Why do short term workers have high mortality? (1/202)

Increased mortality is often reported among workers in short term employment. This may indicate either a health-related selection process or the presence of different lifestyle or social conditions among short term workers. The authors studied these two aspects of short term employment among 16,404 Danish workers in the reinforced plastics industry who were hired between 1978 and 1985 and were followed to the end of 1988. Preemployment hospitalization histories for 1977-1984 were ascertained and were related to length of employment between 1978 and 1988. Workers who had been hospitalized prior to employment showed a 20% higher risk of early termination of employment than those never hospitalized (rate ratio (RR) = 1.20, 95% confidence interval (CI) 1.16-1.29), and the risk increased with number of hospitalizations. For workers with two or more preemployment hospitalizations related to alcohol abuse or violence, the rate ratios for short term employment were 2.30 (95% CI 1.74-3.06) and 1.86 (95% CI 1.35-2.56), respectively. An unhealthy lifestyle may also be a determinant of short term employment. While it is possible in principle to adjust for lifestyle factors if proper data are collected, the health-related selection of workers requires careful consideration when choosing a reference group for comparative studies of cumulative occupational exposure.  (+info)

Violence in the emergency department: a survey of health care workers. (2/202)

BACKGROUND: Violence in the workplace is an ill-defined and underreported concern for health care workers. The objectives of this study were to examine perceived levels of violence in the emergency department, to obtain health care workers' definitions of violence, to determine the effect of violence on health care workers and to determine coping mechanisms and potential preventive strategies. METHODS: A retrospective written survey of all 163 emergency department employees working in 1996 at an urban inner-city tertiary care centre in Vancouver. The survey elicited demographic information, personal definition of violence, severity of violence, degree of stress as a result of violence and estimate of the number of encounters with violence in the workplace in 1996. The authors examined the effects of violence on job performance and job satisfaction, and reviewed coping and potential preventive strategies. RESULTS: Of the 163 staff, 106 (65%) completed the survey. A total of 68% (70/103) reported an increased frequency of violence over time, and 60% (64/106) reported an increased severity. Most of the respondents felt that violence included witnessing verbal abuse (76%) and witnessing physical threats or assaults (86%). Sixty respondents (57%) were physically assaulted in 1996. Overall, 51 respondents (48%) reported impaired job performance for the rest of the shift or the rest of the week after an incident of violence. Seventy-seven respondents (73%) were afraid of patients as a result of violence, almost half (49%) hid their identities from patients, and 78 (74%) had reduced job satisfaction. Over one-fourth of the respondents (27/101) took days off because of violence. Of the 18 respondents no longer working in the emergency department, 12 (67%) reported that they had left the job at least partly owing to violence. Twenty-four-hour security and a workshop on violence prevention strategies were felt to be the most useful potential interventions. Physical exercise, sleep and the company of family and friends were the most frequent coping strategies. INTERPRETATION: Violence in the emergency department is frequent and has a substantial effect on staff well-being and job satisfaction.  (+info)

Estimates of costs of primary care physician turnover. (3/202)

OBJECTIVE: To provide estimates of the institutional costs associated with primary care physician (PCP) turnover (job exit). SUBJECTS AND METHODS: A cohort of 533 postresident, nonfederal, employed PCPs younger than 45 years of age, in practice between 2 and 9 years, participated in national surveys in 1987 and 1991. Data from a national study of physician compensation and productivity and data from physician recruiters were combined with PCP cohort data to estimate recruitment and replacement costs associated with turnover. RESULTS: By the time of the 1991 survey, slightly more than half (n = 279 or 55%) of all PCPs in this cohort had left the practice in which they had been employed in 1987; 20% (n = 100) had left 2 employers in that same 5-year period. Among those who left, self-designated specialties and proportions were general/family practice (n = 104 or 37%); general internal medicine (n = 91 or 33%); and pediatrics (n = 84 or 30%). Estimates of recruitment and replacement costs for individual PCPs for the 3 specialties were $236,383 for general/family practice, $245,128 for general internal medicine, and $264,645 for pediatrics. Turnover costs for all PCPs in the cohort by specialty were $24.5 million for general/family practice, $22.3 million for general internal medicine, and $22.2 million for pediatrics. CONCLUSIONS: Turnover was an important phenomenon among the PCPs in this cohort. This turnover has major fiscal implications for PCP employers because loss of PCPs causes healthcare delivery systems to lose resources that could otherwise be devoted to patient care.  (+info)

Recruitment and retention in the Navajo Area Indian Health Service. (4/202)

OBJECTIVE: To determine why physicians and midlevel providers join, leave, or stay in Navajo Area Indian Health Service (IHS). DESIGN: Cross-sectional analysis of data obtained from questionnaires. SETTING: Navajo Area IHS hospitals. SUBJECTS: Navajo Area health care physicians and midlevel health care providers. Main outcome measures The prevalence of physicians and midlevel providers who plan to leave the Navajo Area IHS, the demographic characteristics of these physicians and midlevel providers, and the most common reasons for staying or leaving. RESULTS: A total of 221 (64%) physicians and midlevel providers responded. Of these, 58% planned to leave eventually, and 47% of all physicians and midlevel providers planned to leave in the next 3 years. Physicians and midlevel providers planning to leave tended to be younger than those planning to stay (P: = 0.009). The most common reason to join the IHS was a desire to work in the Southwest, to stay was the quality of the medical staff, and to leave was lack of administrative support. CONCLUSIONS: A high turnover rate of physicians and midlevel providers may occur in the next 3 years. A combination of factors specific to the provider, the institution, and the environment attracts physicians to the Navajo IHS and encourages them to stay. Factors that push physicians and midlevel providers to leave tend to be specific to the institution and are potentially amenable.  (+info)

GP job satisfaction in 1987, 1990 and 1998: lessons for the future? (5/202)

BACKGROUND: Job satisfaction is an important determinant of physician retention and turnover, and may also affect performance. Objective. Our aim was to investigate changes in GP job satisfaction from 1987 to 1998, covering a period of major change in the organization of British general practice. METHODS: Postal surveys of random national samples of GPs were carried out by separate groups of investigators in 1987, 1990 and 1998. In each survey, the questionnaire contained a standardized job satisfaction scale and a list of 14 job stressors. The final samples consisted of 1817 GPs in 1987 (response rate 45%), 917 GPs in 1990 (response rate 61%) and 1828 GPs in 1998 (response rate 49%). RESULTS: For both men and women, overall job satisfaction declined from 1987 to 1990 and then improved from 1990 to 1998, although satisfaction in 1998 remained below that in 1987. Women tended to report higher levels of satisfaction than men in all 3 years. Satisfaction with nine specific aspects of work showed dissimilar patterns of change over time. From 1987 to 1990, reported levels of stress increased for eight of 14 job stressors. Of these, three subsequently declined in 1998, two remained unchanged and three continued to increase. Of the six job stressors which showed no change from 1987 to 1990, five subsequently increased as sources of stress. Men and women differed in their sources of stress, but the differences were not consistent over time. CONCLUSIONS: The results suggest that GP job satisfaction has improved significantly from the low point reached following the introduction of the 1990/1991 NHS reforms, although reported levels of stress in relation to many aspects of work have continued to increase. The changes are discussed within the context of wider research into the determinants of GP job satisfaction in order to anticipate the likely effects on GPs of future organizational reforms.  (+info)

A quasi-experimental study on a quality circle program in a Taiwanese hospital. (6/202)

OBJECTIVE: To explore the impact of quality circles on job satisfaction, absenteeism, and turnover among hospital nurses in Taiwan. DESIGN: A quasi-experimental research design. SETTING: In November 1995, a study was initiated to establish quality circles in a 500-bed community hospital in Taiwan. After the administrative process and a pilot study, three of the experimental units began implementing the quality circle program in January 1997. For the comparison group, three non-quality circle medical-surgical units were selected from another building. STUDY PARTICIPANTS: All registered nurses on the three selected units who met the criteria of having worked full-time on those units for > or = 6 months were included in the study. There were 53 full-time registered nurses (49 female, four male) who met the criteria and 100% participated. There were no significant differences between the quality circle group and the non-quality circle group in terms of sex, age, and number of years of working experience, education or marital status. INTERVENTIONS: After obtaining administrative approval and support, the pilot study began with 3-month quality circle courses and 3-month quality circle process training for the experimental group nurses. Each circle has been meeting for 1 hour each week to identify problems, barriers, and solutions for effective implementation since 1997. MAIN OUTCOME MEASURES: (i) Demographic data questionnaire; (ii) Stamps and Piedmont's Index of Work Satisfaction; (iii) hospital records for absenteeism and turnover data. RESULTS: The data reveal that nurses of the three quality circle units felt more satisfied (P < 0.01) than did nurses from the three non-participating units. In the non-participating group, 36% had considered leaving the units, compared to 10% of nurses from the quality circle group. The turnover rate was significantly higher for the non-participating group (40%) than for the quality circle group (13%). CONCLUSION: This quality circle program in a Taiwanese hospital significantly improved satisfaction, reduced absenteeism, and lowered turnover of nurses. The findings support other studies reported in the literature.  (+info)

Work-related social skills training for people with schizophrenia in Hong Kong. (7/202)

This article describes a prospective blinded outcome study of a vocational social skills training program developed in Hong Kong for people affected by chronic schizophrenia. The aim was to improve their ability to find and keep a job. Participants were randomly assigned to three groups: a social skills training group with followup support, a social skills training group without followup support, and a comparison group who received standard after-care treatment. Participants who had participated in either of the training groups statistically outperformed those in the comparison group. Those receiving the training plus followup were statistically much more successful at finding and keeping a job than participants in either of the other two groups. A comparatively small amount of followup contact (a monthly group meeting or phone call) for 3 months after the training finished had a very significant effect on participants' success rate.  (+info)

Primary care physician job satisfaction and turnover. (8/202)

OBJECTIVE: To examine the relationship of personal characteristics, organizational characteristics, and overall job satisfaction to primary care physician (PCP) turnover. SUBJECTS AND METHODS: A cohort of 507 postresident, nonfederally employed PCPs younger than 45 years of age, who completed their medical training between 1982 and 1985, participated in national surveys in 1987 and 1991. Psychological, economic, and sociological theories and constructs provided a conceptual framework. Primary care physician personal, organizational, and overall job satisfaction variables from 1987 were considered independent variables. Turnover-related responses from 1991 were dependent variables. Bivariate and multivariate analyses were conducted. RESULTS: More than half (55%) of all PCPs in the cohort left at least 1 practice between 1987 and 1991. Twenty percent of the cohort left 2 employers. PCPs dissatisfied in 1987 were 2.38 times more likely to leave (P < .001). Primary care physicians who believed that third-party payer influence would decrease in 5 years were 1.29 times more likely to leave (P < .03). Non-board certified PCPs were 1.3 times more likely to leave (P < .003). Primary care physicians who believed that standardized protocols were overused were 1.18 times more likely to leave (P < .05). Specialty, gender, age, race, and practice setting were not associated with PCP turnover. CONCLUSIONS: Turnover was an important phenomenon among PCPs in this cohort. The results of this study could enable policy makers, managed care organizations, researchers, and others to better understand the relationship between job satisfaction and turnover.  (+info)