Ricerca-azione sui processi psicosociali del personale durante il cambiamento organizzativo del Dipartimento Chirurgico di un Ospedale del Nord Italia

Organizations are increasingly pushed toward global competitiveness, the pursuit of quality and excellence, continuous change and innovation. The effectiveness of organizational change, which is crucial for competitiveness, increasingly depends on the ability of the organizations to actively support the workers during the process of change (Armenakis & Bedeian, 1999). There is the belief that the psychological experience of people can greatly affect the effectiveness of the implementation of change initiatives (Herold, Fedor, & Caldwell, 2007). Over the past decade, research has shifted from a predominantly macro-level (system level) to a micro level (individual) in order to better understand the role of individual factors in facilitating or hindering the processes of change (Vakola & Nikolaou, 2005). Acquiring deeper knowledge about the individual factors that affect the change is essential to build strategies that ensure the involvement of people during the change and prevent its potential failure. To date, little research has been conducted to examine the effects of organizational change within the nursing work environment. Action research is considered a form of effective research to achieve organizational change in health care systems (Elsey & Lathlean, 2006; Hampshire, 2000). This effectiveness has been attributed to the intrinsic characteristics of action research that have also been identified in the literature on organizational change and are considered important conditions for implementing change: participation and democracy. My thesis describes a longitudinal action research project intended to accompany and guide, from the point of view of the patient-centered models of care, the change in working patterns and processes of two surgical units of a second-level provincial hospital of Northern Italy. In particular, it aims to seek, evaluate and monitor the process of change: • on health care professionals (doctors, nurses and community health workers), some individual factors (attitudes, perceptions and behaviors), the group environment, collaboration and support at the organizational level in order to improve adherence to innovative processes; • on some processes of care (preoperative preparation, patient education, hospital discharge); • on patients in terms of continuity, safety, quality of care and satisfaction. The research lasted 30 months (May 2011 - October 2013). The data were collected at the beginning of the reorganization (time 1), during the change, through the use of a diary to monitor it, and a year and a half after the reorganization (time 2). To collect the data, I used both quantitative methods, through the use of a structured questionnaire for health care professionals and patients, and qualitative methods, through semi-structured interviews, focus groups and observation in the field. Using two questionnaires and running focus groups, I have tried to capture the set of perceptions and expectations shared by health care professionals, whose content reflects feelings, experiences, states of mind on the job, in the relations between the organization and the health care providers involved in a process of organizational change. I have identified the most significant individual variables and those concerning the relation individual/organization, which in the previous research have shown to influence the processes of organizational change. The measures were for the most part translated and adapted/validated in Italian in previous research; some have been created ad hoc to obtain specific information on the quality of the work of nursing.