Abstract
Interventions addressing healthcare workers' mental health should build upon an exhaustive understanding of the major causes of both work-related stress conditions (i.e., job demands) and positive mental health (i.e., job resources) in the workplace at all the levels they might unfold, namely the individual, the group, the leader, and the organization. The chapter draws upon a multilevel workplace mental health needs assessment exercise performed within three different departments of a large healthcare institution and involving both managers and employees. It aims to illustrate the job demands and resources at multiple levels in the targeted organization, differentiate among healthcare workers' mental models of their working conditions, and discuss the research and practical implications of such findings. Also, it offers practical recommendations on how to effectively conduct such activities by, on the one hand, considering both healthcare workers' mental health risk and protective factors and, on the other hand, encompassing multiple workplace levels of analysis.
TopIntroduction
In the healthcare sector, workers are at risk of suffering from poor mental health due to the characteristics of their jobs. For instance, systematic reviews and meta-analyses (e.g., Membrive-Jiménez et al., 2020) have found adverse working conditions – such as work overload, need to mediate interpersonal conflicts, time pressure, and lack of supervisor support – to contribute to the development of nursing managers’ burnout symptoms like emotional exhaustion and depersonalization. Shift work may also negatively impact mental health in healthcare, so that there might be relevant differences between daytime versus nighttime healthcare workers’ mental health (Brown et al., 2020). Conversely, favorable working conditions – such as work autonomy, opportunities for development at work, and influence over one’s work – have been found to negatively correlate with burnout in palliative care nurses (Gómez-Urquiza et al., 2020).
Drawing upon the Job Demands-Resources (JD-R) model (Bakker & Demerouti, 2017, 2018; Schaufeli, 2017), academic literature has highlighted both negative and positive aspects of working in healthcare. The JD-R model conceives the work environment as a potential source of either positive or negative mental health depending on how the work environment is designed, organized, and managed. According to this framework, the work environment can be considered as a constellation of job demands and resources, which differently influence workers’ mental health. On the one hand, job demands refer to physical, psychological, social, or organizational aspects of the job that require physical or psychological efforts from the worker. Examples may be emotional demands, team conflict, heavy workload, time pressure. As such, job demands can be understood as risk factors for healthcare workers’ mental health. Nevertheless, job demands have recently been differentiated into hindering job demands and challenging job demands (Van den Broeck et al., 2010), where the former hinder the optimal functioning of the individual and the latter stimulate work engagement and individual well-being. On the other hand, job resources correspond to physical, psychological, social, or organizational aspects of the job, that healthcare workers can use to counterbalance the costs implied by job demands in terms of physical, cognitive, and emotional energy. Examples may be personal protective equipment, safety devices, cognitive and behavioral patterns, job autonomy, skill variety, performance feedback, support from colleagues or supervisors, role clarity, job control, adequate pay, job security, career opportunities. In addition, recent studies (e.g., Chen et al., 2018) have integrated job resources with personal resources from the positive psychological tradition – such as, for instance, resilience, adaptability, flexibility, optimism, self-efficacy, hope, psychological capital. Job resources are intrinsically motivating and may help healthcare workers fulfill their basic needs, achieve work-related goals, and positively influence their personal growth and development. Although both job demands and job resources can independently impact individual well-being, job resources may buffer job demands by enabling healthcare workers to cope with job demands. In this framework, distress results from an imbalance between job demands and resources; when job demands exceed resources, poor mental health may show up. Specifically, the JD-R model postulates two distinct processes leading to workers’ mental health; through the health impairment process, high job demands are causally linked to burnout over time, while through the motivation process, high job resources result in positive outcomes.
Broetje et al. (2020) performed an integration of previous literature reviews on the topic and identified the key job demands and job resources that nursing staff perceive to be present in their work environment. Healthcare workers’ main job demands included work overload, lack of formal rewards, and work-life interference. In contrast, main job resources included supervisor support, fair and authentic management, transformational leadership, positive interpersonal relations, autonomy, and professional resources such as work equipment, access to necessary information, organization of work tasks.
Key Terms in this Chapter
Needs Assessment: Data collection process aimed to identify organizational needs in terms of work-related mental health, and to select tailored interventions addressing the satisfaction of those needs subsequently.
Mental Health: A state of well-being in which an individual realizes his/her own abilities, can cope with the everyday stresses of life, can work productively, and can contribute to his/her community. Mental health is an integral and essential component of health, which is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. Mental health is more than just the absence of mental disorders or disabilities.
Workplace Well-Being: All aspects of working life, from the quality and safety of physical environment, to how workers feel about their work, their working environment, the climate at work and work organization, which is perceived to be primarily determined by work, and that can be influenced by workplace interventions.
IGLO: Ecological model of mental health in the workplace. The model posits that sources of mental health and well-being at work exist at five different levels, namely the individual (I), the group or work team (G), the leader (L), and the organization (O).
Personal Resources: The physical or psychological aspect of an individual that can help achieve work goals, well-being, and performance.
Bottom-Up Decision-Making: A type of organizational decision-making process whereby employees are seen as key informants about working conditions as well as active actors able to change their workplace environment. As such, employees are directly involved and called to participate in, contribute to, and influence the decision-making process itself.
Top-Down Decision-Making: A type of organizational decision-making process whereby employees are seen as passive subjects of the workplace environment and, therefore, unable to change their workplace environment. As such, employees are not involved in the process and decisions are made by the managers only.
Job Demands: The physical, social, or organizational job aspects requiring sustained physical or psychological effort and costs, which have a detrimental effect on employees’ well-being and job performance.
Job Resources: The physical, psychological, social, and organizational aspects of a job that can help employees achieve work goals, which can boost employees’ well-being and job performance and buffer the detrimental effect of job demands.