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Arbetsvillkor i privat och offentlig sjukvård: Implikationer för personalens attityder och hälsa
Stockholm University, Faculty of Social Sciences, Department of Psychology.
2014 (Swedish)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Working conditions in private and public health care : Implications for personnel attitudes and health (English)
Abstract [sv]

Omvandlingen av sjukvården mot marknadisering och nya driftsformer har huvudsakligen genomförts utifrån ekonomiska och politiska föresatser om ökad effektivitet och vårdkvalitet. Goda arbetsvillkor för personalen är en viktig förutsättning för förverkligandet av dessa mål. Givet det oklara kunskapsläget kring psykologiska implikationer av omställningen i välfärdssektorns styrning var syftet med avhandlingen att studera olika aspekter av arbetsvillkor samt arbetsrelaterade attityder och hälsa i privat, bolagiserad och förvaltningsdriven sjukvård. Det gjordes genom att undersöka hur krav och resurser i arbetet förhåller sig till uppkomsten och utbredningen av utbrändhet hos sjuksköterskor, betydelsen av kontroll i och över arbetet för de anställdas arbetstrivsel samt hur motivationsbaserade kognitioner av bemyndigande hos vårdpersonal förändras vid privatisering och relaterar till attityder och hälsa. De empiriska studierna inkluderade såväl tvärsnittliga som longitudinella enkätdata från tre svenska akutsjukhus med olika driftsform. Resultaten visade högre nivåer av utbrändhet hos sjuksköterskor i privat jämfört med förvaltningsdrivet sjukhus. För arbetstrivsel fanns ingen nivåskillnad mellan de tre driftsformerna. Krav i arbetet hängde samman med högre utbrändhetsnivåer och lägre arbetstrivsel. Flera resurser var förenade med lägre grad av utbrändhet medan kontroll hängde samman med högre trivsel. Vid en förändring från bolagiserad till privat driftsform var vårdpersonalens bemyndigande relativt stabilt. Dock fanns efter privatiseringen en tendens till standardisering då graden av bemyndigande blev mer lika. Likaså skedde en statusmässig differentiering i bemyndigande mellan yrkesgrupperna genom att flera med låg status fick mindre bemyndigande. Sammantaget pekar avhandlingen på fler likheter än skillnader mellan driftsformerna vilket antyder att driftsform tycks ha mindre betydelse för såväl nivå som betydelse av arbetsvillkor för personalens attityder och hälsa.

Abstract [en]

The shift in health care towards marketization and new types of ownership has mainly been carried out for financial and political reasons aimed at increasing care efficiency and quality. Good working conditions for the personnel are essential for these goals. However, knowledge of the implications at the individual level is still limited. Considering this, the aim of this thesis was to study working conditions, work-related attitudes and health in private for-profit (PFP), private non-profit (PNP), and publicly administered (PA) hospitals in three empirical studies. This was done by investigating how demands and resources at work predict the development of burnout, how control within and over work relate to employee job satisfaction, and how perceptions of empowerment change in connection with privatization and relate to attitudes and health. The empirical studies include cross-sectional and longitudinal questionnaire data from three Swedish acute care hospitals with different ownership types. The results showed higher levels of burnout among nurses at the PFP hospital than those at the PA hospital. There was no difference in levels of job satisfaction among the ownership types. Demands were associated with higher burnout levels and lower job satisfaction. Several job resources were associated with lower burnout, while control was related to higher job satisfaction. In a change from PNP to PFP, employees’ empowerment levels remained relatively stable. However, there was a tendency towards standardization as their degrees of empowerment became more similar after privatization. Also, a status-related differentiation in empowerment occurred among the occupational groups as some with low status experienced less empowerment. Altogether, the findings show more similarities than differences among the ownership types, suggesting that ownership is of less importance for both the levels and the impact of working conditions on attitudes and health.

Place, publisher, year, edition, pages
Stockholm: Psykologiska institutionen, Stockholms universitet , 2014. , 92 p.
Keyword [en]
Marketization, health care, ownership type, privatization, work climate, work-related attitudes, health
Keyword [sv]
Marknadisering, sjukvård, driftsform, privatisering, arbetsklimat, arbetsrelaterade attityder, hälsa
National Category
Applied Psychology
Research subject
Psychology
Identifiers
URN: urn:nbn:se:su:diva-102413ISBN: 978-91-7447-884-6 (print)OAI: oai:DiVA.org:su-102413DiVA: diva2:710098
Public defence
2014-05-09, David Magnussonsalen (U31), Frescati Hagväg 8, Stockholm, 10:00 (Swedish)
Opponent
Supervisors
Note

At the time of the doctoral defence, the following paper was unpublishd and had a status as follows: Paper 2: Manuscript.

Available from: 2014-04-15 Created: 2014-04-04 Last updated: 2014-04-22Bibliographically approved
List of papers
1. Predicting nurse burnout from demands and resources in three acute care hospitals under different forms of ownership: A cross-sectional questionnaire survey.
Open this publication in new window or tab >>Predicting nurse burnout from demands and resources in three acute care hospitals under different forms of ownership: A cross-sectional questionnaire survey.
2009 (English)In: International Journal of Nursing Studies, ISSN 0020-7489, Vol. 46, no 1, 95-106 p.Article in journal (Refereed) Published
Abstract [en]

Background: Health care organizations have changed dramatically over the last decades, with hospitals undergoing restructurings and privatizations.

Objectives: The aim of this study is to enhance the understanding of the origin and prevalence of burnout in health care by investigating factors in the psychosocial work environment and comparing three Swedish emergency hospitals with different types of ownership.

Design: A cross-sectional design was used.

Participants: We selected a total sample of 1800 registered nurses from three acute care hospitals, one private for-profit, one private non-profit and one publicly administered. A total of 1102 questionnaires were included in the analyses.

Settings: The examined ownership types were a private for-profit, a private non-profit and a traditional publicly administered hospital. All were situated in the Stockholm region, Sweden.

Methods: Data were collected by questionnaires using validated instruments, in accordance with the Job Demands–Resources Model and Maslach’s Burnout Inventory. Descriptive statistics, correlation analyses, multivariate covariance analyses and multiple regression analyses were conducted.

Results: The results showed that the burnout levels were the highest at the private for-profit hospital and lowest at the publicly administered hospital. However, in contrast to expectations the demands were not higher overall at the for-profit organization or lowest at the public administration unit, and overall, resources were not better in the private for-profit or worse at the publicly administered hospital. Multiple regression analyses showed that several of the demands included were related to higher burnout levels. Job resources were linked to lower burnout levels, but not for all variables.

Conclusions: Profit orientation in health care seems to result in higher burnout levels for registered nurses compared to a publicly administered hospital. In general, demands were more predictive of burnout than resources, and there were only marginal differences in the pattern of predictors across hospitals.

Keyword
burnout, demands, resources, nurses, occupational health, ownership in health care, privatization
National Category
Psychology Applied Psychology
Identifiers
urn:nbn:se:su:diva-14938 (URN)10.1016/j.ijnurstu.2008.08.002 (DOI)000263195100012 ()18823625 (PubMedID)
Available from: 2009-01-07 Created: 2009-01-07 Last updated: 2014-04-04Bibliographically approved
2. Two aspects of control and their importance for job satisfaction: Does ownership matter?
Open this publication in new window or tab >>Two aspects of control and their importance for job satisfaction: Does ownership matter?
(English)Manuscript (preprint) (Other academic)
Abstract [en]

New ownership types have entered the health care sector that besides traditional public hospitals now includes private for-profit and private non-profit companies. The new hospital ownership types typically underscore increased cost and production efficiency, which may have implications for psychosocial work characteristics and job satisfaction among employees.

Objectives: This study set out to investigate how job demands along with control over work (COW) and control within work (CWW) relate to job satisfaction in publicly administered, private non-profit and private for-profit hospitals.

Methods: Questionnaire data came from employees at three hospitals; a publicly administered (n=774), a private non-profit (n=1481) and a private for-profit (n=694) hospital. Besides mean-level analyses, hierarchical regressions with multiple group tests were conducted.

Results: Demands in terms of workload were significantly lower at the publicly administered hospital while control in terms of CWW was significantly higher. Background factors and their associations with job satisfaction differed slightly between ownership types. Notably, attitude to privatization was not associated with job satisfaction within any ownership type. Overall, psychosocial work characteristics, including job demands and control, were significantly associated with job satisfaction while their interactions showed no consistent associations with job satisfaction. As regards the strength of the associations between background factors, psychosocial work characteristics and job satisfaction, no consistent differences emerged between ownership types.

Conclusions: The associations between psychosocial work characteristics at work and job satisfaction seem comparable across ownership types. This perhaps relates to societal demands on the structuring of costs, work and production efficiency that go beyond ownership types.

Keyword
control within, control over, attitudes, ownership, health care
National Category
Applied Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:su:diva-102370 (URN)
Available from: 2014-04-03 Created: 2014-04-03 Last updated: 2014-04-04
3. Privatizing health care in times of new public management: Investigating the role of psychological empowerment using cluster analysis
Open this publication in new window or tab >>Privatizing health care in times of new public management: Investigating the role of psychological empowerment using cluster analysis
2013 (English)In: PsyCh Journal, ISSN 2046-0252, Vol. 2, no 3, 190-208 p.Article in journal (Refereed) Published
Abstract [en]

Although privatization within health care is usually justified using arguments based on efficiency and productivity, the empirical investigations underpinning such arguments are few and ambiguous in their results. Presenting a new theoretical and analytical approach to this research field, we argue that psychological empowerment, reflecting individuals' intrinsic change motivation state, is a crucial prerequisite for the transformation of a nonprofit health care organization to a for-profit one. The general aims of this study were to explore empowerment cognitions during a privatization, to relate these to a selection of key work-related outcome variables, and to identify the effects of privatization in terms of individual level changes in empowerment after privatization. A sample of health care workers (n = 210) provided survey longitudinal data that were analyzed using cluster analysis. Eight clusters were identified at both pre- and postprivatization with each cluster mirroring specific empowerment patterns: Empowered, In Control, Quasi-Empowered, Competent/Normed, Reference, Underused, Misfit, and Powerless. The clusters discriminated on positive work attitudes, mental health complaints, and turnover intentions. The analysis also revealed the complexity of privatization in that a homogenization as well as a differentiation tendency was observed, thereby implicating both socio-structural equality and inequality effects. The results highlighted the relevance of allocating importance to health care workers' psychological empowerment during the privatization process, and of viewing such organizational transformations not as simple shifts in the state of affairs, but as nonlinear processes involving dynamic changes in individual perceptions over time.

Place, publisher, year, edition, pages
John Wiley & Sons, 2013
Keyword
cluster analysis, longitudinal design, person-oriented approach, privatization, psychological empowerment
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:su:diva-97179 (URN)10.1002/pchj.37 (DOI)
Available from: 2013-12-05 Created: 2013-12-05 Last updated: 2014-04-04Bibliographically approved

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