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Working conditions, health and productivity among dentists: a prospective study during rationalization in public dental care
Linköping University, Department of Medicine and Health Sciences, Work and Rehabilitation. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medicine and Health Sciences, Work and Rehabilitation. Linköping University, Faculty of Health Sciences.
Department of Occupational and Environmental Medicine, Lund University, Sweden.
MedTech West/School of Engineering, University of Borås, Borås, Sweden..
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: Rationalizations comprising technological and organizational changes have been implemented in public dentistry in Sweden during the last decades. The effects on dentists´ work conditions health and production has not been investigated.

Aim: This study aims to analyze changes and associations in dentists´ working conditions, health/illness and production during a period of rationalizations.

Material: Sixty-five dentists responded to a questionnaire in 2003 and 2008, measuring work conditions and health. Production was followed in registers.

Results: During the rationalization period the number of treated adult patients increased. Perceived physical work conditions improved, while work control conditions and perception of the leadership deteriorated. Health/illness was a mediating factor between work conditions and production.

Conclusions: Rationalizations aiming to increase production must take into account employees' work conditions and effects on health/illness in order to achieve its goal.

Keyword [en]
Dentistry; Rationalizations; Physical working conditions; Health, Structural Equation Modeling
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-65427OAI: oai:DiVA.org:liu-65427DiVA: diva2:395594
Available from: 2011-02-07 Created: 2011-02-07 Last updated: 2013-09-03
In thesis
1. Work conditions, musculoskeletal disorders and productivity of dentists in public dental care in Sweden: Are dentists working smarter instead of harder?
Open this publication in new window or tab >>Work conditions, musculoskeletal disorders and productivity of dentists in public dental care in Sweden: Are dentists working smarter instead of harder?
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Introduction: During the last 20 years, Sweden and other countries have been adjusting their models of welfare to a changed economic environment. Rationalization, influenced by New Public Management, has been implemented in public dentistry in order to improve efficiency and to streamline activities. This has involved transferring some of dentists’ tasks to dental hygienists and dental nurses. The goal is to achieve a more efficient mix of skills and more interaction between professional groups, in order to utilize all skills better in a more efficient work organization. Organizational changes may have an effect on the work environment both with regard to physical and to psychosocial work conditions and affect health and well-being. In many cases these changes have a profound negative effect on musculoskeletal and mental health, and corresponding risk factors, by reducing the number of natural breaks and thus reducing the efficacy of targeted ergonomic interventions. Dentists in Jönköping County in Sweden perceive high precision demands and poor working postures in their work. The five studies in this thesis describe organizational changes and analyse the risk of illness among dentists in the public sector in Jönköping County.

Aim: The main aim is to study dentists’ physical and psychosocial work conditions and investigate associations with musculoskeletal disorders, work ability and sick leave during a period of extensive rationalizations; secondly, to assess the risk of illness as a basis for recommending preventive measures.

Methods: The present thesis was designed with four cross-sectional studies (Paper I-IV) and one prospective longitudinal study (Paper V). In Paper I, a questionnaire concerning physical and psychosocial work conditions and health was sent out to all employees working in public dental care in Jönköping County in Sweden. To obtain more information on the difficult physical work situation for dentists (Paper I), an observation study with Portable Ergonomic Observation (Paper II) and an sEMG study (Paper III) was then conducted. Paper IV deals with psychosocial issues (using the same survey as in Paper I) and questions in the Eysenk Personality Questionnaire (EPQ) and the Marlowe-Crown scale SD (MCSD), to analyse their impact on perceived physical load. In Paper V, data about physical and psychosocial conditions and health from a survey, as well as production data (number of adult treatments per year per dentist) from computerized patient records (T4), are analysed with regard to changes and associations during a period of extensive rationalizations (2003 – 2008).

Results: In Paper I, dentists reported the poorest physical work conditions of all occupational groups and high prevalence of musculoskeletal disorders. However, relatively low intensity of pain was reported and only a small proportion thought that work was affected. Paper II and Paper III confirmed that dentists’ work is physically demanding, with sitting postures and head bent forward, as well as prolonged low muscle loading. Paper IV shows that physical load is mainly influenced by psychosocial demands and to some extent by loss of work control. The results in Paper V show that during the period of extensive rationalizations between 2003 and 2008, dentists perceive improved precision demands and fewer uncomfortable work postures, but still a high level of physical load. The number of adults treated per dentist also improved, but there was a slight deterioration in work control and leadership.

Conclusions: The results in this thesis show a consistent picture of high perceived physical load due to high precision demands and uncomfortable work postures, supported by observation of body movements (Portable Ergonomic Observation) and sEMG signs during psychosocially demanding circumstances. The rationalizations implemented in Jönköping County during the period 2003-2008 have not resulted in a deterioration of the physical environment, in spite of the fact that dentists produce more treatments of adult patients than before. This result may indicate that rationalizations do not always lead to increased health risks; it depends how they are implemented. Dentists may have changed the way they work for the better, and due to task delegation and SMS reminders a smoother patient flow has probably resulting in a reduction of workload and perceived stress regarding financial loss.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2010. 78 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1191
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-65428 (URN)978-91-7393-348-3 (ISBN)
Public defence
2010-10-29, Originalet, Qulturumhuset, Länssjukhuset Ryhov, Jönköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2011-02-07 Created: 2011-02-07 Last updated: 2013-09-03Bibliographically approved

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Rolander, BoJonker, DirkSvensson, Eva-ChrisEkberg, Kerstin

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