Abstract

۱- Introduction

۲- Methods

۳- Data analysis

۴- Ethical approval

۵- Results

۶- Discussion

۷- Strengths and limitations

۸- Conclusion

References

Abstract

Background
In healthcare systems, human resources play a strategic role that has a significant impact on the whole caring process. When the wellbeing of professionals is low their performance decreases, counterproductive work behaviours may became more likely, and as a result the quality of care is compromised. Studies have shown that leadership style is particularly relevant in relation to the quality of work environments in healthcare organizations.
Objective
The main purpose of this study is to test a model that investigates the relationships between nurse managers’ leadership style and patients’ perception of the quality of the care provided by the nurses, through the mediation of the quality of the working environment (in terms of burnout, interpersonal strain and counterproductive work behaviour).
Design
A multi-centre cross-sectional study was conducted.
Setting
The study was conducted in five hospitals located two in the north, two in the centre and one in the south of Italy.

Participants

Participants were 479 registered nurses (working as staff nurses, while head nurses and nurse managers were excluded) and 829 patients aged 18 years or older, able to read and write Italian and hospitalized for at least 3 days. Severely ill or mentally disabled patients who were not able to fill in the questionnaire were excluded.
Methods
The data were collected through two different questionnaires, one for the nurses and one for the patients. A multilevel analysis was conducted to examine the hypothesized model.
Results
Results confirmed the hypothesis that, when nurses were satisfied with leadership, they felt less burned-out and strained in interpersonal relationships, they engaged less in misbehaviour, and, in turn, patients were more satisfied with the quality of the care provided by the nurses.
Conclusions
The results of this study showed that the characteristics of the organizational context, the leadership, and the behaviours of nurses, influenced patients’ perceptions of nurses’ care. Therefore, managers of healthcare services should take these results into account seriously in order to improve the quality of care provided to patients.

Introduction

To tackle rapid changes in social care and healthcare, and the growing needs of an aging population, healthcare systems need to find new ways to improve the quality of the care provided (World Health Organization, 2016). In this context, human resources play a strategic role, because they are responsible for the final result of care processes (Dubois et al., 2017), and consequently for the quality of the care provided (Donahue et al., 2008). When healthcare employees, in particular nurses, work in stressful organizations their performance quality decreases (Abualrub and Al-Zaru, 2008; Sili et al., 2010), counterproductive work behaviours increase (Fida et al., 2014) and the quality of care is negatively affected (Shen et al., 2018). In line with Karasek’s (1979) classical job demands model as well as the more recent job demand-resource model of burnout (Demerouti et al., 2001), employees who work in demanding environments, that is those that require sustained physical and/or psychological effort such as high work pressure or emotionally challenging interactions with clients or customers, are more at risk of developing chronic stress and burnout in terms of psychophysical exhaustion, lack of interest in their work and a feeling of inadequacy (Bakker and Heuven, 2006; Consiglio, 2014; Demerouti et al., 2001; Maslach et al., 2001). Burnout is an important problem for modern organizations as its prevalence is continuously growing. It is a syndrome characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment (Maslach et al., 1996). Emotional exhaustion makes the subject feel emotionally overloaded, without the strength to start over, and that they can no longer give anything to others, so they escape involvement. Depersonalization is the tendency to perform tasks mechanically, with standardized and stereotypical procedures. Reduced personal accomplishment refers to individuals feeling that they are inadequate at work, that they are failures, and becoming depressed. Workers suffering burnout present anxiety, depression, apathy, weakness and insomnia, but also deviant behaviours such as aggressiveness (Cañadas-De la Fuente et al., 2015). In particular, healthcare workers could be at risk of ‘interpersonal strain’, that is, stress due to the relationship with a patient, but also with colleagues, line managers or fellow-workers (Borgogni et al., 2005). Interpersonal strain could have negative consequences on nurses’ health and well-being (Brotheridge and Grandey, 2002; Tschan et al., 2005; Zapf and Holz, 2006), but could also cause them to modify their behaviours and performances in ways that have a direct impact on patient safety and the quality of the care provided (Zaghini et al., 2017a). A lack of attention to these phenomena on the part of the organization could have repercussions on nursing sensitive outcomes and therefore on care quality (Stalpers et al., 2015). It is therefore essential for healthcare managers to monitor working conditions, because a “healthy” organization is more effective and productive (Burke, 2016).