Psychological work climates and health care worker well-being

Although extensive research has focused on health care worker well-being (or lack thereof) for the past two decades, it appears that burnout and moral distress are increasing, not decreasing, with growing numbers of workers leaving the profession. In its 2019 report, the National Academy of Medicine cited a range of workplace problems—understaffing, poor care coordination, and poorly designed and time-consuming electronic medical records—as leading causes of low clinician well-being. The COVID-19 pandemic only amplified these issues (Harley et al., 2022). Although job stress that arises from structural problems and pandemics must be addressed, an important yet understudied area of inquiry is the collective psychological consequences of these factors in health care workplaces. In a study published earlier this year in Health Care Management Review (HCMR), Porter et al. (2024) found that instrumental ethical climates (perceptions that workers are primarily self-interested and transactional as opposed to benevolent and collaborative) were strongly related to health care workers being targets of bullying behaviors and negatively related to psychological safety. What is striking, however, is the number of respondents in the study (50%) who responded, "often," "very often," or "almost always" to items such as "In my company, people protect their own interests above all else" and "People at my company are concerned with the company's interests, to the exclusion of all else." Furthermore, roughly 20% of respondents indicated they were targets of workplace bullying behaviors at least once a month. This all suggests that poorly designed workplaces and workplace technologies produce dysfunctional instrumental climates that further negatively affect overstretched health care workers. Instrumental climates are consistently negatively correlated with desirable employee outcomes and most frequently associated with unethical behavior (Ozdoba et al., 2022) and abusive supervision (De Hoogh et al., 2021). These studies of instrumental climate together show that when workers believe that their employer's (financial or operational) interest is top priority (as opposed to people), it overrides professional norms of compassionately delivering health care and caring support of co-workers. It also contradicts the public's belief that health care organizations are benevolent, caring places. As such, we need to build on the emerging body of evidence that compassion can be systematically designed into health care delivery (McClelland Ali et al., 2023) to the benefit of health care workers and their organizations. However, we need more evidence of how these practices and relationships (re)shape climate (especially toxic climates like instrumental climate) and outcomes. At HCMR, we welcome work that attempts to understand and redress the workplace conditions that undermine clinician and health worker well-being. That is, we need and seek research that identifies and conceptualizes unhealthy climates, but also what leads to them and on how to change climates from toxic to healthy. Cheryl Rathert Co-Editor-in-ChiefTimothy Vogus Associate EditorLarry R. Hearld Co-Editor-in-Chief