OR 1.9) and headache (OR 1.8). Finally, a poorly experienced psychosocial work environment was significantly related to headache, neck, shoulder and low back pain. The results of this study suggest that work with office machines as well as the psychosocial work environment are important factors in neck and shoulder pain.

Risk factors in the psychosocial work environment for neck and shoulder pain in secretaries.

The relationship between psychologic work variables and reported neck and shoulder pain was examined among secretaries. A battery of questionnaires concerning the experienced psychologic work environment as well as musculoskeletal pain symptoms was completed by 420 secretaries at a large medical center. A relatively "poor" psychologic work environment was compared with an environment that was experienced as "good." A "poorly" experienced psychologic work environment was related to a higher frequency of neck and shoulder pain. The relative risk for frequent neck pain was 2.85 (95% confidence interval 1.28 to 6.32) and for frequent shoulder pain 3.32 (95% confidence interval 1.53 to 7.23). Furthermore, the subindexes of work content and social support at work were found to be related to pain, whereas no clear relationship was found for work demands. The results of this study demonstrate the possible importance of the psychologic work environment in the development of musculoskeletal pain disorders. Future investigations should replicate these findings as well as isolate specific mechanisms so that preventive measures may be instituted.

Receptionists, appointment systems and continuity of care.

The influence of receptionists on continuity of care in four group practices was examined. Twenty two receptionists were observed making 543 appointments and afterwards were interviewed about their personal priority for continuity of care. One of the practices ran a personal list system. It was found that the personal list practice attracted more requests for a specific doctor and time which were then more difficult to satisfy. Most receptionists thought it was important that patients should see the same doctor but their influence seemed to be small compared with that of the doctor as expressed in practice policies. Marked variation in demand for individual doctors was seen in two of the practices without a personal list system.