title: The impact of the hospital work environment on social support from physicians in breast cancer care.
abstract: OBJECTIVE
  Research on determinants of a good patient-physician interaction mainly disregards systemic factors, such as the work environment in healthcare. This study aims to identify stressors and resources within the work environment of hospital physicians that enable or hinder the physicians' provision of social support to patients.
  
  
  METHODS
  Four data sources on 35 German breast cancer center hospitals were matched: structured hospital quality reports and surveys of 348 physicians, 108 persons in hospital leadership, and 1844 patients. Associations between hospital structures, physicians' social resources as well as job demands and control and patients' perceived support from physicians have been studied in multilevel models.
  
  
  RESULTS
  Patients feel better supported by their physicians in hospitals with high social capital, a high percentage of permanently employed physicians, and less physically strained physicians.
  
  
  CONCLUSIONS
  The results highlight the importance of the work environment for a good patient-physician interaction. They can be used to develop interventions for redesigning the hospital work environment, which in turn may improve physician satisfaction, well-being, and performance and consequently the quality of care.
  
  
  CONCLUSIONS
  Health policy and hospital management could create conditions conducive to better patient-physician interaction by strengthening the social capital and by increasing job security for physicians.
authors.affiliation: Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany. Electronic address: lena.ansmann@uk-koeln.de.
authors.forename: Lena
authors.initials: L
authors.lastname: Ansmann
authors.affiliation: Institute of Psychology, University of Education Freiburg, Freiburg, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Wirtz
authors.affiliation: Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Kowalski
authors.affiliation: Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Pfaff
authors.affiliation: Knowledge Center Innovations in Care, Applied University, Rotterdam, The Netherlands.
authors.forename: Adriaan
authors.initials: A
authors.lastname: Visser
authors.affiliation: Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany.
authors.forename: Nicole
authors.initials: N
authors.lastname: Ernstmann
mesh_terms: D001943:Breast Neoplasms / Q000523:psychology / Q000628:therapy*; D005260:Female; D005858:Germany; D006761:Hospitals; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology*; D012944:Social Support; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D016526:Workload / Q000706:statistics & numerical data; D017132:Workplace
keywords: Breast cancer; Multilevel analysis; Patient–physician interaction; Social capital; Support; Work environment