OCCUPATIONAL STRESS AMONG DOCTORS: A CASE STUDY OF PT. B. D. SHARMA UNIVERSITY OF HEALTH SCIENCES ROHTAK

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1 321 OCCUPATIONAL STRESS AMONG DOCTORS: A CASE STUDY OF PT. B. D. SHARMA UNIVERSITY OF HEALTH SCIENCES ROHTAK ABSTRACT MONIKA ARYA*; DR. SATYAWAN BARODA** *Lecturer, School of Management Studies, Bhagat Phool Singh University, Khanpur Kalan, Sonipat. **Reader, Institute of Management Studies and Research, Maharshi Dayanand University, Rohtak. Stress affects the quality of results and gives birth to job dissatisfaction. Health care industry being very sensitive in nature must manage the work related stress of doctors to achieve the objective of service to society. This study result highlights that there are stressful behaviour of doctors while dealing with patients. In case of critical patients stress level is much higher in volume and intensity. Their personal inconveniences such as restlessness and sleep disturbances are indicated. The causes responsible for stress are well taken into consideration and examined carefully. Some new emerging concepts are also highlighted in this study after the crossexamination and action choices to manage occupational stress are recommended for better results. INTRODUCTION Stress affects the quality of results and gives birth to job-dissatisfaction. Health care industry being very sensitive in nature must manage the work related stress of doctors to achieve the objective of service to society. Quality of work and quality of work life is achieved when people have stress free life at work place. It has been proved by some researchers such as a reference given like: Job stress is a recognized problem in health care workers and doctors are considered to be at particular risk of stress and stress related psychosocial problems 1. Doctors have higher degree of psychological morbidity, suicidal tendencies and alcohol dependence than controls of comparable social class 2. Caplan reported that about half of senior medical staff suffers from high level of stress and a similar proportion suffers from anxiety 3. Similarly, Firth-Cozens found that half of the junior doctors in their pre-registration year were suffering from emotional disturbance 4. The delivery of high-quality medical care contributes to improved health outcomes. Doctors job satisfaction affects quality of medical cares that they provides, patient s satisfaction with the doctor, patient s adherence to treatment and decreases doctors turnover 5. Stress is likely to create problems within the organization, which will have the direct or indirect effect on the bottom line. The operating costs certainly rise because of lower productivity, incorrect or random work and mistakes. The employer needs to pay attention on stress factors at the workplace (Yemn and Graham, 2007) 6. When an employee of the organization experiences depression both

2 322 at home and office, it will affect the human relationships with co-workers, work productivity and personal health (William, 2007) 7. Balancing of work and life through time management is highly essential to reduce stress (Leslie, 2007) 8. It may be noted in addition to cost and benefit earnings, stress is an additional burden for humanity. A good work life balance is important. The gap between work life balance leads to greater pressure and stress (Hanna and Romana, 2007) 9. Stresses therefore, is a dynamic condition in which an individual is confronted with an opportunity, constraint or demand related to what the individual desires and for which the outcome is perceived to be both uncertain and important. BRIEF REVIEW OF LITERATURE To some degree stress is an unavoidable characteristic of life and work and, as such, is neither inherently bad nor necessarily destructive. There is, however, a clear difference between being under pressure at work and being subjected to the kind of chronic stress that is potentially damaging to physical, social and psychological well-being. Workplace stress can have a wideranging and negative impact on the well-being of the individual and his or her day-to-day functioning. This is observable at a physical level (e.g. exhaustion, headaches, high blood pressure), a psychological level (e.g. depression, anxiety, low self esteem), a cognitive level (e.g. absent mindedness, failure of attention and memory) and a behavioural level (e.g. absenteeism, aggressive behaviour etc.). STRESS MANAGEMENT Stress management is one of the offshoot tools of the management to reduce stress associated with the business and working environment. The stress management program will help to reduce the stress and cerate job effectiveness in service sectors. Work managers without stress management skills may experience feeling of being let down, unable to cope with the additional stress suffer loss of confidence and self-esteem and a sense of failure. The health and safety executive (HSE) defines stress as change in mood or behaviour, deteriorating relationships with work colleagues, being late to work and absenteeism, frequent complaints and reduced performance indicating unhealthy levels of stress in an individual (Paul 2004) 10. Patterson et al. (1987) 11 in their research work have identified that when the goal is more stressful, a person is likely to perceive zero or minimal stress. OBJECTIVES 1. To understand and evaluate the causes of stress. 2. To find out the effective strategies of stress management. RESEARCH METHODOLOGY This study is primarily based on primary data and information. Questionnaire method was used in collection of data. To confirm the data and information general discussion and unstructured interview method was also used.

3 323 SAMPLING AND SAMPLE SIZE The sample of doctors considered is from various departments of PGIMS, Rohtak. It was decided to consider at least 20% of the doctors of the various departments to evaluate the amount of work-related stress. Statistically, it is desired to have the standard error not more than 10%. 90% of the confidence level is considered to determine the sample size. The sample size for the survey is determined as indicated below:- N= Z 2 {π (1-π)}/E 2 Where, N= Sample size to be determined π= The proportion of sample considered Z= The confidence coefficient (1.64 for 90% confidence level) Accordingly, N=Z 2 {π (1-π)}/ E 2 = (1.64) 2 { }/(0.1) 2 = 43 Respondents However, to make the calculations easy the sample size was increased to 60. A sample of 60 doctors working in different departments in PGIMS, Rohtak was selected on convenient random basis. TEST OF ANALYSIS In addition to tabulation and classification, the key statistical tool used for data analysis is the Kolmogorov-Smirnov: D-test EXPLANATION OF THE TEST Kolmogorov-Smirnov D (K-S) test: The Kolmogorov-Smirnov: D-test is a goodness-of-fit test which tests whether a given distribution is not significantly different from one hypothesized. The Kolmogorov-Smirnov D-test involves the following steps:- 1. Observed numbers and also the proportions are tabulated. 2. Observed cumulative proportions are tabulated. 3. The null proportions specified.

4 The null cumulative proportions are developed. 5. The absolute difference observed and null cumulative proportions are computed. 6. Largest absolute difference is called Kolmogorov-Smirnov D {K-S critical value (D)} is obtained. 7. The critical value using the equation 1.36/ n is computed (where n being the number of samples taken for test). 8. The value of K-S critical value (D) is compared with absolute difference to ascertain the significant differences. ANALYSIS AND INTERPRETATION OF DATA To know the results of the study the interpretation of data has been presented in the form of tables given below: TABLE 1 COMPARATIVE RATINGS OF ALL STRESS PARAMETERS AND THEIR MEANS WITH STANDARD DEVIATIONS N: 43 Sr. No Stress Parameters Max. Min. Mean Standard Deviation 1 Lengthy Working Hours No Regular Sleep Emergency Calls Dealing with Critical Patients Dividing time between Family & Patients High Patient Volume Adverse Press Publicity Senior s Pressure/High Expectations/Work Targets

5 325 9 External /Political Interference Night Duties Availability of Facilities Monotonous Work No Appreciation by Patients for the Work Done Hours Responsibility of Patients Phone calls during Night/Early Morning TABLE 2 SIGNIFICANT DIFFERENCES IN VARIOUS STRESS PARAMETERS N: 43 Sr. No. Stress Parameters K-S Critical Value (D) Calculated Maximum Absolute Difference Significant Difference 1 Lengthy Working Hours Yes 2 No Regular Sleep Yes 3 Emergency Calls Yes 4 Dealing with Critical Patients Yes 5 Dividing time between Family & Patients No 6 High Patient Volume No 7 Adverse Press Publicity No

6 326 8 Senior s Pressure/High Expectations/Work Targets Yes 9 External /Political Interference No 10 Night Duties Yes 11 Availability of Facilities Yes 12 Monotonous Work Yes 13 No Appreciation by Patients for the Work Done Yes Hours Responsibility of Patients No 15 Phone calls during Night/Early Morning Yes RESEARCH HIGHLIGHTS It may be observed that high stress feelings in doctors are due to longer working hours which results from high patient volume and leads to stress. The study on comparative ratings of all parameters indicates that high patient volume, senior s pressure, high expectations and no appreciation by patients are causes of stress in doctors. It may be observed that 79% of the doctors come under stress in their work due to high patient volume, however it may be noted that the doctors feel less or no stress due to adverse press publicity. Some of the factors leading to dissatisfaction with the job are: monotonous work, long working hours, night shifts, to some extent the safety aspect for female doctors. Doctors expressed that they feel stressed while dealing with critical patients and convincing their attendants. It may be observed that doctors have stress due to phone calls during night/early mornings and in dividing time between family and patients. SUGGESTED ACTION CHOICES The management of the hospital should arrange congenial detailed deliberations to manage and to perform their duties. The causes of stress are to be identified and actions should be taken to eliminate it. Apart from this Scrutiny of patients will be helpful in decreasing the volume of patients which is the main cause of stress among doctors. Length of the working hours should be minimised. Round the clock duties should be minimised to 8-10 hours at a stretch. Presence of seniors while dealing with critical patients is also helpful in reducing the stress level among junior doctors. The patients of daily routine ailment or minor illness should be sent to civil hospitals, CHC s and PHC s. Medical staff of the peripheral areas should be trained at

7 327 regular intervals regarding dealing with emergencies. Generally it was found that press persons only hike the unnecessary issues which is one of the most important reason of stress among doctors and it also demotivate them towards the service of society, it is therefore suggested that creditable work done by the doctors should also be encouraged and praised at regular intervals. For avoidance of the political interference regarding the treatment of the patients, it is advisable that top management peoples should come forward and help their junior doctors. Availability of facilities becomes useless without the proper knowledge and maintenance of the latest technology equipments, so proper training programmes should be arrange by the management on regular basis this will improve the availability of facilities and helpful in reducing the stress among doctors. Strict disciplinary actions should be taken against the doctors who were found guilty of taking bribes and undue incentives for the desired treatments of the patients. Senior doctors should help their juniors and treat them with respect. They should not make an undue pressure on them this will very helpful in reducing the stress level among junior doctors. CONCLUSION The study on stress at PGIMS Rohtak, helps to know the various causes for inducing stress among doctors and helps in identifying the actions needed to reduce it. Scrutiny of daily routine ailments patients is one of the offshoot tools of management to reduce the stress of doctors. The study conducted at PGIMS Rohtak reveals that a large number of doctors feels stress at their work place due to lengthy working hours and high patient volume which directly effects their physical and psychological health. It is also noted that doctors were stressed at their work due to senior s pressure, dealing with critical patients, night duties and adverse press publicity. The management of the hospital should minimize the length of working hours up to 8-10 hours at a stretch which helps the doctors to manage and handle their work with less or no stress. An effective way of managing stress among doctors will definitely help to enhance the quality of results as well as to achieve their objective of their service to society. REFERENCES 1) Burbeck R, Coomber S, Robinson SM, Todd C. (2002). Occupational stress in consultants in accident and emergency medicine: A national survey of levels of stress at work. Emerg Med J 19: ) Kapur N, Borrill C, Stride C. (1998). Psychological morbidity and job satisfaction in hospital consultants and junior house officers: multicentre, cross sectional survey. BMJ 317: ) Caplan RP. (1994). Stress, anxiety, and depression in hospital consultants, general practitioners, and senior health service managers. BMJ 309: ) Firth-Cozens J. (1987). Emotional distress in junior house officers. BMJ; 295: ) Coyle YM, Aday LA, Battles JB, Hynan LS. (1999). Measuring and predicting academic Generalists work satisfaction: implications for retaining faculty. Acad Med 74:

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