Organizational and individual work-related factors on longitudinal nurse employee outcomes and productivity costs

Abstract

Presenteeism is the behaviour of employees being physically present at work but with reduced performance. It impairs employee health and affects team productivity resulting in high financial costs wthat potentially exceed those of absenteeism. Nurses are more prone than other occupations in exhibiting presenteeism and is associated with adverse patient outcomes.

Hong Kong public hospitals provide 90 percent of all inpatient services, public hospital nurses work in high-intensity inpatient settings. In addition, Hong Kong is situated in the subtropical climate region, bimodal influenza winter and summer flu surge outbreaks introduces additional stress to an already saturated system, which may bring undesirable impacts on nurse employee outcomes in hospitals. Other than external environmental influence, organizational and individual factors play a role in employee work behaviour. This thesis takes a multi-level approach to address the impact of external, organizational and individual factors on nurse presenteeism and productivity.

The objectives of this study were to 1) quantify Hong Kong public hospital nurse presenteeism prevalence, related productivity costs, and association with workload (as proxied by hospital occupancy rates); 2) quantify the impact of ward- level organizational culture and leadership style on presenteeism and productivity; 3) evaluate the impact of ward-level leadership, individual work factors, workload and personal health locus of control on employee outcomes and 4) identify multi-level mediation pathways between work and individual variables on presenteeism and productivity based on the Jobs Demands-Resources model.

All full-time nurses from three Hong Kong acute care public hospitals with distinctive historical, cultural and religious context (NH1= 2145, NH2=1367 and NH3=1145) were invited to participate in this 3-wave prospective study. The collection periods corresponds to the three service utilization patterns (seasonal winter flu surge (March 2017), summer flu surge (July 2017) and normal (October 2017)). Generalized estimating equation (GEE) and hierarchical linear modelling (HLM) were used to account for the clustering dependency and hierarchical nature of data.

Higher presenteeism patterns in the sample compared to prior studies in western contexts may be attributed to cultural variation. Productivity loss costs among nurses working healthy, working sick and took sick leave were not significantly different. Total costs of nurses who took sick leave (productivity loss and sick leave costs) were highest. The impact of ward-level organizational culture on nurse presenteeism and productivity may differ by distinct hospital founder societal culture and mission.

This study also provided a temporal and multi-level perspective on the impact of ward-level leadership style and individual factors on employee outcomes. During winter flu surge, presenteeism level and work engagement was highest and nurse productivity plateaued. Whereas higher burnout was observed during less heavy workload period. Laissez-Faire passive and Confucius transformational leadership style did not directly impact presenteeism and productivity. However, the two types of leadership impacted presenteeism and productivity through the mediation of individual work resources. Work resources and health locus of control have comparable effects on improving presenteeism and productivity, which could be maneuvered by hospital management. This study provides evidence to support the formulation of future human-resources strategic measures in the future.