Kimberly Jinnett, PhD

Affiliated Faculty
Campus Phone
Address Postal

3333 Calif. St,Laurel Heights, Rm 340
UCSF Box 0646
San Francisco, CA 94118
United States

Biography
Dr. Jinnett is currently affiliate faculty at UCSF in the Institute for Health and Aging, School of Nursing. She is also Research Director at The Center for Workforce Health and Performance (CWHP). CWHP is an independent and objective source for scientific reports and educational resources on healthier, happier and longer working lives. By developing knowledge around workforce health and performance improvement and disseminating it widely through scientific and educational forums, CWHP contributes to the adoption of evidence-based policies and practices that support a healthier, happier and high-performing workforce, a healthier economy and, in turn, healthier and more productive communities.

Dr. Jinnett's main research interests center on connecting organizational policies and practices with individual health-related outcomes. Much of her current research work demonstrates the effects of work climate, treatment and symptoms (e.g., pain, fatigue, sleeping problems, psychological distress) on assessments of work stress, work attendance, job performance and other functional outcomes.

In her continuing research and through prior research at RAND, the Department of Veterans Affairs and the Integrated Benefits Institute she has focused on a variety of organizational areas including staff satisfaction, turnover, treatment team functioning, leadership and staff morale. In addition to studying how managers can be more effective, she has served in senior management and strategic planning positions in a variety of organizational settings including non-profit, county and federal agencies.

Dr. Jinnett received a doctorate in public health and sociology at the University of Michigan, Ann Arbor and her master's of science in public health at UCLA.
MSPH, 1990 - Health Planning & Policy Analysis, University of California,Los Angeles

Reoccurring Injury, Chronic Health Conditions, and Behavioral Health: Gender Differences in the Causes of Workers' Compensation Claims.

Abstract

OBJECTIVE

To examine how work and non-work health-related factors contribute to workers' compensation (WC) claims by gender.

METHODS

Workers (N = 16,926) were enrolled in the Pinnacol Assurance Health Risk Management study, a multiyear, longitudinal research program assessing small and medium-sized enterprises in Colorado. Hypotheses were tested using gender stratified logistic regression models.

RESULTS

For both women and men, having incurred a prior WC claim increased the odds of a future claim. The combination of incurring a prior claim and having metabolic health conditions resulted in lower odds of a future claim. Behavioral health risk factors increased the odds of having a claim more so among women than among men.

CONCLUSIONS

This study provides data to support multifactorial injury theories, and the need for injury prevention efforts that consider workplace conditions as well as worker health.

Mental Health in the Workplace: A Call to Action Proceedings from the Mental Health in the Workplace: Public Health Summit.

Abstract

OBJECTIVE

To declare a call to action to improve mental health in the workplace.

METHODS

We convened a public health summit and assembled an Advisory Council consisting of experts in the field of occupational health and safety, workplace wellness, and public policy to offer recommendations for action steps to improve health and well-being of workers.

RESULTS

The Advisory Council narrowed the list of ideas to four priority projects.

CONCLUSIONS

The recommendations for action include developing a Mental Health in the Workplace 1) "How to" Guide, 2) Scorecard, 3) Recognition Program, and 4) Executive Training.

Perceptions of Barriers to Effective Obesity Care: Results from the National ACTION Study.

Abstract

OBJECTIVE

ACTION (Awareness, Care, and Treatment in Obesity maNagement) examined obesity-related perceptions, attitudes, and behaviors among people with obesity (PwO), health care providers (HCPs), and employer representatives (ERs).

METHODS

A total of 3,008 adult PwO (BMI ≥ 30 by self-reported height and weight), 606 HCPs, and 153 ERs completed surveys in a cross-sectional design.

RESULTS

Despite several weight loss (WL) attempts, only 23% of PwO reported 10% WL during the previous 3 years. Many PwO (65%) recognized obesity as a disease, but only 54% worried their weight may affect future health. Most PwO (82%) felt "completely" responsible for WL; 72% of HCPs felt responsible for contributing to WL efforts; few ERs (18%) felt even partially responsible. Only 50% of PwO saw themselves as "obese," and 55% reported receiving a formal diagnosis of obesity. Despite HCPs' reported comfort with weight-related conversations, time constraints deprioritized these efforts. Only 24% of PwO had a scheduled follow-up to initial weight-related conversations. Few PwO (17%) perceived employer-sponsored wellness offerings as helpful in supporting WL.

CONCLUSIONS

Although generally perceived as a disease, obesity is not commonly treated as such. Divergence in perceptions and attitudes potentially hinders better management. This study highlights inconsistent understanding of the impact of obesity and need for both self-directed and medical management.

Chronic Conditions, Workplace Safety, And Job Demands Contribute To Absenteeism And Job Performance.

Abstract

An aging workforce, increased prevalence of chronic health conditions, and the potential for longer working lives have both societal and economic implications. We analyzed the combined impact of workplace safety, employee health, and job demands (work task difficulty) on worker absence and job performance. The study sample consisted of 16,926 employees who participated in a worksite wellness program offered by a workers' compensation insurer to their employers-314 large, midsize, and small businesses in Colorado across multiple industries. We found that both workplace safety and employees' chronic health conditions contributed to absenteeism and job performance, but their impact was influenced by the physical and cognitive difficulty of the job. If employers want to reduce health-related productivity losses, they should take an integrated approach to mitigate job-related injuries, promote employee health, and improve the fit between a worker's duties and abilities.

Health risk factors as predictors of workers' compensation claim occurrence and cost.

Abstract

OBJECTIVE

The objective of this study was to examine the predictive relationships between employee health risk factors (HRFs) and workers' compensation (WC) claim occurrence and costs.

METHODS

Logistic regression and generalised linear models were used to estimate the predictive association between HRFs and claim occurrence and cost among a cohort of 16 926 employees from 314 large, medium and small businesses across multiple industries. First, unadjusted (HRFs only) models were estimated, and second, adjusted (HRFs plus demographic and work organisation variables) were estimated.

RESULTS

Unadjusted models demonstrated that several HRFs were predictive of WC claim occurrence and cost. After adjusting for demographic and work organisation differences between employees, many of the relationships previously established did not achieve statistical significance. Stress was the only HRF to display a consistent relationship with claim occurrence, though the type of stress mattered. Stress at work was marginally predictive of a higher odds of incurring a WC claim (p

CONCLUSIONS

The unadjusted model results indicate that HRFs are predictive of future WC claims. However, the disparate findings between unadjusted and adjusted models indicate that future research is needed to examine the multilevel relationship between employee demographics, organisational factors, HRFs and WC claims.

Predicting the impact of chronic health conditions on workplace productivity and accidents: results from two US Department of Energy national laboratories.

Abstract

OBJECTIVE

Examine associations of chronic health conditions on workplace productivity and accidents among US Department of Energy employees.

METHODS

The Health and Work Performance Questionnaire-Select was administered to a random sample of two Department of Energy national laboratory employees (46% response rate; N = 1854).

RESULTS

The majority (87.4%) reported having one or more chronic health conditions, with 43.4% reporting four or more conditions. A population-attributable risk proportions analysis suggests improvements of 4.5% in absenteeism, 5.1% in presenteeism, 8.9% in productivity, and 77% of accidents by reducing the number of conditions by one level. Depression was the only health condition associated with all four outcomes.

CONCLUSIONS

Results suggest that chronic conditions in this workforce are prevalent and costly. Efforts to prevent or reduce condition comorbidity among employees with multiple conditions can significantly reduce costs and workplace accident rates.

Implementation of a worksite wellness program targeting small businesses: the Pinnacol Assurance health risk management study.

Abstract

OBJECTIVE

To assess small business adoption and need for a worksite wellness program in a longitudinal study of health risks, productivity, workers' compensation rates, and claims costs.

METHODS

Health risk assessment data from 6507 employees in 260 companies were examined. Employer and employee data are reported as frequencies, with means and standard deviations reported when applicable.

RESULTS

Of the 260 companies enrolled in the health risk management program, 71% continued more than 1 year, with 97% reporting that worker wellness improves worker safety. Of 6507 participating employees, 34.3% were overweight and 25.6% obese. Approximately one in five participants reported depression. Potentially modifiable conditions affecting 15% or more of enrollees include chronic fatigue, sleeping problems, headaches, arthritis, hypercholesterolemia, and hypertension.

CONCLUSIONS

Small businesses are a suitable target for the introduction of health promotion programs.

Employees' work responses to episodes of illness: evidence from the American time use survey.

Abstract

OBJECTIVE

To better understand presenteeism and absenteeism on the basis of the choices employees make about working when they experience episodes of illness.

METHODS

We examine nationally representative data to describe employees' work responses to episodes of illness and how different leave policies contribute to their decisions.

RESULTS

Illness episodes typically result in absence from work rather than working a normal or adjusted routine. Employees adjust their routine when ill primarily to save leave or because they have too much work. Paid sick leave and scheduling flexibility influence the likelihood of absence in different ways.

CONCLUSIONS

Although flexibility to adjust work routines can reduce absences, it is not known to what extent productivity suffers when this occurs. Measures of both short- and long-term presenteeism are necessary to understand the full productivity costs of illness in the workforce.

Medication adherence, comorbidities, and health risk impacts on workforce absence and job performance.

Abstract

OBJECTIVE

To understand impacts of medication adherence, comorbidities, and health risks on workforce absence and job performance.

METHODS

Retrospective observational study using employees' medical/pharmacy claims and self-reported health risk appraisals.

RESULTS

Statin medication adherence in individuals with Coronary Artery Disease was significant predictor (P

CONCLUSIONS

Results suggest integrated health and productivity management strategies should include an emphasis on primary and secondary prevention to reduce health risks in addition to tertiary prevention efforts of disease management and medication management.

Health and productivity as a business strategy: a multiemployer study.

Abstract

OBJECTIVE

To explore methodological refinements in measuring health-related lost productivity and to assess the business implications of a full-cost approach to managing health.

METHODS

Health-related lost productivity was measured among 10 employers with a total of 51,648 employee respondents using the Health and Work Performance Questionnaire combined with 1,134,281 medical and pharmacy claims. Regression analyses were used to estimate the associations of health conditions with absenteeism and presenteeism using a range of models.

RESULTS

Health-related productivity costs are significantly greater than medical and pharmacy costs alone (on average 2.3 to 1). Chronic conditions such as depression/anxiety, obesity, arthritis, and back/neck pain are especially important causes of productivity loss. Comorbidities have significant non-additive effects on both absenteeism and presenteeism. Executives/Managers experience as much or more monetized productivity loss from depression and back pain as Laborers/Operators. Testimonials are reported from participating companies on how the study helped shape their corporate health strategies.

CONCLUSIONS

A strong link exists between health and productivity. Integrating productivity data with health data can help employers develop effective workplace health human capital investment strategies. More research is needed to understand the impacts of comorbidity and to evaluate the cost effectiveness of health and productivity interventions from an employer perspective.

Team leadership and patient outcomes in US psychiatric treatment settings.

Abstract

Previous studies suggest that psychiatric patients mirror the behaviors of the staff members who treat them, but there is little empirical evidence about how staff dynamics affect patients over time. The goals of this study were to examine associations between: (1) team leader discipline and mutual respect among treatment team members; and (2) mutual respect among team members and improvements in patient quality of life. Two models were tested on data from psychiatric treatment teams within the US Veterans Administration. The first examined associations between the discipline of each team's emergent leader and the level of mutual respect among that team's members. The second model tested associations between mutual respect among staff and changes over time in patients' quality of life. The subjects for model 1 were psychiatric staff members (n=785) whose responses were aggregated for team-level analyses (n=78). Mutual respect was highest in social worker-led teams and lowest in physician-led teams. The subjects for model 2 were 1,638 seriously mentally ill patients in 44 of the units examined in the first model. When mutual respect among staff was greater, patients improved more over time in their satisfaction with the quality of their housing, relations with families, social life, and finances. Together, these analyses imply that mutual respect may improve patient outcomes and that leadership by some disciplines may facilitate such dynamics. In general, leaders may consider learning from other disciplines' strengths to improve their impact.

Cross-functional team processes and patient functional improvement.

Abstract

OBJECTIVE

To test the hypothesis that higher levels of participation and functioning in cross-functional psychiatric treatment teams will be related to improved patient outcomes.

DATA SOURCES/STUDY SETTING

Primary data were collected during the period 1992-1999. The study was conducted in 40 teams within units treating seriously mentally ill patients in 16 Veterans Affairs hospitals across the U.S.

STUDY DESIGN

A longitudinal, multilevel analysis assessed the relationship between individual- and team-level variables and patients' ability to perform activities of daily living (ADL) over time. Team data were collected in 1992, 1994, and 1995. The number of times patient data were collected was dependent on the length of time the patient was treated and varied from 1 to 14 between 1992 and 1999. Key variables included: patients' ADL scores (the dependent variable); measures of team participation and team functioning; the number of days from baseline on which a patient's ADLs were assessed; and several control variables.

DATA COLLECTION METHODS

Team data were obtained via self-administered questionnaires distributed to staff on the study teams. Additional team data were obtained via questionnaires completed by unit directors contemporaneously with the staff survey. Patient data were collected by trained clinicians at regular intervals using a standard assessment instrument.

PRINCIPAL FINDINGS

Results indicated that patients treated in teams with higher levels of staff participation experienced greater improvement in ADL over time. No differences in ADL change were noted for patients treated in teams with higher levels of team functioning.

CONCLUSIONS

Findings support our premise that team process has important implications for patient outcomes. The results suggest that the level of participation by the team as a whole may be a more important process attribute, in terms of patient improvements in ADLs, than the team's smooth functioning. These findings indicate the potential appropriateness of managerial interventions to encourage member investment in team processes.

How mental health providers spend their time: a survey of 10 Veterans Health Administration mental health services.

Abstract

BACKGROUND

Allocation of provider time across clinical, administrative, educational, and research activities may influence job satisfaction, productivity, and quality of care, yet we know little about what determines time allocation.

AIMS

To investigate factors associated with time allocation, we surveyed all mental health providers in one Veterans Health Administration (VHA) network. We hypothesized that both facility characteristics (academic affiliation, type of organization of services, serving as a hub for treatment of severely mentally ill, facility size) and individual provider characteristics (discipline, length of time in job, having an academic appointment) would influence time allocation.

METHODS

Eligible providers were psychiatrists, psychologists, social workers, physician assistants, registered or licensed practical nurses or other providers (psychology technicians, addiction therapists, nursing assistants, rehabilitation, recreational, occupational therapists) who were providing care in mental health services. A brief self-report survey was collected from all eligible providers at ten VHA facilities in late 1998 (N = 997). Data regarding facility characteristics were obtained by site visits and interviews with managers. Multilevel modeling was used to examine factors associated with three dependent variables: (i) total time allocation by activity (clinical, administrative, educational, research); (ii) clinical time allocation by treatment setting (inpatient vs. outpatient); and (iii) clinical time allocation by type of care (mental vs. physical). Licensed Practical Nurses (LPNs) were used as the reference group for all analyses because LPNs were expected to spend the majority of their time on clinical activities.

RESULTS

Overall, providers spent most of their time on clinical activities (77%), followed by administrative (11%), and educational (10%). Surprisingly, research activities accounted for only 2% of their time. Multilevel analysis indicated none of the facility-level variables were significant in explaining facility variance in time allocation, but individual characteristics were associated with time allocation. The model for predicting time allocation by inpatient or outpatient settings explained 16-18% of the variance in the dependent variable. In all models, provider discipline and length of time in job played an important role. Having an academic appointment was important only in the model examining total time allocation by activity type.

DISCUSSION

These simple models explained only a small amount of variance in the three dependent variables which were intended to capture issues related to time allocation; and the low number of facilities limited our power to examine effects of facility-level factors. Our models performed better in predicting allocation of clinical time to treatment setting and type of treatment than in predicting overall time allocation. Discipline and length of time in job were significant across all models. In contrast, having an academic appointment was associated with allocating significantly less time to clinical activities and more time to administrative activities but not to any significant difference in time spent in either research or education.

IMPLICATIONS

While a gold standard of optimal time allocation does not exist, it is striking that research, a stated mission of the VHA, accounted for so little of providers' time. The lack of involvement of clinicians in research has implications for recruitment and retention of high-quality mental health providers in this network and for the education of future providers. Without involvement of clinicians, research conducted in the network by nonclinicians may be less relevant to "real-world" clinical issues. Reductions of funds available to mental health, coupled with increased clinical demands, may have prompted this pattern of time allocation, and these findings attest to the challenges faced by large institutions that are charged with balancing many often seemingly competing missions.

Predictors of contact with public service sectors among homeless adults with and without alcohol and other drug disorders.

Abstract

OBJECTIVE

Homeless persons with alcohol and other drug (AOD) disorders face multiple problems that go beyond their AOD use. As a consequence, they commonly access services in multiple sectors in addition to the AOD treatment system. This study examined the predictors of contact with agencies in the health, mental health, social welfare and criminal justice sectors by AOD status among a probability sample of homeless adults in Houston, Texas.

METHOD

Cross-sectional data were collected from a multistage random sample of 797 homeless adults (579 men), age 18 or older, who were living in shelters and on the streets of Houston in 1996. Structured face-to-face interviews provided screening diagnoses for AOD disorders, self-report data on AOD treatment use and candidate predictors of treatment use. Service use was tracked retrospectively through administrative data obtained from 10 federal, state, county and municipal agencies that provide finding for physical and mental health services and AOD treatment, as well as emergency income; we also tracked criminal justice contacts. Logistic regression analyses were stratified by AOD status.

RESULTS

Adjusting for eligibility factors, key aspects of need were significant predictors of any utilization among those without an AOD problem, but not for those with an AOD problem. For those with AOD disorders, contact with one sector was not predictive of contact with other sectors.

CONCLUSIONS

Our findings indicate that AOD disorders hinder utilization of public sector services by homeless persons. These disorders may be masking need or otherwise acting as a barrier to accessing treatment and support.

The temporal relationship between emotional distress and cigarette smoking during adolescence and young adulthood.

Abstract

Empirical evidence regarding the causal nature of the relationship between emotional distress and tobacco use in male and female adolescents provides support for both the distress-to-use and the use-to-distress hypotheses. Using a cross-lagged model with 3 waves of data from 2,961 adolescents followed into young adulthood, the authors tested the hypothesis that this relationship changes over time. As hypothesized, emotional distress in Grade 10 was associated with increased smoking in Grade 12 for both boys and girls. Smoking in Grade 12 was in turn associated with increased emotional distress in young adulthood. The addition of 3 third factors (rebelliousness, deviance, and family problems) to the model did not alter the results. Results suggest that the relationship between tobacco use and emotional distress is a dynamic one in which distress initially leads to use but then becomes exacerbated by it over time.

Access to inpatient or residential substance abuse treatment among homeless adults with alcohol or other drug use disorders.

Abstract

OBJECTIVES

We conducted a theoretically guided study of access to inpatient or residential treatment among a probability sample of homeless adults with alcohol or drug use disorders in Houston, Texas.

METHODS

This study used a cross-sectional, retrospective design with data collected from a multistage random sample of 797 homeless adults age 18 or older who were living in Houston shelters and streets in 1996. Structured, face-to-face interviews produced screening diagnoses for alcohol and drug use disorders, treatment use data, and candidate predictors of treatment use. Logistic and linear regression analyses were performed on the subset of 326 homeless persons with either alcohol or drug use disorder.

RESULTS

27.5% of persons with substance use disorder had accessed inpatient or residential treatment during the past year. Controlling for additional need factors such as comorbidity, persons having public health insurance and a history of treatment for substance problems had greater odds of receiving at least one night of treatment. Contrary to expectation, contact with other service sectors was not predictive of treatment access. Schizophrenia and having a partner appeared to hinder access. Greater need for treatment was associated with fewer nights of treatment, suggesting retention difficulties.

CONCLUSIONS

This study adds to previous findings on access to health care among homeless persons and highlights a pattern of disparities in substance abuse treatment access. Health insurance is important, but enhancing access to care involves more than economic considerations if homeless persons are to receive the treatment they need. Referral relationships across different service sectors may require strengthening.

Case management and quality of life: assessing treatment and outcomes for clients with chronic and persistent mental illness.

Abstract

OBJECTIVE

To examine the impact of treatment setting and exposure to case management services on the quality of life of U. S. veterans with chronic and persistent mental illness.

DATA SOURCES/STUDY SETTING

Data were collected longitudinally on a panel of 895 clients enrolled in 14 pilot programs in Department of Veterans Affairs long-term psychiatric hospitals by the Serious Mental Illness Treatment Research and Evaluation Center during the period 1991-96.

STUDY DESIGN

Data were collected using two primary survey instruments (clinician assessment and client assessment) at baseline, every six months for the first two years, and every year thereafter, for a total of four years of follow-up. Case management exposure over time and its impact on the client's quality of life represent the key variables in the study. Additional controls included a variety of sociodemographic, socioeconomic, and psychiatric characteristics.

DATA COLLECTION/EXTRACTION METHODS

Hierarchical linear modeling was used to control for potential selection bias, test for the compositional effect of treatment setting, and examine the impact of case management exposure over time on the individual client's quality of life.

PRINCIPAL FINDINGS

Increased exposure to case management results in an improved quality of life across several domains, including both objective and subjective dimensions for health, general, leisure, and social, and the subjective dimension only for housing.

CONCLUSIONS

The study findings provide managers, clinicians, and policymakers a fuller understanding of how this mode of service delivery-case management-affects several domains of quality of life for clients with chronic illnesses.

Organizational determinants of psychosocial treatment activity of providers in Va mental health facilities.

Abstract

OBJECTIVE: To identify the determinants of level and intensity of psychosocial treatment activity among staff who deliver services to the severely and mentally ill. METHODS: The study sample consisted of 769 treatment providers working in 77 units in 29 VA mental health facilities. Level of psychosocial care was measured as the number of patient contacts and total hours spent in psychosocial care over a 1 week period. Intensity of psychosocial care was measured as the average time per patient contact. We used hierarchical linear modeling (HLM) to examine the association between level and intensity of care and three categories of determinants - individual provider attributes, work characteristics and treatment setting characteristics. RESULTS: Providers' occupation is related to both the level and intensity of care. Providers with administrative responsibilities also have fewer patient contacts and lower intensity of such contacts. Providers who perceived their pay and benefits more positively had fewer patient contacts and less intensive patient contacts. Positive relationships with patients and providers were also associated with greater levels and intensity of psychosocial treatment activity among providers. Finally, statistically significant differences in psychosocial treatment activity among units were identified although such differences are not attributable to unit size, patient cohort severity or unit workload. CONCLUSIONS: Level and intensity of psychosocial treatment activity vary systematically by individual attributes of providers, characteristics of the work they perform and attributes of the treatment setting. These factors may provide the basis for designing interventions to modify provider behavior in a manner consistent with emerging financial pressures and treatment modalities for the seriously mentally ill.

The effects of treatment team diversity and size on assessments of team functioning.

Abstract

Team-based health care assumes that groups representing multiple disciplines can work together to implement care plans that are comprehensive and integrated. It also assumes that professionals can function effectively in an interdependent relationship with members of other occupational groups. However, we know little about what makes effective team functioning. This article examines the factors related to health care team functioning, with specific emphasis on team demographic composition and size. Hierarchical linear modeling is used to analyze 106 Veterans Affairs (VA) hospitals. Results indicate that individuals who operate on more heterogenous and larger teams have lower perceptions of team functioning.

Absenteeism
Efficiency
Occupational Health
Sick Leave
Time Management