Value-Based Healthcare From the Perspective of the Healthcare Professional: A Systematic Literature Review

Introduction: Healthcare systems increasingly move toward “value-based healthcare” (VBHC), aiming to further improve quality and performance of care as well as the sustainable use of resources. Evidence about healthcare professionals' contributions to VBHC, experienced job demands and resources as well as employee well-being in VBHC is scattered. This systematic review synthesizes this evidence by exploring how VBHC relates to the healthcare professional, and vice versa.Method: Seven databases were systematically searched for relevant studies. The search yielded 3,782 records, of which 45 were eligible for inclusion based on a two-step screening process using exclusion criteria performed by two authors independently. The quality of the included studies was appraised using the Mixed Methods Appraisal Tool (MMAT). Based on inductive thematic analysis, the Job Demands-Resources (JD-R) model was modified. Subsequently, this modified model was applied deductively for a second round of thematic analysis.Results: Ten behaviors of healthcare professionals to enhance value in care were identified. These behaviors and associated changes in professionals' work content and work environment impacted the experienced job demands and resources and, in turn, employee well-being and job strain. This review revealed 16 constructs as job demand and/or job resource. Examples of these include role strain, workload and meaning in work. Four constructs related to employee well-being, including engagement and job satisfaction, and five constructs related to job strain, including exhaustion and concerns, were identified. A distinction was made between job demands and resources that were a pure characteristic of VBHC, and job demands and resources that resulted from environmental factors such as how care organizations shaped VBHC.Conclusion and Discussion: This review shows that professionals experience substantial job demands and resources resulting from the move toward VBHC and their active role therein. Several job demands are triggered by an unsupportive organizational environment. Hence, increased organizational support may contribute to mitigating or avoiding adverse psychosocial factors and enhance positive psychosocial factors in a VBHC context. Further research to estimate the effects of VBHC on healthcare professionals is warranted.

Job Demands and Resources and Employee Well-Being in the Chinese Nonprofit Sector

Although the nonprofit sector in China has grown substantially in past decades, its future is threatened by high turnover and burnout. It is thus necessary to investigate the factors that contribute to employee well-being (EWB) among nonprofit employees in China. This study used 233 foundation employees in China to examine the effects of job demands and resources (JD-R) on EWB. Estimates produced by regression analyses indicated that job resources (JR) have a strong effect on EWB (Beta = 0.53), as well as on the three EWB subscales (workplace, psychological, and life well-being). While job demands (JD) had no effects on overall well-being, they were negatively associated with workplace well-being (WWB) (Beta = −0.12). Robustness tests were conducted to further examine how JD and JR dimensions affect EWB and its subscales. Based on the findings, we underscore the importance of JR for EWB among foundation employees in China as well as that of implementing interventions that may alleviate the cost of emotional workload as a JD.

‘Survival of the fittest’? Perceptions of wellbeing at The Bar of Northern Ireland

This article, based on a qualitative study conducted in June–July 2019, assesses how barristers at the Bar of Northern Ireland perceive wellbeing and mental ill-health within their profession. It will argue that the Bar can be a competitive and potentially hostile workplace environment, leading to detrimental impacts on wellbeing. It will also contend that being a barrister in Northern Ireland provides its own unique challenges for practitioners due to the self-employed independent nature of the role, where practitioners do not work in chambers or stables like their counterparts in England & Wales and Scotland. At the same time, barristers spoke positively about the flexibility of their roles and beneficial forms of collegiality, as well as an evolving culture which places greater emphasis on wellbeing. This article will argue, using the ‘job demands and resources’ model, that efforts should be made to decrease job demands and increase the job resources of barristers of the Bar of Northern Ireland to improve levels of wellbeing. This model could also be applied to the Bar in other jurisdictions to assess the impact of both shared and unique challenges and opportunities.

Job Demands and Resources, Burnout, and Psychological Distress of Employees in the Chinese Non-profit Sector

The non-profit sector in China has expanded significantly in the past few decades. However, employees in non-profits experience high burnout rates, indicating a need to study non-profit work conditions and their effect on employees. This study applies the job demands and resources (JD-R) model and examines the effects of job demands (JD) and job resources (JR) on burnout and psychological distress experienced by non-profit employees, recruited via quota sampling, across China (n = 233). The findings from path analysis showed that JR had strong and negative effects on burnout and on psychological distress, while JD had strong and positive effects on burnout and on psychological distress. Burnout partially mediated the relations between JD-R and psychological distress. These results highlight the importance of JD-R in reducing burnout and psychological distress in non-profit employees in China. Research and practice implications are discussed.

Job Demands and Resources, Burnout, and Psychological Distress of Social Workers in China: Moderation Effects of Gender and Age

Social work is a fast-growing profession in China, with the workforce numbering approximately 1.2 million in 2018. Studies have shown, however, that social workers in China experience high burnout rates and significant psychological distress. Analyzing data collected from 897 social workers in Chengdu, China, we applied the job demands and resources (JD-R) theory to examine the effects of JD-R on burnout and psychological distress in social workers, as well as whether these relations are moderated by gender and age. Results supported a dual process by which JD-R affected both social workers’ burnout and psychological distress through health impairment and motivation processes. Job demands (JD) were associated with high burnout and psychological distress. Meanwhile, job resources (JR) were associated with reduced burnout and psychological distress. Results indicated that JR had greater effects on burnout and distress than did JD. Women and younger professionals appeared to be affected most by JD and psychological distress. The findings support a need for interventions that buffer the effects of JD-R on burnout and psychological distress in social workers in China, focusing on women and younger professionals.

Examining the dimensionality of pre-service teachers’ enthusiasm for teaching by combining frameworks of educational science and organizational psychology

The aim of this study was to obtain a holistic understanding of pre-service teachers’ enthusiasm for teaching (a subject) by examining its structure as well as relevant factors that may be related to it in the first phase of teacher education. For this purpose, we considered two strands of research: educational science and organizational psychology. Accordingly, the professional competence model and the job demands and resources model helped to identify factors that are associated with pre-service teachers’ enthusiasm for teaching. Responses of 211 pre-service biology teachers indicated that enthusiasm for teaching can be considered as one-dimensional. Moreover, we found positive relationships between enthusiasm for teaching and academic self-concept, intrinsic career choice motives and occupational commitment. In contrast, we detected negative relations between enthusiasm for teaching and both emotional exhaustion and intention to quit. No significant relations could be found for enthusiasm for teaching and both professional knowledge and extrinsic career choice motives. Our findings highlight the importance of enthusiasm for teaching in the earliest stage of teachers’ careers. Thus, our study points out relevant factors that could help to maintain high enthusiasm and to keep (pre-service) teachers healthy and in the profession.

Job demands and resources and their relationship with satisfaction and thriving at work in a sample of Chinese doctors: a cross-sectional study

ObjectivesThe current study aimed to evaluate the status quo of perceived job demands and resources respectively among Chinese doctors, to examine the mediating role of work–family conflicts in the relationship between perceived job demands and various indicators of well-being, and to test the mediating role of psychological attachment in the relationship between perceived job resources and thriving at work among Chinese doctors.DesignA cross-sectional online survey study.SettingOnline questionnaires were administered across 30 provinces.ParticipantsA total of 2617 doctors provided sufficiently complete responses to be used in the study.ResultsPerceived job demands (M=3.843, SD=0.791) of participants were positively associated with work–family conflicts (B=0.454, p<0.001) and negatively associated with job satisfaction (B=−0.065, p<0.001) and life satisfaction (B=−0.261, p<0.001). Work–family conflicts partially mediated the relationship between job demands and life satisfaction and fully mediated the relationship between job demands and job satisfaction. Perceived job resources (M=2.474, SD=0.740) among Chinese doctors were positively associated with psychological attachment (B=0.988, p<0.001) and thriving at work (B=0.582, p<0.001). Furthermore, psychological attachment partially mediated the relationship between perceived job resources and thriving at work.ConclusionDoctors in China with high-level job demands tended to exhibit increased work–family conflicts, which in turn threatened their job and life satisfaction. On the contrary, doctors with greater job resources were more likely to thrive at work by increasing their degree of psychological attachment. The current study suggested that Chinese health policymakers and hospital administrators should provide a work environment with a dynamic equilibrium between doctors’ job demands and resources.

“We All Held Our Own”: Job Demands and Resources at Individual, Leader, Group, and Organizational Levels During COVID-19 Outbreak in Health Care. A Multi-Source Qualitative Study

Background: Interventions tackling COVID-19 impact on health care workers’ mental health would benefit from being informed by validated and integrated assessment frameworks. This study aimed to explore the fitness of integrating the Job Demands-Resources (JD-R) model and the Individual-Group-Leader-Organization (IGLO) framework to investigate the pandemic’s impact on health care workers’ mental health. Methods: Qualitative data were collected via 21 semi-structured interviews with senior and middle managers and four focus groups with employees (doctors, nurses, health care assistants) from three areas (Department of Emergency, Department of Medicine, Research Institute of Neuroscience) of a large health care institution facing the first wave of COVID-19. NVivo deductive content analysis of text data was performed. Findings: Several COVID-19-related job demands and resources were found at IGLO levels. Individual-level demands included emotional load, while resources included resilience and motivation. Group-level demands included social distancing, while resources included team support and cohesion. Leader-level demands included managers’ workload, while resources included leader support. Organizational-level demands included work reorganization, while resources included mental health initiatives. Conclusions/Application to Practice: Integrating JD-R and IGLO proved feasible, as job demands and resources could be categorized according to the individual, group, leader, and organization framework. The findings expand previous studies by filling the lack of knowledge on how job demands and resources might unfold at different workplace levels during a pandemic. Results provide unit-level evidence for designing and implementing multilevel interventions to manage health care workers’ mental health during COVID-19 and future pandemics. Our findings offer occupational health practitioners a suitable approach to perform workplace mental health assessment activities.

Leadership and Job Demands-Resources Theory: A Systematic Review

The purpose of this article is to provide a systematic review of leadership and Job Demands-Resources (JD-R) theory. We have analyzed 139 studies that study the relationship between leadership and Job Demands-Resources (JD-R) theory. Based on our analysis, we highlight ways forward. First, research designs can be improved by eliminating endogeneity problems. Regarding leadership concepts, proper measurements should be used. Furthermore, we point toward new theory building by highlighting three main ways in which leadership may affect employees, namely by: (1) directly influencing job demands and resources, (2) influencing the impact of job demands and resources on well-being; and (3) influencing job crafting and self-undermining. We hope this review helps researchers and practitioners analyze how leadership and JD-R theory can be connected, ultimately leading to improved employee well-being and organizational performance.