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Thielmann B, Wagner A, Bozorgmehr A, Rind E, Siegel A, Hippler M, Weltermann B, Degen L, Göbel J, Minder K, Seifried-Dübon T, Junne F, Herrmann-Werner A, Jöckel KH, Schröder V, Pieper C, Eilerts AL, Wittich A, Rieger MA, Böckelmann I. The Predominance of the Health-Promoting Patterns of Work Behavior and Experience in General Practice Teams-Results of the IMPROVE job Study. Healthcare (Basel) 2024; 12:299. [PMID: 38338184 PMCID: PMC10855740 DOI: 10.3390/healthcare12030299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 02/12/2024] Open
Abstract
This study aims to identify the distribution of the "Work-related behavior and experience patterns" (Arbeitsbezogenes Verhaltens-und Erlebnismuster, AVEM) in general practitioners and their teams by using baseline data of the IMPROVEjob study. Members of 60 general practices with 84 physicians in a leadership position, 28 employed physicians, and 254 practice assistants participated in a survey in 2019 and 2020. In this analysis, we focused on AVEM variables. Age, practice years, work experience, and working time were used as control variables in the Spearman Rho correlations and analysis of variance. The majority of the participants (72.1%) revealed a health-promoting pattern (G or S). Three of eleven AVEM dimensions were above the norm for the professional group "employed physicians". The AVEM dimensions "striving for perfection" (p < 0.001), "experience of success at work" (p < 0.001), "satisfaction with life" (p = 0.003), and "experience of social support" (p = 0.019) differed significantly between the groups' practice owners and practice assistants, with the practice owners achieving the higher values, except for experience of social support. Practice affiliation had no effect on almost all AVEM dimensions. We found a high prevalence of AVEM health-promoting patterns in our sample. Nearly half of the participants in all professional groups showed an unambitious pattern (S). Adapted interventions for the represented AVEM patterns are possible and should be utilized for maintaining mental health among general practice teams.
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Affiliation(s)
- Beatrice Thielmann
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, Wilhelmstr. 27, 72074 Tübingen, Germany; (B.T.); (E.R.); (A.S.); (M.H.); (M.A.R.)
- Institute of Occupational Medicine, Faculty of Medicine, Otto von Guericke University Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany;
| | - Anke Wagner
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, Wilhelmstr. 27, 72074 Tübingen, Germany; (B.T.); (E.R.); (A.S.); (M.H.); (M.A.R.)
| | - Arezoo Bozorgmehr
- Institute of General Practice and Family Medicine, University Hospital Bonn, Venusberg-Campus. 1, 53127 Bonn, Germany; (A.B.); (B.W.); (L.D.); (J.G.); (K.M.)
| | - Esther Rind
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, Wilhelmstr. 27, 72074 Tübingen, Germany; (B.T.); (E.R.); (A.S.); (M.H.); (M.A.R.)
| | - Achim Siegel
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, Wilhelmstr. 27, 72074 Tübingen, Germany; (B.T.); (E.R.); (A.S.); (M.H.); (M.A.R.)
| | - Melina Hippler
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, Wilhelmstr. 27, 72074 Tübingen, Germany; (B.T.); (E.R.); (A.S.); (M.H.); (M.A.R.)
| | - Birgitta Weltermann
- Institute of General Practice and Family Medicine, University Hospital Bonn, Venusberg-Campus. 1, 53127 Bonn, Germany; (A.B.); (B.W.); (L.D.); (J.G.); (K.M.)
| | - Lukas Degen
- Institute of General Practice and Family Medicine, University Hospital Bonn, Venusberg-Campus. 1, 53127 Bonn, Germany; (A.B.); (B.W.); (L.D.); (J.G.); (K.M.)
| | - Julian Göbel
- Institute of General Practice and Family Medicine, University Hospital Bonn, Venusberg-Campus. 1, 53127 Bonn, Germany; (A.B.); (B.W.); (L.D.); (J.G.); (K.M.)
| | - Karen Minder
- Institute of General Practice and Family Medicine, University Hospital Bonn, Venusberg-Campus. 1, 53127 Bonn, Germany; (A.B.); (B.W.); (L.D.); (J.G.); (K.M.)
| | - Tanja Seifried-Dübon
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Osianderstr. 5, 72076 Tübingen, Germany; (T.S.-D.); (F.J.)
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Osianderstr. 5, 72076 Tübingen, Germany; (T.S.-D.); (F.J.)
| | - Anne Herrmann-Werner
- Tübingen Institute for Medical Education (TIME), Faculty of Medicine, University of Tuebingen, 72076 Tübingen, Germany;
| | - Karl-Heinz Jöckel
- Center for Clinical Trials, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany; (K.-H.J.); (V.S.)
| | - Verena Schröder
- Center for Clinical Trials, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany; (K.-H.J.); (V.S.)
| | - Claudia Pieper
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany; (C.P.)
| | - Anna-Lisa Eilerts
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany; (C.P.)
| | - Andrea Wittich
- Occupational Health Psychology—Research and Consulting, Sternbergstr 19, 72074 Tübingen, Germany;
| | - Monika A. Rieger
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, Wilhelmstr. 27, 72074 Tübingen, Germany; (B.T.); (E.R.); (A.S.); (M.H.); (M.A.R.)
| | - Irina Böckelmann
- Institute of Occupational Medicine, Faculty of Medicine, Otto von Guericke University Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany;
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Wangler S, Simon A, Meyer G, Ayerle GM. Influence of the birthing room design on midwives' job satisfaction - A cross-sectional online survey embedded in the 'Be-Up' study. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 37:100867. [PMID: 37295182 DOI: 10.1016/j.srhc.2023.100867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/24/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Job satisfaction is an important factor influencing work performance, personal well-being, commitment and retention. The working environment influences job satisfaction. The design of the birthing room could influence the practice of midwives and their satisfaction. This study investigates whether the alternative design of the birthing room implemented in the randomized controlled trial 'Be-Up' (Birth environment-Upright position) has an impact on job satisfaction of midwives. METHOD A cross-sectional survey using an online questionnaire with 50 items addressing job satisfaction and birth room design was performed. The sample (n = 312) consists of midwives whose obstetric units participated in the Be-Up study and, as comparison group, midwives working in non-study obstetric units. These two independent groups were compared using t-tests; correlations and impacts were examined. RESULTS The results of the T-tests revealed statistically significant higher global job satisfaction and higher satisfaction with team support of midwives in the Be-Up room. However, midwives working in customary birthing rooms were more satisfied with the design of the room. The most important predictors of job satisfaction were team factors and understaffing in both groups. CONCLUSION Reasons for diminished satisfaction with the working environment in the Be-Up study may be assumed in uncertainties about emergency management in a new and unfamiliar environment. Furthermore the impact of a single redesigned room within a customary obstetric unit on job satisfaction seems small, as the room is embedded in the ward and hospital environment. More comprehensive concepts on the potential of the work environment influencing midwives' job satisfaction are needed.
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Affiliation(s)
- Sonja Wangler
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany; School of Health Sciences and Management, Baden-Wuerttemberg Cooperative State University (DHBW), Stuttgart, Germany.
| | - Anke Simon
- School of Health Sciences and Management, Baden-Wuerttemberg Cooperative State University (DHBW), Stuttgart, Germany
| | - Gabriele Meyer
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Gertrud M Ayerle
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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3
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Preiser C, Tsarouha E, Weltermann B, Junne F, Seifried-Dübon T, Hartmann S, Bleckwenn M, Rieger MA, Rind E. Psychosocial demands and resources for working time organization in GP practices. Results from a team-based ethnographic study in Germany. J Occup Med Toxicol 2021; 16:47. [PMID: 34663355 PMCID: PMC8522246 DOI: 10.1186/s12995-021-00336-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 09/23/2021] [Indexed: 11/10/2022] Open
Abstract
Background General practitioners (GPs) are challenged, e.g. by long working hours, and as employers they are responsible for the creation of working conditions that prevent work-related psychosocial risks. Leadership behaviour plays an important role within the working conditions of employees, thus we focused on two research questions: To what extent and how do GPs fulfil their role as entrepreneurs and leaders responsible for occupational safety and health of the team members in the organization of working time of the employees? What psychosocial factors result from the way of organization of working time for the practice team? Methods Data was collected by participant observations, individual interviews with six GPs, and five focus group discussions with 19 members of the practice staff in total. We gained access to five general practices through a teaching network associated with the Institute for General Medicine, University Hospital Essen (Germany). The analysis was carried out according to the Grounded Theory approach. Results GPs have several roles and related tasks to fulfil in the organization of working time. This can lead to perceived psychological stress. With regard to the organization of predictable working hours, vacations and sickness absence, the GPs determined the scope of action of the practice assistants. The delegation of these tasks took place to varying degrees and resulted in different work-related resources and stressors. Conclusion We described transactional and transformational leadership behaviours which are all related to specific psychosocial demands and resources and may overlap on site. Leadership training seems recommendable as part of the training of GPs and other future leaders of micro-enterprises to promote self-reflection by the entrepreneurs and leaders and strengthen occupational health of leaders and staff. Supplementary Information The online version contains supplementary material available at 10.1186/s12995-021-00336-w.
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Affiliation(s)
- Christine Preiser
- Institute of Occupational and Social Medicine and Health Services Research, Faculty of Medicine, University Hospital Tuebingen, Wilhelmstr. 27, 72074, Tuebingen, Germany. .,Centre for Public Health and Health Services Research, Faculty of Medicine, University Hospital Tuebingen, Osianderstr. 5, 72076, Tuebingen, Germany.
| | - Elena Tsarouha
- Institute of Occupational and Social Medicine and Health Services Research, Faculty of Medicine, University Hospital Tuebingen, Wilhelmstr. 27, 72074, Tuebingen, Germany
| | - Birgitta Weltermann
- Institute of Family Medicine and General Practice, Faculty of Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Osianderstr. 5, 72076, Tuebingen, Germany
| | - Tanja Seifried-Dübon
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Osianderstr. 5, 72076, Tuebingen, Germany
| | - Sigrid Hartmann
- Institute of Occupational and Social Medicine and Health Services Research, Faculty of Medicine, University Hospital Tuebingen, Wilhelmstr. 27, 72074, Tuebingen, Germany
| | - Markus Bleckwenn
- Department of General Practice, Medical Faculty, University of Leipzig, Ph.-Rosenthal-Str. 55, 04103, Leipzig, Germany
| | - Monika A Rieger
- Institute of Occupational and Social Medicine and Health Services Research, Faculty of Medicine, University Hospital Tuebingen, Wilhelmstr. 27, 72074, Tuebingen, Germany
| | - Esther Rind
- Institute of Occupational and Social Medicine and Health Services Research, Faculty of Medicine, University Hospital Tuebingen, Wilhelmstr. 27, 72074, Tuebingen, Germany
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Degen L, Linden K, Seifried-Dübon T, Werners B, Grot M, Rind E, Pieper C, Eilerts AL, Schroeder V, Kasten S, Schmidt M, Goebel J, Rieger MA, Weltermann BM. Job Satisfaction and Chronic Stress of General Practitioners and Their Teams: Baseline Data of a Cluster-Randomised Trial (IMPROVE job). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189458. [PMID: 34574383 PMCID: PMC8466539 DOI: 10.3390/ijerph18189458] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/19/2021] [Accepted: 08/26/2021] [Indexed: 11/16/2022]
Abstract
Background: A high prevalence of poor job satisfaction and high chronic stress is documented for general practitioners (GPs) and non-physician practice staff from various countries. The reasons are multifactorial and include deficits in leadership, communication and workflows. This publicly funded study evaluates the effectiveness of the newly developed participatory, interdisciplinary, and multimodal IMPROVEjob intervention on improving job satisfaction among GPs and practice personnel. Here, we report the baseline characteristics of the participating GPs and practice assistants, focusing on job satisfaction and perceived chronic stress. Methods: The IMPROVEjob study was performed as a cluster-randomised, controlled trial (cRCT) with German GP practices in the North Rhine Region. The IMPROVEjob intervention comprised two leadership workshops (one for practice leaders only; a second for leaders and practice assistants), a toolbox with supplemental printed and online material, and a nine-month implementation phase supported by IMPROVEjob facilitators. The intervention addressed issues of leadership, communication, and work processes. During study nurse visits, participants completed questionnaires at baseline and after nine months follow up. The primary outcome was the change in job satisfaction as measured by the respective scale of the validated German version of the Copenhagen Psychosocial Questionnaire (German COPSOQ, version 2018). Perceived chronic stress was measured using the Trier Inventory of Chronic Stress (TICS- SSCS). Results: Recruitment of 60 practices was successful: 21 were solo, 39 were group practices. At baseline, n = 84 practice owners, n = 28 employed physicians and n = 254 practice assistants were included. The mean age of all participants was 44.4 (SD = 12.8). At baseline, the job satisfaction score in the total sample was 74.19 of 100 (±14.45) and the perceived chronic stress score was 19.04 of 48 (±8.78). Practice assistants had a significantly lower job satisfaction than practice owners (p < 0.05) and employed physicians (p < 0.05). In the regression analysis, perceived chronic stress was negatively associated with job satisfaction (b= −0.606, SE b = 0.082, p < 0.001, ICC = 0.10). Discussion: The degree of job satisfaction was similar to those in other medical professionals published in studies, while perceived chronic stress was markedly higher compared to the general German population. These findings confirm the need for interventions to improve psychological wellbeing in GP practice personnel.
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Affiliation(s)
- Lukas Degen
- Institute of General Practice and Family Medicine, Medical Faculty of the University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (K.L.); (S.K.); (M.S.); (J.G.); (B.M.W.)
- Correspondence: ; Tel.: +49-(0)-228-287-11156
| | - Karen Linden
- Institute of General Practice and Family Medicine, Medical Faculty of the University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (K.L.); (S.K.); (M.S.); (J.G.); (B.M.W.)
| | - Tanja Seifried-Dübon
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Osianderstraße 5, 72076 Tuebingen, Germany;
| | - Brigitte Werners
- Institute of Management, Operations Research, Ruhr University Bochum, Universitätsstr. 150, 44801 Bochum, Germany; (B.W.); (M.G.)
| | - Matthias Grot
- Institute of Management, Operations Research, Ruhr University Bochum, Universitätsstr. 150, 44801 Bochum, Germany; (B.W.); (M.G.)
| | - Esther Rind
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tuebingen, Wilhelmstr. 27, 72074 Tuebingen, Germany; (E.R.); (M.A.R.)
| | - Claudia Pieper
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Hufelandstr. 55, 45147 Essen, Germany; (C.P.); (A.-L.E.)
| | - Anna-Lisa Eilerts
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Hufelandstr. 55, 45147 Essen, Germany; (C.P.); (A.-L.E.)
| | - Verena Schroeder
- Center for Clinical Trials, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany;
| | - Stefanie Kasten
- Institute of General Practice and Family Medicine, Medical Faculty of the University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (K.L.); (S.K.); (M.S.); (J.G.); (B.M.W.)
| | - Manuela Schmidt
- Institute of General Practice and Family Medicine, Medical Faculty of the University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (K.L.); (S.K.); (M.S.); (J.G.); (B.M.W.)
| | - Julian Goebel
- Institute of General Practice and Family Medicine, Medical Faculty of the University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (K.L.); (S.K.); (M.S.); (J.G.); (B.M.W.)
| | - Monika A. Rieger
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tuebingen, Wilhelmstr. 27, 72074 Tuebingen, Germany; (E.R.); (M.A.R.)
| | - Birgitta M. Weltermann
- Institute of General Practice and Family Medicine, Medical Faculty of the University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (K.L.); (S.K.); (M.S.); (J.G.); (B.M.W.)
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5
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Tsarouha E, Preiser C, Weltermann B, Junne F, Seifried-Dübon T, Stuber F, Hartmann S, Wittich A, Rieger MA, Rind E. Work-Related Psychosocial Demands and Resources in General Practice Teams in Germany. A Team-Based Ethnography. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197114. [PMID: 32998397 PMCID: PMC7579545 DOI: 10.3390/ijerph17197114] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/22/2020] [Accepted: 09/25/2020] [Indexed: 11/16/2022]
Abstract
General practices are established microenterprises in Germany providing a variety of preventive and therapeutic health care services and procedures in a challenging working environment. For example, general practice teams are confronted increasingly with work-related demands, which have been associated with poor psychological and physical outcomes. It is therefore important to gain a better understanding of issues related to occupational health and safety for personnel working in the primary care setting. This study aims to gain an in-depth understanding of psychosocial demands and resources in the primary care setting. We applied an ethnographic design, comprising a combination of participating observations, individual interviews with general practitioners (GPs) (N = 6), and focus group discussion with practice assistants and administrative staff (N = 19) in five general practices in Germany. A grounded theory approach was applied to analyze all data. Our results identified psychosocial demands and resources exemplified mainly along two typical tasks in GP practices: the issuing of medical prescriptions and blood sampling. Main psychosocial demands included factors related to work content and tasks, organization of work, and the working environment. For example, daily routines across all practices were characterized by a very high work intensity including disturbances, interruptions, delegation, and the division of labor between GPs and practice staff. Work-related resources comprised the staff’s influence on aspects related to work organization and social support. The triangulation of methods and data formats allowed the disclosure of interconnectedness between these factors. Although work processes in general practices are complex and required to comply with legal regulations, there are opportunities for practice owners and practice teams to establish working procedures in ways that reduce psychosocial risks and strengthen work-related resources.
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Affiliation(s)
- Elena Tsarouha
- Institute of Occupational and Social Medicine and Health Services Research, Faculty of Medicine, University Hospital Tuebingen, Wilhelmstr. 27, 72074 Tuebingen, Germany; (E.T.); (C.P.); (S.H.); (M.A.R.)
| | - Christine Preiser
- Institute of Occupational and Social Medicine and Health Services Research, Faculty of Medicine, University Hospital Tuebingen, Wilhelmstr. 27, 72074 Tuebingen, Germany; (E.T.); (C.P.); (S.H.); (M.A.R.)
- Centre for Public Health and Health Services Research, Core Facility for Health Services Research, University Hospital Tuebingen, Osianderstr. 5, 72076 Tuebingen, Germany
| | - Birgitta Weltermann
- Institute of General Practice and Family Medicine, Faculty of Medicine, University Hospital Bonn, Venusberg-Campus. 1, 53127 Bonn, Germany;
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, Medical University Hospital Tuebingen, Osianderstr. 5, 72076 Tuebingen, Germany; (F.J.); (T.S.-D.); (F.S.)
| | - Tanja Seifried-Dübon
- Department of Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, Medical University Hospital Tuebingen, Osianderstr. 5, 72076 Tuebingen, Germany; (F.J.); (T.S.-D.); (F.S.)
| | - Felicitas Stuber
- Department of Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, Medical University Hospital Tuebingen, Osianderstr. 5, 72076 Tuebingen, Germany; (F.J.); (T.S.-D.); (F.S.)
| | - Sigrid Hartmann
- Institute of Occupational and Social Medicine and Health Services Research, Faculty of Medicine, University Hospital Tuebingen, Wilhelmstr. 27, 72074 Tuebingen, Germany; (E.T.); (C.P.); (S.H.); (M.A.R.)
| | - Andrea Wittich
- Occupational Psychologist and Psychotherapist, Tuebingen, Germany;
| | - Monika A. Rieger
- Institute of Occupational and Social Medicine and Health Services Research, Faculty of Medicine, University Hospital Tuebingen, Wilhelmstr. 27, 72074 Tuebingen, Germany; (E.T.); (C.P.); (S.H.); (M.A.R.)
| | - Esther Rind
- Institute of Occupational and Social Medicine and Health Services Research, Faculty of Medicine, University Hospital Tuebingen, Wilhelmstr. 27, 72074 Tuebingen, Germany; (E.T.); (C.P.); (S.H.); (M.A.R.)
- Correspondence:
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6
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Weltermann BM, Kersting C, Pieper C, Seifried-Dübon T, Dreher A, Linden K, Rind E, Ose C, Jöckel KH, Junne F, Werners B, Schroeder V, Bois JM, Siegel A, Thielmann A, Rieger MA, Kasten S. IMPROVEjob - Participatory intervention to improve job satisfaction of general practice teams: a model for structural and behavioural prevention in small and medium-sized enterprises - a study protocol of a cluster-randomised controlled trial. Trials 2020; 21:532. [PMID: 32546256 PMCID: PMC7298849 DOI: 10.1186/s13063-020-04427-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/16/2020] [Indexed: 11/11/2022] Open
Abstract
Background Perceived high chronic stress is twice as prevalent among German general practitioners (GPs) and non-physician medical staff compared to the general population. The reasons are multi-factorial and include patient, practice, healthcare system and societal factors, such as multi-morbidity, the diversity of populations and innovations in medical care. Also, practice-related factors, like stressful patient-staff interactions, poor process management of waiting times and lack of leadership, play a role. This publicly funded study evaluates the effectiveness of the newly developed participatory, interdisciplinary, and multimodal IMPROVEjob intervention on improving job satisfaction among general practice personnel. The intervention aims at structural stress prevention with regard to working conditions and behavioural stress prevention for leaders and other practice personnel. Methods In this cluster-randomised controlled trial, a total of 56 general practices will be assigned to either (1) participation in the IMPROVEjob intervention or (2) the waiting-list control group. The IMPROVEjob intervention consists of the following elements: three workshops, a toolbox with supplemental material and an implementation period with regular contact to so-called IMPROVEjob facilitators. The first workshop, addressing leadership issues, is designed for physicians with leadership responsibilities only. The two subsequent workshops target all GP and non-physician personnel; they address issues of communication (with patients and within the team), self-care and team-care and practice organisation. During the 9-month implementation period, practices will be contacted by IMPROVEjob facilitators to enhance motivation. Additionally, the practices will have access to the toolbox materials online. All participants will complete questionnaires at baseline and follow up. The primary outcome is the change in job satisfaction as measured by the respective scale of the validated German version of the Copenhagen Psychosocial Questionnaire (COPSOQ, version 2018). Secondary outcomes obtained by questionnaires and - qualitatively - by facilitators comprise psychosocial working conditions including leadership aspects, expectations and experiences of the workshops, team and individual efforts and organisational changes. Discussion It is hypothesised that participation in the IMPROVEjob intervention will improve job satisfaction and thus constitute a structural and behavioural prevention strategy for the promotion of psychological wellbeing of personnel in general practices and prospectively in other small and medium sized enterprises. Trial registration German Clinical Trials Register: DRKS00012677. Registered on 16 October 2019. Retrospectively, https://www.drks.de/drks_web/navigate.do?navigationId=trial. HTML&TRIAL_ID = DRKS00012677.
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Affiliation(s)
- Birgitta M Weltermann
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany. .,Institute for General Medicine, University Hospital Essen, University of Duisburg-Essen, Hufelandstr 55, 45122, Essen, Germany.
| | - Christine Kersting
- Institute for General Medicine, University Hospital Essen, University of Duisburg-Essen, Hufelandstr 55, 45122, Essen, Germany
| | - Claudia Pieper
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr 55, 45147, Essen, Germany
| | - Tanja Seifried-Dübon
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Osianderstraße 5, 72076, Tuebingen, Germany
| | - Annegret Dreher
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Karen Linden
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Esther Rind
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tuebingen, Wilhelmstr 27, 72074, Tuebingen, Germany
| | - Claudia Ose
- Center for Clinical Trials, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr 55, 45147, Essen, Germany.,Center for Clinical Trials, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Osianderstraße 5, 72076, Tuebingen, Germany
| | - Brigitte Werners
- Institute for Operations Research, Ruhr University Bochum, Universitätsstr 150, 44801, Bochum, Germany
| | - Verena Schroeder
- Center for Clinical Trials, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Jean-Marie Bois
- Center for Clinical Trials, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Achim Siegel
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tuebingen, Wilhelmstr 27, 72074, Tuebingen, Germany
| | - Anika Thielmann
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Monika A Rieger
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tuebingen, Wilhelmstr 27, 72074, Tuebingen, Germany
| | - Stefanie Kasten
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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Rind E, Emerich S, Preiser C, Tsarouha E, Rieger MA. Exploring Drivers of Work-Related Stress in General Practice Teams as an Example for Small and Medium-Sized Enterprises: Protocol for an Integrated Ethnographic Approach of Social Research Methods. JMIR Res Protoc 2020; 9:e15809. [PMID: 32044759 PMCID: PMC7055789 DOI: 10.2196/15809] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/17/2019] [Accepted: 10/20/2019] [Indexed: 11/13/2022] Open
Abstract
Background An increasing shortage of skilled personnel, including medical personnel, has been reported in many postindustrial economies. Persisting and growing trends in absenteeism and incapacity to work due to mental disorders are concerning and have increased political, economic, and scientific interest in better understanding and management of determinants related to the work environment and health. Objective This study protocol describes an integrated approach of social research methods to explore determinants of work-related stress in general practice teams as an example for micro, small, and medium-sized enterprises (SMEs). Methods The methods applied will allow an in-depth exploration of work practices and experiences relating to psychological well-being in general practice teams. An ethnographic approach will be used to develop an in-depth understanding of the drivers of work-related stress in general practice teams. We will combine participating observation and individual interviews with five to seven general practitioners (GPs), and five to seven focus group discussions with the nonphysician staff (3-4 participants per group) in approximately four GP group practices and one single practice in Germany. Data collection and analysis will follow a grounded theory approach. Results The Ethics Committee of the Medical Faculty, University Hospital of Tuebingen, Germany, has approved this study (reference number: 640/2017BO2). Recruitment has commenced with study completion anticipated in mid-2020. Conclusions The data from this project will be used in follow-up projects to develop and test an intervention to reduce and prevent work-related stress in GP practices and other SMEs. International Registered Report Identifier (IRRID) DERR1-10.2196/15809
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Affiliation(s)
- Esther Rind
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tuebingen, University of Tuebingen, Tuebingen, Germany
| | - Sigrid Emerich
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tuebingen, University of Tuebingen, Tuebingen, Germany
| | - Christine Preiser
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tuebingen, University of Tuebingen, Tuebingen, Germany.,Centre for Public Health and Health Services Research, Core Facility for Health Services Research, University Hospital Tuebingen, Tuebingen, Germany
| | - Elena Tsarouha
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tuebingen, University of Tuebingen, Tuebingen, Germany
| | - Monika A Rieger
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tuebingen, University of Tuebingen, Tuebingen, Germany
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- See Acknowledgments section for more information and for collaborators/group members,
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Svedahl ER, Pape K, Toch-Marquardt M, Skarshaug LJ, Kaspersen SL, Bjørngaard JH, Austad B. Increasing workload in Norwegian general practice - a qualitative study. BMC FAMILY PRACTICE 2019; 20:68. [PMID: 31113368 PMCID: PMC6530128 DOI: 10.1186/s12875-019-0952-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 04/26/2019] [Indexed: 01/08/2023]
Abstract
Background General practitioners (GPs) play a key role in securing and coordinating appropriate use of healthcare services, by providing primary and preventive healthcare and by acting as gatekeepers for secondary healthcare services. Historically, European GPs have reported high job satisfaction, attributed to high autonomy and good compatibility with family life. However, a trend of increasing workload in general practice has been seen in several European countries, including Norway, leading to recruitment problems and concerns about the well-being of both GPs and patients. This qualitative interview study with GPs and their co-workers aims to explore how they perceive and tackle their workload, and their experiences and reflections regarding explanations for and consequences of increased workload in Norwegian general practice. Methods We conducted seven focus groups and four individual interviews with GPs and their co-workers in seven GPs’ offices in Mid-Norway: three in rural locations and four in urban locations. Our study population consisted of 21 female and 12 male participants; 23 were GPs and 10 were co-workers. The interviews were analysed using systematic text condensation. Results The analysis identified three main themes: (1) Heavy and increasing workload – more trend than fluctuation?; (2) Explanations for high workload; (3) Consequences of high workload. Our findings show that both GPs and their co-workers experience heavy and increasing workload. The suggested explanations varied considerably among the GPs, but the most commonly cited reasons were legislative changes, increased bureaucracy related to documentation and management of a practice, and changes in patients’ expectations and help-seeking behaviour. Potential consequences were also perceived as varying, especially regarding consequences for patients and the healthcare system. The participants expressed concerns for the future, particularly in regards to GPs’ health and motivation, as well as the recruitment of new GPs. Conclusions This study found heavy and increasing workload in general practice in Norway. The explanations appear to be multi-faceted and many are difficult to reverse. The GPs expressed worries that they will not be able to provide the population with the expected care and services in the future.
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Affiliation(s)
- Ellen Rabben Svedahl
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Håkon Jarls gate 11, 7030, Trondheim, Norway.
| | - Kristine Pape
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Håkon Jarls gate 11, 7030, Trondheim, Norway
| | - Marlen Toch-Marquardt
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Håkon Jarls gate 11, 7030, Trondheim, Norway
| | - Lena Janita Skarshaug
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Håkon Jarls gate 11, 7030, Trondheim, Norway
| | - Silje-Lill Kaspersen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Håkon Jarls gate 11, 7030, Trondheim, Norway.,SINTEF Digital, Department of Health, Trondheim, Norway
| | - Johan Håkon Bjørngaard
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Håkon Jarls gate 11, 7030, Trondheim, Norway.,Forensic Department and Research Centre Bröset, St. Olav's University Hospital Trondheim, Trondheim, Norway
| | - Bjarne Austad
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Håkon Jarls gate 11, 7030, Trondheim, Norway
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Goetz K, Mahnkopf J, Kornitzky A, Steinhäuser J. Difficult medical encounters and job satisfaction - results of a cross sectional study with general practitioners in Germany. BMC FAMILY PRACTICE 2018; 19:57. [PMID: 29743017 PMCID: PMC5944023 DOI: 10.1186/s12875-018-0747-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 04/23/2018] [Indexed: 12/01/2022]
Abstract
Background In primary care 15% of patient encounters are perceived as challenging by general practitioners (GP). However it is unknown what impact these encounters have regarding job satisfaction. The aim of this study was to evaluate which encounters are perceived as challenging by German GPs and whether they were associated with job satisfaction. Methods A total of 1538 questionnaires were sent to GPs in the federal state of Schleswig-Holstein, Germany. GPs should rate 14 medical conditions and 8 traits of patients on the perceived challenge using a Likert scale (1: ‘not challenging at all’ to 10: ‘extremely challenging’). Job satisfaction was measured with the Warr–Cook–Wall job satisfaction scale. A linear regression analyses were used to explore potential associations between for the primary outcome variable ‘overall job satisfaction’. Results Total response was 578 (38%). GPs perceived 16% of their patients as challenging. Psychiatric disorders such as somatization disorder (mean = 7.42), schizophrenia (mean = 6.83) and anxiety disorder (mean = 6.57) were ranked as high challenging while diabetes mellitus type 2 (mean = 4.87) and high blood pressure (mean = 3.22) were ranked as a rather low challenging condition. GPs were mostly satisfied with ‘colleagues’ (mean = 5.80) and mostly dissatisfied with their ‘hours of work’ (mean = 4.20). The linear regression analysis showed no association with challenging medical conditions and traits of patients but only with different aspects of job satisfaction concerning the outcome variable ‘overall job satisfaction’. Conclusions Especially psychiatric conditions are perceived as challenging the question arises, in what amount psychiatric competences are gained during the postgraduate specialty training in general practice and if GPs with a mandatory rotation in psychiatry perceive these conditions as less challenging. Interestingly this study indicates that challenging encounter in terms of challenging medical conditions and traits of patients do not affect GP’s job satisfaction. Electronic supplementary material The online version of this article (10.1186/s12875-018-0747-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Katja Goetz
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany.
| | - Janis Mahnkopf
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - Anna Kornitzky
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - Jost Steinhäuser
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany
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Goetz K, Jossen M, Szecsenyi J, Rosemann T, Hahn K, Hess S. Job satisfaction of primary care physicians in Switzerland: an observational study. Fam Pract 2016; 33:498-503. [PMID: 27288874 DOI: 10.1093/fampra/cmw047] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Job satisfaction of physicians is an important issue for performance of a health care system. The aim of the study was to evaluate the job satisfaction of primary care physicians in Switzerland and to explore associations between overall job satisfaction, individual characteristics and satisfaction with aspects of work within the practice separated by gender. METHODS This cross-sectional study was based on a job satisfaction survey. Data were collected from 176 primary care physicians working in 91 primary care practices. Job satisfaction was measured with the 10-item Warr-Cook-Wall job satisfaction scale. Stepwise linear regression analysis was performed for physicians separated by gender. RESULTS The response rate was 92.6%. Primary care physicians reported the highest level of satisfaction with 'freedom of working method' (mean = 6.45) and the lowest satisfaction for 'hours of work' (mean = 5.38) and 'income' (mean = 5.49). Moreover, some aspects of job satisfaction were rated higher by female physicians than male physicians. Within the stepwise regression analysis, the aspect 'opportunity to use abilities' (β = 0.644) showed the highest association to overall job satisfaction for male physicians while for female physicians it was income (β = 0.733). CONCLUSIONS The presented results contribute to an understanding of factors that influence levels of satisfaction of female and male physicians. Therefore, research and intervention about job satisfaction should consider gender as well as the stereotypes that come along with these social roles.
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Affiliation(s)
- Katja Goetz
- Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany, Institute of Family Medicine, University Hospital Schleswig-Holstein Campus Luebeck, Luebeck, Germany,
| | | | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany, AQUA-Institute for Applied Quality Improvement and Research in Health Care, Goettingen, Germany and
| | - Thomas Rosemann
- Institute of General Practice and Health Services Research, University of Zurich, Zürich, Switzerland
| | - Karolin Hahn
- AQUA-Institute for Applied Quality Improvement and Research in Health Care, Goettingen, Germany and
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Coping with job stress by hospital doctors: a comparative study. Wien Med Wochenschr 2012; 162:440-7. [PMID: 23111656 DOI: 10.1007/s10354-012-0144-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Accepted: 09/19/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Currently only few studies exists focusing on cross-cultural differences in job stress and stress management. The present study aimed to examine and compare job stress and coping behaviour of Australian and German physicians. METHODS The present study was designed as a cross-sectional comparison using questionnaire data of 310 German and 256 Australian hospital doctors. The questionnaires contained items on demography and self-rated subjective coping strategies. The Perceived Stress Questionnaire (PSQ) and the Brief COPE Questionnaire were used to analyze national differences in coping behaviour. RESULTS According to the comparison, German physicians perceived higher values of job stress. Coping behaviour differed significantly between the two doctor samples. CONCLUSIONS This study demonstrated a number of similarities, but also some unexpected differences in Australian and German doctors' job stress and coping strategies. These findings may help direct further research on cross-cultural investigations and health promotion interventions in both countries.
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Behmann M, Schmiemann G, Lingner H, Kühne F, Hummers-Pradier E, Schneider N. Job satisfaction among primary care physicians: results of a survey. DEUTSCHES ARZTEBLATT INTERNATIONAL 2012; 109:193-200. [PMID: 22509226 DOI: 10.3238/arztebl.2012.0193] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Accepted: 09/27/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND A shortage of primary care physicians (PCPs) seems likely in Germany in the near future and already exists in some parts of the country. Many currently practicing PCPs will soon reach retirement age, and recruiting young physicians for family practice is difficult. The attractiveness of primary care for young physicians depends on the job satisfaction of currently practicing PCPs. We studied job satisfaction among PCPs in Lower Saxony, a large federal state in Germany. METHODS In 2009, we sent a standardized written questionnaire on overall job satisfaction and on particular aspects of medical practice to 3296 randomly chosen PCPs and internists in family practice in Lower Saxony (50% of the entire target population). RESULTS 1106 physicians (34%) responded; their mean age was 52, and 69% were men. 64% said they were satisfied or very satisfied with their job overall. There were particularly high rates of satisfaction with patient contact (91%) and working atmosphere (87% satisfied or very satisfied). In contrast, there were high rates of dissatisfaction with administrative tasks (75% dissatisfied or not at all satisfied). The results were more indifferent concerning payment and work life balance. Overall, younger PCPs and physicians just entering practice were more satisfied than their older colleagues who had been in practice longer. CONCLUSION PCPs are satisfied with their job overall. However, there is significant dissatisfaction with administrative tasks. Improvements in this area may contribute to making primary care more attractive to young physicians.
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Affiliation(s)
- Mareike Behmann
- Hannover Medical School, Centre for Public Health and Healthcare, Institute for Epidemiology, Social Medicine and Health Systems Research
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Job stress and job satisfaction of physicians in private practice: comparison of German and Norwegian physicians. Int Arch Occup Environ Health 2011; 85:819-28. [PMID: 22160090 DOI: 10.1007/s00420-011-0725-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Accepted: 11/20/2011] [Indexed: 10/24/2022]
Abstract
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 < 0.01) on the reward scale. A larger proportion of German physicians (27.6%) presented with an effort/reward ratio beyond 1.0, indicating a risky level of work-related stress, compared to only 10.3% of Norwegian physicians. Working hours, effort, reward, and country differences accounted for 37.4% of the explained variance of job satisfaction. 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.
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