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Salutogenic organizations and change pp 37–54Cite as

Organizational Health Intervention Research in Medical Settings

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Abstract

Medical settings, especially hospitals, represent a challenging environment in which to conduct organizational health interventions. This is due to the fact that healthcare professionals tend to hold pathogenic rather than salutogenic views about health and well-being. Additionally, healthcare professional identity and sense of coherence is deeply embedded in role behaviors (i.e., I am a doctor) rather than organizational awareness (i.e., The purpose of the hospital is…). Worksite health promotion interventions in medical settings, despite their prominent character, have yielded mixed results regarding their effectiveness. One of the major challenges is to be both theoretically sound and, at the same time, context appropriate. The proposed chapter will; (1) conceptualize what a health medical organization (hospital) should look like, (2) review organizational health interventions in medical settings in terms of theoretical focus and practical outcomes, (3) identify the salutogenic factors that promote well-being, (4) review the cultural and contextual factors that are barriers to interventions, and (5) reflect on how health intervention researchers can address process and context (intervention) issues in medical setting. All medical settings will be reviewed, but special focus will be given to hospitals and the use of action research which has been extensively used in medical settings.

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References

  • AACCN. (2005). AACN standards for establishing and sustaining healthy work environments: A journey to excellence. American Journal of Critical Care, 14(3), 187–197.

    Google Scholar 

  • Antonovsky, A. (1979). Health, stress and coping. San Francisco: Jossey-Bass.

    Google Scholar 

  • Antonovsky, A. (1987). The salutogenic perspective: Toward a new view of health and illness. Advances, 4(1), 47–55.

    Google Scholar 

  • Antonovsky, A. (1996). The salutogenic model as a theory to guide health promotion. Health Promotion International, 11(1), 11–18. doi:10.1093/heapro/11.1.11.

    Article  Google Scholar 

  • Argyris, C. (1982). Reasoning, learning, and action: Individual and organizational. San Francisco: Jossey-Bass.

    Google Scholar 

  • Bakker, A. B., & Demerouti, E. (2007). The job demands-resources model: State of the art. Journal of Managerial Psychology, 22(3), 309–328. doi:10.1108/02683940710733115.

    Article  Google Scholar 

  • Becker, C. M., Glascoff, M. A., & Felts, W. M. (2010). Salutogenesis 30 years later: Where do we go from here? The International Electronic Journal of Health Education, 13, 25–32.

    Google Scholar 

  • Bourbonnais, R., Brisson, C., Vinet, A., Vézina, M., & Lower, A. (2006a). Development and implementation of a participative intervention to improve the psychosocial work environment and mental health in an acute care hospital. Occupational and Environmental Medicine, 63(5), 326–334. doi:10.1136/oem.2004.018069.

    Article  PubMed  Google Scholar 

  • Bourbonnais, R., Brisson, C., Vinet, A., Vézina, M., Abdous, B., & Gaudet, M. (2006b). Effectiveness of a participative intervention on psychosocial work factors to prevent mental health problems in a hospital setting. Occupational and Environmental Medicine, 63(5), 335–342. doi:10.1136/oem.2004.018077.

    Article  PubMed  Google Scholar 

  • Bronfenbrenner, U. (1979). The ecology of human development. Cambridge, MA: Harvard University Press.

    Google Scholar 

  • Bunce, D., & West, M. A. (1996). Stress management and innovation interventions at work. Human Relations, 49(2), 209–232. doi:10.1177/001872679604900205.

    Article  Google Scholar 

  • Busse, R., Grinter, T., & Svensson, P. G. (2002). Regulating entrepreneurial behaviour in hospitals: Theory and practice. In R. B. Saltman (Ed.), Regulating entrepreneurial behaviour in European health care systems (European observatory on health care systems series, pp. 126–145). Maidenhead: Open University Press.

    Google Scholar 

  • Bygren, L. O., Weissglas, G., Wikström, B. M., Konlaan, B. B., Grjibovski, A., Karlsson, A. B., Andersson, S. O., et al. (2009). Cultural participation and health: A randomized controlled trial among medical care staff. Psychosomatic Medicine, 71(4), 469–473. doi:10.1097/PSY.0b013e31819e47d4.

    Article  PubMed  Google Scholar 

  • Clark, P. R. (2009). Teamwork: Building healthier workplaces and providing safer patient care. Critical Care Nursing Quarterly, 32(3), 221–231. doi:10.1097/CNQ.0b013e3181ab923f.

    PubMed  Google Scholar 

  • Commission of the European Communities. (2008). Green paper on the European workforce for health (COM (2008) 725 final). Brussels: Commission of the European Communities. http://ec.europa.eu/health/ph_systems/docs/workforce_gp_en.pdf. Accessed 29 Nov 2012.

  • Cooper, C. L., & Cartwright, S. (1994). Healthy mind; Healthy organization – A proactive approach to occupational stress. Human Relations, 47(4), 455–471. doi:10.1177/001872679404700405.

    Article  Google Scholar 

  • Cox, T., & Leiter, M. (1992). The health of health care organizations. Work and Stress, 6(3), 219–227. doi:10.1080/02678379208259954.

    Article  Google Scholar 

  • Cuypers, K., Krokstad, S., Holmen, T. L., Knudtsen, M. S., Bygren, L. O., & Holmen, J. (2012). Patterns of receptive and creative cultural activities and their association with perceived health, anxiety, depression and satisfaction with life among adults: the HUNT study, Norway. Journal of Epidemiology and Community Health, 66, 698–703. doi:10.1136/jech.2010.113571.

    Article  PubMed  Google Scholar 

  • de Jonge, J., & Kompier, M. A. J. (1997). A critical examination of the demand-control-support model from a work psychological perspective. International Journal of Stress Management, 4(4), 235–258. doi:10.1023/B:IJSM.0000008152.85798.90.

    Article  Google Scholar 

  • Dunford, B. B., Shipp, A. J., Boss, R. W., Angermeier, I., & Boss, A. D. (2012). Is burnout static or dynamic? A career transition perspective of employee burnout trajectories. The Journal of Applied Psychology, 97(3), 637–650. doi:10.1037/a0027060.

    Article  PubMed  Google Scholar 

  • Dunn, P. M., Arnetz, B. B., Christensen, J. F., & Homer, L. (2007). Meeting the imperative to improve physician well-being: Assessment of an innovative program. Journal of General Internal Medicine, 22(11), 1544–1552. doi:10.1007/s11606-007-0363-5.

    Article  PubMed  Google Scholar 

  • East, L., & Robinson, J. (1994). Change in process: Bringing about change in health care through action research. Journal of Clinical Nursing, 3(1), 57–61.

    Article  PubMed  Google Scholar 

  • Egan, M., Bambra, C., Thomas, S., Petticrew, M., Whitehead, M., & Thomson, H. (2007). The psychosocial and health effects of workplace reorganisation. 1. A systematic review of organisational-level interventions that aim to increase employee control. Journal of Epidemiology and Community Health, 61(11), 945–954. doi:10.1136/jech.2006.054965.

    Article  PubMed  Google Scholar 

  • Firth-Cozens, J. (2001). Interventions to improve physicians’ well-being and patient care. Social Science & Medicine, 52(2), 215–222. doi:10.1016/S0277-9536(00)00221-5.

    Article  Google Scholar 

  • Forster, A. J., Clark, H. D., Menard, A., Dupuis, N., Chernish, R., Chandok, N., Khan, A., et al. (2004). Adverse events among medical patients after discharge from hospital. Canadian Medical Association Journal, 170(3), 345–349.

    PubMed  Google Scholar 

  • Gilbody, S., Cahill, J., Barkham, M., Richards, D., Bee, P., & Glanville, J. (2006). Can we improve the morale of staff working in psychiatric units? A systematic review. Journal of Mental Health, 15(1), 7–17. doi:10.1080/09638230500512482.

    Article  Google Scholar 

  • Hakanen, J. J., Perhoniemi, R., & Toppinen-Tanner, S. (2008). Positive gain spirals at work: From job resources to work engagement, personal initiative and work-unit innovativeness. Journal of Vocational Behavior, 73(1), 78–91.

    Article  Google Scholar 

  • Hampshire, A. J. (2000). What is action research and can it promote change in primary care? Journal of Evaluation in Clinical Practice, 6(4), 337–343.

    Article  PubMed  Google Scholar 

  • Harrop, E., Addis, S., Elliott, E., & Williams, G. (2007). Resilience, coping and salutogenic approaches to maintaining and generating health: A review. London: National Institute for Health and Clinical Excellence (NICE).

    Google Scholar 

  • Hart, F., & Bond, M. (1995). Action research for health and social care: A guide to practice. Buckingham: Open University Press.

    Google Scholar 

  • Hawkes, N. (2012). Almost a quarter of Royal College fellows say their hospitals cannot deliver continuity of care. BMJ (Clinical Research ed.), 345, 4942.

    Article  Google Scholar 

  • Holter, I. M., & Schwartz-Barcott, D. (1993). Action research: What is it? How has it been used and how can it be used in nursing? Journal of Advanced Nursing, 18(2), 298–304.

    Article  PubMed  Google Scholar 

  • House, R., Rousseau, D. M., & Thomas-Hunt, M. (1995). The meso paradigm: A framework for the integration of micro and macro organizational behavior. Research in Organizational Behavior, 17, 71–114.

    Google Scholar 

  • Institute of Medicine. (1999). To err is human. Building a safer health system. Washington, DC: National Academy Press.

    Google Scholar 

  • Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press.

    Google Scholar 

  • Italia, S., Favara-Scacco, C., Di Cataldo, A., & Russo, G. (2008). Evaluation and art therapy treatment of the burnout syndrome in oncology units. Psycho-Oncology, 17(7), 676–680.

    Article  PubMed  Google Scholar 

  • Jones, M. C., & Johnston, D. W. (2000). Reducing distress in first level and student nurses: A review of the applied stress management literature. Journal of Advanced Nursing, 32(1), 66–74. doi:10.1046/j.1365-2648.2000.01421.x.

    Article  PubMed  Google Scholar 

  • Karasek, R. A. (1979). Job demands, job decision latitude, and mental strain: Implications for job redesign. Administrative Science Quarterly, 24(2), 285–308. doi:10.2307/2392498.

    Article  Google Scholar 

  • Karasek, R. A. (1992). Stress prevention through work reorganisation: A summary of 19 international case studies. Conditions of Work Digest; Preventing Stress at Work, 11(2), 23–42.

    Google Scholar 

  • Kompier, M., & Kristensen, T. S. (2001). Organizational work stress interventions in a theoretical, methodological and practical context. In J. Dunham (Ed.), Stress in the workplace: Past, present and future (pp. 169–190). London/Philadelphia: Whurr Publishers.

    Google Scholar 

  • Larsson, G., & Setterlind, S. (1991). A stress reduction program led by health care personnel: Effects on health and well-being. European Journal of Public Health, 1(2), 90–93. doi:10.1093/eurpub/1.2.90.

    Article  Google Scholar 

  • Le Blanc, P. M., Hox, J. J., Schaufeli, W. B., Taris, T. W., & Peeters, M. C. W. (2007). Take care! The evaluation of a team-based burnout intervention program for oncology care providers. The Journal of Applied Psychology, 92(1), 213–227.

    Article  PubMed  Google Scholar 

  • Lewin, K. Z. (1951). Field theory in social science. New York: Harper.

    Google Scholar 

  • Liikanen, H. L. (2003). Art meets life – The arts in hospital initiative and cultural activities in the everyday life and festivities of care units in Eastern Finland. Doctoral Dissertation, University of Helsinki.

    Google Scholar 

  • McCray, L. W., Cronholm, P. F., Bogner, H. R., Gallo, J. J., & Neill, R. A. (2008). Resident physician burnout: Is there hope? Family Medicine, 40(9), 626–632.

    PubMed  Google Scholar 

  • Meyer, J. (2000). Qualitative research in health care: Using qualitative methods in health related action research. BMJ, 320, 178–181. doi:10.1136/bmj.320.7228.178.

    Article  PubMed  Google Scholar 

  • Michie, S., & Williams, S. (2003). Reducing work related psychological ill health and sickness absence: A systematic literature review. Occupational and Environmental Medicine, 60(1), 3–9. doi:10.1136/oem.60.1.3.

    Article  PubMed  Google Scholar 

  • Mikkelsen, A., & Gundersen, M. (2003). The effect of a participatory organizational intervention on work environment, job stress, and subjective health complaints. Journal of Stress Management, 10(2), 91–110.

    Article  Google Scholar 

  • Mikkelsen, A., & Saksvik, P. O. (1999). Impact of a participatory organizational intervention on job characteristics and job stress. International Journal of Health Services: Planning, Administration, Evaluation, 29(4), 871–893.

    Article  Google Scholar 

  • Mimura, C., & Griffiths, P. (2003). The effectiveness of current approaches to workplace stress management in the nursing profession: An evidence based literature review. Occupational and Environmental Medicine, 60(1), 10–15. doi:10.1136/oem.60.1.10.

    Article  PubMed  Google Scholar 

  • Mintzberg, H. (1997). Toward healthier hospitals. Health Care Management Review, 22(4), 9–18.

    Article  PubMed  Google Scholar 

  • Minvielle, E., Aegerter, P., Dervaux, B., Boumendil, A., Retbi, A., Jars-Guincestre, M. C., & Guidet, B. (2008). Assessing organizational performance in intensive care units: A French experience. Journal of Critical Care, 23(2), 236–244. doi:10.1016/j.jcrc.2007.11.006.

    Article  PubMed  Google Scholar 

  • Montgomery, A., Panagopoulou, E., Kehoe, I., & Valkanos, E. (2011). Connecting organisational culture and quality of care in the hospital: Is job burnout the missing link? Journal of Health Organization and Management, 25(1), 108–123.

    PubMed  Google Scholar 

  • Munn-Giddings, C., Hart, C., & Ramon, S. (2005). A participatory approach to the promotion of well-being in the workplace: Lessons from empirical research. International Review of Psychiatry, 17(5), 409–417. doi:10.1080/09540260500238546.

    Article  PubMed  Google Scholar 

  • Munn-Giddings, C., McVicar, A., & Smith, L. (2008). Systematic review of the uptake and design of action research in published nursing research, 2000–2005. Journal of Research in Nursing, 13(6), 465–477. doi:10.1177/1744987108090297.

    Article  Google Scholar 

  • New South Wales. Special Commission of Inquiry into Campbelltown and Camden, & Walker, B. (2004). Final report of the special commission of inquiry into Campbelltown and Camden hospitals. Sydney: NSW Government, Special Commission of Inquiry.

    Google Scholar 

  • ORCAB. (2012). Indicators to evaluate effectiveness of health care interventions. http://orcab.web.auth.gr/. Accessed 6 June 2013.

  • Osilla, K. C., Van Busum, K., Schnyer, C., Larkin, J. W., Eibner, C., & Mattke, S. (2012). Systematic review of the impact of worksite wellness programs. The American Journal of Managed Care, 18(2), 68–81.

    Google Scholar 

  • Parmelli, E., Flodgren, G., Beyer, F., Baillie, N., Schaafsma, M. E., & Eccles, M. P. (2011). The effectiveness of strategies to change organisational culture to improve healthcare performance: A systematic review. Implementation Science, 6, 33. doi:10.1186/1748-5908-6-33.

    Article  PubMed  Google Scholar 

  • Petterson, I. L., & Arnetz, B. B. (1998). Psychosocial stressors and well-being in health care workers. The impact of an intervention program. Social Science & Medicine, 47(11), 1763–1772.

    Article  Google Scholar 

  • Pisljar, T., van der Lippe, T., & den Dulk, L. (2011). Health among hospital employees in Europe: A cross-national study of the impact of work stress and work control. Social Science & Medicine, 72(6), 899–906. doi:10.1016/j.socscimed.2010.12.017.

    Article  Google Scholar 

  • Rivera-Rodriguez, A. J., & Karsh, B. T. (2010). Interruptions and distractions in healthcare: Review and reappraisal. Quality & Safety in Health Care, 19(4), 304–312. doi:10.1136/qshc.2009.033282.

    Article  Google Scholar 

  • Rolfe, G. (1996). Going to extremes: Action research, grounded practice and the theory-practice gap in nursing. Journal of Advanced Nursing, 24(6), 1315–1320.

    Article  PubMed  Google Scholar 

  • Rotondi, A. J., Angus, D. C., Sirio, C. A., & Pinsky, M. R. (2000). Assessing intensive care unit performance: A new conceptual framework. Current Opinion in Critical Care, 6(3), 155–157.

    Article  Google Scholar 

  • Seren, S., & Baykal, U. (2007). Relationships between change and organizational culture in hospitals. Journal of Nursing Scholarship, 39(2), 191–197. doi:10.1111/j.1547-5069.2007.00166.x.

    Article  PubMed  Google Scholar 

  • Sevdalis, N., Forrest, D., Undre, S., Darzi, A., & Vincent, C. A. (2008). Annoyances, disruptions, and interruptions in surgery: The disruptions in surgery index (Disi). World Journal of Surgery, 32, 1643–1650.

    Article  PubMed  Google Scholar 

  • Shaha, M., & Rabenschlag, F. (2007). Burdensome situations in everyday nursing: An explorative qualitative action research on a medical ward. Nursing Administration Quarterly, 31(2), 134–145. doi:10.1097/01.NAQ.0000264862.87335.e4.

    Article  PubMed  Google Scholar 

  • Skela Savič, B., & Pagon, M. (2008). Relationship between nurses and physicians in terms of organizational culture: Who is responsible for subordination of nurses? Croatian Medical Journal, 49(3), 334–343.

    Article  PubMed  Google Scholar 

  • Skela Savič, B., Pagon, M., & Robida, A. (2007). Predictors of the level of personal involvement in an organization: A study of Slovene hospitals. Health Care Management Review, 32(3), 271–283. doi:10.1097/01.HMR.0000281628.22526.0a.

    Article  Google Scholar 

  • Spânu, F., Băban, A., Bria, M., & Dumitrascu, D. L. (2012). What happens to health professionals when the ill patient is the health care system? Understanding the experience of practising medicine in the Romanian socio-cultural context. British Journal of Health Psychology. doi:10.1111/bjhp.12010.

    PubMed  Google Scholar 

  • Spataro, S. E. (2005). Diversity in context: How organizational culture shapes reactions to workers with disabilities and others who are demographically different. Behavioral Sciences & the Law, 23(1), 21–38. doi:10.1002/bsl.623.

    Article  Google Scholar 

  • Tanna, N. K. (2005). Action research: A valuable research technique for service delivery development. Pharmacy World & Science, 27(1), 4–6.

    Article  Google Scholar 

  • Tuisku, K., Pulkki-RåBack, L., Ahola, K., Hakanen, J., & Virtanen, M. (2012). Cultural leisure activities and well-being at work: A study among health care professionals. Journal of Applied Arts & Health, 2(3), 273–287. doi:10.1386/jaah.2.3.273_1.

    Article  Google Scholar 

  • Türköz, Y. (2004). Relationships between the participation of a private hospital’s employees in quality studies and their attitudes towards work and institution. http://www.merih.net/m1/wyturk04.htm. Accessed 5 Sept 2012.

  • Väänänen, A., Anttila, E., Turtiainen, J., & Varje, P. (2012). Formulation of work stress in 1960-2000: Analysis of scientific works from the perspective of historical sociology. Social Science & Medicine, 75(5), 784–794. doi:10.1016/j.socscimed.2012.04.014.

    Article  Google Scholar 

  • van Wyk, B. E., & Pillay-Van Wyk, V. (2010). Preventive staff-support interventions for health workers. Cochrane Database of Systematic Reviews (Online), 17(3), CD003541. doi:10.1002/14651858.CD003541.pub2.

  • Waterman, H., Webb, C., & Williams, A. (1995). Parallels and contradictions in the theory and practice of action research and nursing. Journal of Advanced Nursing, 22(4), 779–784.

    Article  PubMed  Google Scholar 

  • Waterman, H., Tillen, D., Dickson, R., & de Koning, K. (2001). Action research: A systematic review and guidance for assessment. Health Technology Assessment, 5(23), iii–157.

    PubMed  Google Scholar 

  • Weir, R., Stewart, L., Browne, G., Roberts, J., Gafni, A., Easton, S., & Seymour, L. (1997). The efficacy and effectiveness of process consultation in improving staff morale and absenteeism. Medical Care, 35(4), 334–353.

    Article  PubMed  Google Scholar 

  • Wiskow, C., Albreht, T., & de Pietro, C. (2010). How to create an attractive and supportive working environment for health professionals. World Health Organization 2010 and World Health Organization, on behalf of the European Observatory on Health Systems and Policies 2010: http://www.euro.who.int/__data/assets/pdf_file/0018/124416/e94293.pdf. Accessed 13 Sept 2012.

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Authors and Affiliations

  1. Department of Educational and Social Policy, University of Macedonia, Thessaloniki, Greece

    Anthony Montgomery, Karolina Doulougeri & Katerina Georganta

  2. Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Efharis Panagopoulou

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  1. Anthony Montgomery
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  2. Karolina Doulougeri
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  3. Katerina Georganta
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  4. Efharis Panagopoulou
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Correspondence to Anthony Montgomery .

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  1. University of Zürich, Hirschengraben 84, Zürich, 8001, Switzerland

    Georg F. Bauer

  2. University of Zürich, Hirschenbgraben 84, Zürich, 8001, Switzerland

    Gregor J. Jenny

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Montgomery, A., Doulougeri, K., Georganta, K., Panagopoulou, E. (2013). Organizational Health Intervention Research in Medical Settings. In: Bauer, G., Jenny, G. (eds) Salutogenic organizations and change. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-6470-5_3

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