https://orcid.org/0000-0001-6884-7759
ABSTRACT
Background
Due to shortage in workforce and difficulties in recruiting social and health-care managers, it is crucial to investigate and develop the work well-being of managers. The existing evidence mostly concerns clinical contexts in social and health-care. We studied work well-being through the following categories: (1) individual factors, (2) social factors, (3) professional support from the manager, (4) work-related factors, and (5) organizational factors. The study aims to investigate (1) management levels, (2) years of experience in management, and (3) professional groups that are connected to their work well-being in these categories.
Methods
We conducted a survey (N = 281) and formed logistic regression models to answer the research questions.
Results
Working as an upper-level manager, having more than 26 years of managerial experience, and working as a physician or in a group ‘other’ are factors that are positively connected to work wellbeing. While in the middle of one’s managerial career (6–25 years) or working as a nurse manager is negatively connected to work well-being.
Conclusions
This study produces specific knowledge to understand the factors connected to social and health-care managers’ work well-being and to identify those groups that are at a risk of experiencing poor well-being at work.
Introduction
This study investigates social and health-care managers’ work well-being and identify the factors affecting it. We examined regression models using social and healthcare managers’ explaining factors (management level, years of experience in management, and professional groups) along with work well-being categories. The categories are:(1) individual factors, (2) social factors, (3) professional support from the manager, (4) organizational factors, and (5) work-related factors [Citation1]. These categories included several factors that affect work well-being, either positively or negatively (). We also studied work well-being by integrating these five categories. In this study, work well-being is a large, complicated, and diverse phenomenon concerning individuals’ well-being at work, which is affected by numerous factors, not only in the workplace but also in the personal lives of workers [Citation2, Citation3]. It is a part of the subjective experience of holistic well-being in an individual [Citation4]. The study was conducted in public social and health-care institutions in Southern and Central Ostrobothnia in Finland.
Table 1. Affecting factors of social- and health-care managers’ work well-being.
In Finland, and internationally, research focusing on the work well-being and work ability of employees belonging to different professional groups in social- and health-care is carried out [Citation4] on the following topics: work well-being of social- and health-care workers in clinical work see [Citation5, Citation6], burnout see [Citation7–9], and stress [Citation10]. In connection with the coronavirus pandemic of recent years, the workload of the personnel and its effects are studied [Citation11]. For example, Antikainen et. al [Citation11] studied the well-being at work of nursing managers and nurses during the pandemic. According to the results, work well-being weakened due to the increase in workload. This was due to the redesign, organization, and management of nursing functions, among other things. [Citation11]
According to previous studies, the work well-being of those in management positions in various fields is good see [Citation12]. Managers feel better at work than employees [Citation13] and report less stress [Citation14]. However, managers suffer from an imbalance between work and personal life [Citation12].
In a literature review conducted previously [Citation1], several factors affecting the well-being of managers working in different industries were identified. For example, position in management [Citation13, Citation15, Citation16], a higher level of influence [Citation12], decision latitude [Citation17], and job control [Citation18, Citation19] affected managers’ work well-being. Social support positively affected managers’ work wellbeing [Citation17, Citation18, Citation20] as along with ethical culture equating with ethical perceptions [Citation21]. Ethically challenging situations [Citation22], increased emotional demands [Citation23], overcommitment [Citation24, Citation25], and addiction to work [Citation26] have been reported as preventive factors for managers’ work well-being. Effort-reward balance and personal work goals were investigated in a few studies [Citation24, Citation25, Citation27, Citation28], and it was shown that effort-reward imbalance was a preventive factor for work well-being [Citation27].
The well-being of social and healthcare managers has been studied from different perspectives. Based on previous literature, this research focuses on the work well-being of nursing staff managers, such as ward nurses [Citation11, Citation18]. Negative manifestations of work well-being, such as burnout among ward nurses, have also been studied [Citation29]. We argue that there is still a lack of knowledge, especially regarding factors such as management level, years of experience in management, and professional groups. The relevance of the study arises from a gap in the information on how those background factors are connected to work well-being.
Social and healthcare organizations are often led by professionals who have been educated in the social or healthcare profession. In many cases, physicians manage physicians, social workers manage social workers, and nurses manage nurses. Furthermore, social and healthcare organizations typically have multiple hierarchical levels. These pyramidally arranged levels can be described as follows: (1) upper, (2) middle, and (3) first. Managers at these levels have different responsibilities. First-level managers are responsible for day-to-day management, and act directly with workers and in operational activities. Middle-level managers are responsible for accomplishing the goals and policies set by top management. They serve as the link between first- and top-level managers, motivate and assist first-level managers, and communicate feedback to the upper management, who are in charge of planning, strategising, and formulating overall organizational objectives and policies [Citation30].
Most studies assume that the managerial employees of an organization are a homogenous group. In reality, their responsibilities, job definitions, seniority, years of experience, power, and status can differ at various levels of management. These can impact the demands placed on them, the stress and strain experienced, and the opportunities to maintain and attend to one’s health and well-being [Citation30]. Previous studies have found evidence that management level is an important factor of employee well-being [Citation1, Citation2, Citation30]. Singh and Prakash [Citation30] found that management level accounted for approximately one-tenth of the variation in psychological health and well-being scores. This impact was felt particularly at the middle management level compared with the upper- and first-line levels. Middle managers experienced relatively worse psychological well-being and health than upper- and lower-level managers [Citation30]. Furthermore, upper managers assessed their work well-being statistically and significantly better, concerning organizational factors (e.g. possibility to develop own knowhow and salary), than first-level and middle managers [Citation2]. Also, the levels of control and authority over decisions may differ between managerial levels. Managerial position, decision latitude, and job control were previously found to affect social- and health-care managers’ work well-being [Citation1].
An earlier study showed that years of experience as a manager was connected to work well-being. Managers with more years of experience assessed their work well-being better than those with less experience [Citation2]. In turn, in a study of health workers, excessive work pace had the greatest negative impact on health workers with the highest seniority [Citation31]. Hamama [Citation9] studied burnout among social workers working with children. One of the most prominent findings was the correlations between professional seniority, the support of colleagues and direct supervisors, and the sense of burnout. Social workers with less seniority experience less burnout when receiving stronger support from colleagues and managers [Citation9].
Previous studies have shown that different professional groups have different well-being [Citation31]. Dudutiene et al. [Citation31] found that, compared with other groups, professional groups significantly differed in their approach to psychosocial risk determinants and organizational intervention objects. Their findings confirmed that public sector physicians’ work is more hectic and stressful than other health workers’ work, which may lead to psychological problems and burnout. They found that physicians are stressed by workload, overtime, and tight deadlines [Citation31]. In another study that investigated social and healthcare managers’ work well-being, nurse managers assessed their work well-being to be worse than professional group, with no direct responsibility for patients [Citation2].
The explanatory factors (professional group, years of experience as a manager, and management level) chosen for closer analysis have been discussed in earlier studies see [Citation2, Citation9, Citation12, Citation14, Citation30]. In this study, social and healthcare managers were defined as first-line, middle, and upper managers who work in the social and healthcare fields in the public sector and represent their own professions (social work managers, nursing managers, medical managers, etc.). We used the term supportive to describe factors that improve work well-being, and the term preventive to describe factors with a negative effect on work well-being. Drawing on realism, this study is based on the perception that when individuals subjectively experience a factor that affects their work well-being, their experience is affected either positively or negatively [Citation32].
Materials and methods
Materials
This study was conducted using a cross-sectional survey. We asked social and healthcare managers to evaluate the presence or absence of work well-being affecting factors (supportive and preventive) by using an instrument specifically developed to measure the work well-being of social and health-care managers. The questionnaire contained five categories introduced in a previous study [Citation2]: (1) individual factors, (2) social factors, (3) professional support from the manager, (4) work-related factors, and (5) organizational factors. These categories consist of several factors that support and/or prevent social and healthcare managers’ work well-being and, therefore, indicate its status [Citation1, Citation2].
The questionnaire consisted of 84 questions in different categories: (1) individual factors (30 questions); (2) social factors in the workplace (12 questions); (3) professional support from the manager (9 questions); (4) organizational factors (16 questions); and (5) work-related factors (10 questions). The questions were based on a Likert scale (1 = strongly agree, 2 = partially agree, 3 = neither agree nor disagree, 4 = partially disagree, and 5 = strongly disagree). In addition, background information was requested (7 questions). Two questions on social factors related to working with policymakers consisted of the option, ‘does not apply to me.’ For ease of interpretation, the coding of the answers was changed before the analysis; thus, the answer option ‘strongly agree’ was coded 5, and ‘completely disagree’ was coded 1. In a previous study, the instrument was found to be reliable and valid [Citation2].
The sample was a total sample composed of social- and healthcare managers working at the public sector in South and Central Ostrobothnia, Finland. Survey data (n = 281) from September to November 2019 were collected in Finnish and Swedish using the RedCap software [Citation33], which is managed by Tampere University. A cover letter and hyperlink to the questionnaire were sent to the organizations’ contact persons, who sent it to the respondents. Contact persons informed us of the number of emails sent, and we calculated the response rate as 53%. One organization missed the information. The data obtained were analyzed using IBM SPSS Statistics 26 software. Frequencies and percentages were used to describe the data.
Methods
To answer our research questions, we chose multiple logistic regressions from all the multivariate methods. This enabled us to simultaneously study the dependence of dichotomized response variables on more than one explanatory variable [Citation34]. Another important reason for using logistic regression analysis was that not all sum variables were normally distributed [Citation35]. We tested the sum variable distributions using the Kolmogorov-Smirnoff test and found that only the sum variable overall work well-being was normally distributed (p = 0.20).
We calculated the sum of variables based on the work well-being framework of health- and social-care managers [Citation1, Citation2]. To describe work well-being as a whole, we created a sum variable of overall work well-being. The variable contained all previously described categories of social and healthcare managers’ work well-being.
Odds ratio (OR) and 95% confidence intervals (CIs) were used. Our strategic choice was to use the enter method to identify the statistical model that best explains the results. We based our choice on previous literature [Citation34]. The explanatory variables identified were professional group, years of managerial experience, and management level. The response variables identified were the sum of overall work well-being, individual factors, social factors, professional support from the manager, work-related factors, and organizational factors. Demographic variables were also used to adjust the statistical models. As we decided to use logistic regression analysis, we dichotomized our sum variables into poor or average work well-being (1.0–3.50) and good or excellent work well-being (3.51–5.0).
We created logistic regression models for the six previously described response variables that define work well-being. The regression models were divided into two groups. In Group 1, we formed regression models that explained the following variables: 1. management level, 2. years of management experience, and 3. professional groups (social care management, nursing management, medical management, etc.). However, we did not adjust for demographic variables including age, sex, and education. In Group 2, we examined work well-being regression models based on explanatory variables 1–3, but with adjustments for age, sex, and education.
This study was conducted in accordance with the ethical principles of the Finnish Advisory Board on Research Integrity [Citation36]. The ethics committee of the Tampere region expressed favourable opinions on the study (Opinion 27/2019). All the participating organizations issued their research permits. Participation in the study was voluntary and based on informed consent was obtained. None of the participants or organizations were identified in this study.
Results
Among the respondents, 52% were nursing managers, 23% were social work managers, and 11% were physicians. Fifteen respondents answered ‘other’ to their professional group. The results are provided in Appendix , along with descriptive information of the samples in the work well-being categories. presents the descriptive information of the samples in the work well-being categories according to the explaining variables.
Table 2. The descriptive information of the sample in the work well-being categories according to the explaining variables.
Individual factors
In terms of individual factors, based on the results of the regression model with adjustment for demographic variables, compared with having 0–5 years of experience, having more years of experience as a manager (more than 26 years; OR, 0.35; 95% CI, 0.12–0.98) appeared to be a supportive variable (). Furthermore, in the model without adjustments for age, sex, and education (Appendix ), managers with more than 26 years’ experience did not differ significantly.
Table 3. Social- and health-care managers’ risk of belonging to a group with poor or average work well-being (with adjustments for age, sex, and education).
Social factors
In terms of social factors, managers with 16–25 years of experience had a significantly higher risk (OR, 2.59; 95% CI, 1.04–6.44) of belonging to a group with poor or average work well-being than managers with 0–5 years of experience (). Nursing managers were also found to have a statistically and significantly greater risk (OR, 2.33; 95% CI, 1.14–4.79) of belonging to a group with poor or average work well-being when compared to social-care managers. This result was also obtained using a crude model (Appendix ).
Professional support from the manager
In the category professional support from the manager, the adjusted model (.) showed that compared with managers with shorter years of experience (0–5 years), those with longer years of experience {(6–15 years [OR, 2.35; 95% CI, 1.06–5.2]) and (16–25 years [OR, 3.22; 95% CI, 1.16–8.95])} had a higher risk of belonging to a group with poor or average work well-being. Similar results were obtained for the crude model (see Appendix ).
Organizational factors
Regarding organizational factors, when comparing social-care managers, belonging to a group of physicians (OR, 0.26; 95% CI, 0.09–0.77) or other groups (OR, 0.35; 95% CI, 0.13–0.92), were identified as a protective factor. This effect was observed only in the regression model where demographic variables were adjusted (). Managers who reported 16–25 years of experience had a higher risk (OR, 2.70; 95% CI, 1.03–7.13) of belonging to a group with poor or average work well-being than the control group, which was composed of managers who had worked as managers for 0–5 years. Furthermore, we found that more than 26 years of managerial experience was a protective factor (OR, 0.32; 95% CI, 0.12–0.90) for belonging to a group with poor or average work well-being. This effect was observed in both crude and adjusted models. Concerning the management level, when comparing first-line managers, we found that the upper management level also appeared to be a protective factor (OR, 0.28; 95% CI, 0.11–0.72) in both models.
Work-related factors
Concerning work-related factors, in the regression model where demographic variables were not adjusted, managers with 16–25 years of experience had a greater risk (OR, 2.25; 95% CI, 1.00–5.04) (Appendix ) of belonging to a group with poor or average work well-being than those with shorter or longer years of experience. However, when the demographic variables were adjusted for, the effect disappeared ().
Overall work well-being
Concerning social and healthcare managers’ overall work well-being, in the crude model (Appendix ), managers with 16–25 years of experience had a greater risk OR, 2.68; 95% CI, 1.14–6.30) of belonging to a group with poor or average work well-being than managers with shorter or longer years of experience. However, when demographic variables (age, education, and sex) were adjusted for, the effects disappeared, and none of the explanatory variables were significantly connected to the factor of overall work well-being ().
Discussion
We identified both supportive and preventive factors that are connected to the work well-being of social- and health-care managers. We found that the management level was connected to work well-being. Working as an upper-level manager was a preventive factor in terms of organizational factors. Furthermore, years of experience as a manager appeared to be both a supportive and a preventive factor, depending on the work well-being category. Concerning the individual and organizational factors, having more than 26 years of managerial experience appeared to be a supportive factor, whereas having less experience (6–15 years and 16–25 years) was found to be a preventive factor in terms of professional support from the manager. Furthermore, 16–25 years of experience is a preventive factor for social factors. We also found that professional group was connected to work well-being. Working as a nurse manager appeared to be a preventive variable, whereas working as a physician or in the group ‘other’ was a supportive variable concerning organizational factors. We did not make hypotheses but assumed that years of experience as a manager, management level, and professional group could be connected to work well-being in different categories. The results show that our assumptions are partly correct.
According to the results of the regression models, years of experience as a manager appeared to be the most important factor connected to the work well-being of social- and health-care managers. An earlier study showed evidence of a U-shaped relationship between age and job satisfaction, from a moderate level in the early years of employment, increasing until retirement [Citation37]. Our results partially supported this result; although we adjusted for age in our regression models, we found that concerning social factors and professional support from the manager, being in the middle of one’s managerial career was a risk factor. Furthermore, concerning organizational factors, having more (more than 26 years) working experience as a manager is a supportive factor of one’s work well-being. We argue that work experience may precisely be the factor affecting work well-being.
A previous study showed that low job support (including understanding and support received from superiors and workmates) doubled the probability of high-level work stress [Citation38], consistent with our results. Concerning professional support from the manager, we found that managers who were in the middle of their managerial careers tended to have a higher risk of having worse work well-being than those who had shorter or longer working experience as managers. Furthermore, working as a nursing manager appears to be risky in terms of social factors. These results are in line with earlier study that showed that nursing managers are at risk of more severe stress than doctor managers, especially if they have no social support at work [Citation38]. According to an empathy study of healthcare professionals in Finland, physicians tend to feel more positive emotions at work than nurses do. Their emotions predicted more positive, engaged, and prosocial behaviours than nurses. Even though nurses are empowered by helping patients and their own work community – limited possibilities, low wages, lack of respect, and leadership problems –prevent them from successfully managing their work.[Citation39] This subject needs further clarification among nursing managers, and these might be the root causes for our results.
We found that working as a physician or in group ‘other’ and working in upper management are supportive factors in terms of organizational factors. Within organizational factors, there are some sub-factors that might explain the result that working as a physician or in the group ‘other’ is a supportive factor. For example, dissatisfaction with one’s salary could explain why nursing managers assess their work well-being as worse than that of physician managers. There is earlier evidence that nurses’ rewards, commitment, and job satisfaction are connected [Citation40].
In this study, we examined the effects of explaining variables by controlling for demographic variables, and identified groups of social- and health-care managers who are at a greater risk of lower work well-being. An essential part of work well-being management is identifying the target groups and tailoring interventions to the specific needs of each target group [Citation31].
Limitations of the study
This study has several limitations. Due to its cross-sectional design, causal relationships could not be established. Further, the sample size was small (n = 281). Because Finland is quite a homogeneous country, we claim that the results are generalizable to Finnish social- and health-care managers, even with reservation, as the study participants (N = 281) account for only a small section of the Finnish health-care and social managers. The study and instrument were characterized based on aspects of the Finnish healthcare and social services system. However, these results can be used in other countries as well, as long as it is taken into account that the research has been carried out in a Finnish context.
Conclusions
Using a cross-sectional study, we identified health- and social-care manager groups who were at a greater risk of poor or average work well-being. Work well-being is a complicated phenomenon affected by numerous factors, as demonstrated in this study. It is impossible to examine this phenomenon through one affecting factor or explanatory variable. However, this study produced knowledge of the background factors connected to social- and health-care managers work well-being, which is a topic that has not gained much research attention. The scientific value of this study stems from this fact. Our results can be highly informative and useful, and enlightens and adds insight into the theoretical basis of social and healthcare managers’ work well-being. This knowledge, produced together with work well-being categories, which divide it into smaller categories, helps to look at this large phenomenon in smaller sections. Therefore, planning and conducting tailored and well-targeted interventions for those groups who are at a greater risk of poor or average work well-being is easier. Attention should be paid to health- and social-care managers who are in the middle of their careers or who work as nursing managers. Our results provide organizations with a better understanding of the factors affecting health- and social-care managers’ work well-being. Further research, internationally, would be beneficial to gain a more detailed understanding of the work well-being of those manager groups who are at a greater risk of poor or average work well-being.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Additional information
Funding
Notes on contributors
Niina Herttuala
Niina Herttuala, MSc (Nursing), doctoral researcher. Her main areas of research is work well-being in social- and healthcare and nursing.
A. Konu
Anne Konu, PhD (Social and health policy), Docent in Tampere University (Faculty of Social Sciences, Health Sciences). Her main research areas are well-being and social and health care management.
L. Kokkinen
Lauri Kokkinen, PhD (Social and health policy), works as a Research Director in Tampere University. He has extensive experience in social and health policy and management and he has published on these themes in highly ranked international journals. Kokkinen participates in several international research consortiums, serves in the multisectoral Finnish Advisory Board for Public Health, and is a founding member of WHO Collaborating Centre for Health in All Policies and Social Determinants of Health in Tampere University
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