Why are working conditions important?

This post is an automatic translation from a text written in Slovenian. Translation is generated with use of DeepL Pro tool. Original text is postaed and available here: https://paradim.si/category/slovensko-zdravstvo-2022-23/

In my post on motivation, I already wrote about Hertzberg’s theory of motivation, which shows that working conditions are divided into hygiene factors (increasing or decreasing dissatisfaction) and motivators (increasing or decreasing satisfaction and motivation). This is already one of the important considerations when we look at the impact of working conditions. Satisfied members of an organisation produce high quality work, increase their level of innovation and creativity, while dissatisfied members reduce their input, build a negative working climate, are more absent and may even leave the organisation.

International health issues

In this paper, we will focus a little less on general theory and more on the field of healthcare. Manyisa and van Aswegen (2017) in their paper Factors affecting working conditions in public hospitals: a literature review (orig. Factors affecting working conditions in public hospitals: A literature review) examined healthcare in a broader international context. They included both developed and developing countries and identified six main (issue) themes describing working conditions in healthcare:

1. Increased or increasing workload
2. Extended or long working hours
3. Shift work (extended working hours and/or irregular working hours)
4. Inadequate (or poor) infrastructure
5. Staff shortages or understaffing
6. Budgetary constraints

The consequences of these problems include, but are not limited to: (a) increased prevalence of hypertension, cardiovascular diseases, musculoskeletal disorders, chronic inflammation, diabetes in healthcare staff, (b) reduced quality of service and dehumanisation of patients, (c) increased absenteeism (i.e. (d) burnout and depression, (e) failure to catch up with advances in medical technology, (f) increased number of injuries, (g) increased number of errors at work, including misdiagnoses and prescribing inappropriate (wrong) treatment, (h) family problems such as dysfunctional marriages and reduced time spent with children and the elderly.

This kind of data is (probably alarming to anyone who is aware of it). However, everyone interprets them a little differently. It is probably a complex and interconnected web of factors, in which improving certain elements (in our case, the most talked about at the moment is additional staff and pay rises) would also have an impact on others. The authors mention the inheritance, entrenchment or inherency of patterns (in this case, shift work), which may also be part of the problem (which the announced pay rise is unlikely to solve in our country). The following comes to mind for me … and I will allow myself one personal reflection. Not as presuming to know the solutions, but as offering my own (perhaps even purely hypothetical) thoughts.

A personal reflection: human limits and the negative cycle

In an intellectually intensive industry, i.e. an industry where a lot is known and the quality of decisions is important (i.e. it is not how many times you make a decision that matters, but how well you make a decision in a given situation), the principle that “the more you do, the more you make or create” cannot apply. We know the limits of the human brain and, according to the available data, it can function optimally for about 4 hours a day; if we are interested in satisfactory functioning, this time is a little longer. If we do not get the necessary rest and regeneration (this is where the burnout phases start), our performance drops. And if we still persist beyond the limit, our performance drops again to a lower level. And so on. So, because we do not take into account the limits of the human being, we lower the performance capacity.

This drop is not very visible. For example, we can do the same number of treatments and the outside eye observing it all will not see the difference. In the details, however, we actually (and the data show this) make several mistakes: misreading the results, misdiagnosing, misdiagnosing the treatment. That is to say, for some patients, the medical treatment they (could) have received did not make much sense, some patients had their time in health facilities increased, some patients were referred for unnecessary tests, etc. So, there is inefficient work (and spending) and inefficient use of the staff that we (still) have available.

So we know the limits of man, but we go beyond them because we are supposed to “do it any other way”. If we look at the whole picture in detail, I think we can reasonably doubt whether it is having any effect. When we cross the boundaries, mistakes start to happen and inefficiency sets in. Stress increases, burnout starts, sickness absence increases, working conditions deteriorate, staff attrition starts. Then we push the boundaries even further and the cycle accelerates. Personal distress worsens the atmosphere or climate in the ward and makes the situation even worse.

Could we set limits before this happens? Work as much as (one person) can work. Setting such limits would mean better working conditions for those involved and probably attract a few extra doctors to come. Such a work design would mean less exhaustion and less personal distress, and thus less tension (energy increases the capacity for self-control and self-regulation, while exhaustion reduces it), improved relationships and a better general climate. It is probably clear that I want to draw attention to the possibility of a reverse, positive cycle in the case of good working conditions. If the virtuous cycle does happen, we have more health personnel and increased capacity for health work.

The other reserves that need to be found, in my opinion, must not be found in overburdening the doctor, because that would trigger the start of a negative cycle. The question that is in order here is this: what tasks are doctors currently performing? And, additionally, what are they all spending their energy on? The second question also covers perceived personal pressures, which are stimulated by softer environmental factors (and may originate e.g. in disorganised communication, including e.g. a non-existent feedback channel in a job, and the solution in the establishment of a communication role). Here there is room for the following questions: can any of the identified tasks be solved or taken on by digital technology? Which of these tasks are in urgent need of a doctor and healthcare staff? What can other roles and staff from other (complementary) professional disciplines contribute to the tasks and objectives? (Facilitating or supporting roles have, of course, a long-established validity in organisational theory.)

So, can we seek solutions by making it clear as a basic premise that people have working boundaries, not crossing them, and thus initiating a virtuous cycle? (Is this, in fact, the way to reach the theoretical maximum capacity of the health system?) And that we look for other reserves in other directions, in innovation, in integration and integration of other disciplines, and so on?

Conclusion

I will conclude with a metaphor from sport – cycling. In recent years, the following of this sport (with the remarkable successes of Slovenian cyclists) has increased dramatically in our country. The most exposed in the world of cycling are the three-week races: the Tour de France, the Giro d’Italia and the Vuelta a Espana. This format of competition produces a number of stage winners, with the main prize being the overall victory in all stages.