La relazione fra cittadini e operatori sociosanitari,Misura della qualità percepita e del burnout,nei reparti di ostetricia.

Introduction Work stress and burnout are not just a problem of people but refer to the social environment in which persons work. Both the structure and how the working environment opertes influence the way people interact and how they carry out their work. Ratanawongsa, Wright, & Carrese (2008) studies show that low levels of welfare transaction affect relationships with patients, interactions with colleagues and health services that are offered. This study confirms, as already shown in other researches (Papp et al., 2004) that there is a positive correlation among workers welfare, the way they perceive the quality of the treatement they offer to patients and their career satisfaction. The quality in obstetrics -related to the perceived quality of the "new mothers"- show that appraising women’s satisfaction, and in general that of health services users, has increasingly become a standard for it is essential to certify quality services (Bramadat, Driedger, 1993; Garcia, 1989; Mason, 1989).The relationship between midwife and mother necessarily affects women's experience of childbirth (Niven, 1994; Kennedy , 1995; Halldorsdottir, & Karlsdottir, 1996; Walsh, 1999; Anderson, 2000) which can be negative or positive (Berg et al., 1996; Green et al., 2000). Inside the Hospital organization an important aspect in quality perceived by patients is derived from the concept of perceived quality that emphasizes the fundamental role of the subject as the recipient of the effects of total quality. Goals To observe the relationship between health and social professionals and patients in order to investigate whether the relational process influences the perceived quality of users of a service, that is obstetrics. To investigate whether work stress (burnout) is a factor that influences the perceived quality of users. Construction of an instrument with due psychometric properties for measuring the quality perceived by the "new mothers" in departments of obstetrics. To Measure the quality perceived by the "new mothers". To Measure the burnout of health and social workers in five departments of obstetrics under investigation in central Italy. Method The work had two distinct phases: the qualitative one and the quantitative one Subjects The survey took place with social and health operators and patients of the obstetrics unit of the hospitals of Florence, Pistoia, Prato, Poggibonsi and Empoli. Instruments Systematic and shared observation using a naturalistic mode, sharing the work with operators and with the (health and social service) users admitted in the department. Discussion groups, semi-structured interviews. Maslach Burnout Inventory (Sirigatti, Stefanile, 1993) and a questionnaire specifically constructed to measure the perceived quality by new mothers. Procedure Group discussions on issues relating to: daily problems, expectations, personnel’s feelings towards the organization of the work, interpersonal relations of new mothers with health and social workers. In the obstetrics department small informal discussion groups on (topics) subjects related to organizational life, stress, business communication . All participants in the survey agreed to fill in the questionnaires independently proposed. The experimental standardized deliveries provided for a brief presentation of the study and passive mentoring during compilation. Statistical analysis All interviews have been first transcribed and then analyzed through the construction of an overview on the principles of Grounded Theory (Glaser e Strauss, 1967). Check of the existence of the prerequisites of the inferential analysis carried out subsequently; the samples produced by balancing factors of interest, assess the shape of the distribution of the three dependent variables relating to the M.B.I. size and variables assumed for the purpose-built questionnaire. Use of correlation coefficients, Pearson's r, and parametric and nonparametric inferential statistics (ANOVA). For the analysis of the of the questionnaire’s structure specifically constructed for the research has been conducted an exploratory factor analysis to check the existence of the hypothesized factors by analyzing the maximum likelihood, the method of rotation Oblimin. Through a cross - validation procedure the dataset has been randomly divided into two subsamples. Plausibility check size by calculating Cronbach's alpha and by calculating the correlation coefficients item - total correct. Verification of the factorial structure of the questionnaire specially constructed with a confirmatory factor analysis with maximum likelihood method. Results The participants of the interwiews have unanimously lamented the difficulty in communication and reporting, identifying this misunderstanding as a reason for conflict, perceiving it as a stress factor in working life. Questionnaire to measure perceived quality: factor structure consisting in 22 items distributed in five factors: Relationship with socio health, time of delivery, Comfort, Care of the newborn, Acceptance, explaining 55.35% of total variance. Measurement of the Alpha Cronbach. whether the item was excluded from the scale, alpha values of between .91 and .70 total. Second order factor analysis: The results obtained indicate a good fit of the theoretical model to data. Although the chi-square is significant, other indexes (NNFI = 0.93 ; CFI = 0.94 ; RMSEA = 0.056) are satisfactory, (Bentler, 1990; Browne, 1990). The ANOVA is used to check the difference between average scores for quality of service in relation to the variable unit of obstetrics, confirming for the variables under consideration the existence of significant differences for all five variables. check/ confirmation of the existence of a relationship between service quality and the three MBI scales The results show a positive correlation between staff satisfaction subscale of the MBI and the scale of perceived quality compared to the Comfort in the structure r = .831, p <0.05; There is an additional positive correlation with the scale of perceived quality for the care of the newborn r =. 823, p <0.05. The scale of the MBI Depersonalization significantly negatively correlated with the scale of perceived quality inherent in the time of first admission to hospital, acceptance, r = -. 941, p <0.01. Through the correlation between the three subscales of the MBI and the index of total quality to verify the existence of a relationship produced a correlation between the index and adverse affects overall quality of the Depersonalization subscale and r = -. 854, p < 12:05 a positive correlation between the subscale of personal satisfaction index for total r = .889, p <0.05. Conclusions This work has met the goal to create an instrument with due psychometric quality to measure the perceived quality in the area of the birth by the "new mothers" and to highlight - in agreement with research of Leiter, Harvie, Frizzell (1997) and Garmann, & Corrigan (2002) as burnout in health and social workers may have an 'influence over quality perceived by patients. In particular, how the relationship between operators and patients can foretell the perceived quality. Regarding the outline of investigative tools of perceived quality in health, survey instrument for the sector of the birth has been developed. It is characterized by fast delivery and due psychometric structure. As far as the results of correlations between the MBI and the perceived quality of the new questionnaire are concerned, we can observe significant correlations between the level of depersonalization (DP) and total quality index, unlike the work of Corrigan and Garman, in agreement with the work Leiter, Harvie and Frizzell. The other aspect to emphasize (in contrast to findings in literature) is the relevance given to the issue of relationship between operators and patients, compared to the lack of energy / emotional exhaustion as a factor influencing perceived quality.