Can the type of organisational structure affect individual well-being ...

Giornale Italiano di Medicina del Lavoro ed Ergonomia Supplemento A, Psicologia
© PI-ME, Pavia 2008 2008; Vol. 30, N. 1: A44-A51
http://gimle.fsm.it ISSN 0391-9889
A.M. Zotti, G. Omarini, P. Ragazzoni 1
Can the type of organisational structure affect individual well-being
in health and social welfare occupations?*
Servizio di Psicologia, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno
1 DORS - Centro di Documentazione per la Promozione della Salute - Regione Piemonte
ABSTRACT. The aim of this study was to analyse the perceived
stress and individual resources of people involved in health
and social welfare occupations, and evaluate whether
belonging to different organisational structures leads
to different reactions. To this end, we used the Maslach
Burnout Inventory, the Coping Inventory for Stressful
Situations, and the Team Climate Inventory. The sample
consisted of 327 subjects (67% females) with a mean age
of 35.9 ± 8.8 years; most had a middle or high school diploma
(63%), and they had been employed in the same place for
about four years (47.5 ± 7.3 months): 103 worked for health
and social welfare cooperatives, and 224 for a local health
authority. The results showed average burnout values and
coping strategies prevalently aimed at directly solving the
stressing situation in both working contexts. In comparison
with the variables expressing the perceived organisational
climate, sociodemographic characteristics did not seem to have
a determining influence on the perception of individual stress.
Comparison of the subjects employed in the two settings
showed that organisational vision and a sense of belonging
significantly determined subjective well-being, with the
healthcare workers showed greater individual ill-being
and a worse vision (i.e. an unclear perception of hospital
choices and objectives). Our findings confirm that subjective
well-being in high-touch occupations may be determined
by the organisational culture: a mutual aid culture such as
that of a cooperative has a protective effect despite the fact
that the employment situation of the workers is more
precarious and flexible than that of workers employed in highly
structured environments such as that of a hospital.
Key words: high-touch professions, burnout, coping,
organisational climate.
RIASSUNTO. Questo studio si è proposto di effettuare
una analisi dello stress percepito e delle risorse individuali
di operatori coinvolti in professioni socio-sanitarie e valutare
se l’appartenenza a differenti strutture organizzative
determini un differente modo di reagire. Gli strumenti usati
sono: Maslach Burnout Inventory, Coping Inventory
for Stressful Situations, e Team Climate Inventory.
Il campione è costituito da 327 soggetti di 35.9 ± 8.8 anni
età media; prevalentemente di sesso femminile (67%),
con licenza di scuola media superiore (63%), e mediamente
impiegati nella stessa realtà lavorativa da circa quattro
anni (47.5 ± 7.3 mesi). 103 soggetti sono impiegati in
cooperative socio-sanitarie, 224 sono impiegati in azienda
sanitaria. I risultati evidenziano valori medi di burn-out
e strategie di coping prevalentemente orientate alla soluzione
diretta della situazione stressante, sia per il comparto
cooperative che sanità. Le caratteristiche socio-demografiche
sembrano non influire in modo determinante sulla
percezione dello stress individuale rispetto alle variabili
che esprimono la percezione del clima organizzativo.
Il confronto tra soggetti impiegati in cooperative sociali
e soggetti impiegati in azienda sanitaria spiega infatti come
sia la visione organizzativa ed il senso di appartenenza
a determinare in misura significativa il benessere soggettivo:
i soggetti della sanità mostrano maggiore malessere
individuale unitamente ad una peggiore Vision, ossia una
percezione non chiara delle scelte e degli obiettivi aziendali.
Il lavoro di indagine svolto conferma quanto il benessere
soggettivo nell’ambito delle high-touch professions possa
essere determinato dalla cultura organizzativa; la cultura
mutualistica come quella delle cooperative risulta avere
un effetto protettivo pur essendo i suoi lavoratori in una
condizione lavorativa più precaria e flessibile rispetto
ai lavoratori impiegati in una realtà altamente strutturata
come quella dell’azienda sanitaria.
Parole chiave: high-touch professions, burnout, coping,
clima organizzativo.
“There is no lack of work: it is we who lack the intuition
to understand that it is radically changing, and the
imagination to organise it differently.” (1).
Introduction
The literature concerning occupational stress highlights
a decrease in “acute” reactions, and an increase in chronic
and passive reactions (2). The number of people seeking
help because of working stress is increasing, as is the
number of legal actions being instituted against employing
organisations (3).
* This study was conducted within the framework of the 2000 Ministry of Health Strategic Project “Health risk prevention in living and working
environments” ISPESL sub-project - Risk factors and management of occupational stress.

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In order to understand the phenomena associated with
stress in the workplace, it is also necessary to consider the
concept of organisational stress, which covers the elements
related to roles and settings that can be found in any
working environment. Those relating to the setting include
a lack of meaningful leadership, poor company communications,
little or no supervision of working activities,
a restrictive definition of responsibilities, and a bad
organisational climate in general. The organisational
climate consists of the rules and values of the organisation,
as well as the collective feelings and beliefs of group
members; furthermore, as it is shared, it affects people’s
behaviours and performances. In other words, the
organisational climate can be seen as a diversified
perception of an organisation’s formal and informal
policies, practices and procedures (4).
We are living at a time of transition: the old society in
which people had the same job throughout their lives is
becoming one in which they can expect to have a number
of different jobs characterised by a spatial and territorial
dispersion (5) that is leading to the redefinition of
individual well-being and organisational climates.
Although the problem of occupational stress is particularly
obvious in the field of healthcare, less is known
about the personal burdens produced by areas of employment
characterised by flexibility, uncertainties in terms of roles and
tasks, and principally economic motivations.
The so-called tertiary sector has for some years
represented one of the main features of global and national
economies, and the value of the goods/services offered by
“social enterprises” has now reached highly significant
proportions. Social Cooperatives in Italy are an
occupational reality for more than 500,000 people who are
delegated by public bodies to supply social, health,
educational, cultural and logistics services, and it is
acknowledged that the entire welfare system would
collapse without their support (6).
In the case of nursing staff, the main sources of stress
identified in the literature are the lack of clarity concerning
their role, difficulties in programming shifts and working
groups, their extraneity to decision-making processes,
their low social status and a lack of support (7, 8).
The sources of stress for tertiary workers can be
attributed to three types of precariousness: their limited
possibilities of making short- or long-term forecasts and
plans concerning their professional, personal and familial
future; difficulties in acquiring significant professional
experience that can be successfully transferred from one
employer to another; and the destructuring (and often
elimination) of the spatial and relational aspects of work
that underlie personal identity and social integration (9).
Given the rapid changes induced by globalisation and
economic contraction in stable and consolidated working
systems such as healthcare, as well as in the still undefined
systems characterising the tertiary sector, the aim of this
study was to investigate the individual well-being of
people working in the health and social welfare sectors and
assess whether its is related to specific individual
characteristics or affected by the organisational and
juridical structure of their working environments (10, 11).
Materials and methods
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Invitations to participate in a survey of individual
stress and organisational climates were sent to various
social cooperatives and healthcare institutions in Eastern
Piemonte, and were accepted by seven social cooperatives
and one local health authority that provides both hospital
and territorial services.
Assessment tools
The self-administered instruments used to identify the
sources of stress and the strategies used to cope with it
were:
• Sirigatti and Stefanile’s 1993 Italian version (12) of the
Maslach Burnout Inventory (MBI) (13) that was
designed to measure burnout and is specific for people
working in the human services or so-called high-touch
professions. It consists of three scales: Emotional
Exhaustion (EE), which is indicative of the perceived
lack of emotional resources; Depersonalisation (DP),
which indicates the presence of negative, cynical
feelings towards the object of the professional
intervention; and Personal Accomplishment (PA),
which indicates the degree of satisfaction with one’s
professional role and the perception of being more or
less prepared to deal with working situations.
• Pedrabissi and Santinello’s 1994 Italian version (14) of
Endler & Parker’s 1990 Coping Inventory for Stressful
Situations (CISS) (15), which is capable of identifying
personal behavioural abilities for managing stressing
situations regardless of the working setting. It is
divided into three subscales: Task-oriented Coping
(TC), which is oriented towards directly confronting
the stressful situation; Emotion-oriented Coping
(EC), which is oriented towards confronting and
managing the emotions related to the stressful
situation; and Avoidance-oriented Coping (AC),
which is oriented towards avoiding the stressful
situation by means of Distraction (DC) through other
activities and situations, and Diversion (SDC) through
relationships with other people.
• Anderson & West’s 1994 Team Climate Inventory
(TCI) (16) in the 2002 Italian version adapted by
Ragazzoni, Baiardi, Zotti, Anderson and West (17),
which describes perceptions of the structural, relational
and management characteristics of the working
environment. It is divided into five subscales: Vision
(VI), which indicates the clarity and sharing of the
working group’s rules and objectives; Task
Orientation (TO); Participative Safety (PS), which
indicates the extent to which workers feel they can
participate in the company culture without any risk;
Support for Innovation (SI), intended as the
perception of practical and emotional support; and
Interaction Frequency (IF), which indicates the
frequency of communicative exchanges between the
members of the working group.
The tests, together with an extensive introduction
explaining the objectives of the research and guaranteeing

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anonymity, as well as detailed instructions, were distributed
directly or via an internal mailing system, and to be
returned in a sealed and anonymous envelope.
Sampling
1) In the Cooperative setting, a non-probabilistic sample
was used for reasons of convenience and on the basis
of the concrete possibility of finding subjects on site at
the time the investigation was carried out.
2) In the Heathcare setting, the probabilistic model was
based on the random selection of workers from the
universe of reference.
Statistics
The data were analysed by means of the SPSS 14.0 for
Windows statistical program (18) using frequency
distribution analysis (χ 2 ), Spearman’s non-parametric
correlation, the Student t test, multiple regression analysis,
analysis of variance, and analysis of covariance because of
the presence of variables determining the dishomogeneity
of the study samples. A p value of

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Table II. Sociodemographic characteristics of the Healthcare sample (n=224)
Gender Males Females
31 179
Age bands, years 23-30 31-40 41-50 51-59
(M = 37.5 ± 8.7) 23% 41% 29% 7%
(range 23-59)
Marital status Single Married Separated/divorced Widowed Other
33% 55% 9% 1% 1%
Number of children None 1 2 3
48% 31% 20% 1%
Education Primary school Middle school High school University Degree
– 17% 73% 9% 1%
Working position Supervisor Qualified nurse General nurse
11% 78% 11%
Months worked 37
(M = 177 ± 102.6) 15.7% 3.9% 80.4%
(range 12-432)
Service/Dept. Hospital Non-hospital Administration/staff
74% 23% 3%
Working group Yes No
37% 63%
were female, younger and without children had high
avoidance- distraction- and social diversion-oriented
coping scores. Vision of the working organisation and the
frequency of social interactions correlated with education:
the higher the level of education, the higher the scores
expressing a clear and shared vision of the organisational
climate.
On the other hand, all of the intra-test correlations were
high and express between-construct consistency: in
particular, it is clear that individual ill-being (emotional
exhaustion) significantly correlated with high emotionoriented
coping scores and low scores for the perception of
the organisational climate.
A multiple regression analysis designed in order to
investigate in detail whether and how individual and
organisational characteristics were predictive of subjective
ill-being showed that emotional exhaustion (R 2 = .276; F =
12.676; p

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Table III. Significant correlations between the sociodemographic characteristics and psychological variables of the study population (n = 327)
MBI CISS TCI
Gender Age Educa- Marital N° of
tion status children
EE DP PA TC EC AC DC SDC VI TO PS SI
Gender –
Age – –
Education – – –
Marital status .12 .37 – –
N° of children – .41 – .44 –
M EE – .11 – – – –
B DP – .11 – – – .43 –
I PA – – – – – –.26 –.21 –
TC – – – – – – – .35 –
C
EC – – – – – .47 .26 –.23 – –
I
AC .17 –.14 – – –.15 – – – .20 – –
S
DC .12 – –.11 – –.13 – – – .14 – .86 –
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S
SDC .20 –.17 – –.11 –.13 – – .18 .27 – .75 .46 –
VI – – .16 .13 – –.27 –.23 .30 .21 – – – .13 –
T TO – – – – – –.22 –.25 .33 .23 – .12 – .16 .66 –
C PS – – – – – –.24 –.22 .33 .21 – .16 – .24 .50 .66 –
I SI – – – – – –.30 –.22 .31 .16 –.13 .12 – .18 .62 .73 .80 –
IF – – .16 .14 – – – .25 – – – – .15 .35 .45 .62 .60
Rho di Spearman p

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which the Cooperative sample had a lower mean score
(15). Our subjects, and to a significantly greater extent
those operating in the tertiary sector, use stress handling
strategies that are prevalently oriented towards confronting
situations, rather than emotional restructuring and avoidance.
Team Climate Inventory
Table VI shows that the Cooperative sample
significantly differed from the healthcare sample in
relation to two of the five scales, showing greater clarity
concerning the values and objectives of the organisation to
which they belong (Vision) and declaring better support
for innovation. The analysis revealed only one significant
interaction between the groups and gender in relation to
the Vision scale (F = 4.096; p

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confirmed by the fact that their reaction to stress is
prevalently oriented towards the emotional restructuring of
the effects of critical situations rather than towards
confronting and solving the situations themselves.
Although it is commonly believed that burnout is
primarily an individual problem, and that the people
experiencing it do so because of personal defects or
deficiencies inherent in their characters, behaviour or
productive capacity, our data reveal that the characteristics
of the place in which they work also significantly affect
individual well-being and working satisfaction. The
structure and functioning of the workplace mould the way
in which people interact and carry out their duties.
It is likely that the public health system requires the
achievement of conflicting objectives: care and attention
towards the subjective nature of the user and, simultaneously,
the rapid and precise execution of technical
routines in a limited time, with a high level of performance
and a very low possibility of error. This creates a sensation
of constant tension, confusion concerning priorities, and
disorientation. On the other hand, social cooperatives,
which are characterised by a simpler and less rigid
hierarchical structure, probably allow duties to be
performed in a more flexible manner that valorises the
individuality of both the worker and the user.
Born as a social phenomen of aggregation in the face
of institutional inadequacies, and subsequently organised
as autonomous professional institutions, cooperatives
seem to give their working members a clearer picture of
Table VI. Mean Team Climate Inventory scores
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Cooperatives Healthcare
TCI (n = 103) (n = 224) F p
Vision 38.75 ± 8.06 36.26 ± 8.57 8.592 .004
Task orientation 21.66 ± 6.01 20.50 ± 6.91 3.097 ns
Participative safety 25.04 ± 4.75 23.64 ± 5.54 5.092 .02
Support for innovation 34.25 ± 6.68 31.95 ± 8.34 7.941 .005
Interaction frequency 10.82 ± 2.28 10.40 ± 2.96 2.720 ns
Table VII. Mean Team Climate Inventory scores by duration of employment and organisational type
TCI 37 months F° p<
Coop 35.62 ± 9.78 42.44 ± 7.38 40.90 ± 5.07
Vision 5.797 .003
H’care 37.69 ± 9.15 32.50 ± 9.24 35.90 ± 8.51
Coop 21.03 ± 6.90 23.11 ± 5.37 22.48 ± 5.52
Task orientation 2.768 ns
H’care 22.84 ± 5.16 19.38 ± 8.05 19.99 ± 7.19
Coop 24.31 ± 5.07 26.89 ± 2.84 25.46 ± 4.60
Participative safety 3.904 .02
H’care 25.81 ± 4.22 22.50 ± 5.18 23.17 ± 5.71
Support for innovation Coop 32.38 ± 7.32 37.67 ± 5.76 35.33 ± 5.89
H’care 34.03 ± 7.47 30.88 ± 7.29 31.62 ± 8.19
3.530 .03
Coop 9.74 ± 2.20 11.33 ± 1.65 11.54 ± 2.17
Interaction frequency 6.207 .002
H’care 10.88 ± 2.24 10.13 ± 2.94 10.38 ± 2.34
° Interaction between months of employment and organisational type
their reference values and objectives, and offer greater
support to innovation and new proposals, possibly also as
a result of their statutory by-laws and the fact that they
have to adapt to the continuously changing laws of the
market.
Our findings highlight the fact that the organisational
climate (intended as an individual description of the social
setting or context to which a person belongs) can be the
most important determinant of individual well- or ill-being.
Climate is a diversified perception of organisational
policies, practices, and formal and informal procedures (4).
It is likely that, as it stands, the restructuring of public
facilities on the basis of a company model, which has
introduced the criteria of efficiency and effectiveness that
guide the processes and development of private companies,
is not functional to individual and organisational wellbeing.
The logic of scientific management (19) pervading the
world of public health (which is characterised by the rigid
formal organisation of tasks, how they should be carried
out and by whom, and training) all too often ignores the
characteristics of the people occupying the various
positions in the organisation, and lead to the development
of subjective ill-being and professional dissatisfaction.
On the other hand, we can hypothesise that the typical
entrepreneurship of cooperatives, which is based on
mutual aid and solidarity, is an exemplary case of rooting
economic activity in a social fabric and system of values
that (for its very survival) shifts the priority from the

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pursuit of individual profit towards the production of
collective benefits (20), thus encouraging its worker
members to develop ties of reciprocity and share actions
and objectives (21), which are reflected in the organisation
itself and individual resources.
In the final analysis, our investigation confirms that
companies (particularly in the field of healthcare) are far
from offering a real organisational culture that combines
individual well-being with economic and working ends,
and that training, the analysis of processes, or group work
alone cannot replace a culture of affectivity and interaction
founded on a shared analysis of one’s own working life.
Actions aimed at relieving occupational stress should
therefore not only concentrate on the individual
characteristics of the most vulnerable, but also foresee
structural interventions aimed at the organisation itself, its
culture and the values it proposes.
Acknowledgements
The authors would like to thank Dr. Elena Serravalle for her
collaboration in collecting the protocols, and Kevin Smart (Link s.r.l.,
Milan) for his help in preparing the English version of the text.
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Reprint request: Dr. Anna Maria Zotti, Servizio di Psicologia, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno,
Via per Revislate 13, 28010 Veruno (NO), Italy, Tel. +39-0322.884782, Fax +39-0322.884816, E-mail: annamaria.zotti@fsm.it