title: Improving the psychosocial work environment.
abstract: OBJECTIVE
  This paper reports a pilot project to evaluate the effectiveness of a participatory organizational intervention to improve the psychosocial work environment in one long-term care unit.
  
  
  BACKGROUND
  Since the early 1990s, health care institutions in Quebec have been constantly changing in order to improve the efficiency of the health care system. These changes have affected the work environment and have contributed to higher rates of burnout and absenteeism among nurses and other health care workers.
  
  
  METHODS
  The study participants were health care workers in a long-term care unit (n = 60). The participatory organizational intervention was based on a contract and carried out by a work team. Work constraints were identified, and an action plan implemented, The effectiveness of the intervention was evaluated by pre- and postintervention questionnaires: the Job Content Questionnaire, Effort-Reward Imbalance Questionnaire and Psychiatric Symptom Index.
  
  
  RESULTS
  There was a significant increase in reward (P < or = 0.01) and a significant decrease in Effort-Reward Imbalance (P < or = 0.01) following the intervention. Absenteeism rates decreased from 8.26% to 1.86% over the study period, but in the rest of the institution remained the same. However, there was a significant decrease in social support from supervisors (P < 0.05) at post-test.
  
  
  CONCLUSIONS
  Participation by health care workers and action plans targeting problematic aspects of the psychosocial work environment are key elements in interventions to improve their health. However, such interventions present challenges, such as the involvement of managers, involvement of all relevant participants, and re-establishment of trust within work teams. Recognition and respect must be re-established, and supervisors must engage with health care workers and give support at all stages of the intervention.
authors.affiliation: CHSRF/CIHR, Nursing Health Services Research Unit (NHSRU), Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada. melanie.lavoie-tremblay@mcgill.ca
authors.forename: Mélanie
authors.initials: M
authors.lastname: Lavoie-Tremblay
authors.forename: Renée
authors.initials: R
authors.lastname: Bourbonnais
authors.forename: Chantal
authors.initials: C
authors.lastname: Viens
authors.forename: Michel
authors.initials: M
authors.lastname: Vézina
authors.forename: Pierre J
authors.initials: PJ
authors.lastname: Durand
authors.forename: Louis
authors.initials: L
authors.lastname: Rochette
mesh_terms: D000041:Absenteeism; D006282:Health Personnel; D006801:Humans; D008134:Long-Term Care; D009726:Nurses; D009784:Occupational Diseases / Q000517:prevention & control / Q000523:psychology*; D016272:Occupational Health; D009936:Organizational Innovation; D010865:Pilot Projects; D013315:Stress, Psychological; D016526:Workload; D017132:Workplace / Q000523:psychology*