A longitudinal investigation of structural empowerment profiles among healthcare employees.

PURPOSE: Research on structural empowerment has typically adopted a variable-centered perspective, which is not ideal to study the combined effects of structural empowerment components. This person-centered investigation aims to enhance our knowledge about the configurations, or profiles, of healthcare employees' perceptions of the structural empowerment dimensions present in their workplace (opportunity, information, support, and resources). Furthermore, this study considers the replicability and stability of these profiles over a period of 2 years, and their outcomes (perceived quality of care, and positive and negative affect). DESIGN: Participants completed the same self-reported questionnaires twice, 2 years apart. METHODS: A sample of 633 healthcare employees (including a majority of nurses and nursing assistants) participated. Latent transition analyses were performed. RESULTS: Five profiles were identified: Low Empowerment, High Information, Normative, Moderately High Empowerment, and High Empowerment. Membership into the Normative and Moderately High Empowerment profiles demonstrated a high level of stability over time (79.1% to 83.2%). Membership in the other profiles was either moderately stable (43.5% for the High Empowerment profile) or relatively unstable (19.7% to 20.4% for the Low Empowerment and High Information profiles) over time. More desirable outcomes (i.e., higher positive affect and quality of care, and lower negative affect) were observed in the High Empowerment profile. CONCLUSIONS: These results highlight the benefits of high structural empowerment, in line with prior studies suggesting that structural empowerment can act as a strong organizational resource capable of enhancing the functioning of healthcare professionals. These findings additionally demonstrate that profiles characterized by the highest or lowest levels of structural empowerment were less stable over time than those characterized by more moderate levels. CLINICAL RELEVANCE: From an intervention perspective, organizations and managers should pay special attention to employees perceiving low levels of structural empowerment, as they experience the worst outcomes. In addition, they should try to maintain high levels of structural empowerment within the High Empowerment profile, as this profile is associated with the most desirable consequences. Such attention should be fruitful, considering the instability of the High Empowerment and Low Empowerment profiles over time. REGISTRATION: NCT04010773 on ClinicalTrials.gov (4 July, 2019).

Impact of empowering leadership on emotional exhaustion: A controlled interventional study in a large French university hospital complex.

AIM: The aim of this study is to assess the effect of a systemic intervention on the evolution of empowering leadership and emotional exhaustion in a university hospital sub-centre compared to a control sub-centre, both being part of a large French university hospital complex. BACKGROUND: Empowering leadership is a promising strategy for developing hospital team engagement and performance. However, the bureaucratic functioning of large hospitals, characterized by a managerial culture of control and a stratified organization, can be a barrier to empowering leadership. METHODS: The intervention included empowering leadership training, direct field experimentation of empowering leadership and coaching, involving all the sub-centre hierarchical levels for 12 months. Data were collected before and after the intervention. A total of 441 and 310 participants were, respectively, included in the intervention and control sub-centres. RESULTS: Empowering leadership was decreased, and emotional exhaustion was increased in the control sub-centre, while the scores remained stable in the intervention sub-centre. The increased emotional exhaustion in the control sub-centre could partially be explained by the change in empowering leadership. CONCLUSION: In a context of decreased empowering leadership and increased emotional exhaustion, the intervention had a protective effect. Implications for the design of future interventions were discussed. IMPLICATIONS FOR NURSING MANAGEMENT: This study unequivocally showed the benefit of transforming hospital management towards empowering leadership, to prevent increased emotional exhaustion. REGISTRATION NUMBER: This study is registered on ClinicalTrials.gov on 4 July 2019 (NCT04010773).

Risque zoonotique : médecins généralistes et vétérinaires sont-ils prêts à collaborer ?

INTRODUCTION: Zoonotic risk is a major public health concern that should be addressed through close collaboration between veterinarians and physicians. Yet the few studies available in this field highlight the absence of such collaboration and point to organizational and cultural constraints as explanatory factors. None of them have investigated potential psychosocial determinants. METHODS: This qualitative study is a comparative exploration of veterinarians' and physicians' relationship to zoonotic risk and interprofessional collaboration. Individual exploratory interviews were held with fourteen practicing veterinarians and ten general practitioners - all of whom were French. Their different perceptions of zoonotic risk and collaboration were described by means of a thematic analysis. The social representations of each profession with regard to the other were investigated using attitudinal analyses. RESULTS: Collaboration between general practitioners and veterinarians is commonly perceived as non-existent. The main limiting factors on collaboration are: first, greater psychosocial involvement with regard to zoonotic risk among veterinarians than among general practitioners, due to differences in the degree of exposure to these diseases and in the expertise and values regarding the human-nature relationship; second, contrasting assessments of the others' profession (social desirability), evidenced in veterinarians' negative representations of general practitioners who, conversely, deem veterinarians to be particularly competent; and, thirdly, different perceptions of collaboration (social utility), as a keen interest in collaboration is witnessed among veterinarians, whereas general practitioners see it as only moderately useful. CONCLUSION: It is essential to promote places where physicians and veterinarians can meet locally, so that perceptions of zoonotic risk can evolve, particularly among physicians, along with veterinarians' beliefs about and attitudes towards them.

Psychosocial and Organizational Processes and Determinants of Health Care Workers' (HCW) Health at Work in French Public EHPAD (Assisted Living Residences): A Qualitative Approach Using Grounded Theory.

In a context marked by negative health indicators that make structural aspects more salient, this paper aimed at understanding and explaining the processes and determinants at work that positively and negatively interfere with the professionals' health in the French public nursing home environment. To this purpose, the qualitative approach by grounded theory was chosen. In total, 90 semi-structured interviews were recorded and 43 were transcribed; in addition, 10 observations of 46 participations in meetings and working groups were carried out in four public service and hospital establishments. Our results indicate that the role of health workers, its definition, and its execution are fundamental to the understanding of their health at work. Two protective and constructive processes are involved in the maintenance and development of the professionals' health in this work, with considerable confrontations with death and suffering: individual and collective control of emotional and cognitive commitment, and the development of resources for formation, information, and cooperation. Nonetheless, they are jeopardized when a lasting imbalance is generated between the work's demands and the available resources. This leads to a loss spiral in organizational, inter-individual, and individual resources that makes it difficult to sustain work.