High workload and job stress are associated with lower practice performance in general practice: an observational study in 239 general practices in the Netherlands

Background  

The impact of high physician workload and job stress on quality and outcomes of healthcare delivery is not clear. Our study explored whether high workload and job stress were associated with lower performance in general practices in the Netherlands.     

Job stress and job satisfaction of physicians in private practice: comparison of German and Norwegian physicians

Purpose

This study examined job satisfaction and job stress of German compared to Norwegian physicians in private practice.

Methods

A representative sample of physicians in private practice of Schleswig–Holstein, Germany (N?=?414) and a nationwide sample of Norwegian general practitioners and private practice specialists (N?=?340) were surveyed in a cross-sectional design in 2010. The questionnaire comprised the standard instruments “Job Satisfaction Scale (JSS)” and a short form of the “Effort-Reward Imbalance Questionnaire (ERI)”.

Results

Norwegian physicians scored significantly higher (<0.01) on all items of the job satisfaction scale compared to German physicians (M 5.57, SD 0.74 vs. M 4.78, SD 1.01). The effect size was highest for the items freedom to choose method (d?=?1.012), rate of pay (d?=?0.941), and overall job satisfaction (d?=?0.931). While there was no significant difference in the mean of the overall effort scale between German and Norwegian physicians, Norwegian physicians scored significantly higher (p?Conclusions Job satisfaction and reward were significantly higher in Norwegian than in German physicians. An almost threefold higher proportion of German physicians exhibited a high level of work-related stress. Findings call for active prevention and health promotion among stressed practicing physicians, with a special focus on improved working conditions.     

Workload and job satisfaction among general practitioners: a review of the literature

The workload of general practitioners (GPs) is an important issue in health care systems with capitation payment for GPs services. This article reviews the literature on determinants and consequences of workload and job satisfaction of GPs. Determinants of workload are located on the demand side (list size and composition of the patient population) and the supply side (organization of the practice and personal characteristics of the GP). The effects of workload and job satisfaction on workstyle and quality of work have been reviewed. The length of consultations or booking intervals seems to be an important restriction for workstyle and quality of work.     

Understanding physicians' intentions to withdraw from practice: the role of job satisfaction, job stress, mental and physical health

Health care organizations may incur high costs due to a stressed, dissatisfied physician workforce. This study proposes and tests a model relating job stress to four intentions to withdraw from practice mediated by job satisfaction and perceptions of physical and mental health.     

Mental health and stress in the workplace: the case of general practice in the UK

This study adopted a 'workforce' perspective in a study of job strain in primary care (general practice) in the UK. It explored the level of stress amongst workers in general practice and between practices and examined the relationship between level of stress and work characteristics. Postal questionnaires were sent to a random sample of general practices (n = 81) in southern England. The study showed that 23% of all responders could be classified, according to the GHQ-12, as suffering from mental distress with practice managers having the highest level of stress and clerical and administrative staff the lowest. Work characteristics as measured by Karasek's Job Content Instrument were shown to be significant predictors of job stress as were marital status and health status. The implications of these findings are discussed, particularly focusing on the value of the job strain model for explaining job stress in general practice.     

Work in mental health: a job satisfaction and work impact study

Knowledge of job satisfaction and work impact among psychiatric staff is highly useful for policymakers and mental health professionals. Since there are few studies on this issue in Brazil, a cross-sectional study was carried out among mental health professionals. Data were collected for 133 professionals from 4 mental health services in Rio de Janeiro, using SATIS-BR and IMPACTO-BR scales and a socio-demographic questionnaire. Statistical associations were analyzed using the Mann-Whitney, Kruskal-Wallis, and chi-square tests and multiple linear regression. SPSS 10.1 for Windows was used for statistical analyses. Mean satisfaction was 3.30 and mean work impact was 2.08 (on a scale from 1 to 5). 62.4% of subjects reported moderate satisfaction. Mental health workers with less schooling showed higher satisfaction. Work impact was not associated with any explanatory variable. The results for job satisfaction were similar to those of other studies. Work impact was very low. Unlike studies from the United States and Europe, there were no differences between the community-based and in-hospital staff.     

Explaining global job satisfaction by facets of job satisfaction: the Japanese civil servants study

Objectives  

Management of job satisfaction is of growing importance in terms of the maintenance of employees’ health. This study aimed to evaluate which and to what extent facets of job satisfaction contributed to global job satisfaction.     

农民工职业紧张与工作满意度关系

目的 初步探讨农民工职业紧张与工作满意度关系:心理资本的中介作用。方法 整群随机抽取安徽建筑工地、民营企业899名农民工,运用付出-回报失衡问卷、工作满意度问卷和心理资本问卷进行测量。结果 889名农民工工作满意度平均得分为(65.04±10.91)分,心理资本4个维度平均得分自我效能为(22.1±5.34)分,希望(23.7±4.67)分,韧性(23.5±3.61)分,乐观(22.6±2.69)分;外在付出与工作满意度呈负相关(r=-0.150,P<0.001),回报、内在投入和心理资本均与工作满意度呈正相关(均P<0.001),职业紧张在工作满意度的解释增量为30.6%,心理资本的中介作用对工作满意度解释增量为22.5%。结论 农民工工作满意度一般,外在付出、回报、内在投入对于工作满意度有良好的预测作用,心理资本在回报、内在投入与工作满意度的关系中起中介作用。     

Income-based incentives in UK general practice

Since 1990, income-based economic incentives have ostensibly become more important in the remuneration structure of UK general practitioners. For incentives to fulfil their role, however, GPs must possess discretion over income-generating activity and be assumed to be income maximisers. Evidence from one English health authority suggests that a very high proportion of GP income continues to be determined by patient characteristics and the scope for a discretionary response to income incentives is correspondingly small. Where discretion does exist, higher levels of GP incomes do not appear to militate against further discretionary income raising, except in the case where this income and budgetary discipline are in conflict.     

Occupational stress and job satisfaction among physicians: sex differences.

The present study provides empirical findings from a national survey of physicians and addresses issues of sex differences in the nature of occupational stress experienced by physicians, and the sources of satisfaction in medical practice. Data were collected using questionnaires from 2584 physicians. The sample was randomly selected to represent physicians in all Canadian provinces. About 10% of the respondents were female. Measures included self-reports of stress and satisfaction, demographic variables, practice characteristics, and attitudes about health care. Major sources of stress indicated by female and male physicians were time pressures on the job, and major sources of satisfaction were relationships with patients and colleagues. Sex differences were found in terms of the specific variables that predicted job stress and satisfaction. However, for both women and men, various work setting variables positively predicted occupational stress and negatively predicted job satisfaction. Significant sex differences were present in both demographic and situational variables as well as measures of occupational stress and attitudes about health care. Correlations indicate that for both female and male physicians, high levels of occupational stress was associated with less satisfaction with medical practice and more negative attitudes about the medicare system and health care in general, and high job satisfaction was related to fewer specific work stressors and more positive attitudes about health care. Several methodological limitations necessitates caution in interpreting the findings. Nevertheless, the results may have some implications for future health care policies and procedures.     

Understanding practice management: a qualitative study in general practice

Reports a qualitative study of practice managers' roles and responsibilities in eight practices in the Grampian region of Scotland. Observes wide variations in the roles and responsibilities of managers associated with the size and fundholding status of the practice. Notes that larger practices had better developed management structures allowing the managers to delegate tasks and undertake a more proactive planning and executive role, and that medium and smaller practices had less well developed management structures and managers were more likely to act as practice administrators with limited autonomy. Concludes that practice managers are playing an increasingly important role in general practice. Also that the influential role of the practice manager in the development of practice policies and the transfer of administrative responsibilities from the partners to the manager have all contributed to a change in general practitioners' perceptions of the practice manager.     

Teachers in general practice: a comparative study

Thirty-nine randomly selected general practitioners in the Cambridgeshire Health Area were surveyed in an attempt to determine whether there were prior differences between those practitioners who choose to become involved with undergraduate medical students and those who choose not to.
Teachers were found to have graduated more recently, subscribe to more journals and were more likely to use medical libraries than non-teachers.
All the solo practitioners in the study and two of the four practitioners in two-man groups belonged to a subgroup of non-teachers who had never had students and did not want students in the future. This subgroup also subscribed to fewer journals than the other groups, bought fewer textbooks and used medical libraries less.
The only prior differences between teachers and non-teachers that have been demonstrated are year of graduation and type of practice. Other differences could well be attributed to the influence of the students themselves. Studies are needed to clarify this issue, especially as it relates to continuing medical education.     

Motivation and job satisfaction among medical and nursing staff in a Cyprus public general hospital

Background  

The objective of this study was to investigate how medical and nursing staff of the Nicosia General Hospital is affected by specific motivation factors, and the association between job satisfaction and motivation. Furthermore, to determine the motivational drive of socio-demographic and job related factors in terms of improving work performance.     

Employee job stress in the AIDS service organization: a study of personal and job factors

This study examined employees' perceived job stress in a community-based AIDS service organization. The study reveals that: 1) these employees have a relatively low level of job stress and 2) their perceived job stress is correlated not to personal characteristics but to job-related factors, including job security, work/family conflict, and role ambiguity/conflict. Implications concerning the results of the study are discussed.     

Stress, burnout and job satisfaction in rural psychiatric nurses: a Victorian study

OBJECTIVE: To measure the level of stress, burnout and job satisfaction in rural psychiatric nurses in Victoria, Australia. METHOD: This present study presents the findings of a research study undertaken with rural psychiatric nurses (n = 136) in two rural mental health services in Victoria. The study designed to measure their level of stress, burnout and job satisfaction using the Maslach Burnout Inventory (MBI), the Nursing Stress Scale (NSS) and Job Satisfaction Scale (JSS). RESULTS: The findings indicated that a low number rural psychiatric nurses suffered from 'high' level of burnout and the majority of nurses reported 'low level' of emotional exhaustion and depersonalisation scores. On the personal accomplishment subscale, only 11% recorded a 'high' score and 87% recorded 'low' score. On the Nursing Stress Scale, the 'workload' was the highest perceived stressor followed by 'inadequate preparation'. CONCLUSIONS: Paradoxically, the majority of rural psychiatric nurses stated that they were satisfied with their job, particularly with current situation at work, aspects of support and the level of involvement in decision making.     

The impact of pay-for-performance on professional boundaries in UK general practice: an ethnographic study

The 2004 new General Medical Services (nGMS) contract exemplifies trends across the public services towards increased definition, measurement and regulation of professional work, with general practice income now largely dependent on the quality of care provided across a range of clinical and organisational indicators known collectively as the 'Quality and Outcomes Framework' (QOF). This paper reports an ethnographically based study of the impact of the new contract and the financial incentives contained within it on professional boundaries in UK general practice. The distribution of clinical and administrative work has changed significantly and there has been a new concentration of authority, with QOF decision making and monitoring being led by an internal QOF team of clinical and managerial staff who make the major practice-level decisions about QOF, monitor progress against targets, and intervene to resolve areas or indicators at risk of missing targets. General practitioners and nurses, however, appear to have accommodated these changes by re-creating long established narratives on professional boundaries and clinical hierarchies. This paper is concerned with the impact of these new arrangements on existing clinical hierarchies.     

Achieving multiple topic shifts in primary care medical consultations: a conversation analysis study in UK general practice

The 'by the way' phenomenon, while commonly described in medical texts on the consultation, has not been systematically explored from an interactional perspective. Starting from a 'noticing' of an example of this phenomenon we studied a collection of over 200 recorded consultations in British general practice. New topics were introduced by both parties, but more commonly by patients, who used two sorts of device to change topic: an announcement, usually at the start of a consultation, but sometimes later, that they had multiple topics, which we have called a 'pre-announcement', and an apparently unexpected sudden change of topic, which we have called an 'in-situ announcement'. These phenomena occurred in about one third of our unselected collection of recorded consultations, drawn from nine doctors, and 27 surgery (office) sessions. We argue that this management of multiple topics is an important and normal part of the consultation, in contrast to its problematic status implied in some medical literature.     

Pragmatic model of patient satisfaction in general practice: progress towards a theory.

A major problem in the measurement of patient satisfaction is the lack of an adequate theory to explain the meaning of satisfaction, and hence how it should be measured and how the findings are interpreted. Because of the lack of a fully developed theory, when developing patient satisfaction questionnaires for use in general practice, a simple model was used. This model was pragmatic in that it linked together empirical evidence about patient satisfaction without recourse to more general social or psychological theory of behaviour, other than to define satisfaction as an attitude. Several studies with the questionnaires confirm in general the components of the model. However, the importance of personal care had not been sufficiently emphasised, and therefore the model has been revised. It can now serve as a basis for future research into patient satisfaction, in particular as a stimulus for investigating the links between components of the model and underlying psychological or other behavioural theories.