Associations between psychosocial working conditions and quality of care (i.e., careless errors, perceived social interactions with patients) – a cross-sectional study among medical assistants

Purpose Adverse psychosocial working conditions in the health care sector are widespread and have been associated with a reduced quality of patient care. Prior qualitative work suggests that medical assistants assume that their poor working conditions mainly lead to a poorer quality of care in terms of increased errors due to carelessness and poorer social interactions with patients. We aimed to provide evidence for the first time for medical assistants in Germany based on a quantitative study.

Methods A total of 944 medical assistants participated in a survey (09/2016-04/2017). The effort-reward imbalance (ERI) questionnaire was used to capture psychosocial working conditions. Careless errors (3 items, e.g. measurement or documentation errors) and the quality of interactions (3 items) with patients were measured by a questionnaire developed by the study team based on qualitative research. Responses were provided on a 5-point Likert scale with higher scores reflecting poorer quality of care. We used exposures which were dichotomized by tertiles or established cut offs (i.e., ERI ratio >1.0) and outcomes which were dichotomized by quintiles in Poisson regression analysis.

Results A high ERI ratio was significantly associated with elevated prevalences of reporting frequent careless errors [prevalence ratio (PR) = 2.53] or poor interactions with patients [PR = 3.62]. High effort showed the same pattern of associations which were statistically significant [PR= 1.45 and PR= 1.88, respectively]. For reward, the expected significant inverse relationships were observed [PR = 0.53 and PR = 0.42, respectively].

Conclusions Our study suggest that higher work stress is associated with more errors due to carelessness and poorer patient interaction among medical assistants. Prospective studies are needed to verify causal relationship.

Publication History

Article published online:
02 September 2021