An evaluation of job stressors amongst primary health care doctors

Abstract

The Department of Primary Health Care has a chronic history of poor retention and high rate of absenteeism. The manpower shortages are constraining the services provided at the health centres. Meanwhile demand is increasing due to demographic trends, ever increasing patients' expectations, as well as the shift of secondary care towards more day cases and shorter hospital stays. Internationally, organisations have long awakened to the fact that job stress management makes personal and financial sense. Literature has shown that strong correlations exist between the presence of occupational stress and the performance of clinicians, the GPs' psychological well-being, as well as retention of doctors within organisation settings (Kahn & Byosiere, 1992). Job stress has been identified as a causal antecedent of job satisfaction in GPs (Williams et al., 2002; Kahn & Byosiere, 1992). Stress at work is therefore a direct threat to the overall efficiency and effectiveness of health care organisations (Cooper & Cartwright, 1994). The study aimed at identifying occupational stressors and evaluates their outcome amongst the doctors at the health centres. This information enables the identification of appropriate organisational remedies. The case study was designed to create triangulation of evidence enhancing the internal reliability and the generisability of the results. Sections from the Job Descriptive Index from Bowling Green State University supplemented the occupational stressors scales by P.E. Spector and J.M. Jex. These statistically established tools for the evaluation of occupational stress were supported by other methods of data collection, including the calculation of turnover indices and the rate of absenteeism. The results from the health centres were compared with those obtained from other health care departments. In-depth interviews were fundamentally important to alleviate particular features pertaining to the PHC in Malta. The evaluation established that doctors at the PHC are experiencing an alarming degree of work stress. Occupational stressors are negatively influencing the performance of these GPs, leading to very high levels of absenteeism and triggering most of the resignations in the department. Meanwhile, the presence of occupational stress among the doctors is compromising the efficiency of the services provided by the organisation. Qualitative and quantitative workloads with the related time pressure are the major stressor. These are closely followed by stress arising from lack of career advancement opportunities. The doctors also reported difficulties to identify the nature of their work within the conventional medical specialities that already exist. They frequently encounter situations where they perceive lack of skills. The clinicians feel constrained by the present organisation structure and management style. The lack of support and the absence of any form of consultation are increasingly stressful for these employees. An Appointments System has been identified as the most effective organisation remedy for stress arising from workload. Such a system can potentially influence the distribution of demand, controlling work overload and leading to a more interesting case mix. Evidently a Job Analysis is fundamentally important to formulate role descriptions, learning and training specifications, as well as career development plans. This job analysis, together with the introduction of a Personal Development Plan will minimise stress from role ambiguities while creating opportunities for career advancements. The

incongruence that exists between these professionals and organisation structure, as well as management style can be aligned through a Decentralisation Process driven by People-Centred leadership in the department of PHC. These systems are known to generate a feeling of involvement, participation and support among doctors. The data available by virtue of this study would enable management to implement appropriate measures to minimise occupational stress. Reducing work stressors is intended to improve performance and retention of the health centres doctors, avoid service disruption and loss of valuable resources. This approach may not only resolve the present situation but also ensure that the services of this organisation remain sustainable in the future.