Background
Methods
Setting
Design and study sample
Intervention: collective participatory work design in hospital physicians work
Measures
Hospital physician working conditions
Patient care quality
Process and implementation information
Statistical analysis
Results
Intervention
Problem category | Physicians’ solutions for implementation |
---|---|
Work organization | - Joint ward rounds to improve mutual coordination of physicians’ and nurses’ work schedules during mornings, |
- Redirection of external telephone calls to reduce unnecessary workflow interruptions (to head physicians’ secretary), | |
- Regularly scheduled consultation hours for relatives of patients in the afternoon, | |
Leadership quality | - Re-implementation of annual performance feedback and appraisal interview through departments’ head physicians, |
- Enhanced presence of supervisors on wards, | |
Internal information flow and quality | - Enhanced transparency of time documentation and subsequent salary accounting, |
- Implementation of department electronic whiteboard to spread information, | |
Qualification and training | - Inner-departmental schedule for specialty training, |
- Enhanced practice of case conferences in the department to discuss current patients, | |
- Access online libraries; financial support of external training visits |
Qualitative data: implementation status within timeline and process-related factors
Quantitative data: hospital physicians work organization and quality of care
Subjects
Baseline (T1) | Follow-up (T2) | ||||||
---|---|---|---|---|---|---|---|
Surveyed groups
|
Eligible physicians
|
Participating physicians
|
%
|
Physicians employed
|
Participating physicians
|
%
| |
Physicians
|
Intervention
| 35 | 19 | 54.3 | 37 | 21 | 56.8 |
Control
| 27 | 19 | 70.0 | 25 | 16 | 64.0 | |
Admitted patients
|
Participating patients
|
%
|
Admitted patients
|
Participating patients
|
%
| ||
Patients
|
Intervention
| 1009 | 437 | 43.3 | 1027 | 621 | 60.5 |
Control
| 751 | 305 | 40.6 | 805 | 296 | 36.8 |
Time | Intervention departments | Control departments | Test for difference | |||
---|---|---|---|---|---|---|
Physicians
| Age in years (M,SD) | T1 | 39.11; 7.6 | 40.65; 10.7 | (t = -0.49; df = 33); n.s. | |
Organizational tenure in years (M, SD) | T1 | 7.42; 4.68 | 8.14; 8.37 | (t = -0.33; df = 35); n.s. | ||
Gender, male (N,%) | T1 | 16 (84.2) | 10 (52.6) |
(Chi
2
= 4.39; df = 1); p = .04*
| ||
Position (%) | (1) | T1 | 6 (31.6) | 4 (23.5) | (Chi2 = 0.99; df = 1); n.s. | |
(2) | T1 | 7 (36.8) | 5 (29.4) | |||
(3) | T1 | 6 (31.6) | 8 (47.1) | |||
Inpatients
| Age in years (M, SD) | T1 | 57.56; 17.23 | 63.71; 15.98 | (F = 2.52; df = 697); n.s. | |
T2 | 58.37; 17.82 | 64.24; 16.96 | (F = 1.35; df = 890); n.s. | |||
Length of hospital stay in days (M, SD) | T1 | 7.44; 7.90 | 6.86; 5.92 | (F = 0.06; df = 649); n.s. | ||
T2 | 6.48; 7.21 | 6.41; 5.79 | (F = 0.05; df = 851); n.s. | |||
Gender, male (N,%) | T1 | 194 (46.85) | 169 (58.48) |
(Chi
2
= 8.73; df = 1); p < .01
| ||
T2 | 282 (46.53) | 137 (48.92) | (Chi2 = 0.06; df = 1); n.s. |
Outcome I: hospital physicians work organization
Intervention departments | Control departments | Significance testing | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
Baseline | Follow-up | Baseline | Follow-up | Group x Time | ||||||
N = 19 | N = 21 | N = 19 | N = 16 | (ANOVA) | ||||||
Indicators of hospital physicians’ work conditions | M | SD | M | SD | M | SD | M | SD | F(df = 1); p | |
1 | Workflow interruptions | 4.04 | .67 | 3.77 | .68 | 4.05 | .59 | 4.06 | .47 | 0.69; n. s. |
2 | Conflicts in role and task demands | 3.42 | .60 | 2.83 | .67 | 3.30 | .82 | 3.27 | .64 |
3.03; .09
†
|
3 | Colleague support | 3.11 | .77 | 3.38 | .74 | 3.58 | .68 | 3.31 | .46 |
2.91; .09
†
|
4 | Quality losses | 3.12 | .95 | 2.83 | .73 | 2.98 | .93 | 2.83 | .74 | 0.54; n. s. |
5 | Quality of cooperation with patient relatives | 3.47 | .51 | 3.71 | .56 | 3.74 | .65 | 3.44 | .63 |
3.90; .05*
|
6 | Quality of cooperation with nursing staff | 3.74 | .73 | 4.05 | .59 | 4.00 | .88 | 3.81 | .66 | 2.21; n. s. |
Outcome II: patient care quality
Intervention departments | Control departments | Significance tests | |||||||
---|---|---|---|---|---|---|---|---|---|
Baseline | Follow-up | Baseline | Follow-up | Group x Time | |||||
N = 410 | N = 604 | N = 286 | N = 281 | (ANOVA) | |||||
Indicators of patient care quality | M | SD | M | SD | M | SD | M | SD | F(df = 1); p |
1 Organization of physicians’ care | 4.20 | .82 | 4.23 | .75 | 4.13 | .76 | 4.01 | .84 |
3.67; .056†
|
2 Quality of information from physicians | 4.08 | .83 | 4.16 | .77 | 3.88 | .88 | 3.93 | .81 | 0.14; n. s. |