The relationship between organizational policies and practices with work limitations within a cohort of hospital patient care workers [abstract].

Details

• Personal Author:
  Boden LI ; Dennerlein J ; Hashimoto D ; Kenwood C ; Nagler E ; Sabbath EL ; Sorensen, Glorian ; Sparer E ; Wagner G
• Description:
  Statement of the problem: Health care is one of the largest and fastest growing industries in the United States and has the most nonfatal injuries and illnesses. Much of the health and safety research among healthcare workers has examined illness and injury endpoints without accounting for the impact of adverse health of workers on their productivity. The work limitations questionnaire (WLQ) measures the degree to which someone is experiencing limitations at work due to health problems, and the degree of health-related productivity loss. Previous research has demonstrated that the WLQ and other similar scales (e.g. workability) with health outcomes. These measures are crucial to understanding worker health, because they measure both chronic health conditions, and the potential impact of these conditions on productivity. While the WLQ is limited in specificity of health conditions, it offers an overall picture of worker health and performance. Previous studies have examined the relationship between work organization factors and the WLQ, however these studies have mostly been conducted among injured workers within the general population, and have not accounted for industry specific factors. With the desired long-term goal of informing and guiding priorities for future workplace interventions within the healthcare industry, we conducted an analysis of the relationship between organizational policies and practices (OPPs) (specifically, safety practices, ergonomic practices, and people oriented culture) and work limitations. Procedures: The data in this analysis were collected as part of a survey of hospital workers that aimed to quantify the relationship between worksite programs, policies, and practices with worker health and economic outcomes at the unit and individual level. The survey was conducted among registered nurses (RNs), licensed practical nurses (LPNs), and patient care associates (PCAs) in 2014 at two large teaching hospitals in Boston, Massachusetts. Workers were eligible for participation if they worked at least 20 hours per week in patient care services and had direct patient care responsibilities. The questions on ergonomic practices, safety practices, and people-oriented culture were based on a modified version of the Organizational Policies and Practices (OPPs) questionnaire. Work limitations were measured using a modified version of the short form Work Limitations Questionnaire (WLQ). Demographic covariates included age, gender, race/ethnicity, education, and body mass index (BMI, generated from height and weight). Work characteristics included job title, tenure, hours worked, and unit type. Workers in the float pool were excluded from this analysis, as they did not have a primary association with a unit. Analyses: We first examined correlations in the data between the modified WLQ measure and the three specific OPPs. We then completed a series of random intercept multi-level models for each of the three OPPs using stepwise selection of covariates. Each model included the OPP score as the independent variable, the WLQ score as the dependent variable, and a unit variable as the random effect in the model to account for the unit-to-unit variability in OPP scores. We also explored interactions of the covariates with the main effect. We explored additional models containing interactions between OPPs that were statistically significant in the simple models to assess the effect of confounding and to further explain the relationships. Results: There were 1398 individuals who completed the survey (response rate 71%), and an additional 73 respondents were excluded from this analysis due to incomplete surveys or status as a float pool nurse. Of the resulting 1325, most were white (81%), female (94%), and nurses (90%), with a mean age of 41 years. Individual OPP scores were weakly but significantly correlated with WLQ scores (r=0.11 for safety practices, r=0.16 for ergonomic practices and people-oriented culture; p-values for all >0.0001). In the regression models, there was a statistically significant association between unit safety practices and worker WLQ scores, which grew stronger when adjusting for individual worker characteristics (job title, age, and BMI) (beta = -3.22; p-value=0.025). Units with better safety practices were associated with workers with fewer work limitations, meaning better overall health. The direction of the associations between WLQ and unit ergonomic practices and between WLQ and unit people-oriented culture were similar although, each slightly lower in magnitude and not statistically significant. Other models examining interactions between main effects and covariates and other possible confounding did not change the previously described associations. Practical Implications: Given the high rate of injuries and illnesses among healthcare workers, an increased focus on improving OPPs, specifically safety practices, to improve health and safety outcomes is needed. Conclusions: This study demonstrated the importance of organizational policies and practices in improving worker health outcomes and reducing work limitations in acute care settings. Specifically, practices related to worker safety should be the focus of intervention efforts by researchers and practitioners, given the strong relationship with work limitations. [Description provided by NIOSH]
• Subjects:
  Cohort Studies Epidemiology Health Personnel Occupational Health Safety Surveys And Questionnaires
• Keywords:
  TWH; Total Worker Health; Injuries; Cohort studies; Epidemiology; Health care workers; Nurses; Work organization; Policy; Safety practices; Questionnaires
• Publisher:
  American Psychological Association
• Document Type:
  Text
• Funding:
  Cooperative Agreement
• Genre:
  Abstract or Summary
• Place as Subject:
  Kansas ; Massachusetts ; Minnesota ; OSHA Region 1 ; OSHA Region 5 ; OSHA Region 7
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  1-2
• NIOSHTIC Number:
  nn:20065686
• Citation:
  Work, Stress and Health 2017: Contemporary Challenges and Opportunities, The 12th International Conference on Occupational Stress and Health, June 7-10, 2017, Minneapolis, Minnesota. Washington, DC: American Psychological Association, 2017 Jun; :1-2
• Federal Fiscal Year:
  2017
• NORA Priority Area:
  Healthcare and Social Assistance ; Construction
• Performing Organization:
  Harvard University, Boston, Massachusetts
• Peer Reviewed:
  False
• Start Date:
  20070901
• Source Full Name:
  Work, Stress and Health 2017: Contemporary Challenges and Opportunities, The 12th International Conference on Occupational Stress and Health, June 7-10, 2017, Minneapolis, Minnesota
• End Date:
  20260831
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:b4b219569d85838841988b5ca91a477c8e2660c1dc550aa8eafa0b5b9d51af898291a41f5c7e0f7ae50e61e742c36c4df803f03a7c7bc6ef1100a314aea29772
• Download URL:
  https://stacks.cdc.gov/view/cdc/249510/cdc_249510_DS1.pdf
• File Type:
  [PDF - 435.82 KB ]