Working conditions of health care workers and their associations with patient's safety, quality of care and occupational health

Background and Objective: In Taiwan, as hospitals face intensifying market competition and cost containment efforts by the National Health Insurance, the use of extended work shifts and contingent employment contracts has escalated. The objective of this study was to investigate the working conditions of health care workers in Taiwan, and to examine their associations with indicators for patient's safety, quality of care and workers' health status.

Methods: In-depth interviews with 10 health care workers, including physicians, nurses and administration staff were conducted to understand the manpower arrangements and management practices in selected health care settings. Current regulations and mechanisms for ensuring adequate hospital staffing were also reviewed. In addition, data from a nationwide surveillance system for quality of care was analyzed to examine the relationship of manpower arrangements with the fatality rate, infection rate, rate of medication errors, and occurrence of falls in patients during hospitalization.

Results: The results showed that long working hours, extended work shift, and manpower shortage were common in health care settings. Adverse working conditions were associated with poor outcomes on patient's safety and quality of care, as well as higher perceived risk at work, lower job satisfaction and higher psychological stress among health care workers. Some problems were identified through interviews and policy analyses.

Conclusions: Findings of this study indicated that heavier work loads were associated with poor quality of care and higher levels of distress among health care workers. We identified problems with the current regulations and made recommendations for reform.