Workplace policies and quality of working life (QoWL) during the COVID-19 pandemic in Jordanian hospitals

1.Introduction

The quality of work-life (QoWL) is a generic phrase that refers to the favorable or unfavorable work environment for people working in an organization [1,2]. High QoWL is a multidimensional concept that is necessary for human resource empowerment in healthcare settings [3,4]. A better QoWL is essential in lowering tension inside and outside the workplace, anxiety, depression, and stress, and meeting workers’ demands [5–8]. However, workplace stress harms QoWL, with severe effects on employees’ physical and psychological health. Organizations are increasingly considering QoWL as one of the main variables to act upon to encourage workplace well-being [1,7–9]. In the healthcare sector, the QoWL of healthcare workers (HCWs) is a critical issue since it directly impacts the quality of patient care. Several studies have examined the QoWL impact on the quality of service offered to patients worldwide, as workplace stressors and a lack of adequate coping resources may affect health professionals’ mental and physical well-being [10–12].

COVID-19 exacerbates stressful healthcare workplaces. The fast-spreading outbreak has put an enormous strain on global healthcare systems. It has resulted in high healthcare demands, poor clinician-patient ratios, higher patient mortality, mental and physical stress, and rationing of healthcare resources for HCWs. Rapid increases in the number of suspected and confirmed positive cases, low personal protective equipment (PPE) supplies, overburdened work schedules, widespread media coverage of the pandemic, and perceived insufficient organizational support, all these conditions substantially increased burnout and stress among HCWs [13–16]. Alrawashdeh et al. reported that a lack of a sufficient supply of PPE acted as a risk factor for burnout during clinical practice during the COVID-19 pandemic [17]. This finding is consistent with Morgantini et al. who discovered that a sufficient supply of PPE acted as a protective factor against burnout during the COVID-19 pandemic [18]. Fear of disease transmission and quarantine, the possibility of infecting their family and friends, caring for coworkers as patients, feelings of stigmatization, and rejection by others in their community made frontline HCWs vulnerable to temporary and long-term psychological distress issues [15,16,19]. Further, HCWs were physically and emotionally exhausted by the heavy workload, exacerbated by high staff absence rates, which forced those who remained to work longer hours and at a higher intensity [14,20,21]. Despite all these difficulties and challenges, HCWs demonstrated their professionalism and perseverance and showed their resilience during the pandemic [20,22].

Hospitals play a key role in responding to emergencies such as pandemics. During COVID-19, several hospitals have adopted different strategies and policies to protect their HCWs and alleviate anxiety among them, including proper PPE, weekly shifts, period screening of their employees, vaccination, and other infection prevention and control (IPC) measures [23–26]. Despite these precautions, several studies revealed infection among HCWs, posing a concern to other patients, coworkers, and families [27,28]. Wong et al. investigated HCWs’ views towards supportive workplace policies during the pandemic and their association with health-related quality of life (HRQoL) in Hong Kong. Their study findings revealed that 16% of 1048 respondents mentioned that their organization had no workplace interventions or guidance related to the COVID-19 pandemic. Those who said they had a workplace policy were dissatisfied with it in terms of comprehensiveness (36%), timeliness (38%), and transparency (63%). Only 68% of respondents stated that their workplace had face masks in terms of the policy measure [29]. Yfantis et al. conducted a nationwide survey to determine the preparedness of hospitals in Greece and Cyprus to cope with the COVID-19 pandemic. Their findings revealed moderate levels of hospital preparedness to cope with the pandemic in both countries [30]. In the U.S., in a long-term care facility in Washington State, it was found that insufficient infection management protocols led to the spread of infection to 81 residents, 34 employees, and 14 visitors [31].

COVID-19 screening protocols state that HCWs should, at the very least, check themselves for fever and other COVID-19 symptoms and remain at home if they become sick. They can then seek more advice from occupational health. A study conducted among infected HCWs in Washington found that 65% of 48 HCWs with confirmed COVID-19 reported working for a median of two days (range, 1–10 days) while experiencing COVID-19 symptoms [32]. HCWs should also be informed about the importance of reporting all unprotected COVID-19 exposures to occupational health services so that job restrictions, self-quarantine, and monitoring can be determined. Since the beginning of the COVID-19 outbreak, the Jordanian government has followed the WHO’s guidelines and alerts to restrict the spread of COVID-19; a variety of preventive and control measures have been implemented at the local and national levels [17,33–35]. However, Suleiman et al. study revealed that only 18.5% of frontline physicians in Jordan had adequate access to PPE in a survey of frontline physicians in Jordan [36]. These precautionary measures and policies were developed to prevent COVID-19 and/or alleviate anxiety and stress in hospitals, but the impact of these policies on QoWL has not been studied in detail, especially in the Middle East and North Africa (MENA) region. To this end, this study aimed to examine the relationship between organizational workplace policies and measures, including infection prevention and control (IPC) policies, supply of PPE, COVID-19 precautionary measures, and the QoWL among healthcare workers in Jordan.

2.Methods

3.Results

Table 1 demonstrates the socio-demographics of the participants. Four hundred eighty-four participants filled out the questionnaire, with a retrieval rate exceeding the calculated sample size. The mean age of the respondents was (34.8 ± 8.28 years), and no statistically significant differences (P = 0.140) between males and females were found. The sample consisted of 279 females and 205 males (57.6 and 42.4%, respectively). The majority of the respondents (66.1%) were married, and two-thirds of them (66.6%) had at least one child at home. Moreover, about half of the respondents (49.2%) had elderly parents’ care responsibilities, and 45.7% of them were working in public hospitals.

Table 2 summarizes the descriptive data for the six subscales, the WRQoL score, and the overall QoWL score. The mean score for total WRQoL was (M = 2.95), and the mean score for overall QoWL was (M = 3.00; SD = 1.08), showing that HCWs working in Jordanian hospitals had an average level of overall QoWL.

Table 3 demonstrates various demographic effects on the WRQoL. It is clear that age, gender, having children at home, education, job title, experience, employment status, and suffering from a chronic disease significantly affected the WRQoL scale.

4.Discussion

This is the first study to investigate the influence of hospital workplace policies and measures from different perspectives (infection prevention and control, supply of PPE, and COVID-19 precautionary measures) on the QoWL among Jordanian HCWs during the current pandemic. Our study examined the overall QoWL of HCWs in various hospital settings. The results revealed that the overall WRQoL and sub-scale scores were average. This result is consistent with many previous studies conducted in different countries during the pandemic [44,45], with lower reported scores in WCS, HWI, and SAW dimensions. Other studies found that the quality of work life among different healthcare professionals was low during the pandemic [46–48]. Our linear regression analysis showed a significant relationship between participants’ socio-demographics and WRQoL. Among the current study participants’ socio-demographics, age, gender, educational degree, job title, and employment status were statistically significant predictors for the WRQoL. Our model also showed that years of experience, having children, and having a chronic disease(s) were associated with the WRQoL.

Age, marital status, education, work experience, position, department, shifts, and employment status are all significantly correlated with work-life quality [45]. Relatively high positions and more professional experience, especially those in the medical and diagnostic divisions, had greater WRQoL [49]. Prolonged occupation, household income, institutional and administrative consideration, social interactions, and vocational activities would be uniquely associated with WRQoL [50].

No significant association exists between the degree of education or years of experience and the quality of nursing work life (QNWL) [44]. These findings are congruent with the results of the Almalki et al. (2012) study [51] but contradicted those of Moradi et al. (2014) who found that nurses with associate degree had a better quality of life than others [52].

Higher-level nurses had lower QNWL scores because they have greater professional expectations and could be emotionally exhausted when their work environment does not satisfy those expectations [52]. Regarding participants’ experience, our finding contradicts with Mordai et al. who found that more than 15 years of professional expertise had higher QoWL than others [52], justified that more work experience has less occupational stress and better employment stability, which may contribute to a higher QoWL. Unlike the situation during COVID-19, decreased WRQoL may be attributed to the present emergency circumstances and increased work pressure and stress caused by undiscovered aspects of the infection [53].

Marital status did not correlate with any WRQoL subscale, similar to [44,49]. Unlike [51,54], studies found a significant correlation between QNWL and marital status. And in our research, having parents’ responsibilities didn’t have any prediction for any subscales. In contrast to Suleiman et al.’s results on HWI, the work-life-home-life subscale was moderately pleased by the majority of respondents. The majority of respondents (62.9 percent) said they did not have appropriate policies for parental leave, and they considered that childcare facilities should be offered (68.8 percent) [44]. Dependent adult variable was significantly related to QoWL; those who had dependent individuals were less satisfied with their QNWL than those who did not have dependent adults [51]. The study discovered that nurses who had kids were more satisfied with their QoWL than those who did not [51]. Unlike Suleiman et al.’s study, there was no significant association between total QNWL scores and dependent children and adults [44].

A systematic review provided an in-depth examination of the factors contributing to a person’s QoWL while living with chronic physical disease. In line with our results, employees who suffer excessive exhaustion, concentration issues, distress, or mobility problems, might have a detrimental effect on QoWL [55]. In line with our findings Suleiman et al. determined no substantial variation in QNWL between private and public hospital sectors. Regardless of the type of hospital in Jordan, nurses have similar working conditions and obstacles [44].

Our findings also demonstrated that hospital workplace policies and measures were significantly associated with better QoWL. Satisfaction with workplace policies and measures in terms of comprehensiveness, timeliness, and transparency was positively connected to WRQoL, with a good fit for the proposed model (Adj. R² = 0.916). This finding is consistent with Wong et al. who suggested that workplace policies and measures could improve work-life outcomes and reduce HCWs’ perceived risk of infection [29]. Those who are concerned about the risk to themselves and their loved ones would benefit from comprehensive, timely, and transparent information about the COVID-19 pandemic and infection control guidelines in their workplace. Wong et al. also demonstrated the importance of workplace policies and measures in mitigating the enormous stress caused by the COVID-19 pandemic, as well as the importance of accurate information in mitigating uncertainty.

In this study, the highest satisfaction with IPC programs was found to be associated with a higher quality of life in the workplace. Measures to improve IPC have been shown to minimize the spread of infections, notably in healthcare facilities. IPC measures such as adequate handwashing points can immediately improve HCWs’ satisfaction and productivity by reducing the transmission of COVID-19. Therefore, dissatisfaction with the hospital’s IPC measures may result in a negative work attitude, which may have a negative impact on patient care quality [56]. In accordance with the present findings, previous studies have confirmed that the existence of transparent protocols and comprehensive IPC programs significantly improved psychological impact measures such as workplace safety and satisfaction with institutional strategies; this demonstrates the crucial significance of institutionalizing international and local protocols and guaranteeing their effective usage to keep HCWs healthy and operational [57–59]. HCWs who are stressed or depressed may experience significant mental health consequences that jeopardize their capacity to provide high-quality treatment [60,61]. The psychological health of Jordan’s frontline doctors was found to be concerning. According to their results, Suleiman et al., only 28.2 percent of physicians were satisfied with their hospital’s infection control policy, and only 19.8 percent felt safe at their workplace. More than 90% of clinicians were concerned about the risk of illness spreading to their uninfected patients or their families [36].

In addition to other IPC measures, HCWs rely on PPE to keep themselves and their patients safe from being infected and infecting others. During the pandemic, even developed countries have experienced shortages in PPE. Thus, this is not uncommon in a resource-constrained context. The WHO has previously warned that increased demand, panic purchasing, stockpiling, and abuse would cause severe and escalating disruption to the worldwide supply of PPE [62]. Another important finding of the current study was that all items relative to supply, use, accessibility, and adherence to the use of PPE were positively correlated with WRQoL. Protective measures, such as the availability of PPE in the healthcare workplace, were critical variables in improving QoWL during pandemics. This finding broadly supports the work of other studies in this area. For example, during the peak of the COVID-19 epidemic in China, a study designed to examine healthcare staff conditions and job satisfaction, as well as their associated predictors, revealed that PPE access predicted improved physical health and job satisfaction, demonstrating its importance beyond physical protection [63]. Inadequate PPE supply may leave HCWs dangerously ill-equipped to care for COVID-19 patients, placing them at risk of infection and impeding COVID-19 prevention and control. Different studies showed the implications of PPE shortages, as, during the COVID-19 outbreak, inadequate PPE supplies contributed to clinical practice burnout [17,18,64].

Healthcare workers must take additional precautions to protect themselves and prevent disease spread in the workplace. Several studies indicated the importance of COVID-19 precautionary measures to the quality of work-life [65–67]. This research study found that the existence and adherence to COVID-19 preventive measures were positively connected to WRQoL. This result was confirmed by earlier research conducted by Zhang et al. who found it is important to raise health awareness and educate HCWs about health to develop preventative beliefs, build healthy attitudes, and support beneficial behaviors [67]. These factors, in turn, positively affect work satisfaction. Medical education and training should be regularly conducted by healthcare facility management to guarantee that knowledge is easily communicated to all staff types [68,69]. Also, our results were consistent with previous studies that established it is critical that all HCWs worldwide have an appropriate understanding of COVID-19 - its clinical presentation, diagnosis, recommended therapy, and known preventative and precautionary measures [67,70]. HCWs caring for COVID-19 patients should take additional precautions to protect themselves and prevent disease spread in the workplace, which in turn could enhance WRQoL among healthcare providers. Such precautionary measures include wearing proper personal protective equipment and receiving training on appropriately dressing, removing, and disposing of this equipment.

However, our findings are consistent with what is known about job satisfaction, broadly and during the pandemic. Afulani et al. examined signs of significant stress and burnout among HCWs in Ghana and a perceived low level of preparedness to respond to the COVID-19 pandemic. Their results indicated that greater fear of infection partially contributes to the effect of perceived preparedness on stress and burnout [71]. That is, insufficient preparation leads to fear of infection, which leads to high stress and burnout. As a result of its association with stress and burnout, inadequate preparedness may have cascading impacts on HCW job satisfaction, productivity, quality of care, and workforce turnover [71,72]. All of which would impair HCWs’ efforts toward COVID-19 containment. Existing research indicates that characteristics related to preparedness include the availability of PPE, transparent procedures and isolation wards, training, and excellent management communication [36,73]. Improving these would boost perceived preparedness, reduce infection fear, and reduce stress and burnout. The development of national and regional mitigation strategies and plans to reduce the time required to provide the necessary equipment and testing; the provision of adequate test kits and PPE; disease tracking systems; availability of inexpensive point-of-care initiatives; disaster management and response training for HCWs; and the establishment of a medical reserve corps of licensed individuals are all recommended steps toward preparedness [74,75]. These initiatives would assist in improving HCW preparedness for COVID-19.

5.Conclusion

The findings revealed that satisfaction with workplace policies was a significant predictor of WRQoL. Their absence might raise the risk of disease transmission and impact healthcare professionals’ QoWL, thereby affecting the safety of patients. Unfortunately, the present study found that HCWs at Jordanian hospitals had an average WRQoL scale and subscale levels. It is worth focusing on workplace policies to improve the QoWL. Efforts by healthcare decision-makers at the national and corporate levels should attempt to ensure the availability of protective standards and guidelines in workplaces to alleviate workplace infection risk while also focusing on improving the QoWL. Improving hospital policy management can also help minimize the stress and fear that HCWs experienced during the pandemic, which will enhance their work conditions and improve their performance and the quality of health service. We strongly encourage hospitals to scale up training on IPC measures, notably hand washing techniques and proper use of PPE, and the construction of effective risk management points of care with a high concern index to adequately protect HCWs’ physical and psychological well-being and improve their working circumstances. Finally, the findings of this study provide a baseline for determining the quality of HCWs’ work lives in hospitals, specifically in Jordan. Further studies might investigate new measures to improve HCWs’ WRQoL during pandemics. The study also recommends that hospital human resource departments regularly conduct such a survey to evaluate the level of their HCWs’ QoWL and develop initiatives to improve it.