Healthcare workers' sustainable employability in relation to quality of care: an umbrella review.

Abstract

There is a wealth of reviews investigating the relations between healthcare worker (HCW) variables and quality of care (QoC) outcomes. Individually, these reviews predominantly focus on one aspect relevant to HCWs' functioning at work, unintentionally contributing to a scattered body of evidence. This umbrella review uses the concept of sustainable employability (SE)-a multidimensional construct that captures an individual's long-term ability to function adequately at work and in the labour market-to integrate existing reviews on the topic, and to examine if and how HCWs' SE is related to QoC. An umbrella review of systematic reviews was conducted. Systematically conducted reviews or meta-analyses of empirical primary studies (quantitative, qualitative or mixed methods) were included. Reviews were eligible for inclusion if they included studies that focused on HCWs providing direct patient care; explored a relation between SE indicators and QoC outcomes; were peer-reviewed and published in an academic journal in either English or Dutch and were appraised as high-quality reviews. We followed the Joanna Briggs Institute manual for Evidence synthesis when conducting this review. Nine verified indicators of SE, pertaining to health, well-being and competence domains of SE, were used to identify published reviews in Embase, Medline, PsycINFO and CINAHL up until 10 May 2024. Quality of reviews was critically appraised with the Joanna Briggs Institute Critical Appraisal Instrument. Data were extracted by one reviewer in a standardised form with a second reviewer verifying outcome data that directly informed our evidence statements. 55 high-quality reviews were included, and 6 SE indicators linked to 19 QoC outcome categories were identified, distinguishing a total of 50 unique relations-whether positive, negative, partial, absent or mixed. Although extensive, evidence is disproportionally represented, with reviews on 'burn-out' and 'lack of knowledge/skills' being over-represented and well-established. Only four reviews covered multiple SE domains simultaneously. When theoretically integrated, there is an impressive array of evidence showing the crucial role of HCWs' SE for QoC. Researchers are advised to adopt more multidimensional perspectives and concepts to empirically validate the interrelatedness of individual HCW variables for QoC. Practitioners may use this overview to consider interventions that target multiple indicators of HCWs' SE.