As part of a project to devise a set of rules for assessing the risks of work-related stress in Italy, a survey of healthcare employees was commissioned with the support of the healthcare employers’ association, FIASO. The survey identifies the main drivers of well-being at work. Most important, according to the research, is ‘achievement of professional identity’, while ‘identification with the organisation and the community’ plays a positive though marginal role.
New work-related stress protocol
A report, Development and protection of well-being and organisational health in healthcare (in Italian, 3.88Mb PDF), is being promoted by the Italian Federation of Hospital and Local Health Agencies (FIASO) with the aim of establishing a shared protocol for assessing the risks of work-related stress. This is in response to the implementation of the 2004 framework agreement on work-related stress (77.4Kb PDF) drawn up by the European Trade Union Confederation (ETUC) in collaboration with various European employers’ organisations. The framework was included in Italy’s legislative decree 81/2008.
The protocol includes:
- an in-depth communication and information plan, as part of the risk assessment;
- data collection about a workforce from internal records, consistent with 2010 guidelines (in Italian, 571Kb PDF) issued by Italy’s Institute for Prevention and Safety at Work (Ispesl), thus involving both human resources (HR), internal occupational health and safety services and unit managers, complemented by a workforce-wide survey;
- the involvement of opinion leaders (management, unit heads and other persons identified as relevant) in mainstreaming both the questionnaire filling and the outcomes.
Survey method
The survey was carried out between May and July 2011 across 14 health and hospital companies. More than 50,000 employees were invited to take part. The return rate of completed questionnaires was 24.9%.
While distribution of respondents by gender and age was consistent with the overall population, there was a lower response rate from employees with a seniority of less than 15 years. The response was also lower from those who did not work in directly health-related posts, such as those in administration or technical roles.
Because of the low response rate, the findings could not be applied to the overall population of the companies asked to take part, or to the health sector in general.
Organisational well-being
Perceived organisational well-being was at the heart of the survey, since it employs several scales currently in use by both work and community psychologists. These scales include organisational identification (Mael and Ashforth,1992), sense of organisational community (Burroughs and Eby, 1998), psychological empowerment (Spreitzer, 1995), strategies for coping with working conditions (Amirkhan, 1990), and psychological well-being scales (Keyes, 2009)
The scores reported in Table 1 are extracted by means of factor analysis. The factors of skills and significance gain the highest scores, while a respondent’s intention to leave their current job scores lowest.
By comparing results with previous studies, the average scores for the factors of psychological well-being, skills and significance on the one hand and workload on the other are well above those of previous studies employing these scales. Intention to change job is considerably lower, due to the high job security in public healthcare.
Table 1: Perceived well-being at work| | Average value | Standard deviation |
|---|
Influence (Empowerment) | 3.42 | 0.94 |
Self-determination (Empowerment) | 3.55 | 1.02 |
Skills (Empowerment) | 4.26 | 0.64 |
Significance (Empowerment) | 4.20 | 0.82 |
Sense of organisational community | 3.58 | 0.79 |
Identification with the organisation | 3.49 | 0.76 |
Job satisfaction | 3.92 | 1.16 |
Target-sharing | 3.77 | 0.90 |
Clarity of roles | 3.95 | 0.95 |
Skills recognition | 3.33 | 1.04 |
Active coping* | 3.92 | 0.82 |
Search for social support** | 3.27 | 1.07 |
Avoidance coping*** | 2.56 | 0.93 |
Psychological well-being (range 1–6) | 4.66 | 0.95 |
Workload | 3.57 | 0.98 |
Work–life balance | 2.90 | 1.18 |
Intention to change job | 2.01 | 1.28 |
Notes: range 1= lowest score; 5 (or 6, in case of psychological well-being) = highest score.
* the active adaptation to stressful situations by facing the problem or controlling emotions;
** the tendency to share the problem with colleagues and friends in order to solve the problem;
*** any attempt to ignore the threat of the stressful event.
Source: FIASO, 2012
The best measures of well-being at work are job satisfaction, psychological well-being, and any intention to change job, according to the survey findings. Indicating a willingness to change job is regarded as a negative measure of well-being. The measures are regressed on the investigated dimensions and controlled by the socio-demographic variables of age and gender in order to identify the main factors affecting well-being at work.
Empowerment, followed by skills recognition and work–life balance, are the main variables in organisational well-being. These are shown in Table 2, which plots the regression coefficients, and their significance.
Factors that played a marginal role were identification with the organisation and its goals (organisational identification) and with the organisation as a community (communitarian identification). Role clarity and objective sharing also played a marginal role.
It is noted in the research that both psychological well-being and intention to change job may be affected by individual career expectations and by opportunities offered in a local context.
Table 2: Perceived organisational well-beingDependent variable | Intention to change job | Psychological well-being | Job satisfaction |
|---|
Gender | 0.003 | 0.035** | 0.018 |
Age | -0.071** | -0.040** | -0.030** |
Identification with the organisation | -0.025* | -0.005 | 0.026* |
Sense of organisational community | -0.186** | 0.004 | 0.125** |
Target-sharing | -0.056** | -0.058** | 0.080** |
Empowerment | -0.180** | 0.207** | 0.325** |
Active coping | 0.027* | 0.249** | 0.025* |
Coping by seeking social support | 0.055** | 0.057** | -0.003 |
Avoidance coping | 0.042** | -0.017* | -0.004 |
Workload | 0.027** | 0.051** | 0.006 |
Clarity of roles | 0.032** | 0.186** | 0.052** |
Skills recognition | -0.161** | 0.079** | 0.166** |
Work–life balance | 0.093** | -0.157** | 0.070** |
Adjusted R2*** | 0.30 | 0.31 | 0,43 |
Notes: gender: 1=man, 2=woman; * significant at 95%; ** significant at 99%. ***Adjusted R2=dependent variable; variability explained by the independent variables.
Source: Fiaso, 2012
Commentary
The survey report provides a methodological tool for the risk assessment of work-related stress. It complements the abovementioned 2010 guidelines issued by Ispesl.
By providing evidence consistent with existing literature, it highlights the central role of the full achievement of a professional identity and how this can affect well-being at work. Work–life balance is the most influential organisational variable, reflecting the prevalence of highly skilled professionals with shared professional identities over organisational commitment.
References
Amirkhan, J. H. (1990), ‘A factor analytically derived measure of coping: The Coping Strategy Indicator’, Journal of Personality and Social Psychology, Vol. 59, No. 5, pp. 1,066–1,074.
Burroughs, S. M. and Eby, L. T. (1998), ‘Psychological sense of community at work: A measurement system and explanatory framework’, Journal of Community Psychology, Vol. 26, pp. 509–532.
Keyes, C. L. M., Wissing, M., Potgieter, J. P., Temane, M., Kruger, A. and van Rooy, S. (2008), ‘Evaluation of the mental health continuum-short form (MHC-SF) in Setswana-speaking South Africans’ Clinical Psychology’, Psychotherapy, Vol. 15, No. 3, pp. 181–192.
Mael, F. and Ashforth, B. E. (1992), ‘Alumni and their alma mater: A partial test of the reformulated model of organizational identification’, Journal of Organizational Behavior, Vol. 13, No. 2, pp. 103–123.
Spreitzer, G. H. (1995), ‘Psychological empowerment in the workplace: Dimensions, measurement and validation’, Academy of Management Journal, Vol. 38, No. 5, pp. 1,442–1,465.
Theorell T. and Karasek R. (1990), Healthy work: Stress, productivity and the reconstruction of working life, Basic Books, New York.
Mario Giaccone, Ires