Search

BACKGROUND The SARS-CoV-2 pandemic impacted access to inpatient rehabilitation services. At the current state of research, it is unclear to what extent the adaptation of rehabilitation services to infection-protective standards affected patient-centered care in Germany. OBJECTIVE The aim of this study was to determine the most relevant aspects of patient-centered care for patients in inpatient rehabilitation clinics under early phase pandemic conditions. METHODS A deductive-inductive framework analysis of online patient reports posted on a leading German hospital rating website, Klinikbewertungen (Clinic Reviews), was performed. This website is a third-party, patient-centered commercial platform that operates independently of governmental entities. Following a theoretical sampling approach, online reports of rehabilitation stays in two federal states of Germany (Brandenburg and Saarland) uploaded between March 2020 and September 2021 were included. Independent of medical specialty groups, all reports were included. Keywords addressing framework domains were analyzed descriptively. RESULTS In total, 649 online reports reflecting inpatient rehabilitation services of 31 clinics (Brandenburg, n=23; Saarland, n=8) were analyzed. Keywords addressing the care environment were most frequently reported (59.9%), followed by staff prerequisites (33.0%), patient-centered processes (4.5%), and expected outcomes (2.6%). Qualitative in-depth analysis revealed SARS-CoV-2–related reports to be associated with domains of patient-centered processes and staff prerequisites. Discontinuous communication of infection protection standards was perceived to threaten patient autonomy. This was amplified by a tangible gratification crisis of medical staff. Established and emotional supportive relationships to clinicians and peer groups offered the potential to mitigate the adverse effects of infection protection standards. CONCLUSIONS Patients predominantly reported feedback associated with the care environment. SARS-CoV-2–related reports were strongly affected by increased staff workloads as well as patient-centered processes addressing discontinuous communication and organizationally demanding implementation of infection protection standards, which were perceived to threaten patient autonomy. Peer relationships formed during inpatient rehabilitation had the potential to mitigate these mechanisms.

Up to 50% of unsuccessful implementations of organizational change are due to a lack of organizational readiness for change (ORC). This qualitative study aims to investigate the experiences of occupational physicians (OPs) and staff of test and training centers (ETTCs) with team effectiveness in the context of ORC. The change setting is the implementation of a new occupational health program in a multicentric randomized controlled trial for musculoskeletal disorders (MSD) in Germany. Two rounds of expert interviews with OPs (1st round: n = 10, 2nd round: n = 13) and one round of expert interviews with ETTCs (n = 9) were conducted and analyzed with a deductive–inductive procedure. The focus of the analysis was the assessment of change commitment and change efficacy, as well as their influence on general ORC on a collective level according to Weiner’s model (2009). Differential critical assessment of change by the care providers led to a missing collective change commitment and consequently to a missing organizational change commitment. Main inhibiting factors include lacking feedback about (e.g., recruitment) success, limited time resources of and narrow communication between responsible study staff, along with a low rate of utilization and limited adherence of the study population. Main facilitators include standardized procedures and documentation along with easy-access digital tools. Researchers may use the findings to improve the development of new intervention studies, especially in a randomized setting.

Background: Musculoskeletal and mental disorders are often comorbid, with complex correlations of pain, impairment due to pain, disability, and psychological wellbeing. This study investigates the role of psychological wellbeing in a worksite healthcare program for employees within a German randomized controlled trial. Methods: For our analyses we used data of the module for minor musculoskeletal complaints (N = 180). The intervention included a workplace-related training and case manager support. Results: Changes over time were significant in the disability score (t(179) = 9.04, p < 0.001), pain intensity (t(179) = 9.92, p < 0.001), and psychological wellbeing (t(179) = −4.65, p < 0.001). Individuals with low vs. high psychological wellbeing showed significant differences in their disability scoret0,t1 (tt0(178) = −4.230, pt0 < 0.001, tt1(178) = −2.733, pt1 < 0.001), pain intensityt0,t1 (tt0(178) = −3.127, pt0 < 0.01, tt1(178) = −3.345, pt1 < 0.01, and motivationt0 (tt0(178) = 4.223, pt0 < 0.001). The disability score∆ mediates the impact of pain intensity∆ on psychological wellbeingt1 (beta = 0.155, p < 0.05). Psychological wellbeing∆ had an impact on the disability scoret1 (beta = −0.161, p < 0.01). Conclusions: The lower the psychological wellbeing is at an intervention’s beginning, the higher the potential is for its improvement, which might affect individuals’ experienced impairment due to pain. In order to achieve the best outcomes, interventions should include both pain-related and psychological aspects. Future research needs to explore the causality of the found interrelationships further.

Background Rural and urban areas hold different health challenges and resources for resident small and medium-sized enterprises (SMEs) and their employees. Additionally, residents of urban and rural areas differ in individual characteristics. This study aims at investigating potential rural-urban differences (1) in the participation rate in workplace health promotion (WHP) and (2) in the relationship of WHP and health relevant outcomes in residents living in rural or urban German areas and working in SMEs. Methods Data of a large German Employee Survey in 2018 were used and analyzed by chi-square and t-tests and regression analyses regarding job satisfaction, sick days, and psychosomatic complaints. A total of 10,763 SME employees was included in analyses (23.9% living in rural, 76.1% living in urban areas). Results Analyses revealed higher participation rates for SME employees living in rural areas. SME employees living in urban areas reported more often the existence of WHP. Results showed (a) significance of existence of WHP for psychosomatic complaints and (b) significance of participation in WHP for job satisfaction in SME employees living in urban but not for those living in rural areas. Conclusion The revealed disparities of (1) higher participation rates in SME employees living in rural areas and in (2) the relationship of WHP aspects with health relevant outcomes are of special interest for practitioners (, e.g. human resource managers), politicians, and researchers by providing new indications for planning and evaluating WHP measures.

Musculoskeletal disorders (MSDs) are among the most common cause for reduced work capacity and sick leave. Workplace health promotion programs are often neither tailored to the workplace nor the individual needs of the employees. To counteract lacking intersectional care, this four-year randomized controlled trial (RCT) aimed to investigate the effects of modular coordinating case management (treatment group) compared to supported self-management (control group) on MSD specific sick leave days (routine data), workability (WAI), self-efficacy (self-efficacy scale), and pain (German pain questionnaire, GPQ). The study network comprised 22 companies, 15 company health insurance funds, and 12 pension funds in Germany. Overall, 852 participants (Module A/early intervention: n = 651, Module B/rehabilitation: n = 190, Module C/reintegration: n = 10) participated. Both groups achieved fewer sick leave days, higher workability, and less pain (p < 0.0001) at follow-up compared to baseline. At follow-up, the coordinating case management group showed fewer disability days (GPQ), lower disability scores (GPQ), and lower pain intensities (GPQ) than the supported self-management group (p < 0.05), but no superiority regarding MSD specific sick leave days, workability, nor self-efficacy. Module A showed more comprehensive differences. The accompanying process evaluation shows barriers and facilitators for the implementation of the program, especially in a RCT setting.

Managers play a key role in realizing a humane organization of work. Transformational leadership aims to identify and examine leadership behaviors that strengthen employees’ awareness of the importance and values of task outcomes by articulating a vision for the future, providing a realistic action plan, and giving individualized support. Previous studies have revealed associations between transformational leadership and the psychological wellbeing of employees in different settings, while others did not find such associations. As research based on longitudinal data remains rare, this study builds on longitudinal data from two employee surveys conducted in 2015 and 2018 in a medium-sized German company. In this study, transformational leadershipt0 and gender had a significant impact on transformational leadershipt1, while psychological wellbeing∆, social capital∆, and age did not. Psychological wellbeingt0 and social capital∆ had a significant impact on psychological wellbeingt1, but transformational leadership∆, age, and gender did not. Therefore, it is worthwhile for companies to invest in social capital and focus on gender aspects at work. As underlying mechanisms regarding employees’ psychological wellbeing may differ between companies, it is worthwhile for each organization to conduct mental risk assessments to identify “red flags” and implement suitable measures.

Background The provision of low-value care services in low back pain management is a problem of global scope. Inappropriate imaging, overmedication, and overused invasive therapies are prevalent in physician services. Yet, little is known about overused low-value physiotherapy services. Most studies addressing physiotherapy overuse in low back pain management arose from countries in which physiotherapy is established in primary care. However, measures and instruments addressing physiotherapy overuse limitedly fit legislative conditions of health systems in which physiotherapy is a service of secondary care. Thus, this scoping review’s purpose is to map existing research designs and instruments aiming to detect overused low-value physiotherapy services taking specific healthcare settings and aspects of medical overuse into account. Methods The development of this scoping review is guided by the Arksey and O’Malley framework. A two-step, peer-reviewed search strategy in accordance with the PRESS checklist will be conducted on MEDLINE (PubMed), Web of Science, and CINHAL. Additionally, gray literature will be searched on Google Scholar. Preprints of empirical studies will be included. Initially, two reviewers will independently screen articles for eligibility by title and abstract. A third reviewer will mediate discrepancies. Uncertainties will be eliminated by a full-text analysis or by contacting the corresponding authors. A four-step analytical process will guide result reporting focusing on major research questions outlined in this protocol. Numerical and narrative tables, graphics, and narrative summaries will be the methods to summarize and collate results. In the final step, the German health system will serve as an exemplary setting and frame to practically apply results. Discussion Results of this scoping review will help researchers to systematically select overuse measures referring to aspects of the overuse typology, specific healthcare settings, and physiotherapy services. It will further provide information on the limitations of present studies and will give advice on how to address them. Moreover, this review will illustrate to what degree existing studies succeed to comprehensively cover the concept of the overuse typology. Systematic review registration This protocol has been registered on the open science framework (https://doi.org/10.17605/OSF.IO/PMF2G).

Occupational physicians (OPs) offer a wide range of health support for employees and are confronted with varying job characteristics and demands. They monitor occupational health and safety and promote work(place)-related health measures and assessments. While helping employees to (re)gain a healthy status, their own job satisfaction as well as the investigation of their working conditions have earned limited research attention. Thus, this scoping review aims to summarize the current state of knowledge concerning OPs’ working conditions, i.e., work-related resources and stressors. PubMed, Web of Science and LIVIVO as well as grey literature were screened for relevant English or German articles until 10/2021. From a total of 1683 identified publications, we analyzed 24 full text articles that fulfilled all inclusion criteria. The overall study sample included 3486 male (54.6%), 2892 female (45.3%) and 5 diverse OPs, from which 1049 OPs worked in full-time (85.6%) and 177 in part-time (14.4%). The majority (72.4%) worked for the Occupational Health Service (OHS), 13% were self-employed, and 14.6% worked for a company/in-house service. The classification of stressors and resources was based on an inductively generated categorization scheme. We categorized 8 personal, relational and environmental resources and 10 stress factors. The main resources were support for personnel development and promotion, positive organizational policy, promoting work-life balance and other aspects of health. Key stressors were information deficits, organizational deficiency and uncertainty as well as socioeconomic influences and high professional obligations. The working conditions of OPs are still a topic with too little research attention. This scoping review reveals several starting points to maintain a healthy OP workforce and gives recommendations for action for the near future.

Up to 50% of unsuccessful implementations of organizational change are due to a lack of organizational readiness for change (ORC). This qualitative study aims to investigate the experiences of occupational physicians (OPs) and staff of test and training centers (ETTCs) with team effectiveness in the context of ORC. The change setting is the implementation of a new occupational health program in a multicentric randomized controlled trial for musculoskeletal disorders (MSD) in Germany. Two rounds of expert interviews with OPs (1st round: n = 10, 2nd round: n = 13) and one round of expert interviews with ETTCs (n = 9) were conducted and analyzed with a deductive–inductive procedure. The focus of the analysis was the assessment of change commitment and change efficacy, as well as their influence on general ORC on a collective level according to Weiner’s model (2009). Differential critical assessment of change by the care providers led to a missing collective change commitment and consequently to a missing organizational change commitment. Main inhibiting factors include lacking feedback about (e.g., recruitment) success, limited time resources of and narrow communication between responsible study staff, along with a low rate of utilization and limited adherence of the study population. Main facilitators include standardized procedures and documentation along with easy-access digital tools. Researchers may use the findings to improve the development of new intervention studies, especially in a randomized setting.

Health literacy (HL) is an interplay of individual and organizational health literacy (OHL). While individual HL has been intensively studied, the importance of OHL has become a greater focus of research attention. The National Action Plan Health Literacy in Germany emphasizes the promotion of HL in all areas of everyday life, including occupation and the workplace. The proposed scoping review aims at identifying and evaluating definitions, empirical studies and instruments on OHL targeting employee recipients. The search will be conducted in two consecutive steps and guided by expert-panel discussions in accordance to the method of Consensus Development Panels. The search will be conducted in Web of Science, PubMed and Google Scholar according to the methodological framework of Arksey and O’Malley and supplemented by the snowball principle and a hand search. All records will be included that were published until the final search date. To define eligibility criteria, the PCC framework of the Joanna Briggs Institute is used. The scoping review will critically discuss whether a new definition of OHL in the context of employee health is of purpose for future research and practice. Nonetheless, it will provide orientation in the context of employee health, also facing the consequences of SARS-CoV-2.

Occupational physicians (OPs) are key figures for advising employees and employers about prevention and health at the workplace. However, knowledge of their views on participation in health promotion measures is sparse. This qualitative study aims to explore occupational physicians&rsquo, experiences with employee participation in a randomized controlled workplace measure for musculoskeletal disorders (MSDs) in Germany. We conducted eight semi-structured telephone interviews with occupational physicians. Interviews were transcribed verbatim and analyzed using a combination of conventional and directed content analysis. Findings were mapped based on Andersen&rsquo, s behavioral model of health services use, resulting in four categories and 10 subcategories. (a) Contextual factors of the measure comprised impacts of the healthcare system and company environment, (b) individual factors of measure participation comprised demographic, social, belief, and MSD need characteristics, (c) health behavior during the measure included OPs&rsquo, communication, employees&rsquo, personal practices and measure participation, and (d) outcomes of participation included health status, satisfaction, and dissatisfaction with the measure. Findings imply occupational physicians&rsquo, and employees&rsquo, views should be investigated on a broader scale. Researchers should use present statements for the development of intervention studies, while political and managerial authorities can improve organizational conditions of prevention based on these findings.

Wahrend sich die bisherigen Ausfuhrungen auf die Methode der evidenzbasierten psychischen Gefahrdungsbeurteilungen beziehen, wird im Folgenden beispielhaft auf ein spezifisches Instrumentarium eingegangen, das die Anforderungen einer evidenzbasierten psychischen Gefahrdungsbeurteilung erfullt: das MIKE-Instrumentarium. Die Abkurzung MIKE steht fur MItarbeiterKEnnzahlen und verdeutlicht bereits, dass vor allem die Belange und die Beurteilungen der Beschaftigten im Unternehmen im Vordergrund stehen. Es sei an dieser Stelle darauf hingewiesen, dass das hier vorgestellte MIKE-Instrumentarium beispielhaft fur die evidenzbasierte psychische Gefahrdungsbeurteilung ist.

Ziel der Methode der evidenzbasierten psychischen Gefahrdungsbeurteilung ist es, die gesundheitlichen Risiken am Arbeitsplatz erstens durch eine evidenzbasierte Analyse der psychischen Gefahrdungen aufzudecken und zweitens geeignete evidenzbasierte Gegenmasnahmen einzuleiten. Ein evidenzbasiertes System beinhaltet drei Komponenten: Prinzipien der evidenzbasierten Gefahrdungsbeurteilung, ein Gefahrdungscontrolling und evidenzbasierte Instrumente und Verfahren.

Ausgangspunkt einer jeden evidenzbasierten psychischen Gefahrdungsbeurteilung ist ein theoretisches Modell, das wissenschaftlich abgesichert ist und die Ursachen psychischer Gefahrdungen erklart. Ein haufig genutztes Grundmodell ist das Anforderungs-Ressourcen-Modell. Dieses Modell hat sich in der Wissenschaft weitgehend durchgesetzt, auch weil es andere Modelle wie das Demand-Control-Modell, das Gratifikationskrisen-Modell sowie das Puffermodell der sozialen Unterstutzung zu integrieren versteht.

Due to increasing digitalisation, today&rsquo, s working world is changing rapidly and provides managers with new challenges. Digital leadership is an important factor in managing these challenges and has become a key concept in the discussion about what kinds of skills managers need for digital transformation. The main research question our study explored was if digital leadership is associated with psychological well-being in upper-level managers. Based on a qualitative pilot study and relevant literature, we developed a new scale for digital leadership in managers. We conducted an online survey with a sample of 368 upper-level managers from a large German ICT-company. Using a stepwise logistic regression analysis, potential effects of digital leadership on psychological well-being (WHO-5) were analysed. Logistic regression analyses showed that better skills in digital leadership were significantly associated with higher well-being. Results also showed that gender, age and managerial experience had no effect in our model. Our study provides a valuable insight into the association between digital leadership and well-being in managers. However, further research is necessary to validate the newly developed scale for digital leadership and to confirm a causal effect in the relationship between digital leadership and well-being.

Due to the current digital transition, companies are under pressure to pursue digitalization and often initiate far-reaching transformation processes. As a result, managers must drive change within a company and are involved in important decision-making processes. In the present study, we focused on two cognitive job demands in managers related to change due to digital transformation: perceived choice overload and pressure from digitalization. We assumed that the extent of challenging cognitive demands at work is rising and negatively influencing managers&rsquo, psychological well-being. We conducted an online survey with a sample of 368 upper-level managers from a large ICT-company, where, at the time of the study, extensive transformation processes were taking place. Using multivariate regression analysis, potential prognostic effects on well-being were tested. Results showed that lower well-being was significantly associated with higher choice overload, but not with perceived pressure from digitalization. In our explorative study, we investigated two potential job demands in managers that, to our knowledge, have not yet been scientifically tested. Given the unsettled state of the field, it is important to try to further understand when choice overload and pressure from digitalization occur and when these may trigger negative health consequences.

Background: Randomized controlled trials (RCTs) are regarded as the most internally valid means of estimating the effectiveness of complex public health interventions, but the recruitment of participants can be difficult. The aim of this study was to explore factors that may have affected the recruitment of employees with musculoskeletal disorders (MSDs) to a multicenter worksite health promotion program from the perspective of recruiting case managers. Methods: Factors in recruitment to the RCT were explored using three focus group discussions with case managers. Data were processed using MAXQDA and analyzed with a combination of content and sequence analysis. Results: Findings showed that randomization is a major challenge for recruitment. Case managers adapted their communication with, and approaches to possible participants because of the randomization design and employed coping strategies to compensate for allocation into the control arm of the study. Perceptions of the superiority of the intervention group over the control group, perceptions of the (mis)match of participants to one of the groups, as well as the understanding of the necessity of randomization for effectiveness evaluations, further affected recruitment. Perceived expectations of possible participants and their (emotional) reactions to the randomization allocation also complicated recruitment. Conclusion: We were able to gain insight into the challenges of randomization for the recruitment of participants to a multicenter RCT. This study assisted the development of strategies to overcome barriers in the ongoing implementation process of the trial (i.e., the adaption of best practice information sheets and newsletters). There remains a need to develop effective interventions to help those recruiting to trials.

ObjectivesNurses are generally found to be vulnerable to burnout, but nurses working in cancer care are even more so, since this profession is characterised by continuous confrontation with suffering and death. This study was designed to identify cut-off scores for job strain, that is, low job control and high job demands, for a sample of nurses working in breast cancer care. The main goal was to find cut-off scores, which predict the risk of nurses of developing a mental disorder from high job strain.DesignThe design was a cross-sectional survey study.SettingThe study is based on an employee survey in breast cancer centres in Germany.Participants688 nurses received a questionnaire; 329 nurses from 33 hospitals participated in the survey (return rate: 50.2%).Primary and secondary outcome measuresDependent variable: psychological well-being, measured by the WHO-5 Well-being Index; independent variables: job control and job demands, measured by the Job Content Questionnaire (JCQ).ResultsMultivariable analysis indicates that low job control and high job demands are prognostic factors for low well-being. In a receiver operating curve (ROC) analysis, the cut-off scores, which demonstrated a maximum Youden index, were 34.5 for job control and 31.4 for job demands. The combination of both scales from a logistic regression analysis resulted in an area under the curve of 0.778. Sensitivity and specificity are 70.3% and 74.2%, respectively. The total of correct classification was 63.3%.ConclusionThe determined cut-off scores indicate that there is a risk of becoming psychologically ill from a high workload when an individual reaches a score of ≤34.5 for job control and ≥31.4 for job demands. The described method of establishing risk-based cut-off scores is promising for nursing practice and for the field of occupational health. Transferability and generalisability of the cut-off scores should be further analysed.