Form
Approved OMB
No. 0920-xxxx
Exp.
Date: xx/xx/20xx
HOSPITAL LEADER SURVEY QUESTIONS ON WORKING CONDITIONS AND MENTAL HEALTH
You are invited to participate in an online questionnaire conducted by JPA Health on behalf of the National Institute for Occupational Safety and Health (NIOSH), to better understand hospital practices that promote staff mental health.
Completing the voluntary questionnaire should take about 10 minutes. You may refuse to take part or exit the questionnaire at any time. You can skip any question you do not wish to answer.
There are no direct benefits to questionnaire participation. Risks to participation are minimal, with the main foreseeable risk being breach of confidentiality. Although this questionnaire does ask you to indicate the functional area in which you work (e.g., business operations, clinical operations, human resources, etc.), it does not collect information on your name, email address, or IP address.
Responses will be collected and stored in a secure, electronic format on the REDCap survey system. JPA’s research partner Education Development Center (EDC) will analyze all data on NIOSH’s secured network.
JPA/EDC will report all results in aggregate. No one at your workplace will be able to identify you or your answers based on your position, and no one will know whether or not you participated in the study. Information collected as part of this study will not be used or distributed for other research studies.
If you have questions at any time about this assessment, you may contact JPA Senior Vice President Christina Zurla at [email protected] or 202-870-5487; and/or EDC Principal Research Scientist Kim Dash, PhD, MPH, at [email protected] or 617.618.2425.
Please select your choice below. You may print a copy of this consent form for your records. Clicking on the “Agree” button indicates that:
You have read the above information
You voluntarily agree to participate
You have reached the age of majority (18 in most states)
O Agree
O Disagree
Public
reporting
burden
of
this collection
of
information is
estimated
to
average
10
minutes
per
response,
including
the
time
for
reviewing
instructions,
searching
existing data
sources,
gathering
and
maintaining
the
data
needed,
and
completing and reviewing the
collection
of
information.
An
agency
may
not
conduct
or
sponsor,
and
a
person
is
not
required
to
respond to
a
collection
of
information unless
it
displays a
currently
valid
OMB
control number.
Send
comments
regarding
this
burden
estimate
or
any
other
aspect
of
this
collection
of
information,
including
suggestions
for
reducing
this
burden
to
-
CDC/ATSDR
Reports
Clearance
Officer;
1600
Clifton Road
NE,
MS D-74,
Atlanta,
Georgia
30333
ATTN:
PRA
(0920-xxxx).
Position
SCREENING QUESTION: Which of the following best describes the setting where you currently work? Select one. If you work in more than one setting, pick the setting where you spend the most time.
Hospital
Health care system or hospital network
Outpatient clinic
Long-term care facility
Clinical lab
Hospice
Home care
Other (please specify):
[If response is something other than hospital, then respondent will be thanked for their time and exited from the survey.]
Which best describes the area of your senior leadership (i.e., executive) role in your hospital?
Business operations (finance, marketing)
Clinical operations (clinical directors, chief clinical officers)
Human Resources/Wellness
Information/Informatics
Nursing
Patient care
Other:
I do not hold a senior leadership role [Respondent will be thanked for their time and exited from the survey.]
How long have you served in this role at your hospital (in years)? (number)
Perceptions of Job-Related Distress or Burnout
Mental health includes your emotional, psychological, and social well-being. If affects how you think, feel, and act. It also helps determine how you handle stress, relate to others, and make healthy choices. On a scale of 1 – 10, how much does your job affect your mental health? 1 = strongly believe that my job does NOT affect my mental health; 10 = strongly believe that my job DOES affect my mental health
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
|
|
|
|
|
|
|
|
|
Burnout can affect your mental health. Staff who experience burnout often feel drained and exhausted by their jobs, find their jobs more stressful and frustrating, and struggle to focus on and complete work tasks Thinking about the hospital where you work, what percent of staff (e.g., nurses, physicians, technicians) would you say have experienced burnout in the past 12 months?
None
A few (between 1% than 19%)
Some (between 20% and 39%)
About half (between 40% and 59%)
Most (between 60% and 79%)
Nearly all (80% or more)
In your opinion, how likely are the following to contribute to burnout among staff at your hospital?
1 = Extremely Unlikely 3 = Unlikely 5 = Likely 7 = Extremely Likely
|
1 |
2 |
3 |
4 |
5 |
6 |
7 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Practices to Reduce Job-Related Distress or Burnout
Which of the following does your hospital currently provide?
|
Yes |
No |
Don’t know |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
If respondent answers yes to 7f, 7g, or 7h, then, ask: Which of the following mental health, health, and wellness services does your hospital currently provide to staff? Select all that apply.
|
Yes |
No |
Don’t know |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Knowledge, Attitudes, and Practices Related to Mental Health Services
If staff at your hospital accessed mental health services how likely is it that they would experience the following? 1 = Extremely Unlikely 3 = Unlikely 5 = Likely 7 = Extremely Likely
|
1 |
2 |
3 |
4 |
5 |
6 |
7 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
In your opinion, if your hospital wants its staff to obtain professional services for mental health concerns how important is it that . . .
|
Not at all important |
Somewhat important |
Moderately important |
Very important |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
During the past 3 months, how often have you heard the following at your hospital:
|
Never |
A few times a year or less |
Once a month or less |
A few times a month |
Once a week |
A few times a week |
Every day |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
During the past 3 months, how often have staff at your hospital:
|
Never |
A few times a year or less |
Once a month or less |
A few times a month |
Once a week |
A few times a week |
Every day |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
During the past 3 months, how often have you and other senior leaders at your hospital . . .
|
Strongly disagree |
Disagree |
Neutral |
Agree |
Strongly agree |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Please indicate the extent to which you agree or disagree with the following statements.
At this hospital . . . |
Strongly disagree |
Disagree |
Neutral |
Agree |
Strongly agree |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Campaign Awareness
Are you aware of the [name of customizable toolkit for healthcare executives]?
Yes
No
If respondent answers NO to question 15, then they will be thanked and exited from the survey.
16. If yes, where did you learn about the [toolkit]?
Coworker
Hospital leadership
Family member
Radio
Print news
NIOSH website
Online
Social media ad
17. Did you use the [name of customizable toolkit for healthcare executives] in the past 12 months?
Yes
No
Campaign Promotion
18. a. Did you share [campaign] materials with other hospital leaders?
Yes
No
b. If yes, with how many?
1 – 3
4 – 6
7 – 9
10 or more
19. a. Did you talk about the campaign with other hospital leaders?
Yes
No
b. If yes, with how many?
1 – 3
4 – 6
7 – 9
10 or more
Campaign Engagement/Knowledge
20. Did the [campaign] provide guidance on . . .
|
Yes |
No |
Don’t Know |
|
|
|
|
|
|
|
|
|
|
|
|
Behavioral Intent and Change
21. Did the [campaign] help you . . .
|
Yes |
No |
|
|
|
|
|
|
|
|
|
d. Take one or more concrete steps toward modifying working conditions at your hospital that affect staff mental health?
|
|
|
e. Implement one or more changes to policies and practices that support staff mental health? |
|
|
|
|
|
Hospital Characteristics
22. Which best describes your hospital based on the way it is funded?
23. How many beds are in your hospital?
24. Where is your hospital currently located?
Urban (serves a community of 50,000 or more people)
Suburban (serves a community of more than 2,500, but fewer than 50,000 people)
Rural (serves a community of 2,500 or fewer people)
Multiple settings (serves urban, suburban, and/or rural populations)
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Novicki, Emily (CDC/NIOSH/OD/ODDM) |
File Created | 2024:08:17 01:38:02Z |