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As previously mentioned, when working in environments that involve high-reliability, high-intensity work, individuals and teams are faced with a number of demands that can leave individuals feeling cognitively and emotionally exhausted. Such exhaustion can impede effective teamwork. For example, Gevers, van Erven, de Jonge, Mass and de Jong (2010) investigated the combined effects of acute and chronic job demands on acute job strain during medical emergencies. In the study the term ‘acute job strain’ encompassed cognitive strain which includes ‘narrowing of attention and impairment of declarative memory and information processing’ (p.1577) and physical strain which included ‘reduced fine motor skills, increased transpiration and physical fatigue’ (p.1577). In their study Gevers et al. (2010) found that acute job demands such as cognitive and emotional demands that are characteristic of emergency situations can impede effective teamwork behaviour (e.g., coordination, communication, monitoring and back up), but only when they resulted in acute job strain. The results showed that when doctors and nurses were required to do a lot more emotionally draining work they were more likely to experience acute job strain. Although acute cognitive and physical strains negatively influenced effective teamwork, effective teamwork was particularly impeded by acute emotional strain. This research is relevant to this thesis because incident management personnel are subjected to time pressure and a strong sense of urgency. Therefore, they also have high levels of responsibility and, at times, high levels of risk.

Chapter 2: Literature review 51 Day, Sibley, Scott, Tallon and Ackroyd-Stolarz (2009) conducted a study with air medical healthcare (AMH) professionals (n=106) to investigate the extent to which work stressors and barriers to patient care influence burnout. They also examined the extent to which job control and team efficacy (collective efficacy) decreases burnout and negatively impacts work stressors on burnout. The results showed that safety incidents, worries about medical hassles and catastrophes and barriers to patient care accounted for significant variance in emotional exhaustion and depersonalisation. Emotional exhaustion is ‘a depletion of emotional, physical, and interpersonal resources causing the individual to feel

fatigued. This exhaustion leads employees to emotionally and cognitively distance themselves from work and become cynical (i.e.,

depersonalization)’ (p. 8).

Day et al. (2009) argued that the findings from their study are compatible with others (e.g., Aasa, Brulin & Barnekow-Bergkvist 2005; Neale 1991) who found that there was a definite link between levels of work-related fears and levels of wellbeing. In terms of the extent to which team efficacy decreased burnout, the results showed that participants who had greater confidence in their teams’ skills and training experienced lower exhaustion, depersonalisation and lower emotional exhaustion regardless of how much they worried about blockages to patient care. This is important to this thesis because as will be discussed later, participants in the study place high importance on having confidence in self and

confidence in others. It will also be shown that such collective

experiences are built around a set of shared understandings of beliefs and values (Louis 1986). The literature related to team/collective efficacy on performance is discussed in Section 2.5.2 of this chapter.

Table 2.2 summarises the studies reviewed in this section. These studies showed that when working in a high-consequence environments people

Chapter 2: Literature review 52 are susceptible to stress and burnout because high-reliability organisations are characterised by cognitive and emotional demands. Such demands can influence people’s wellbeing (e.g., quality of sleep, poorer memory) which in turn can lead to poor performance. The limitations to these studies are that they used self-report measures only and did not consider the broader systemic issues that will influence work stress and burnout.

53 Table 2.2 The contributions and problematics of studies examining stress and burnout

Author and date Examined Results Contributions to this

Thesis

Problematics of the studies

Rutledge et al. (2009) • The relationships

between work stress, work activity patterns and sleep

• Higher work stress and

lower sleep quality are linked with poorer memory

• Conducted in a high-

consequence environment whilst engaged in work activities

• Does not consider cultural

elements which is an important element given the ways in which the various groups (e.g., physicians and nurses) work together and their dynamics

Gevers et al. (2010) • The effect of job

demands on job strains in emergencies and its consequences for individual teamwork behaviour

• Cognitive and emotional

demands impede effective teamwork behaviour

• Conducted in high-

consequence environment

• Examined cognitive and

emotional demands which are characteristic of high

reliability organisations

• Examined the linkages

between cognitive and emotional demands and teamwork

54

Author and date Examined Results Contributions to this

Thesis

Problematics of the studies

Day et al. (2009) • Workplace stressors and

burnout, and the

moderating impact of job control and team

efficacy

• There is a definite link

between work related fears and wellbeing

• Enhanced team efficacy

decreased burnout

• Examined the linkages

between collective efficacy (including perceptions of self and other team members) and burnout

• Conducted with participants

who engage in high intensity, high reliability work

• Conducted focus groups

• minimal examination of the

linkages between collective efficacy, burnout and performance

Chapter 2: Literature review 55