The sustainable employability of healthcare workers is associated with quality of care and vice versa, but how both interact remains largely unknown. This study aims to better understand the underlying mechanisms that explain the interconnectedness between healthcare workers’ sustainable employability and quality of care by examining organisational practices in two hospital teams that work on improving specific clinical processes.

A qualitative study was conducted, where team leaders, department managers and healthcare teams were observed and interviewed about their experiences with, and perspectives on, the (organisation of the) respective clinical process and daily (quality improvement) work. Transcripts and field notes were analysed in accordance with reflexive thematic analysis.

The emergency room and operating room of a recently merged Dutch hospital.

A total of 49 hours of observations and 10 interviews were conducted with team leaders, department managers, (scrub) nurses, physicians and other allied health professionals. Interviewees were purposively recruited when they were involved in, or considered knowledgeable about, the clinical processes.

This study identified three mechanisms as a result of different organisational practices that affected healthcare workers’ sustainable employability and quality of care separately and set in motion their interconnectedness: routinely overburdened staff, prolonged perceived distance between staff and regular disregard of raised concerns by staff. Over time, as these mechanisms remained unaddressed, undertows of slumbering sentiments—discontent, distrust and inertia—emerged. These sentiments proved hard to bring to the surface and to resolve and, in turn, may further compromise sustainable employability of healthcare workers and quality of care.

In this study, we show how the relationship between the sustainable employability of healthcare workers and quality of care is set in motion by seemingly unrelated organisational practices. To benefit both healthcare workers and patients, leadership and healthcare teams are urged to prevent (undertows of) slumbering sentiments by recognising sentiments as important signals of dysfunctional circumstances and by effectively organising participatory practices that enable healthcare workers’ voice and input.

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.