Felicitas Stuber

Objectives Hospitals are psychologically demanding workplaces with a need for context-specific stress-preventive leadership interventions. A stress-preventive interprofessional leadership intervention for middle management has been developed. This phase-II study investigates its feasibility and outcomes, including work-related stress, well-being and transformational leadership. Design This is a mixed-methods study with three measure points (T0: baseline, T1: after the last training session, T2: 3-month follow-up). Additionally, focus groups were conducted to assess participants’ change in everyday work. Setting A tertiary hospital in Germany. Participants N=93 leaders of different professions. Intervention An interactive group setting intervention divided in five separate sessions ((1) self-care as a leader, (2) leadership attitudes and behaviour, (3) motives, needs and stressors of employees, (4) strengthen the resource ‘team’, (5) reflection and focus groups). The intervention was conducted between June 2018 and March 2020 in k=5 runs of the intervention. Outcome measures Feasibility and acceptance were measured with a self-developed intervention specific questionnaire. Psychological outcomes were assessed with the following scales: work-related strain with the Irritation Scale, well-being with the WHO-5 Well-being Index and transformational leadership with the Questionnaire of Integrative Leadership. Results After the intervention at T2, over 90% of participants reported that they would recommend the intervention to another coworker (92.1%, n=59) and all participants (n=64) were satisfied with the intervention and rated the intervention as practical relevant for their everyday work. Participants’ self-rated cognitive irritation was reduced, whereas their well-being and transformational leadership behaviour were improved over time. Focus group discussions revealed that participants implemented intervention contents successfully in their everyday work. Conclusions This intervention was feasible and showed first promising intraindividual changes in psychological outcomes. Participants confirmed its practical relevance. As a next step, the intervention will be evaluated as part of a multicentre—randomised controlled trial within the project SEEGEN (SEElische GEsundheit am Arbeitsplatz KrankeNhaus).

Background: Mental health and stress prevention aspects related to workplace in hospitals are gaining increasingly more attention in research. The workplace hospital is characterized by high work intensity, high emotional demands, and high levels of stress. These conditions can be a risk for the development of mental disorders. Leadership styles can hinder or foster work-related stress and influence the well-being of employees. Through leadership interventions, leaders may be encouraged to develop a stress-preventive leadership style that addresses both, the well-being of the leaders and of the subordinates. A comprehensive qualitative description of leaders’ experiences with interventions on the topic of stress-preventive leadership is yet missing in the literature. Therefore, we address leaders of middle management regarding the development of stress-preventive leadership styles through supporting interventions. The research questions are: How do leaders of middle management perceive their leadership role in terms of effectiveness in stress prevention? Which potentials and limits in the implementation of stress-preventive leadership are experienced? Methods: The study follows a qualitative research design and content analysis. We conducted individual interviews with leaders of middle management (n = 30) of a tertiary hospital in Germany for the participatory development of an intervention. This intervention, consisting of five consecutive modules, addressed leaders of middle management in all work areas within one hospital. After participation in the intervention, the leaders were asked to reflect on and evaluate the implementation of the contents learned within focus group discussions. Overall 10 focus group discussions with leaders (n = 60) were conducted. Results: The results demonstrate that leaders of middle management perceived potentials for a stress-preventive leadership style (e.g., reflection on leadership role and leadership behavior, awareness/mindfulness, and conveying appreciation). However, limits were also mentioned. These can be differentiated into self-referential, subordinate-related, and above all organizational barriers for the implementation of stress-preventive leadership. Conclusions: Some of the organizational barriers can be addressed by mid-level leadership interventions (e.g., lack of peer-exchange) or possibly by adapted leadership interventions for top management (e.g., lack of stress-preventive leadership styles in top level management). Other organizational limits are working conditions (e.g., staff shortage) that can only be influenced by health policy decisions.

Purpose: An increasing prevalence of work-related stress and employees’ mental health impairments in the health care sector calls for preventive actions. A significant factor in the workplace that is thought to influence employees’ mental health is leadership behavior. Hence, effective leadership interventions to foster employees’ (leaders’ and staff members’) mental health might be an important measure to address this pressing issue. Methods: We conducted a systematic review according to the PRISMA statement (Liberati et al. 2009) and systematically searched the following databases: PubMed (PMC), Web of Science, PsycINFO (EBSCOhost), EconLit (EBSCOhost), and Business Source Premier (EBSCOhost). In addition, we performed a hand search of the reference lists of relevant articles. We included studies investigating leadership interventions in the health care sector that aimed to maintain/foster employees’ mental health. Results: The systematic search produced 11,221 initial search hits in relevant databases. After the screening process and additional literature search, seven studies were deemed eligible according to the inclusion criteria. All studies showed at least a moderate global validity and four of the included studies showed statistically significant improvements of mental health as a result of the leadership interventions. Conclusions: Based on the findings, leadership interventions with reflective and interactive parts in group settings at several seminar days seem to be the most promising strategy to address mental health in health care employees. As the available evidence is limited, efforts to design and scientifically evaluate such interventions should be extended.

General practices are established microenterprises in Germany providing a variety of preventive and therapeutic health care services and procedures in a challenging working environment. For example, general practice teams are confronted increasingly with work-related demands, which have been associated with poor psychological and physical outcomes. It is therefore important to gain a better understanding of issues related to occupational health and safety for personnel working in the primary care setting. This study aims to gain an in-depth understanding of psychosocial demands and resources in the primary care setting. We applied an ethnographic design, comprising a combination of participating observations, individual interviews with general practitioners (GPs) (N = 6), and focus group discussion with practice assistants and administrative staff (N = 19) in five general practices in Germany. A grounded theory approach was applied to analyze all data. Our results identified psychosocial demands and resources exemplified mainly along two typical tasks in GP practices: the issuing of medical prescriptions and blood sampling. Main psychosocial demands included factors related to work content and tasks, organization of work, and the working environment. For example, daily routines across all practices were characterized by a very high work intensity including disturbances, interruptions, delegation, and the division of labor between GPs and practice staff. Work-related resources comprised the staff’s influence on aspects related to work organization and social support. The triangulation of methods and data formats allowed the disclosure of interconnectedness between these factors. Although work processes in general practices are complex and required to comply with legal regulations, there are opportunities for practice owners and practice teams to establish working procedures in ways that reduce psychosocial risks and strengthen work-related resources.

Am Arbeitsplatz Krankenhaus besteht eine besonders hohe Stressbelastung, was ein Risiko für die Entstehung psychischer Erkrankungen sein kann. Da Führungskräfte die Gesundheit der Beschäftigten beeinflussen können, kann eine Führungskräftefortbildung verhältnispräventiv wirken. Dieser Beitrag beschreibt gesundheitsförderliche Führungsstile und stellt dann exemplarisch eine entsprechende Führungskräftefortbildung aus einem Teilprojekt eines BMBF geförderten Verbundprojektes vor.

Introduction: A good relationship quality between leaders and staff members promotes mental health and prevents stress. To improve the relationship quality, it is important to identify variables which determine relationship quality at the workplace. Therefore, this study aims to identify specific leadership characteristics which support the development of a positive relationship between hospital leaders and staff members. Methods: A cross-sectional study design was applied. A total number of 1,137 leaders (n = 315) and staff members (n = 822) of different professions (physicians, nursing staff, therapeutic professionals, administration staff, IT staff, clinical services, office assistants, scientists, others) working at a tertiary hospital in Germany assessed transformational leadership style as a staff-oriented leadership style and leader–member relationship quality by self-report questionnaires [integrative leadership questionnaire (FIF), leader–member exchange (LMX-7) questionnaire]. The data were statistically analyzed by mean comparisons and a multiple linear regression analysis. Results: Leaders rated their own transformational leadership style (M = 3.98, SD = 0.43) systematically higher than staff members assessed their leader (M = 2.86, SD = 1.04). Evaluation of relationship quality showed similar results: leaders evaluated their relationship quality to one exemplary staff member higher (M = 4.06, SD = 0.41) than staff members rated their relationship quality to their direct leader (M = 3.15, SD = 0.97). From the staff members’ perspective, four sub-dimensions of transformational leadership, that is, “individuality focus,” “being a role model,” “fostering innovations,” and “providing a vision” showed large effect sizes in the regression analysis of relationship quality (R² = 0.79, F (14,690) = 189.26, p < 0.001, f = 1.94). Discussion: The results of our study are in line with previous investigations in other working contexts and point to a profession-independent association as the professional group of participants did not contribute to the variance explanation of the regression analysis. The exploration of potential determinants of relationship quality at work can, for example, support the development of leadership training programs with a focus on transformational leadership style. This might be an opportunity to foster high relationship quality between leaders and staff members and consequently might represent one strategy to prevent stress in the health care sector.

Medical students, and especially international medical students (IMS), have been shown to experience more psychological distress than the general student population in Germany. In order to address these issues, a structured Tandem Program (TP) to reduce stress and foster social integration of IMS has been introduced at the Medical Faculty of Tuebingen. The Tandem Program was evaluated prospectively with perceived stress (PSQ-20) as the main outcome. Secondary outcomes were ‘motives to participate’ in the TP, ‘specific stressors’, and ‘experiences made’ during the program. Stress levels of IMS at the beginning of the program (t₀) (M = 48.14, SD = 11.95) were higher than those of German participants (M = 39.33, SD = 8.31) (t (67) = −3.66, p < 0.001). At the end of the TP (t₁), stress levels of international students were significantly lower than at t₀. “Improved ability to work in a team” was seen as one of the most beneficial factors. The results indicate that tandem programs at medical faculties may be a promising curricular intervention towards reducing stress levels, improving integration of international students, and to enhance intercultural and team-oriented competencies in both international and national medical students.

Objectives: This study analyses the perceived relevance of stress-dimensions in work-settings from the differential views of Human Resource Managers (HRM), Occupational Physicians (OP), Primary Care Physicians (PCP) and Psychotherapists (PT) in Germany. Methods: Cross-sectional study design, using a self-report questionnaire. Descriptive measures and explorative bivariate methods were applied for group-comparisons. Results are presented as rankings of perceived importance and as polarity profiles of contrasting views. Results: N = 627 participants completed the questionnaires (HRM: n = 172; OP: n = 133; PCP: n = 136; PT: n = 186). The stress dimensions with the highest mean ratings across all four professions were: ‘social relationships in the work place’ (M = 3.55, SD = 0.62) and ‘superiors´ leadership style’ (M = 3.54, SD = 0.64). Mean ratings of perceived relevance of stress dimensions differed most between HRM and the three medical professions. Conclusions: The perceived importance of work-related stress-dimensions seems to be higher in the medical disciplines (OP, PCP, PT) than in the group from the management sector (HRM). However, no fundamental disagreement on the role of work-related stress-dimensions seems to hinder e.g., intensified efforts of cooperation across sectors in tackling the “stress-pandemic” and improving the (mental) health of employees.