Work stressors, strains and hospital unit performance

Hospital employees who work in an environment with zero tolerance to error, face several stressors that may result in psychological, physiological, and behavioural strains, and subsequently, in suboptimal performance. This thesis includes two studies which investigate the stressor-to-strain-to-performance relationships in hospitals. The first study is a cross-sectional, multi-group investigation based on secondary data from 65,142 respondents in 172 acute/specialist UK NHS trusts. This model proposes that senior management leadership predicts social support and job design which, in turn, moderate stressors-to-strains across team structure. The results confirm the model's robustness. Regression analysis provides support for main effects and minimal support for moderation hypotheses. Therefore, based on its conclusions and inherent limitations, study one lays the framework for study two. The second study is a cross-sectional, multilevel investigation of the strain-reducing effects of social environment on externally-rated unit-level performance based on primary data from 1,137 employees in 136 units, in a hospital in Malta. The term "social environment" refers to the prediction of the moderator variables, which is to say, social support and decision latitude/control, by transformational leadership and team climate across hospital units. This study demonstrates that transformational leadership is positively associated with social support, whereas team climate is positively associated with both moderators. At the same time, it identifies a number of moderating effects which social support and decision latitude/control, both separately and together, had on specific stressor-to-strain relationships. The results show significant mediated stressor-to-strain-to-performance relationships. Furthermore, at the higher level, unit-level performance is positively associated with shared unit-level team climate and with unit-level vision, the latter being one of the five sub-dimension of transformational leadership. At the same time, performance is also positively related to both transformational leadership and team climate when the two constructs are tested together. Few studies have linked the buffering effects of the social environment in occupational stress with performance. Therefore, this research strives to make a significant contribution to the occupational stress and performance literature with a focus on hospital practice. Indeed, the study highlights the wide-ranging and far-reaching implications that these findings provide for theory, management, and practice.

The interactive effect of workplace stressors and mood on creativity and implementation activities: a dual level approach

This thesis analyses the impact of workplace stressors and mood on innovation activities. Based on three competitive frameworks offered by cognitive spreading activation theory, mood repair perspective, and mood-as-information theory, different sets of predictions are developed. These hypotheses are tested in a field study involving 41 R&D teams and 123 individual R&D workers, and in an experimental study involving 54 teams of students. Results of the field study suggest that stressors and mood interact to predict innovation activities in such a way that with increasing stressors a high positive ( or negative) mood is more detrimental to innovation activities than a low positive (or negative) mood, lending support to the mood repair perspective. These effects are found for both individuals and teams. In the experimental study this effect is replicated and potential boundary conditions and mediators are tested. In addition, this thesis includes the development of an instrument to assess creativity and implementation activities within the realm of task-related innovative performance.

Work-related stressors and psychological strain in the sales force:the role of intrinsic and extrinsic motivation

The contemporary workplace appears rife with psychological strain, which can have considerable deleterious outcomes to the firm and the individual. However, research on strain in the sales force is underdeveloped. This paper reports the results of a study of the antecedents and consequences of psychological strain in the sales force, with particular attention to the roles of role ambiguity, emotional exhaustion, and intrinsic and extrinsic motivation. Emotional exhaustion is found to increase strain. Intrinsic motivation reduces strain under conditions of relatively high role ambiguity, but leads to more strain under conditions of low role ambiguity. Strain is found to have a J-shaped relationship with turnover intentions, and is linearly related to lower job satisfaction and lower job performance.

Workplace duties or opportunities? Challenge stressors, regulatory focus, and creativity

Previous research has produced contradictory findings about the impact of challenge stressors on individual and team creativity. Based on the challenge-hindrance stressors framework (LePine, Podsakoff, & LePine, 2005) and on regulatory focus theory (Higgins, 1997), we argue that the effect of challenge stressors on creativity is moderated by regulatory focus. We hypothesize that while promotion focus strengthens a positive relationship between challenge stressors and creativity, prevention focus reinforces a negative relationship. Experimental data showed that high demands led to better results in a creative insight task for individuals with a strong trait promotion focus, and that high demands combined with an induced promotion focus led to better results across both creative generation and insight tasks. These results were replicated in a field R&D sample. Furthermore, we found that team promotion focus moderated the effect of challenge stressors on team creativity. The results offer both theoretical insights and suggest practical implications. © 2013 Elsevier Inc.

Positive mood is not always good:the role of team mood and work stressors for creative work performance

Presentation of an abstract

The impact of stressors and regulatory focus on creativity:a dual level of analysis

Presentation

Positive mood is not always good:the role of team mood and work stressors for creative work performance

Presentation of an abstract

Attentional demand and cost responsibility as stressors in shopfloor jobs

Two studies were conducted to test for the effects of attentional demand and cost responsibility on psychological strain. One was a field experiment involving operators of computer-based manufacturing equipment, and the other was a cross-sectional investigation of employees in a wide range of jobs. The results showed increased strain only for those in jobs high on both attentional demand and cost responsibility. Implications for job design for new manufacturing technologies are discussed.

Developmental stability and leadership effectiveness

Developmental stability is the degree to which we can withstand environmental or genetic stressors during development. Fluctuating asymmetry (FA), concerns the extent to which the right and left side of the body is asymmetrical and is one way to measure developmental stability. Two studies were carried out that examined both the predictive value of leader FA with leadership behaviors and its role in facilitating group performance. The first study examined the hypothesis that a leader's FA is correlated with scores on the Multifactor Leadership Questionnaire (MLQ). The results revealed individuals with a more asymmetrical morphology scored higher on the transformational, but not transactional, dimensions of leadership behavior. A second study examined the hypothesis that asymmetrical morphology and leadership effectiveness would share a positive relationship. In this study participants who led a business game exercise, revealed a positive relationship between FA and self-reported well-being and task satisfaction. Importantly, there was also a positive correlation between the leader's FA score and group performance. The role that developmental stability may play in leadership effectiveness is discussed in the wider context of evolutionary psychology.

Teamwork and well-being:the role of social support

This thesis explores, in a team context, using the Michigan Model, the relationship between social support, stress and well-being outcomes. The studies reported were carried out in Post Office Ltd. Study one examines differences in social support source and type for employees working in teams and quasi teams. Analysis was carried out at the individual level. The results supported previous work on well-being in teams: individuals working in teams report significantly higher levels of well-being, job satisfaction and organisational commitment than those individuals in quasi teams. Members of teams reported greater satisfaction with support from their manager and colleagues, and all types of support compared to members of quasi teams. Manager support and specific types of support mediated the relationship between team working and well-being outcomes. In terms of stressors, satisfaction with manager support and emotional challenge predicted greater influence which was positively related to the well-being outcomes. Study two conducted at the team level builds on relationships established in study one. Stage one explored teamness, the extent to which, along a continuum the team was well-defined. Stage two explored teamness agreement, the extent to which the team agreed on their teamness. The extent to which the Branch Office were a well-defined team had a positive effect on team functioning; participation, innovation and commitment to task excellence. Team functioning was associated with higher levels of satisfaction with manager and team support and all types of support. Working in a well-defined team was associated with job satisfaction, mediated by positive team functioning and social support. Teamness agreement predicted team well-being, clarity of objectives, work demands and satisfaction with reality check. Working in a team was not associated with performance. This thesis advances understanding in the area of team working and processes within teams, advancing understanding of the specifics of social support from different so urces and types of support. The studies reveal the key role of team functional characteri stics in creating the vehicle through which supportive interactions take place. which contribute to positive outcomes associated with working in a well-defined team.

Are HRM practices related with patient mortality in NHS hospitals?:A study examining the underlying reasons for such an association

This thesis will report details of two studies conducted within the National Health Service in the UK that examined the association between HRM practices related to training and appraisal with health outcomes within NHS Trusts. Study one represents the organisational analysis of 61 NHS Trusts, and will report training and appraisal practices were significantly associated with lower patient mortality. Specifically, the research will show significantly lower patient mortality within NHS Trusts that: a) had achieved Investors in People accreditation; b) had a formal strategy document relating to training; c) had tailored training policy documents across occupational groups; d) had integrated training and appraisal practices; e) had a high percentage of staff receiving either an appraisal or updated personal development plan. There was also evidence of an additive effect where NHS Trusts that displayed more of these characteristics had significantly lower patient mortality. Study one in this thesis will also report significantly lower patient mortality within the NHS Trusts where there was broad level representation for the HR function. Study two will report details of a study conducted to examine the potential reasons why HR practices may be related to hospital performance. Details are given of the results of a staff attitudinal survey within five NHS Trusts. This study examined will show that a range of developmental activity, the favourability of the immediate work environment (in relation to social support and role stressors) and motivational outcomes are important antecedents to citizenship behaviours. Furthermore, the thesis will report that principles of the demand-control model were adopted to examine the relationship between workplace support and role stressors, and workplace support, influence, and an understanding of role expectation help mitigate against the negative effects of work demands upon motivational outcomes.

Self-attentional processes in anxiety:an experimental study

Self-attention research has demonstrated a relationship between dispositional self-focus, anxiety proneness and fear arousal. In addition, the effect of self-focus manipulations on approach-avoidance tasks involving a feared stimulus are strikingly similar to the effects obtained from manipulation of other cognitive factors such as perceived self-efficacy. A number of experiments were designed to explore the relationship between self-focused attention and ffilxiety. Data from the experiments demonstrate that self-attention influences a variety of cognitive variables which have been considered as central factors in anxiety. Concomitants of self-focus are increased awareness of physiological arousal and overestimation of such arousal, the identification of self-discrepancies, cognitive failures and performance deficits and the activation of physical threat concepts in memory. These factors are conceptualised as central in the negative evaluation of physiological arousal and coping resources in anxiety. Clinically anxious individuals typically have high scores in dispositional self-consciousness and body-consciousness. In patients suffering from generalised anxiety or panic disorders maladaptive self-focusing tendencies can be related to specific life stressors which render aspects of the self salient. An analysis of the ideational component of anxiety revealed three subcomponents; negative social ideation (worry about other people's reaction to the self), negative somatic ideation (worry about physical symptoms and health) and obsessional ideation (the experience of uncontrollable and repetitive thoughts) which were differentially associated with measures of dispositional self-focus. The frequency and content of an.xious w-orry is associated with specific self-focusing tendencies. It is proposed that the 'attentional style' of the individual is an important determinant of the nature and intensity of their affective response in a threatening situation. A self-attentional model of anxiety is proposed and the complex interaction between self-focus and other cognitive factors in anxiety such as appraisal of arousal and coping resources and perceived levels of self-efficacy is discussed. The model presents new directions for research and therapeutic intervention in anxiety.

On the modulation of the effects of some 5 - HT - related agents in axiety models

The results of an investigation into how stressors interact with the action of serotonergic agents in animal models of anxiety are presented. Water deprivation and restraint both increased plasma corticosterone concentrations and elevated 5-HT turnover. In the elevated X-maze, water deprivation had a duration-dependent "anxiolytic" effect. The effect of restraint was dependent on the duration of restraint and was to inhibit maze exploration. Water-deprivation did not influence the action of diazepam or any 5-HT1A ligand in the X-maze. Restraint switched the "anxiogenic" effect of 8-0H-DPAT to either "anxiolytic" or inactive, depending on the time after the restraint when testing was performed. The Vogel conflict test detected an "anxiolytic" "anxiolytic"V"anxiolytic""anxiolytic" effect of buspirone which was additive with "anxiolytic" effects of pindolol and propranolol. Diazepam and fluoxetine were also active, but 8-0H-DPAT, ipsapirone, gepirone and yohimbine were inactive. In the elevated X-maze, "anxiogenic" responses to picrotoxin, flumazenil, RU 24969, CGS 12066B, fluoxetine and 8-0H-DPAT were detected. Other 5-HT1A ligands were inactive. Diazepam and corticosterone had "anxiolytic" effects. Increasing light intensity did not change behaviour on the elevated X-maze, but was able to reverse the effect of 8- OH-DPAT to an "anxiolytic" action. This effect was attributed to a presynaptic mechanism, because it was abolished by pCPA. The occurence of different behaviours in different reglons of the maze was shown to be susceptible to modulation by "anxiolytic" and "anxiogenic" drugs. These results are discussed in the context of there being at least two separate 5-HT mechanisms which are involved in the control of anxiety.

The role of emotional labour and role stress on burnout and psychological strain in high contact service employees

This study examines the relationships between job demands (in the form of role stressors and emotional management) and employee burnout amongst high contact service employees. Employees in customer facing roles are frequently required to manage overwhelming, conflicting or ambiguous demands, which they may feel ill-equipped to handle. Simultaneously, they must manage the emotions they display towards customers, suppressing some, and expressing others, be they genuine or contrived. If the in-role effort required of employees exceeds their inherent capacity to cope, burnout may result. Burnout, in turn, can have serious detrimental consequences for the psychological well being of employees. We find that both emotional management and role stressors impact burnout. We also confirm that burnout predicts psychological strain. In line with the Job Demands and Resources Model, we examine the mitigating impact of perceived support on these relationships but do not find a significant mitigating impact.