State of the Sector | Healthcare and Social Assistance: Identification of Research Opportunities for the Next Decade of NORA. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication 2009-139, Morgantown, WV: National Institute for Occupational Safety and Health, 2009 Aug; :75-86
Work organization refers to the design of the job and the way it is performed and managed. The National Occupational Research Agenda (NORA) identifies six major components of work organization: work schedule, job design, interpersonal relationships with supervisors and coworkers, career concerns, management style, and organizational characteristics [Huang et al. 2002; Hurrell and Kelloway 2007; Sauter et al. 2002]. Some experts also include work-home interface. Sauter et al.  also considers the external factors that have a strong influence on work organization including economic, legal, political, technological, and demographic forces at the national/international level. Poor match between organization of work and the capabilities, resources, or needs of workers can lead to a stress response; reduced time available for sleep, family, and nonwork activities; and longer exposures to occupational hazards. These immediate effects can lead to mood disturbances; difficulty thinking; disturbed sleep; fatigue; pain; neurological, cognitive, and physiological dysfunction; and negative health behaviors such as smoking and substance abuse. These can lead to a wide variety of injuries and illnesses for the worker. In addition, worker stress and fatigue can lead to negative impacts to the employer and community such as medical errors, shortages of healthcare workers, and automobile crashes while commuting to and from work (Table 25). Table 25 lists an overview of the hazards associated with poor organization of work and adverse outcomes reported in the literature. Career concerns include low status in the organization, inadequate pay, job insecurity, lack of promotion or growth prospects, unclear or unfair performance evaluation systems, and being over-skilled or under-skilled for the job. Organizational climate and culture and violence in the workplace are discussed in more detail in other sections of this document. Work hours, worker control over their job, support, aspects of job design and content particularly relevant to HCSA, staffing, and interpersonal relationships will be discussed in more detail below.