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Editorial ARTICLE

Front. Psychol. | doi: 10.3389/fpsyg.2020.02236

Editorial: Healthy Healthcare: Empirical Occupational Health Research and Evidence-Based Practice Provisionally accepted The final, formatted version of the article will be published soon. Notify me

 Annet H. De Lange1, 2, 3, 4*, Lise Lovseth5, 6,  Kevin R. Teoh7 and  Marit Christensen5
  • 1Open University of the Netherlands, Netherlands
  • 2HAN University of Applied Sciences, Netherlands
  • 3Norwegian University of Science and Technology, Norway
  • 4Faculty of social sciences, University of Stavanger, Norway
  • 5NTNU Social Research, Norway
  • 6Department of Psychiatry, St. Olavs University Hospital, Norway
  • 7University of London, United Kingdom

Many countries within the European Union report significant difficulties in retaining and recruiting healthcare workers and are facing increasing levels of predicted staff shortages over the long term (European Commission, 2020). There is substantial scientific research from the past few decades that point to the importance of organizational practices and the psychosocial design of jobs for the promotion of the occupational health of healthcare workers ; such practices, along with healthy job design, can help sustain the availability and continuity of appropriate levels of quality of healthcare delivery . Despite these suggestions, recurrent data shows that occupational health-related disorders such as burnout and depression are continually increasing among healthcare workers worldwide (Greenberg, Docherty, Gnanapragasam, & Wessely, 2020;Herkes, Churruca, Ellis, Pomare, & Braithwaite, 2019;Schot, Tummers, & Noordegraaf, 2019;Teoh, Hassard, & Cox, 2020;Wang, Zhou, & Liu, 2020).The challenge, therefore, lies in translating important knowledge from occupational health psychology into healthy practices and the job designs within healthcare organizations.Contemporary occupational health psychology researchers are making strides in generating new knowledge that has the potential to improve the health and well-being of both healthcare workers and patients (Robert et al., 2011;Teoh et al., 2019). However, this knowledge typically focuses on the work-related predictors and outcomes of healthcare workers but may not reach its full potential or be perceived as relevant problems by clinicians, leaders or patients. This is because it often ignores indicators of patient care and, or, excludes the influence of organizational practices and the wider system. As a discipline, occupational health psychology can do more to recognize the complexity of organizations, synergies, processes and the relevance of context when developing knowledge related to healthcare organizations.Current developments and challenges in healthcare create the need to develop a new research agenda for occupational health psychology that emphasizes the investigation of integrative perspectives linking worker health and well-being to concepts of quality of patient care and the organization of healthcare services. The aim of this special issue, on the topic "Healthy Healthcare", was to call for new occupational health psychology to develop research approaches and transfer evidence-based knowledge and practice to the healthcare settings and its management . Approaching occupational health psychology from a Healthy Healthcare perspective is important to generate new knowledge on the necessary pathways or interventions to retain healthcare workers at work, and to maintain or positively influence the quality of healthcare service delivery.The current position paper, therefore, aims to: (i) introduce the concept of Healthy Healthcare and how it relates to occupational health psychology; (ii) summarize the accepted papers in this special issue and discuss how they relate to the concept of Healthy Healthcare; and (iii) to present a new research agenda, drawing on occupational health psychology research to further advance our understanding of the concept of Healthy Healthcare.Healthy Healthcare: A new paradigm.'Healthy Healthcare' refers to a new interdisciplinary system-based perspective of healthcare practices encompassing three main pillars: (1) quality of patient care; (2) worker health and well-being; and (3) the organization and practices of healthcare organizations. It recognizes that healthcare systems must be organized, managed and financed in balance with the health and performance of available workers . Moreover, it emphasizes the importance of a contingent perspective where one size does not fit all contexts and the heterogeneous workforce. This means that knowledge production within a Healthy Healthcare perspective should be sensitive to contextual factors and the continuous adaptation and changes in healthcare to meet societal developments. It also realizes that benefits in one pillar (e.g., patient care, health workers, organizational practice) can potentially disadvantage another pillar. Ultimately a system-based perspective considering the dynamics between the patient(s), the worker(s) and the complex healthcare system will lead to a more resourceefficient delivery of high-quality healthcare services.Within this position paper, we focus on occupational health psychology as a discipline from which research and practice are crucial to inform and advance Healthy Healthcare. The inter-disciplinary nature of Healthy Healthcare aligns well with the discipline of occupational health psychology given that the latter is also inherently multidisciplinary and draws on occupational health and psychology as well as being inclusive of public health, human factors, organizational studies, economics, industrial engineering and more (Houdmont & Leka, 2010). Crucially, the general principles of occupational health psychology (Cox et al., 2000) as being (a) an applied science, (b) evidence-driven, (c) oriented towards problem-solving, (d) multidisciplinary, (e) participatory, and (f) focused on intervention, with an emphasis on primary prevention, all resonate strongly with the concept of Healthy Healthcare.The complexity of a system-based perspective of Healthy Healthcare requires a continuously interdisciplinary focus sensitive to contextual differences in healthcare practice.It also requires a variety of methodologies to study system components, their interrelatedness, the uniqueness of those relations and their potential effects on each Healthy Healthcare pillar.To facilitate knowledge development about Healthy Healthcare from an occupational health psychology perspective, this special issue called for new empirical as well as review studies in different contexts of healthcare that helped bridge understanding across the three Healthy Healthcare pillars: (i) the organization of healthcare; (ii) workers health and well-being; and (iii) the quality of care provided.In total, six papers were accepted. The special issue includes a systematic review examining the influence of psychosocial work characteristics in explaining mental health of nursing staff (Broetje, Jenny, & Bauer, 2020 Behavior as a useful theoretical and conceptual framework to explore the attitudes, perceived organizational norms and perceived behavioral control of managers regarding the design and implementation of work design interventions in hospitals. Semi-structured interviews were carried out with 37 upper and middle managers in a German hospital and showed that although most managers were aware of the importance of health-related work design, there was a substantial variation in the perceived organizational norms related to the mental health promotion of employees. Behavioral control for supporting interventions is seen to operate more on an individual and team level, and less on the organizational level. Therefore, to enable and motivate hospital managers to support health-related work design, hospitals need to establish clear organizational norms that the health promotion of their workers is an important organizational goal. The study contributes to increased theoretical and conceptual knowledge on the design and successful implementation of work design interventions for hospital workers mental health. They also found sufficient support for differences in the proposed model relationships across age category and argue that a non-normative, tailor-made approach to ageing at work might help protect the nurses' career sustainability across the life-span. Together, these six papers offer important contributions to the relationship between each of Health Healthcare pillar (such as relations between organizational practices, job design and worker well-being) for different types of healthcare practices and contexts among a variety of healthcare workers, but also include knowledge about the interrelatedness with concepts within and between the main pillars of the current system perspective. This includes healthcare assistants, nursing workers, upper and middle managers within a hospital, different levels of seniority as well as different levels of organizational practices. Moreover, the research questions of these papers address the diverse issues related to Healthy Healthcare through different theoretical frameworks such as the JD-R Model and theory (Bakker & Demerouti, 2017), the Self-Determination Theory (Deci, Olafsen & Ryan, 2017), Ajzen's Theory of Planned Behavior (Ajzen, 1991), the Selection Optimization and Compensation Theory (Baltes & Baltes, 1990) and the Socio-emotional Selectivity Theory (Carstensen, 2019). Also, the papers contribute to Healthy Healthcare by using different methodological approaches, including qualitative and quantitative, cross-sectional and longitudinal, as well as a meta-analytical review approach. As a result, using these different methodologies the papers provide valuable new in-depth insights into the mechanisms and processes within different aspects of Healthy Healthcare, including the importance of supportive work environments as well as healthy job design to create resourceful and healthy healthcare workers. In other words, these papers individually provide us with new relevant insights, but we can further summarize the lessons learned and also discuss unresolved issues of the published papers to the Healthy Healthcare concept.Congruent with the majority of studies within occupational health psychology that focus on the healthcare sector, most articles in this special issue focus on only two out of the three pillars in the system perspective of Healthy Healthcare. That is the relationship between the organization of healthcare and workers efficiency and health or well-being. The effect on patient outcomes such as indicators of patient safety, satisfaction or other relevant patientbased outcomes is less frequent investigated. Also, existing research efforts would benefit from a stronger emphasis on positive outcomes like work engagement or meaning of work, or the simultaneous interplay between positive and negative factors and outcomes in the different pillars of Healthy Healthcare, than the current main focus of existing research on negative concepts of work demands and unhealthy consequences for the workforce. Similarly, there is a need for more team-based or organizational level outcomes and not only on the individual-level data outcomes that dominate the research to date.Even more scarce are studies that examine the relationship between all three Healthy Healthcare pillars that are facilitated by an interdisciplinary focus between occupational health psychology and for instance health economics, technology or medicine. These are all contributing factors that hinder the uptake and implementation of knowledge gained from occupational health psychology into healthcare practices by administrators and policymakers.As these stakeholders are typically tasked with the delivery of resource-efficient and quality of healthcare delivery, concepts related to technology in healthcare (Iyer, Stein, & Franklin, 2020), capacity planning (Gheasi & De Lange, 2020), and clinical and economical concepts (Gheasi & De Lange, 2020) are particularly salient to them. All these alternative perspective and research approaches will help facilitate the uptake of evidence-based knowledge and practices from occupational health psychology into Healthy Healthcare practices that are fundamentally important for the development of a resource-efficient delivery of high-quality healthcare services by a competent, motivated and healthy workforce.One of the most important conclusions of the current issue is that the included studies recognize the importance of sharing insights related to creating a Healthy Healthcare concept.They identify and provide knowledge on concepts within each pillar and their interrelatedness with concepts within and between the main pillars of the current system perspective.Based on the system-based perspective of Healthy Healthcare we present an updated integrative research model that can be used in future research of occupational health psychology (Figure 2). The model includes the current investigated pathways among occupational health psychology-related concepts and their outcomes at a micro, meso and macro level. The model demonstrates the contextual sensitivity of this system-perspective at the individual level as well as within a wider societal, national, governmental and macro context that influences all factors and relationships within the model (Gheasi & De Lange, 2020;. <Figure 2 here> Based on the important contributions from the studies in this special issue, the Healthy Healthcare system perspective and the model (Figure 2) we recommend that future research initiatives in occupational health psychology should consider:Healthy Healthcare. Although the included topics in the current issue investigated one or two relevant pillars of Healthy Healthcare (e.g., mostly healthcare worker and organization), the full concept of Healthy Healthcare remains theoretically as well as empirically untested and further theoretical and empirical research is needed to develop and examine the core concepts postulated by it. Emphasis needs to be placed on linking different antecedents of its three core pillars, including the mechanisms that explain these relationships to possible outcomes among patients, healthcare workers and organizations. These will contribute to the development and refining the overarching theoretical model presented in Figure 2 above.Occupational health researchers typically neglect the fact that relationships are situated within a wider context, with important factors at the organisational, sectoral, societal and national level all influencing the three Healthy Healthcare pillars . Also, factors at the individual level can influence macro-level outcomes (e.g., mortality and infection rates, patient satisfaction). The proliferation of more advanced multilevel analysis techniques and the collection of data across different levels and sources provide opportunities for researchers to capture the complexity of this system perspective within their study designs . The input of large-scale datasets on a regional as well as a national level on healthcare data also offers new research directions. Besides, studies of diversity in terms of age (Van der Heijden et al., 2020;De Lange et al., 2020), gender, ethnicity, and immigrants (Mackert et al., 2011) and studies of healthcare workers in developing and third-world countries (McCoy et al., 2008) are also less common. This is concerning as unpaid workers are a large part of healthcare service delivery worldwide (Taylor, 2004) and an ageing workforce implies demographic changes that affect healthcare practice substantially. Equally, ethnic minorities are more likely to experience poorer working conditions (Kinman, Teoh & Harris, 2020) and that the gendered nature of healthcare work has implications for work-life boundaries among healthcare workers (Halford, Kukarenko, Lotherington, & Obstfelder, 2015). A more inclusive and sustainable view of the workforce is needed to more accurately, and fairly, represent those working in the healthcare sector.4 Situating leadership within Healthy Healthcare. The importance of leadership in creating healthy workplaces was highlighted in earlier research (Furunes, 2018(Furunes, , 2020, but a concept like health-promoting leadership has not yet been well established in occupational health research and models and therefore warrants further exploration and new research. With critical questions being posed on the how we can better understand the influence leadership has on the three Healthy Healthcare pillarsworkers well-being (Nielsen & Taris, 2019), patient safety and care (Sfantau et al., 2017), and organisational systems and strategy (Bonardi et al., 2018) -developments here will have direct relevance for Healthy Healthcare, particularly where research looks at more than one pillar.5 Positive well-being. The more detailed and holistic examination of what well-being is in the field of occupational health psychology has not yet caught on within much of the research involving the health services (Bakker et al., 2008;Scheepers et al., 2015).Here, the emphasis still is on ill-health and, in particular, burnout. However, well-being exists as a much broader construct , and the narrative within the related-healthcare research needs to shift to include more positive manifestations of well-being, including prevalence, their processes and nomological networks, and interventions. Crucially, this encompasses patient care as well, with quality of care not merely being about the absence of disease or infirmity, but facilitating conditions that allow patients and society to thrive and flourish as well.6 Primary-interventions. Within occupational health psychology, there has recently been a focus on the need for identifying resources at multiple levels and called for interventions to strengthen resources at four levels within the organization: the Individual, the Group, the Leader and the Organisational level (IGLO model) to develop interventions to ensure employee health and well-being (Day & Nielsen, 2017;. The systems perspective embraced by Healthy Healthcare necessitates organisational-level participatory interventions. Much of the intervention research within healthcare has typically been at the individual level in the form of well-being (Regehr et al., 2014) or skills and competency-based training (Ginsburg et al., 2005). Where organisational-level interventions are carried out (Dixon-Wood et al., 2013;Weigl et al., 2013), these focus only on two of the three Healthy Healthcare pillars. It is here that occupational health psychology, which has seen exponential growth in our understanding of primary and organisational type interventions, could contribute. Principles such as risk assessments, participation, manager support and a continuous learning cycle are essential in this process, and more research is needed to support primary and multilevel interventions that seek to change the larger healthcare system (Nielsen & Noblet, 2018). In the present position paper, we argued that a system-based perspective is needed to address the challenges faced in healthcare and to increase the uptake of knowledge from occupational health psychology into healthcare. The Healthy Healthcare perspective provides a framework to do so by advocating examination and linking of the three pillars of organisational practices, workers' health and well-being and quality of patient care. Here, occupational health psychology is not only well placed to embrace Healthy Healthcare, but equally offers considerable expertise and insights to advance the concept further. While the papers in this Special Issue shed important light in our understanding and concepts of occupational health psychology to Healthy Healthcare, we outline seven points within a new future research agenda, namely: (i) develop an overarching theory and concepts of Healthy Healthcare (see the suggested framework in Figure 2); (ii) embrace more multi-level study designs; (iii) capture the diversity of the healthcare workforce; (iv) situate leadership within Healthy Healthcare; (v) expand our focus of well-being to include more positive manifestations; (vi) focus on primary and organisational-level interventions; and (vii) to embrace different research methodologies and paradigms.

Keywords: healthy healthcare, Worker health, Patient outcomes, Research agenda, Organisational practice

Received: 10 Jul 2020; Accepted: 10 Aug 2020.

Copyright: © 2020 De Lange, Lovseth, Teoh and Christensen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Mx. Annet H. De Lange, Open University of the Netherlands, Heerlen, Netherlands,