Health among hospital employees in Europe: A cross-national study of the impact of work stress and work control

Abstract

This article analyses the effect of working conditions on the health of hospital employees across Europe. Hospital employees often have demanding jobs that increase their stress levels and, consequently, their risk of health problems. Work control – typified by employee autonomy and working time flexibility – helps them cope with high levels of work stress. Researchers have traditionally studied the relationship between working conditions, coping strategies and occupational health from an individual perspective. We argue that the individual work–health relationship is closely connected with the social and institutional context. This study explores how work stress and work control influence the health of hospital employees and aims to understand cross-country differences in this respect. Using data on over 1500 hospital employees who participated in the study ‘Quality of work and life in a changing Europe’ (2007) in eight European countries, we used ordinal regression analyses to test a range of hypotheses. The results show that work stress has a negative effect on the health of hospital employees, while work control is not found to have any effect on their health. Comparative analyses reveal that the effects of working conditions on health vary across European countries. While working overtime is more closely related to poorer health in Eastern European countries, we found evidence of a positive relationship between job autonomy and health in Western Europe only, indicating that circumstances in the working environment have differing effects on employee health in Eastern and Western Europe.

Introduction

Work can impact health in numerous ways; in turn, a person’s state of health can impact on how work is carried out. Previous research shows that this effect becomes even more pronounced in difficult circumstances (e.g. International Labour Organization, 1998, Parent-Thirion et al., 2007). This paper demonstrates the importance of working conditions for the health of employees working in public hospitals in Europe. According to the recent research conducted across the European Union, 40 percent of employees in the healthcare sector report constant health problems (Parent-Thirion et al., 2007). Previous studies have indicated various reasons for poorer health outcomes among healthcare workers. The nature of healthcare work makes jobs in this sector inherently demanding: it requires contact with distressed and ill people, constant learning, and precision in meeting quality standards (Parent-Thirion et al., 2007). In addition, healthcare professionals are often required to work unsocial hours and overtime (Lee, McCann, & Messenger, 2007). Employees face heavier workloads, more tasks and longer hours (Gundersen, 2001, Lapido and Wilkinson, 2002). All these potentially harmful circumstances may contribute to higher levels of work stress, which has been found to be related to various health problems (e.g. Ala-Mursula et al., 2002, Bakker et al., 2003, De Jonge et al., 2000).

The literature has investigated tools to alleviate health problems related to work stress, thereby preventing the negative influence of work stress on health (e.g. EU Commission, 2002, pp. 9–11). Among these, work control is found to reduce stress and enhance overall well-being (Sparks, Faragher, & Cooper, 2001). The work control concept refers to job autonomy, with employees having more flexibility in their work (Green, 2006, Parent-Thirion et al., 2007). In this paper we argue that job autonomy, while necessary, is not the only requirement for work control. Research shows that time autonomy is equally important (Ala-Mursula, 2006). Employees who feel able to choose how and when to perform their work, as opposed to being instructed, are intrinsically motivated and accept more personal responsibility for their work (Hackman and Oldman, 1975, van der Lippe, 2007). We aim to test whether hospital employees working under greater stress can derive health benefits from both job and time autonomy.

Although we have a growing understanding of the causes of occupational health problems, research suggests that the work–health relationship is also influenced by contextual triggers, such as a country’s social, economic and cultural determinants (Bambra, Fox, & Scott-Samuel, 2005). Differences in public expenditure on the healthcare system and labor market may lead to cross-country variations in the effect of work stress on health. Economic recession for example has a profound effect on such working conditions as security and control, and this might lead to changes in distress levels and physical health. Lower expenditure is likely to result in more health problems (Dahl et al., 2006). Lu, While, and Barriball (2005) show that nurses feel increasing levels of work stress when labor shortages arise or working conditions deteriorate. Furthermore, research showing that employees in all sectors in Western Europe exercise more work control over their tasks and schedules contrasts sharply with the situation in Eastern European countries, where employees report much less flexibility at work (Parent-Thirion et al., 2007).

The purpose of this paper is twofold. First, it intends to test the effects of work stress and work control on the health of hospital employees. The study extends the concept of work control by distinguishing between job autonomy and time autonomy. Doing so helps us to understand what kind of autonomy plays a greater role in enabling hospital employees to cope with work stress. Second, the paper is based on a comparative study of data gathered in eight European countries (Netherlands, Finland, Sweden, United Kingdom, Germany, Portugal, Hungary, and Bulgaria), making it possible to identify cross-country differences and better understand these differences in the work–health relationship.