Effects of job characteristics,team climate,and attitudes towards clinical guidelines

Abstract

The aim of this study was to form and test a model of the antecedents and possible moderators of the use of clinical guidelines among healthcare professionals. A postal questionnaire survey of all workers in six health centres around Finland. was carried out in April 1996. The health centres were selected to represent all different areas of Finland. A total of 748 (65.5%) of the healthcare workers completed and returned the questionnaire. Of the respondents 95% were women, 16% physicians or dentists, 31% registered nurses, and 27% practical nurses. It was hypothesized that besides positive attitudes towards guidelines, job characteristics and team climate affect the use of guidelines. Three alternative models of possible main and moderating effects of attitudes, job characteristics, and team climate were formed and tested. These models were tested using hierarchical regression analysis and structural equation modelling (LISREL8). All of the hypothesized main effects and the moderating effect of job characteristics between attitudes towards and the use of guidelines were supported. According to our results important factors behind the general positive or negative attitudes towards guidelines are the usefulness, reliability, practicality, and availability of the guidelines. Also, the overall individual, team, and organizational competence to follow the procedures recommended, seemed to be vital. Moreover, those whose job motivation potential was high were more ready to use clinical guidelines even when their attitudes towards guidelines were the same.

Get full access to this article

View all access options for this article.

References

Grimshaw J. , Russel I. Effect of clinical guidelines on medical practice: a systematic review of rigorous valuations. Lancet 1993; 342: 1317-22.

Field M.J. , Lohr KN Guidelines for clinical practice; from development to use. Washington, DC: National Academy Press, 1992.

Eddy DM Desinging a practice policy. Standards, guidelines and options. J Am Med Assoc, 1990; 263: 3077-84.

Field M J , Lohr KN , eds. IOM. Clinical practice guidelines: directions for a new program. Washington, DC: National Academy Press, 1990.

Grol R. National standard setting for quality of care in general practice: attitudes of general practitioners and response to a set of standards. Br J Gen Pract, 1990; 40: 361-64.

Hellbruck RP Medical guidelines: a valid and reliable management tool. Int J Health Planning Management, 1997 ; 12: 51-62.

Mansfield CD Attitudes and behaviours towards clinical guidelines: the clinicians' perspective. Qual Health Care, 1995; 4: 250-55.

Kanouse DE , Jacoby I. When does information change practitioners' behaviour? Int J Technol Assessment in Health Care, 1988; 4: 27-33.

Rappolt SG Clinical guidelines and the fate of medical autonomy in Ontario. Soc Sci Med, 1997; 44: 977-87.

10.

Hackman JR , Oldham GR Development of the job diagnostic survey. J App Psychol , 1975; 60: 159-70.

11.

Hackman JR , Oldham GR Motivation through the design of work: test of a theory. Organizational Behav Hum Perf, 1976; 16: 250-79.

12.

Bandura A. Representing personal determinants in causal structures. Psychological Review, 1984; 91: 1175-84.

13.

Hackman JR , Oldham GR Work Redesign Reading: Addison-Wesley , 1980.

14.

West MA The social psychology of innovation groups. In: West MA , Farr JL , eds. Innovation and creativity at work: psychological and organizational startegies . Chichester: John Wiley, 1990: 309-33.

15.

Kivimäki M. , Kuk G. , Elovainio M. , Thomson L. , Kalliomäki-Levanto T. , Heikkilä A. The Team Climate Inventory (TCI)- four or five factors? Testing structure of TCI in samples of low and high complexity jobs. J Occup Organ Psychol, 1997; 70: 120-26.

16.

Abbey A. , Dickson JW R & D work climate and innovation in semiconductors. Academy of Management J, 1983; 26: 362-8.

17.

Elovainio M. , Lindström K.

Sosiaali- ja terveydenhuollon työyhteisöjen toimivuus Suomessa. (Characteristics of organizations and personnel in the social and healthcare sector in Finland.)

STAKES Raportteja 113, Gummerus Oy, Helsinki, (In Finnish), 1993.

18.

Elovainio M. , Eccles M. , Mäkelä M. Attitudes towards guidelines and a scale for measuring them. In Thorsen T , Mäkelä M , eds. Changing professional practice. Theory and practice of clinical guidelines implementation DSI, Report 99.05.

19.

Cohen J. , Cohen P. Applied multiple regression/correlation analysis for the behavioural sciences . 2nd edn. Erlbaum: Hillsdale, 1983.

20.

Karasek R. , Theorell T. Healthy work. Stress, productivity, and the reconstruction of working life . New York: Basic Books, 1990.