Organisational-level risk and health-promoting factors within the healthcare sector—a systematic search and review
Introduction: The healthcare sector is globally experiencing increasing demands and workplace interventions on an organisational level is sought to create healthy workplaces. The aim of this study was to provide an overview of Nordic research on the work environment and health of healthcare professionals, with a focus on identifying organisational-level risk and health-promoting factors.
Methods: This systematic search and review was based on an analysis of studies published in peer-reviewed journals between 1 January 2016 and 3 January 2023. The selected studies investigate the relationships between organisational-level risk and health-promoting factors and measures of health and well-being among healthcare professionals during ordinary operations. To increase applicability, this systematic search and review was limited to the Nordic countries as they share the same context with a publicly-funded widely accessible healthcare system. A total of 2,677 articles were initially identified, with 95 original studies meeting the criteria for relevance and quality.
Results: Identified organisational risk and health-promoting factors were categorised into five categories: work schedule distribution, operations design and work methods, ergonomic conditions, working conditions and personnel policies, and the organisation’s ethical environment. In addition, two themes across the categories emerged, providing further insight into the implications for practice. The first theme emphasises risk and health-promoting factors in the actions that employers take to fulfil the organisation’s goals. The second theme emphasises risk and health-promoting factors in connection with the ability of employees to do their jobs at a level of quality they deem acceptable.
Conclusion: Several organisational-level risk and health-promoting factors were identified, and the results indicate that the actions that employers take to fulfil the health-care organisation’s goals and promote the ability of employees to provide high-quality care are important for the health and wellbeing of healthcare employees.
1 Introduction
High-quality healthcare is essential for social welfare, and attention to the health and wellbeing of healthcare workers is a crucial aspect of this effort. Reduced health in healthcare workers can have adverse effects on the individual healthcare workers. In addition, it may also lead to reduced quality in patient care, the risk of accidents, and challenges attracting and retaining a skilled workforce. Maintaining healthcare workers´ health is especially important since the competition for healthcare professionals is increasing due to an aging population in many societies (1–6). Despite this, healthcare in Europe is recognised as a high-risk sector from an employee wellbeing perspective (7), and healthcare workers report the highest levels of work-related stress compared to other professionals (8). They also experience poor wellbeing (9, 10) and physical symptoms (11).
Challenges within the healthcare sector arise from demands connected to healthcare work, which include contact with distressed and ill patients, work overload, up-to-date learning, and high-quality standards of performance (8). In addition, ongoing medical developments have resulted in growing demands for speed, complexity, and responsibility; an increased administrative burden, and reduced autonomy among healthcare workers (12, 13). In order to maintain healthy workplaces, job demands need to be manageable, and workers need to have access to sufficient resources to balance these demands (14). This challenging situation is not unique to Europe, and the World Health Organization (WHO) estimates that within the healthcare sector alone, there will be a shortfall of 10 million employees globally by 2030 (15).
Creating healthy workplaces requires organisational approaches that aim to improve working conditions and the organisation of work, rather than individual approaches that aim to improve workers’ competencies, knowledge, and coping capacity (16–18). In addition, instead of simply preventing harm, an approach that focuses on promoting employee wellbeing has been recommended as a way to improve working conditions within the healthcare sector (19). Such organisational-level interventions require not just in-depth knowledge of the healthcare sector (i.e., challenges, structure, and processes imbedded in that system and culture) but also knowledge on risk and health-promoting factors (i.e., working conditions that increase the likelihood of illness among employees or reduce the likelihood of health, and increase the likelihood of health among employees or reduce the risk of illness, respectively) that may be targeted (20, 21).
At present, the knowledge of the impact of risk and health-promoting factors on the workplace level within the healthcare sector is extensive, as a wide range of systematic reviews have been performed. These systematic reviews have provided evidence of the associations between burnout and a high workload, time constraints, value incongruence, low level of control, insufficient support from colleagues and managers, lack of collaboration, inadequate rewards, insufficient staffing, shifts exceeding 12 h, limited scheduling flexibility and uncertain employment conditions (22–25); musculoskeletal disorders and pain due to awkward working postures, a large number of patients, administrative work, vibration, and repetitive work (26, 27); and job satisfaction with workload and income, responsibility, recognition, autonomy and collaboration (28, 29).
However, there is still limited knowledge of the underlying causes of the presence or absence of these risk and health-promoting factors (i.e., risk and health-promoting factors on a higher organisational level). Following the principles of the hierarchy of controls for occupational safety and health (30, 31), risks to health and wellbeing should be reduced or eliminated by targeting the organisational level rather than the workplace or individual level. Thus, there is an urgent need to increase knowledge on organisational-level risk and health-promoting factors that may be used to improve the health of employees within the healthcare sector. To increase applicability to practice, this systematic review was limited to the Nordic context (Denmark, Finland, Iceland, Norway and Sweden), where all countries have a publicly-funded, widely accessible healthcare system (32).
The aim of this study was to provide an overview of Nordic research on the work environment and health of healthcare professionals, with a focus on identifying organisational-level risk and health-promoting factors.
2 Methods
2.1 Study design
Due to the multifaceted nature of organisational-level risk and health-promotive factors, in combination with the absence of earlier systematic reviews that could be used to guide the search, a broad scope that incorporates multiple study types rather than focusing on a single preferred study design had to be used. Thus, this study was carried out as a systematic search and review with a narrative summary (33) and reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 statement (34); see supporting information on-line Supplementary material (Prisma 2020 checklist). This study has not been reviewed by the Swedish Ethical Review Authority. This is not required for this type of study according to the Swedish Ethical Review Act. Informed consent to participate was not applicable in this study. No protocol exists for this review, since it was first commissioned as a part of a government assignment to the Swedish Agency for Work Environment Expertise and the absence of ethical review requirements.
2.2 Inclusion and exclusion criteria
Studies investigating health-related risk and health-promoting factors for healthcare professionals in the Nordic countries that were published in peer-reviewed journals between 1 January 2016 and 3 January 2023 were included. The start date of the searches was a pragmatic choice used to increase the relevance of the included studies by reflecting the current context and normal operations. The search strategy was structured according to SPIDER (sample, phenomenon of interest, design, evaluation, and type of research) as we expected a wide range of study designs, including quantitative, qualitative, and mixed method designs (35). Studies were included if they examined the relationship between health and illness in relation to risk and health-promoting factors at the organisational level, or employees’ experiences of these factors. Descriptive studies that described relationships without examine the relationship between health and illness in relation to risk and health-promoting factors at the organisational level were excluded. Outcomes that cannot be directly seen as an aspect of health or illness have also been excluded, although they may be an outcome of a risk or health-promoting factor and related to health or illness. For example, various performance-related outcomes, such as patient satisfaction, quality of care, or incidents, have been excluded since such outcomes do not directly reflect worker health. Outcomes related to employee turnover, such as the desire to leave or remain in the workplace or organisation, have also been excluded. Finally, studies conducted under non-ordinary or non-generalisable conditions, such as pandemics or crises, have been excluded. Complete inclusion and exclusion criteria can be found in Table 1.
