Work intensification and health outcomes of health sector workers
| Pages | 342-359 |
| Published date | 04 March 2019 |
| DOI | https://doi.org/10.1108/PR-10-2017-0287 |
| Date | 04 March 2019 |
| Author | James Chowhan,Margaret Denton,Catherine Brookman,Sharon Davies,Firat K. Sayin,Isik Zeytinoglu |
| Subject Matter | HR & organizational behaviour,Global HRM |
Work intensification and
health outcomes of health
sector workers
James Chowhan
School of Human Resource Management, York University, Toronto, Canada
Margaret Denton
Department of Health, Aging & Society and Gilbrea Centre, McMaster University,
Hamilton, Canada
Catherine Brookman
Catherine Brookman Consulting & Associates, Toronto, Canada
Sharon Davies
McMaster University, Hamilton, Canada
Firat K. Sayin
Sobey School of Business, Saint Mary’s University, Halifax, Canada, and
Isik Zeytinoglu
McMaster University, Hamilton, Canada
Abstract
Purpose –The purpose of this paper is to examine the mediating role of stress between work intensification
and musculoskeletal disorders (MSDs) focusing on personal support workers (PSWs) in home and
community care.
Design/methodology/approach –The analysis sample of 922 comes from the 2015 survey of PSWs
employed in Ontario, Canada. The endogenous variable is self-reported MSDs, and the exogenous variable is
work intensification. Stress, measured as symptoms of stress, is the mediating variable. Other factors shown
in the literature as associated with stress and/or MSDs are included as control variables. Structural equation
model regression analyses are presented.
Findings –The results show that stress mediates the effect of work intensification on PSW’s MSDs. Other
significant factors included being injured in the past year, facing hazards at work and preferring less
hours –all had positive and significant substantive effects on MSDs.
Research limitations/implications –The survey is cross-sectional and not longitudinal or experimental
in design, and it focuses on a single occupation in a single sector in Ontario, Canada and, as such, this can
limit the generalizability of the results to other occupations and sectors.
Practical implications –For PSW employers including their human resource managers, supervisors,
schedulers and policy-makers, the study recommends reducing work intensification to lower stress levels
and MSDs.
Originality/value –The findings of this study contribute to the theory and knowledge by providing
evidence on how work intensification can affect workers’health and assist decision makers in taking actions
to create healthy work environments.
Keywords Quantitative, Stress, Advanced statistical, Work intensification, Musculoskeletal disorders,
Personal support workers
Paper type Research paper
Introduction
In the past few decades, the home and community care sector has experienced major
restructuring in Canada and elsewhere, with profound changes in the work and work
environment (Aronson and Neysmith, 2006; Boris and Klein, 2015; Broadbent, 2014; Denton
et al., 2006; Saks,2016). In Canada, home and community care servicesare primarily delivered
by provincial, territorial and some municipal governments as well as funded through federal
Personnel Review
Vol. 48 No. 2, 2019
pp. 342-359
© Emerald PublishingLimited
0048-3486
DOI 10.1108/PR-10-2017-0287
Received 2 October 2017
Revised 16 July 2018
Accepted 23 August 2018
The current issue and full text archive of this journal is available on Emerald Insight at:
www.emeraldinsight.com/0048-3486.htm
342
PR
48,2
government tax transfers (Government of Canada, 2016). Throughout the years, demand for
home and communitycare services (e.g. the numberof patient referrals, typesof patient needs
and complexity) has continuously increased, but the budgets allocated have not increased
commensurately(Home Care Ontario, 2017).In particular, home care servicesmake up a lower
proportion of the budget than a decade ago (Home Care Ontario, 2011). As a result,
organizations providing care services have not been able to hire additional staff to
accommodate the increase in services demanded (OCSA, 2016). Consequently, the work has
intensified forworkers already employed in the system withthese workers being expected to
provide more services in less time, at the same time that tasks have increased in complexity
(Denton et al., 2006). Looking at similar work factors (such as non-standard work and job
insecurity), home and community care workers have reported substantive associations with
stress (Zeytinoglu et al., 2015). In home and community care workplaces, and generally in
healthcare sector, musculoskeletal disorders (MSDs) have been the most common
occupational illnesses reported by workers (PSHSA, 2013).
In this study, we focus on the largest healthcare occupational group in home care:
personal support workers (PSWs). There is no universally agreed occupational title for
PSWs. For example, they are called health support workers in the UK (Saks, 2016), home
healthcare aides, among other terminologies, in the USA (Boris and Klein, 2015) and home
care workers in Japan (Broadbent, 2014). In Canada, they are called personal care workers,
home support workers or healthcare aides, with PSW being the most commonly used
occupational title in Ontario, Canada (OMAESD, 2011). These workers provide care for
patients discharged from the hospital, elderly, persons with disabilities and individuals
living in the community requiring care to remain at home safely. PSWs assist persons
receiving care with activities of daily living such as personal care, homemaking and clinical
care services such as measuring a client’s blood pressure, temperature or pulse.
The purpose of the study is to examine PSWs’experience of work intensification and its
effect on the physical health outcome of MSDs. The objectives are first, to examine the direct
association between work intensification and MSDs, and second, to test the mediating role
of stress in work intensification and MSDs for PSWs in home and community care. Data
come from our 2015 survey of PSWs in Ontario, Canada.
This study contributes to the theoretical and practical knowledge in a few ways. First,
the theories of work stress, focusing on demand-control model (Karasek and Theorell, 1990)
and the effort-reward imbalance (Siegrist, 1996), show the importance of work factors on
stress and the corresponding effect of stress on many health outcomes including MSDs
(Hauke et al., 2011). Our study introduces work intensification as a risk factor in the work
environment affecting stress and MSDs, enhancing the theoretical understanding of stress
and MSDs. Second, our study contributes to emerging empirical knowledge on workers’
experience with work intensification and its effect on health outcomes (see e.g. Boxall and
Macky, 2014; Chesley, 2014; Wichert, 2002; Franke, 2015; Saloniemi et al., 2004; Zeytinoglu
et al., 2007) by focusing on an increasingly important sector of home and community care
and the largest occupational group in the sector. Third, the findings of this study can
contribute to practitioner, employer and policy-maker knowledge by providing evidence on
how work intensification can affect PSWs’health and assist in taking actions to create
healthy work environments.
Understanding the relationships among work intensification, stress and MSDs from a
healthy work environment perspective is beneficial for improving the health and work life of
PSWs. It is also important to understand the relationships from the perspective of PSW
employers including human resource managers, supervisors, schedulers and policy-makers.
Evidence on the effect of work intensification on workers’emotional and physical health can
aid in the development of practices and policies that mitigate subsequent associated health
problems and absences of PSWs, as the sector has a high absenteeism rate incurring costs
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intensification
and health
outcomes
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