Background
Healthcare staff are often subjected to high workload and insufficient opportunities for
recovery. Recovery (including sleep) is an important factor for good health and
performance , not least during periods of high stress and strain. Previous research has
shown that leadership and organisational factors play a major role in employee health and
performance. However, managers in healthcare often report a demanding work situation
themselves, which might affect their own health and become an obstacle for the
leadership. Thus, healthcare managers have a key role in promoting their employees'
recovery, but to be able to manage that important task, they may also need support for
managing their own recovery. Furthermore, there is a lack of research on how healthcare
managers can work with supporting employees' recovery.
In a previous research project, the investigators developed and evaluated a
group-administered proactive recovery programme for new nurses, focusing on enhancing
beneficial strategies for recovery. The programme showed promising effects in terms of
reduced burnout and fatigue symptoms. However, the intervention was directed only towards
the employees, on the individual level. A focus on interactions with organisational
factors and leadership is likely needed to support long-term recovery among healthcare
staff.
Aims
To evaluate an intervention programme, "Leadership for recovery", for first-line
healthcare managers in Swedish hospital settings, focusing on both 1) strategies for
promoting own recovery and 2) strengthening a "leadership for recovery" (a leadership
that promotes employee recovery).
The main question the study aims to answer are:
- Can a group-based intervention programme with a focus on strengthening first-line
healthcare managers' own recovery and leadership for recovery improve their
employees' recovery?
The hypotheses are:
The leadership for recovery program will:
improve the employees' recovery (including sleep)
improve the employees' health, including somatic symptoms and burnout symptoms
improve the employees' cognition
reduce the employees' work interference with personal life
reduce the employees' intention to leave work
Research design
The study is a cluster randomised controlled trial. Participating managers will be
randomised to either intervention group or control group. Employees of managers in both
the intervention and control group will be invited to participate in the study. Thus, the
employees are beforehand (before recruitment) already assigned (cluster randomised) to
intervention or control group based on which group their manager belongs to.
Recruitment
Managers are recruited from Swedish hospitals through contacts with Human Resources
Departments and second-line managers. All employees of participating managers will be
invited via e-mail for participation in the study.
Procedure
The intervention programme for managers includes both educative and reflective parts with
a focus on promoting strategies for recovery. It is based on previous interview studies
with nurses and first-line healthcare managers (unpublished results), previous
interventions for a health promoting leadership, our previously evaluated recovery
programme for nurses, and organisational behavioural management techniques. The first
parts of the programme focus mostly on managers' own recovery, and the latter parts focus
on ways to promote employees' recovery. The programme consists of 6 group sessions
distributed over approximately 6 months.
Employees in both intervention and control group will fill out surveys at baseline
(before intervention group managers' start the leadership intervention) post-intervention
(about 1 month after intervention group managers' fifth session) and at follow-up (12
months after baseline). A subsample (voluntary) will also fill out diaries and wear
actigraphy wristbands (objective sleep measure) at baseline and follow-up. Employees in
the intervention and control group will be compared in terms of effects of the programme.
Primary outcomes will be measures of recovery (including sleep). Secondary outcomes
include measures of general health; somatic symptoms; burnout symptoms; cognition and
work performance; work interference with personal life and intention to leave work. Both
primary and secondary outcomes will be measured in both surveys and diaries. Sleep will
also be measured through actigraphy wristbands. Data from surveys and diaries/actigraphy
will be analysed and reported separately.
Randomisation and masking
The randomisation will be performed by a person not working in the project that is
blinded to the participants. Block randomisation will be used. The randomisation will be
made separately for different hospital sites (i.e. managers from the same hospital site
will be randomised together, so that the ratio will be 1:1 for intervention/control group
in each hospital site if possible). The randomisation may occur continuously as
participants sign up for the study. If two or more managers work at the same unit/ward
(shared leadership) they will be assigned to the same group.
It is not possible for participants or group leaders to be blinded to group allocation.
Sample size
The aim is to recruit approximately 80 first-line healthcare managers to be randomized to
intervention or control group. Employees of participating managers will be invited to
participate in the study. Based on the assumption that every manager has ≈ 40 employees,
in total ≈ 3200 employees will be invited to participate. The investigators expect
approximately 30% to sign up for the study, i.e. 960 participants.
Drop out from the program
Managers who drop out of the leadership program will be asked if they are willing to
continue filling out questionnaires.
Data analysis plan
To be published. The analyses will follow the intention to treat principle. Per-protocol
analysis will also be conducted.