Psychosocial work environment in Swedish primary healthcare: a cross-sectional survey of physicians’ job satisfaction, turnover intention, social support, leadership climate and change fatigue | Human Resources for Health
Light DW. Alienation and stress among doctors: dilemmas and possible solutions. Prof Prof. 2015. https://doi.org/10.7577/pp.1333.
Google Scholar
SKR. Produktivitet effektivitet regioner 2022. Accessed 09 Sept 2023.
Socialutskottet. Inriktningen för en nära och tillgänglig vård – en primärvårdsreform. 2020/2021. Accessed 18 Sept 2023.
Anskär E, Lindberg M, Falk M, Andersson A. Time utilization and perceived psychosocial work environment among staff in Swedish primary care settings. BMC Health Serv Res. 2018;18:166. https://doi.org/10.1186/s12913-018-2948-6.
Google Scholar
Vu-Eickmann P, Li J, Müller A, Angerer P, Loerbroks A. Associations of psychosocial working conditions with health outcomes, quality of care and intentions to leave the profession: results from a cross-sectional study among physician assistants in Germany. Int Arch Occup Environ Health. 2018;91:643–54. https://doi.org/10.1007/s00420-018-1309-4.
Google Scholar
Iliffe S, Manthorpe J. Job dissatisfaction, “burnout” and alienation of labour: undercurrents in England’s NHS. J R Soc Med. 2019;112:370–7. https://doi.org/10.1177/0141076819855956.
Google Scholar
Nilsen P, Fernemark H, Seing I, Schildmeijer K, Ericsson C, Skagerström J. Working conditions in primary care: a qualitative interview study with physicians in Sweden informed by the Effort-Reward-Imbalance model. BMC Fam Pract. 2021;22:149. https://doi.org/10.1186/s12875-021-01500-1.
Google Scholar
McKinlay JB, Marceau L. New wine in an old bottle: does alienation provide an explanation of the origins of physician discontent? Int J Health Serv. 2011;41:301–35. https://doi.org/10.2190/HS.41.2.g.
Google Scholar
Lövtrup M. Läkares arbetsmiljö har blivit sämre. 2016. Accessed 15 June 2023.
Lövtrup M. Läkarna nu fler än sjuksköterskorna bland Erstas patienter. 2017. Accessed 15 June 2023.
Socialstyrelsen. Bedömning av tillgång och efterfrågan på legitimerad personal i hälso- och sjukvård samt tandvård Nationella planeringsstödet 2022 (2022–2–7759). 2022. Accessed 01 Aug 2023.
Ström M. Många allmänläkare i riskzonen för långvarig sjukskrivning. 2019. Accessed 01 Aug 2023.
Vårdanalys. Vården ur primärvårdsläkarnas perspektiv 2019. Rapport 2020–5. 2020. Accessed 17 Sept 2023.
Buchbinder SB, Wilson M, Melick CF, Powe NR. Estimates of costs of primary care physician turnover. Am J Manag Care. 1999;5:1431–8.
Google Scholar
Hann M, Reeves D, Sibbald B. Relationships between job satisfaction, intentions to leave family practice and actually leaving among family physicians in England. Eur J Public Health. 2011;21:499–503. https://doi.org/10.1093/eurpub/ckq005.
Google Scholar
Williams ES, Konrad TR, Scheckler WE, Pathman DE, Linzer M, McMurray JE, et al. Understanding physicians’ intentions to withdraw from practice: the role of job satisfaction, job stress, mental and physical health. Adv Health Care Manag. 2001;2:243–62.
Google Scholar
Buchbinder S, Melick CF. Primary care physician job satisfaction and turnover. Am J Managed Care. 2001;7:701–13.
Google Scholar
Degen C, Li J, Angerer P. Physicians’ intention to leave direct patient care: an integrative review. Hum Resour Health. 2015;13:74. https://doi.org/10.1186/s12960-015-0068-5.
Google Scholar
Croxson CH, Ashdown HF, Hobbs FR. GPs’ perceptions of workload in England: a qualitative interview study. Br J Gen Pract. 2017;67:e138–47. https://doi.org/10.3399/bjgp17x688849.
Google Scholar
Ead H. Change fatigue in health care professionals–an issue of workload or human factors engineering? J Perianesth Nurs. 2015;30:504–15. https://doi.org/10.1016/j.jopan.2014.02.007.
Google Scholar
Shanafelt TD, West CP, Sinsky C, Trockel M, Tutty M, Satele DV, et al. Changes in burnout and satisfaction with work-life integration in physicians and the general US working population between 2011 and 2017. Mayo Clin Proc. 2019;94:1681–94. https://doi.org/10.1016/j.mayocp.2018.10.023.
Google Scholar
Day A, Crown SN, Ivany M. Organisational change and employee burnout: the moderating effects of support and job control. Saf Sci. 2017;100:4–12. https://doi.org/10.1016/j.ssci.2017.03.004.
Google Scholar
De Vries MSE, De Vries MS. Repetitive reorganizations, uncertainty and change fatigue. Public Money Manag. 2023;43:126–35. https://doi.org/10.1080/09540962.2021.1905258.
Google Scholar
Rafferty AE, Jimmieson NL. Subjective perceptions of organizational change and employee resistance to change: direct and mediated relationships with employee well-being. Br J Manag. 2017;28:248–64. https://doi.org/10.1111/1467-8551.12200.
Google Scholar
Bernstrøm VH, Kjekshus LE. Effect of organisational change type and frequency on long-term sickness absence in hospitals. J Nurs Manag. 2015;23:813–22. https://doi.org/10.1111/jonm.12218.
Google Scholar
Brown R, Wey H, Foland K. The relationship among change fatigue, resilience, and job satisfaction of hospital staff nurses. J Nurs Scholarsh. 2018;50:306–13. https://doi.org/10.1111/jnu.12373.
Google Scholar
Fernemark H, Skagerström J, Seing I, Ericsson C, Nilsen P. Digital consultations in Swedish primary health care: a qualitative study of physicians’ job control, demand and support. BMC Fam Pract. 2020;21:241. https://doi.org/10.1186/s12875-020-01321-8.
Google Scholar
McKinley N, McCain RS, Convie L, Clarke M, Dempster M, Campbell WJ, et al. Resilience, burnout and coping mechanisms in UK doctors: a cross-sectional study. BMJ Open. 2020;10: e031765. https://doi.org/10.1136/bmjopen-2019-031765.
Google Scholar
Nilsen P, Seing I, Ericsson C, Birken SA, Schildmeijer K. Characteristics of successful changes in health care organizations: an interview study with physicians, registered nurses and assistant nurses. BMC Health Serv Res. 2020;20:147. https://doi.org/10.1186/s12913-020-4999-8.
Google Scholar
Sansom A, Calitri R, Carter M, Campbell J. Understanding quit decisions in primary care: a qualitative study of older GPs. BMJ Open. 2016;6: e010592. https://doi.org/10.1136/bmjopen-2015-010592.
Google Scholar
Fernemark H, Skagerström J, Seing I, Hårdstedt M, Schildmeijer K, Nilsen P. Working conditions in primary healthcare during the COVID-19 pandemic: an interview study with physicians in Sweden. BMJ Open. 2022;12: e055035. https://doi.org/10.1136/bmjopen-2021-055035.
Google Scholar
Nilsen P, Fernemark H, Seing I, Schildmeijer K, Skagerström J. Seven lessons from the coronavirus pandemic for primary health care: a qualitative study of registered and assistant nurses in Sweden. Scand J Caring Sci. 2022;36:1197–205. https://doi.org/10.1111/scs.13082.
Google Scholar
Marchand C, Peckham S. Addressing the crisis of GP recruitment and retention: a systematic review. Br J Gen Pract. 2017;67(657):e227–37. (Epub 2017 Mar 13).
Google Scholar
Bernerth JB, Walker HJ, Harris SG. Change fatigue: development and initial validation of a new measure. Work Stress. 2011;25:321–37. https://doi.org/10.1080/02678373.2011.634280.
Google Scholar
Martinussen PE, Magnussen J, Vrangbæk K, Frich JC. Should I stay or should I go? The role of leadership and organisational context for hospital physicians’ intention to leave their current job. BMC Health Serv Res. 2020;20(1):400. https://doi.org/10.1186/s12913-020-05285-4.PMID:32393343;PMCID:PMC7212554.
Google Scholar
Karasek R, Theorell T. Healthy work: stress, productivity and the reconstructions of work life. New York: Basic Books; 1990.
Chen G, Kirkman BL, Kanfer R, Allen D, Rosen B. A multilevel study of leadership, empowerment, and performance in teams. J Appl Psychol. 2007;92:331–46. https://doi.org/10.1037/0021-9010.92.2.331.
Google Scholar
Nyberg A, Bernin P, Theorell T. The impact of leadership on the health of subordinates. 2005. Accessed 18 Sept 2023.
SKR. Patientavgifter i öppen hälso-och sjukvård år 2023. 2023. Accessed 18 Sept 2023.
Socialdepartementet. Hälso-och sjukvårdslag. 2017. Accessed 18 Sept 2023.
Socialstyrelsen. About the Swedish Healthcare system. 2020. Accessed 17 Sept 2023.
SKR. Ekonomi och verksamhetsstatistik. 2021. Accessed 13 Sept 2023.
Hagqvist E, Ekberg K, Lidwall U, Nyberg A, Landstad BJ, Wilczek A, et al. The Swedish HealthPhys Study: study description and prevalence of clinical burnout and major depression among physicians. Chronic Stress. 2022;6:247054702210838. https://doi.org/10.1177/24705470221083866.
Google Scholar
SCB. Om SCB. 2023. Accessed 04 June 2023.
Mueller CW, McCloskey JC. Nurses’ job satisfaction: a proposed measure. Nurs Res. 1990; 39: 113–116. Accessed 05 May 2023.
Warr P, Cook J, Wall T. Scales for the measurement of some work attitudes and aspects of psychological well-being. J Occup Psychol. 1979;52:129–48.
Google Scholar
Mobley WH. Employee turnover, causes, consequences, and control. Reading, MA: Addison-Wesley; 1982.
Berthelsen H, Westerlund H, Søndergård Kristensen T. COPSOQ II: en uppdatering och språklig validering av den svenska versionen av en enkät för kartläggning av den psykosociala arbetsmiljön på arbetsplatser. Stockholm: Stressforskningsinstitutet; 2014.
Nyberg A, Alfredsson L, Theorell T, Westerlund H, Vahtera J, Kivimaki M. Managerial leadership and ischaemic heart disease among employees: the Swedish WOLF study. Occup Environ Med. 2009;66:51–5. https://doi.org/10.1136/oem.2008.039362.
Google Scholar
Setterlind S, Larsson G. The stress profile: a psychosocial approach to measuring stress. Stress Med. 1995;11:85–92. https://doi.org/10.1002/smi.2460110116.
Google Scholar
Camilleri J, Cope V, Murray M. Change fatigue: the frontline nursing experience of large-scale organisational change and the influence of teamwork. J Nurs Manag. 2019;27:655–60. https://doi.org/10.1111/jonm.12725.
Google Scholar
Beatty PC, Willis GB. Research synthesis: the practice of cognitive interviewing. Public Opin Q. 2007;71(2):287–311.
Google Scholar
Ware JE, Snow KK, Kosinski M, Gandek B. SF-36 health survey. Manual and interpretation guide. Boston, MA: The Health Institute, New England Medical Center; 1993.
Nationella Vårdkompetensrådet, Socialstyrelsen. Kompetensförsörjning i primärvården. 2022. Accessed 18 Sept 2023.
Cohidon C, Wild P, Senn N. Practice organization characteristics related to job satisfaction among general practitioners in 11 countries. Ann Fam Med. 2019;17:510–7. https://doi.org/10.1370/afm.2449.
Google Scholar
Owen K, Hopkins T, Shortland T, Dale J. GP retention in the UK: a worsening crisis. Findings from a cross-sectional survey. BMJ Open. 2019;9:e026048. https://doi.org/10.1136/bmjopen-2018-026048.
Google Scholar
Austin CL, Saylor R, Finley PJ. Moral distress in physicians and nurses: impact on professional quality of life and turnover. Psychol Trauma. 2017;9:399–406. https://doi.org/10.1037/tra0000201.
Google Scholar
Windover AK, Martinez K, Mercer MB, Neuendorf K, Boissy A, Rothberg MB. Correlates and outcomes of physician burnout within a large academic medical center. JAMA Internal Med. 2018;178:856. https://doi.org/10.1001/jamainternmed.2018.0019.
Google Scholar
Lambert EG, Lynne Hogan N, Barton SM. The impact of job satisfaction on turnover intent: a test of a structural measurement model using a national sample of workers. Soc Sci J. 2001;38:233–50. https://doi.org/10.1016/S0362-3319(01)00110-0.
Google Scholar
Sibbald B, Bojke C, Gravelle H. National survey of job satisfaction and retirement intentions among general practitioners in England. BMJ. 2003;326:22. https://doi.org/10.1136/bmj.326.7379.22.
Google Scholar
Försäkringskassan. Sjukfrånvaro i psykiatriska diagnoser En registerstudie av Sveriges arbetande befolkning i åldern 20–69 år. 2020. Accessed 01 June 2023.
Johansson SBS, Jacobaeus A, Burström B, Taloyan M, Andersson E. Arbetsmiljön i primärvården – intervjuer med läkare och sjuksköterskor. 2019. Accessed 28 Apr 2023.
Sinsky CA, Shanafelt TD, Dyrbye LN, Sabety AH, Carlasare LE, West CP. Health care expenditures attributable to primary care physician overall and burnout-related turnover: a cross-sectional analysis. Mayo Clin Proc. 2022;97:693–702. https://doi.org/10.1016/j.mayocp.2021.09.013.
Google Scholar
Li J, Galatsch M, Siegrist J, Müller BH, Hasselhorn HM. European NEXT Study Group Reward frustration at work and intention to leave the nursing profession—Prospective results from the European longitudinal NEXT study. Int J Nurs Stud. 2011;48:628–35. https://doi.org/10.1016/j.ijnurstu.2010.09.011.
Google Scholar
Hodkinson A et al. Associations of physician burnout with career engagement and quality of patient care: systematic review and meta-analysis. Bmj. 2022: 378.
Cox CB, Gallegos E, Pool GJ, Gilley KM, Haight N. Mapping the nomological network of change fatigue: identifying predictors, mediators and consequences. J Organ Change Manag. 2022;35:718–33. https://doi.org/10.1108/jocm-12-2021-0369.
Google Scholar
Rafferty AE, Griffin MA. Perceptions of organizational change: a stress and coping perspective. J Appl Psychol. 2006;91:1154–62. https://doi.org/10.1037/0021-9010.91.5.1154.
Google Scholar
Coetzee R, Visagie J, Ukpere W. Leading a successful change intervention in a modern organisation: Key elements to consider. Afr J Bus Manag. 2012;65:12068.
Brown R, Da Rosa P, Pravecek B, Carson P. Factors associated with changes in nurses’ emotional distress during the COVID-19 pandemic. Appl Nurs Res. 2023;69: 151659. https://doi.org/10.1016/j.apnr.2022.151659.
Google Scholar
Vårdanalys. Ordnat för omställning. 2023. Accessed 30 Augt 2023.
The National Board of Health and Welfare, Nationellt riktvärde för fast läkarkontakt i primärvården [National guideline value for fixed doctor contact in primary care] In Swedish. Art.nr: 2022–4–7896. Accessed 3 June 2024.
Van Ham I, Verhoeven AAH, Groenier KH, Groothoff JW, De Haan J. Job satisfaction among general practitioners: a systematic literature review. Eur J Gen Pract. 2006;12:174–80. https://doi.org/10.1080/13814780600994376.
Google Scholar
Orgambídez-Ramos A, de Almeida H. Work engagement, social support, and job satisfaction in Portuguese nursing staff: a winning combination. Appl Nurs Res. 2017;36:37–41. https://doi.org/10.1016/j.apnr.2017.05.012.
Google Scholar
Shanafelt TD, Gorringe G, Menaker R, Storz KA, Reeves D, Buskirk SJ, et al. Impact of organizational leadership on physician burnout and satisfaction. Mayo Clinic Proc. 2015;90:432–40. https://doi.org/10.1016/j.mayocp.2015.01.012.
Google Scholar
Eneroth M, Gustafsson Sendén M, Schenck Gustafsson K, Wall M, Fridner A. Threats or violence from patients was associated with turnover intention among foreign-born GPs–a comparison of four workplace factors associated with attitudes of wanting to quit one’s job as a GP. Scand J Primary Health Care. 2017;35:208–13. https://doi.org/10.1080/02813432.2017.1333319.
Google Scholar
SKR. God och nära vård 2021 En omställning av hälso- och sjukvården med primärvården som nav. 2021. Accessed 18 Sept 2023.
Zhou AY, et al. Factors associated with burnout and stress in trainee physicians: a systematic review and meta-analysis. JAMA Netw Open. 2020;38:e2013761–e2013761.
Google Scholar
Bowling A. Research methods in health: investigating health and health services. Maidenhead, UK: Open University Press; 2014.
Brodie DA, Williams JG, Owens RG. Research methods for the health sciences. Reading, UK: Harwood Academic; 1994.
Statistics Sweden. Minska Bortfallet [Reducing drop-outs]. In Swedish. 1997. Accessed 5 June 2023.
link
