A STUDY ON OCCUPATIONAL STRESS AMONG DOCTORS OF GOVERNMENT GENERAL HOSPITALS IN KRISHNA DISTRICT, A.

P
A Synopsis submitted to the Acharya Nagarjuna University (ANU), in partial fulfillment for the award of the degree of

MASTER OF PHILOSOPHY

SUBMITTED BY DAVID RAJU GOLLAPUDI

((Regd. No:C09MP016004)

Under the Guidance of Dr. NAGA RAJU BATTU

MBA, M.Phil., Ph.D

Department of Human Resources Management ACHARYA NAGARJUNA UNIVERSITY

CENTRE FOR DISTANCE EDUCATION

ACHARYA NAGARJUNA UNIVERSITY NAGARJUNA NAGAR

BACKGROUND OF THE RESEARCH
INTRODUCTION

Change is an inevitable element in the history of human civilization. Human beings have learnt their lessons of coping with these multitude waves of changes to ensure their future survival. Initially, these changes were scarce, later they became more and fast at pace, and along the way they posed problems for human to cope with these changes. This condition of inability to cope with the environmental changes, have caused a new phenomenon called Stress. Stress is simply a consequent of a disturbance to the equilibrium state that existed previously. In the new millennium, stress has become a common and serious problem faced by almost everyone at one point of time or the other. This problem has become so common both in developed and developing countries that people have called it the third wave plague (Sutherland and Cooper1, 1990) Stress in our society is very prominent both in our personal as well as professional lives. None of our occupation is free from stress. But the occupations that we consider more stressful are medical, teaching, office work, labors and police. Internal and external factors have contributed to increase stress in almost all occupations. Changing environment, new technologies, changing government policies, downsizing in Hospitals, increase in shifts; they are all causing stress on employees. So, I motivated to know the employee occupational stress at workplace. Stress in workplace, particularly, is reported to be on the rise in many countries. It is the major issue that many labor unions are making big hue and cry, so that respective authorities will take appropriate actions to safeguard the workers welfare.
1. Sources of Work Stress in Hurrell, Murphy, Sauter and Cooper [eds] Occupational Stress: Issues and Developments in Research, London, Taylor and Francis (1988)

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
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stress of doctors to achieve the objective of service to the society. Quality of work and quality of work life is achieved when people have stress free life at work place. It has been proved y 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 problems2 . Doctors have higher degree of psychological morbidity, suicidal tendencies and alcohol dependence than controls of comparable social class3. Caplan reported that about half of senior medical staff suffers from high level of stress and a similar proportion suffers from anxiety4. Similarly, Firth-Cozens5 found that half of the junior doctors in their pre-registration year were suffering from emotional disturbance. The delivery of high-quality medical care contributes to improved health outcomes. Doctors job satisfaction affects quality of medical cares that they provides, patientss satisfaction with the doctors, patients adherence to treatment and decreases doctors turnover6. Stress is likely to create problems within the organisation, 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 work place (Yemn and Graham. 2007)7. When an employee of the organisation experience depression both at home and office, it will affect the human relationship with co-workers, work productivity and personal health (William. 2007)8. Balancing of work and life through time management is highly essential to reduce stress (Leslie, 2007)9.
2. 3. 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: 511-12. Caplan RP. (1994). Stress, anxiety, and depression in hospital consultants, general practitioners, and senior health service managers. BMJ 309: 1261-63.

4. 5. 6. 7. 8. 9.

Firth-Cozens J. (1987). Emotional distress in junior house officers. BMJ; 295: 533-36. Coyle YM, Aday LA, Battles JB, Hynan LS. (1999). Measuring and predicting academic Generalists work satisfaction: implications for retaining faculty. Acad Med 74: 1021-27. Yemm and Graham (2007). Is your workplace suffering from contagious stress, Management services, Winter, Vol. 51, No. 4, pp. 46-47. Williams Terrie M (2007). Public Relations Tactics, November, Vol. 14, No. 11, pp. 10-11 Leslie Delperdang (2007). Financial Executive, January/February, Vol. 23, No.1, p. 64. Hanna D R and Romana M (2007). Debrifing after a Crisis, Nursing Management, August, Vol.38, No. 8, pp. 38-47.

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
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work life balance leads to greater pressure and stress (Hanna and Romana, 2007)10. 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
STATEMENT OF THE PROBLEM

Several studies point out that the relationship between occupational stress and job satisfaction & commitment has remained a topic of interest ever since it was introduced. These studies point to that the continued interest is the result of the belief that, if properly managed, employees organisational commitment can lead to valuable consequences such as organisation success, reduced employee turnover and non-attendance. This quest to harness the possible organisational pay back has resulted in a number of researches that focus on the scenery and relationship between occupational stress and job satisfaction This study focuses on Occupational Stress (OS) and Job Satisfaction among Expertise Medical Doctors of Andhra Pradesh Government Hospitals with special reference to Krishna District, A.P. Various levels of stress and aspects of job dissatisfaction are probed, to see how they are related to each other. The relationship of these variables with demographic characteristics has also been analyzed. An extensive literature revealed that a great deal has been written about the causes and adverse effects of occupational stress as well as the importance of organisational commitment for the realization of organizational and professional goals. However, very few studies were found which address this relationship in the Medical Field of Krishna District, Andhra Pradesh. The review of the

literature also shows some reports on Occupational Stress, Job Satisfaction and personnel management related problems.
10. Paul J Siracusa (2004). Financial Executive, January/February, Vol. 20, No. 1, p. 64.

The aim of this study is to identify the stressors issues that will influence the government doctors job satisfaction. We selected Doctors because they have been consistently identified as a group experiencing high stress at work (Sigler
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and Wilson, 1988). More work and professional stress have been facing by the government doctors. This study also aims at exploring the relationship between stress factors and doctors performance in the context of Andhra Pradesh State Health and Science Council with special reference to Krishna District. The problem to be investigated is to, examine the relationship between occupational stress and stress probing factors of Medical Doctors at their workplace. Further, this study aims to explore the level, causes and dimensions of occupational stress of doctors who are working in Government General Hospitals, Krishna District, Andhra Pradesh

INTRODUCTION OF THE TOPIC Stress in this society is not something that is invisible. Person whether a child, adult, men, women, employed, unemployed everyone is facing stress in his/her own way. Job life is one of the important parts of our daily lives which cause a great deal of stress. Due to the competitive nature of the job environment most of the people in the world are spending their time for job related work purposes resulting ignore the stressor those are influencing their work and life. Usually people are more worry about their outcome of their work that can even affect the way they treat other people and how they communicate with their peers and customers. For example, people with a higher percentage of occupational stress may not be satisfied with their job and therefore they will not feel happy working in the organization. They may feel frustrated or burned out when they are having problems with peers or customers. This may leave a negative impact to the organization itself. Therefore, it is very important for employer and employees to realize the stress and the stressor that cause all the negative effects.

Stress at work is an increasingly common feature of modem life. A survey11 of 28,000 workers in 215 organizations in the United States linked stress at work to poor work performance, acute and chronic health problems, and employee burnout. In the United Kingdom, researchers have estimated that
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360 million working days are lost through sickness each year at an estimated cost of 8 billion ($12.8 billion; Sigman, 1992). The U.K12 health and Safety Executive has estimated that at least half of these lost days are related to workplace stress. Individuals and their organizations face a growing problem of managing stress at work but are hampered by a lack of understanding of the nature of occupational stress. When stress was first studied in the 1950s, the term was used to denote both the causes and the experienced effects of pressures. More recently, however, the word stressor has been used for the stimulus that provokes a stress response. Currently, the disagreement among researchers concerns the definition of stress in humans and their argument is based on the following question: Is stress primarily and external response that can be measured by changes in glandular secretions, skin reactions, and other physical functions, or is it an internal interpretation of, or reaction to, a stressor; or is it both. Every person has his own definition of stress. But according to Van Wyk13 (in Olivier & Venter, 2003), stress is derived from the Latin word Strictus that translates into taut, meaning stiffly strung. Oliver and Venter (2003) rely on the definition of Dr. Hans Seyle14, who defined stress in physiological terms, as a non-specific or generalized bodily response. The human body has a natural chemical response to a threat or demand, commonly known as the flight or fight reaction, which includes the release of adrenalin. Once the threat or demand is over the body can return to its natural state.
11. Ivancevich, Matteson, Freedman, & Phillips, 1990; Kohler & Kamp, 1992 12. A survey conducted by European Foundation for the Improvement of Living and Working Conditions, 1996 13. Van Wyk, J. (1998). Stresbelewing by onderwysers. Ongepubliseerde DEd-proefskrif. Port Elizabeth: Universiteit van Port Elizabet 14. "A Syndrome Produced by Diverse Nocuous Agents" - 1936 article by Hans Selye from The Journal of Neuropsychiatry and Clinical Neurosciences. The Stress of life. New York: McGraw-Hill, 1956.

A STRESSOR is an event or set of conditions that causes a Stress response. STRESS is the bodys physiological response to the stressor, and STRAIN is the bodys longer-term reaction to chronic stress. Occupational Stress can be defined as the harmful physical and emotional response that occurs when the requirements of the job do not match the
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capabilities, resources, or needs of the worker. Job stress can lead to poor health and even injury. Long term exposure to job stress has been linked to an increased risk of muscular skeletal disorders, depression and job burnout and may contribute to a range of debilitating diseases, ranging from cardiovascular disease to cancer. There are large number of occupational stressors of varying degree and nature experienced by male and female employees. At work place stressors can be poor physical condition at work place, Downsizing, Privatization, Hiring freezes, Contingent work (e.g. part-time or temporary), Shift work/Rotating schedules, Quality Programs/Worker Participation schemes, little autonomy or control over ones Job, Nonexistent career ladders, Inadequate resources to do the job, High demands, workload, time pressures, Lack of job security, Understaffing, Mandatory overtime, Violence/Harassment. Stress level changes according to Hierarchy. Lower level employees both male and female experience stress in different way as compare to upper level and middle level.

Consequences of Stress
Stress produces a range of undesirable, expensive, and debilitating consequences, which affect both individuals and organizations. In organizational setting, stress is nowadays becoming a major contributor to health and performance problems of individuals, and unwanted occurrences and costs for organizations. Stress can result in Absenteeism Turn over Reduced job involvement Job dissatisfaction Its physical symptoms can be: 1. Headaches 2. Stomach problems 3. Eating disorders
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4. Sleep disturbances 5. Fatigue 6. Muscle aches & pains 7. Chronic mild illnesses 8. High Blood Pressure 9. Heart disease 10. Stroke Its psychological & Behavioral symptoms can be: Anxiety Irritability Low morale Depression Burnout Alcohol & drug Feeling powerless Isolation from co-workers Musculoskeletal disorders Effect of Job Stress on work outcomes When person get stress on physic, emotion and behavior that person become looser or he escapes from working. His behavior towards work changes and ultimately the effect shows on different work outcomes. This workout comes are as under: Performance Productivity Job dissatisfaction Reduce job involvement Absenteeism Turnover Work ineffectiveness Health
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STRESSES IN HEALTHCARE Healthcare is widely perceived as one of the most inherently stressful employment sectors (Anderson, Cooper, & Willmott15, 1996; MacDonald, Karasek, Punnett, & Scharf, 2001; McGrath, Reid, & Boore, 2003; Weinberg & Creed, 2000), and so there has been extensive research into work stress in healthcare. The majority of research deals with the identification of sources of stress, that is, the stressors (Lambert & Lambert, 2001). One conclusion from the research on stress is that there are a vast number of stressors in healthcare, and most stressful events seem to involve multiple stressors. The factors identified as stressors are complex, and some factors might not be stressful in isolation (Healy & McKay, 1999; Hopkinson et al., 1998). Furthermore, one reason for the diversity of stressors identified could be the use of different concepts and measures. Factors related to Patients seem to be the most critical Occupational Stress Factors (OSF) in creating stress among doctors while work overload, role conflict, and role ambiguity seem to cause less stress in Indian scenario. This conclusion was reached over a decade ago by Tyler and Cushway (1995), who implied that intrinsic, factors such as as death and dying were receiving too much attention. Then again, according to other researchers (e.g. Erlen & Sereika, 1997; McVicar, 2003), caring for the emotional needs of patients is an important source of stress, and may even be the main one.
15. Anderson W., Cooper C. & Willmott M. (1996) Sources of stress of the Natiional Health Service: a comparison of seven occupational groups. Work and Stress, 10(1), 88-95

Erlen and Sereika16 (1997) found, however, that stress levels increased with the increase of other demands, for instance keeping up with new developments in healthcare, having too much to do, having too many interruptions, and insufficient numbers of staff. Another major source of stress is interpersonal relations at work, such as being subject to group pressure and having opinions not accepted by the

work group (MacDonald et al., 2001); or too many expectations from others (Edwards, Burnard, Coyle, Fothergill, & Hannigan, 2000). In some cases, the organisational structure is the direct source of stress, creating stressors such as organisational injustice (Kivimki, Elovainio, Vahtera, & Ferrie, 2003), a lack of organisational involvement (Kirkcaldy & Martin, 2000), and a misunderstanding by management of the needs of the department (McGowan, 2001). A major theme in stress research is the importance of being in control of one's work situation; that is, being able to influence decisions or being given the opportunity to be involved (Troup & Dewe, 2002). However, research in healthcare regarding lack of control at work is contradictory. Mkinen, Kivimki, Elovainio, and Virtanen (2003) emphasised that, for healthcare personnel, increased responsibility and role expansion in primary nursing diminished the potentially favourable effects of increased autonomy and control. Reid et al. (1999) identified extensive responsibility as the most frequently reported stressor. Nurses regarded their contact with patients as highly rewarding, but felt burdened by a strong sense of being constantly responsible for their patients. Likewise, Nordam17, Srlie, and Forde (2003) concluded that physicians felt stressed by the responsibility and loneliness involved in decision-making. Overload at work might lead to overload at home, as couples are usually now both employed, and share family responsibilities (Majomi, Brown, & Crawford, 2003). Cushway and Tyler (1996) found that the strongest and most relevant sources of stress were not the ones leading to most psychological distress.
16. Erlen, J. A., & Sereika, S. M. (1997). Critical care nurses, ethical decision-making and stress. Journal of Advanced Nursing, 26(5), 953-961.

17. Nordam, A., Sorlie, V., & Forde, R. (2003). Integrity in the care of elderly people, as narrated by female physicians. Nursing Ethics, 10, 388_403.

For instance, work-home conflicts were not a major source of stress, but they were the main predictor of poor health. Wheeler (1998) has argued that stress research has spent decades highlighting the determinants of stress in nurses, but has offered few solutions for the problems. He has also stated that although the studies highlight common sources of stress, a common source of stress does not
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necessarily represent the most important source of stress for any given individual (p 40). Stress is to a large extent a matter of perception, as it always involves a feeling self. The past decades radical changes in healthcare have generated changes in the sources of stress. For instance, we now have the knowledge to do more than we have resources for, raising new issues of standards, ethics, and morality in healthcare. MORAL DISTRESS IN HEALTHCARE A concept somewhat similar to that of stress of conscience is moral distress. Moral distress was first described in 1984 by Jameton (1993), and since then the term has been used in several studies (e.g. Corley, Elswick, Gorman, & Clor, 2001). In Sweden, Silfverberg (1996) has used the term ethical stress, as has Raines18 (2000), while Ltzn et al. (2003) have used the term moral stress for similar notions. Jameton19 (1993) defined moral distress as a negative feeling occurring when institutional or other constraints make it difficult or even impossible for nurses to act according to their moral conviction that is, their values. Similar conceptualisation was given by Corley et al. (2001), who developed the Moral Distress Scale (MDS) from research on the moral problems that nurses are confronted with. Healthcare employees experience strain when they are in situations of contradictory ethical demands and when they feel they know what should be done but are prevented from acting in line with this insight. The MDS assesses three factors; individual responsibility, not in the patients best interests, and deception. According to Hanna (2004), the conceptualisation of moral distress is unequivocal and not distinct.
18. Raines ML. Ethical decision making in nurses. Relationships among moral reasoning, coping style, and ethics stress. JONAS Healthcare Law Ethics Regulation. 2000;2:2941. 19. Jameton, A. (1993). Dilemmas of moral distress: moral responsibility and nursing practice. AWHONN's Clinical Issues in erinatal and Women's Health Nursing, 4(4), 542-551.

For instance, moral distress seems to differ depending on whether the focus is on norms or feelings. It lacks a clear and inclusive definition, and is problematic since its definition is based on the way in which it arises. Various sources of moral distress have been described. However, most refer to injustices towards patients, failings in patient advocacy, and personnel not
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being able to work in accordance with their own values or provide adequate care (Austin, Bergum, & Goldberg, 2003; Corley, 2002; Corley et al., 2001; Georges & Grypdonck, 2002; vander Arend & Remmers-van den Hurk, 1999)20. Most researchers have investigated moral distress in nurses; however, Klvemark, Hglund, Hansson, Westerholm, and Arnetz (2004) showed that other categories of healthcare personnel also experience moral distress. They concluded that moral distress occurred when institutional constraints prevented staff from acting according to their moral belief system, but also when staff did follow their morals and in doing so were forced to clash with, for example, legal regulations. Wilkinson21 (1987) argued that moral distress leads to feelings of frustration, anger, and guilt, stemming from an inability to act according to ones values. According to Kelly22 (1998), moral distress is a consequence of not preserving one's moral integrity, that is, not being able to live up to ones moral convictions. Moral integrity is connected to self and identity, and so, in the words of Kelly, When moral integrity is threatened so are self and identity (p. 1137). Consequently, moral distress is closely related to self-criticism and self-blame. Kelly concludes that the degree of moral distress seems to be connected to the degree of personal responsibility and accountability for patient care, and also to moral ideals about nursing. Moral distress is primarily described in relation to institutional obstacles, while stress of conscience can also cover stress due to, for instance, self-selected actions or neglect, an aspect also addressed by some research into moral distress. The concepts of morality and conscience are closely related but not synonymous. Conscience can be in agreement with morals,
20. Austin, W., Bergum, V., & Goldberg, L. (2003). Unable to answer the call of our patients: mental health nurses' experience of moral distress. Nursing Inquiry, 10(3), 177-183.

21. Wilkinson, J. M. (1987). Moral distress in nursing practice: experience and effect. Nursing Forum, 23(1), 16-29. 22. Kelly B(1998). Preserving moral integrity:a follow-up study with new graduate nurses.Journal of Advanced Nursing,28(5)1134-1145.

or it can be opposed to and critical of them (cf. Ricoeur, 1992, pp. 342- 352). This is evident, for instance, in Arendts (1963/1994, pp. 278-279; 1971) thoughts on conscience and evil, and Eichmanns trial for war criminality in Nazi Germany. The court ruled that even if Eichmann did nothing wrong in terms of the morals of the culture he was living in, his conscience should have objected to those morals. According to Frankl (1959/2000, p. 32), conscience is a pre-moral value
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perception which emerges prior to any formulated moral. The study and it starts from the identification of the problem to the final plans of for the data collection.

NEED AND SIGNIFICANCE OF THE STUDY Occupational stress, job satisfaction and commitment have long been worry for employees and employers, and it has been deliberate among varied professional groups. In the available literature, the work of Doctors is portrayed as challenging and intrinsically stressful, even a high degree of occupational stress may be measured a part of their job. Studies on occupational stress have been at length carried out by past researchers mainly in the western countries. Due to lack of studies addressing the issue of doctors occupational stress in Andhra Pradesh, India, it is questionable whether western findings can be applied in the non-western context, like India. For instance, people in the western countries have an individualistic direction toward job where as people in the South Asian countries in general have a collective direction. Therefore, more studies are needed to erase the doubton the applicability of western studies in the Indian Context. The present study is unique as it is an attempt to describe the occupational stress among Government General Hospital Doctors in the context of Krishna District, Andhra Pradesh, India. In India, some studies have address the causes of occupational stress, but its relationship with job satisfaction and commitment in the Medical field has not been studied by the researchers so far. This research is significant because this relationship is being studied for the first time in Krishna District, Andhra Pradesh, India. This study is significant because of the insights and contributions is provides for the doctors to better understand the occupational stressors inherent in the function of their workforce through the antecedents including age, experience, job position, gender, qualification, income and marital status. Furthermore, this study develops an understanding of the commitment and job satisfaction and achievement their organization goals effectively. The Government General

Hospital which comes under Andhra Pradesh Vidhya Vidhana Parishat (APVVP)
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can utilize the research findings to formulate suitable strategies to address the stress related problems of their employees. Exploration and understanding of this relationship in the government hospital doctors is going to be a unique contribution of this study. In the context of the present study, little research has been conducted to investigate the occupational stress experienced by doctors in a developing country like India. India comprises of about 35% population who are below poverty line and it is this part of the population who approach government hospitals for their medical treatment because they cannot afford to get the expensive treatment done in a private hospital. The study involves one of the prominent government hospitals in Costal Districts i.e. Machilipatnam District Health Center, Andhra Pradesh, India. A typical day of a doctor in this hospital starts with attending patients in the OPD (in case of physicians) or performing surgery in the operation theatre (in case of a surgeon), then visiting the wards, taking lectures, guidance to doctoral students and research, attending emergency cases and working for long hours. Besides these activities, he/she has administrative duties and family responsibilities to perform as well. Moreover, this govt. job prohibits private practice which may also be a cause of dissatisfaction among the doctors. This proliferation of roles that the doctors have to undertake during their everyday educational and clinical practice lead to stress which has become an inherent feature of work life of the doctors and growing evidence suggest that it may increase in severity. Medical knowledge is increasing exponentially, the disease patterns are changing, the approach to health care delivery and medical education is shifting and also professional roles and boundaries are being modified. Work-related stress has been implicated as a major contributing factor to growing job dissatisfaction among doctors. It has been found that job stress impacts not only on doctors health but also their abilities to cope with job

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demands. This will seriously impair the provision of quality care and the efficacy of the health service delivery. To the best of our knowledge there is a paucity of Indian work in this field which is another reason to undertake this study. HEALTH MEDICAL & FAMILY WELFARE DEPARTMENT

ANDHRA PRADESH VAIDYA VIDHANA PARISHAD

Established in the year 1986 under an act of legislation, Andhra Pradesh Vaidya Vidhana Parishad deals exclusively with the middle level hospitals of bed strengths ranging from 30 to 350. These secondary institutions also referred to as first referral hospitals are 228 in number and are called District Hospitals, Area Hospitals, Community Health Centres and Specialty Hospitals including 25 civil dispensaries.
District Hospitals Area Hospitals Community Health Centres Specialty Hospitals Civil Dispensaries TOTAL 20 56 117 10 25 228

HOSPITALS UNDER CONTROL OF APVVP

The District Hospital has ten service specialties i.e. General Medicine, General Surgery, Obstetrics & Gynecology, Pediatrics, Ophthalmology, Orthopedics, ENT, Dental, Radiology and Anesthesiology. It has on its rolls, 11 Civil Surgeon Specialists along with 18-20 Civil Assistant Surgeons. In addition to this, there are Para-Medical posts comprising 48 to 78 Staff Nurses, 3 Lab Technicians, 3 Radiographers and other staff. In terms of equipment, district hospital have all the major items such as 500 mA X-ray unit, Ultrasound Scanner, Endoscopes, Boyles Apparatus, ECG, Defibrillator, Cardiac Monitor and similar such items.
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The Area Hospital which is in general a 100 bedded hospitals caters to four specialties i.e. General Medicine, General Surgery, Obstetrics & Gynecology and Pediatrics. As a result, each Area Hospital has 4 posts of Civil Surgeon Specialists and a complement of 10-12 Civil Asst. Surgeons. In addition, there are 24 Staff Nurses, 3 Lab Technicians1 Radiographer and other technical staff and supportive medical staff. In terms of equipment, Area Hospital have 300 mA Xray units, Ultra Sound Scanner, Boyles Apparatus, ECG and basic theatre equipment. The Community Health Centre provides only general services without involvement of any specialties there is a provision for 4-5 Civil Assistant Surgeons and in many places one post of Deputy Civil Surgeon/Civil Surgeon are available. The equipment is more basic and comprises 60 mA X-ray along with basic surgical equipment.

Krishna
1 2 3 4 5 6 7 8 D.H. Machilipatnam CHC Avanigadda CHC Nandigama AH Nuziveedu CHC Thiruvuru AH Gudivada CHC Mylavaram Teaching Hospitals Vijayawada Total Beds in Position 350 50 50 100 50 100 30 410 1140

OBJECTIVES OF THE STUDY

The objective of this empirical study was to examine the occupational stress and job satisfaction among the doctors of government general hospitals, Krishna District, Andhra Pradesh, India. The literature review failed to provide
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any viable data about the nature and level of occupational stress of doctors in Krishna District. Therefore, this study attempts to help fill this vacuum by

providing additional information that might be of interest to the researchers, Hospital Doctors. The specific objectives of this study are: (i) To determine the factors causing occupational (role) stress among doctors working in Government General Hospitals, Krishna District, Andhra Pradesh, India. (ii) To examine the stress levels at work place among doctors working in the hospital. In the present study the population consisted of doctors in all of the units/wards/departments Machilipatnam (District at Government Headquarter General Hospital), Hospital in

Vijayawada

Government General Hospital, and Gudivawada Government Hospital. The respondents were scattered in

all units/wards/departments already stated at Government General Hospitals. Because the nature of work of the doctors it made difficult to conduct face interviews and a questionnaire was ideal as the respondents used their own time and pace to complete the questionnaire. Judgment sampling was used for the selection of the doctors which was found to be a convenient and economical method.

RESEARCH METHODOLOGY The methodology includes research design, population and sample, data collection and data analysis process are outlined. For many systematic inquiry

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application of appropriate methods and a scientific bent of minds are a sine-quanon. This has an important bearing on the collection of the reliable information The present study is to acquire an intensive opinion about the level of occupational stress among the doctors of Government Hospitals in Krishna District, Andhra Pradesh. For this purpose, a Descriptive Research method was followed. The study in this content have utilized the available material about various aspects of HRM, data collected through well-planned interview with the Doctors, Nurses and other staff of the Hospitals of Krishna District.

RESEARCH DESIGN: A research design is an arrangement of conditions for collection and analysis of data in a manner that aims to combine relevance to the research. It is the conceptual structure within which research is conducted and it constitutes the blueprint for the collection, measurement and analysis of data. It includes an outline of what the researcher will do from within the hypothesis and its operational implications to the final analysis of data. The Descriptive & Analytical Research design was used for the study. Descriptive research design was included extensive surveys by interviewing the doctors and fact finding enquires of different kinds to know the level of stress among them. The major purpose of descriptive research is to description of the sources of stress at work place.

SOURCE OF DATA
The relevant data was collected both from the primary sources and secondary sources. The primary data was collected from the Medical Doctors working in Government General Hospitals at Machilipatnam, Vijayawada and Gudivada of Krishna District, through a structured questionnaire. the structured questionnaire was prepared with the consultation of the guide and hospital Superintendent at Machilipatnam.

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The secondary data was collected through news papers, journals, magazines, already submitted thesiss websites etc.

QUESTIONNAIRE ADMINISTRATION:
The Occupational Role Stress scale - ORS (Pareek,2002)14 was used as a tool to measure 10 role stresses, i.e. self-role distance, inter-role distance, role stagnation, role isolation, role ambiguity, role expectation conflict, role overload, role erosion, resource inadequacy and personal inadequacy. ORS is a 5-point scale (0 to 4), containing five items for each role stress and a total of 50 statements.

POPULATION SIZE:

Two hundred and fifty three (253) questionnaires were distributed to the respondents and one hundred and fifty (150) questionnaires (duly completed) were received back from the respondents. This means that about 59% of the questionnaires (duly completed) were returned. The hospitals selected for this

study in Krishna district are shown in table-1. The academic rank of the faculty members and their experience is shown in Table 1

23. Pareek u. 2002.training instruments in hrd and od. tata mcgraw hill publishing company ltd. new delhi

Table 1: Showing Hospital wise Response to the questionnaire

Sl.

Place of Hospital

No. of

No. of

% of
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No 1 Machilipatnam General Hospital 2 Vijayawada General Hospital 3 Gudivada Health Center

Questionnaires Questionnaires Response Distributed duly filled 100 50 19.76 100 80 31.62 53 20 7.91 253 150 59.29

Table2: Showing the Academic ranks and experience of faculty members.

Academic Rank Professors Associate Professors Assistant Professors Doctors, H.S & others

Number Percentage Years of Experience 32 12.8 Between 15-25 Years 28 18.8 Between 10-15 Years 35 23.3 Between 5-10 Years 55 33.3 Less than 5 Years Table 3: Type of Respondents

Respondents Percentage of Respondents

Male Female 92 58 61.30% 38.70%

SAMPLING AND SAMPLE SIZE:

The respondents comprised of 92 (61.3%) male doctors and 58 (38.7%) female doctors. Total number of samples are 150 i.e. n=150. We have made an attempt to form a representative sample which included all ranks of doctors working in the hospital. Due care has been taken in giving representation to female doctors as well. The sample of doctors considered is from various departments of Government Hospitals, Machilipatnam, Vijayawada and Gudiwada. 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

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determine the sample size. The sample size for the survey is determined as indicated below:-

N= Z2 { (1-)}/E2
Where, N= Sample size to be determined = The proportion of sample considered Z= The confidence coefficient (1.64 for 90% confidence level) Accordingly,

N= Z2 { (1-)}/E2
= (1.64)2 {0.20.8}/(0.01)2 = 41.9904 (approximate to 50) Respondents from each place of survey. However, to make the calculations easy the sample

size was increased to 150. A sample of 150 doctors working in different departments in Government Hospitals, Machilipatnam, Vijayawada and Gudiwada was selected on convenient random basis.

TEST OF ANALYSIS After collection of data both from primary and secondary sources, it was analysed by applying test statistics and analytical tools. The major analytical tool was used in this research was weighted average method and factor analysis method. To rank the different sources of stress at work place, the tabulation and classification techniques were used. In addition to this, key statistical tools like the Kolmogorov-Smirnov (D-Test) and Fama Eigen (F-Test) were applied to draw the inferences. PERIOD OF STUDY: The present study was undertaken during 2010-201, in which it was divided into three stages as such. Stage I was of research problem and collection the literature of the topic chosen. Stage II was of analysis and interpretations by using different statistical tools and Stage III was findings and recommendations.
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LIMITATIONS The present study has been suffered with serious limitations during the study period. 1. The present study is only confined to only occupational stress among doctors. 2. The present study on Occupational Stress among Doctors is only confined to Government General Hospitals, Krishna District, Andhra Pradesh but not applicable to other regions of the state and country. 3. 4. The study is confined to a 2009-2011. Accuracy of the study was purely based on the information as given by the respondents.

PLAN OF THE STUDY (CHAPTERISATION)

The whole study is divided in to 5 Chapters. Chapter 1 Introduction (Objectives, need and importance of the study) Chapter 2 Company Profile (APVVP) Chapter 3 Literature Survey & Theoretical Framework (Employee Stress Management) Chapter 4 Data Analysis & Interpretation (Tables, diagrams, charts, statistics etc.) Chapter 5 Findings & Suggestions

DATA ANALYSIS

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WEIGHTED AVERAGE OF SOURCES OF STRESS SERIAL ORDER WISE Sl.No: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Sources of Stress Emergency calls during surgery hours coping with phone calls during night and early morning Night Calls Dealing with problem patients Demands of job on family life Interruption of family life by telephone Fear of assault during night visits Demands of job on social life Dividing time between spouse and patients 24 hour responsibility for patients Remaining alert when on calls Dealing with relatives as patients Arranging admissions Dealing with friends as patients Adverse press publicity Home visits Worrying about patients' complaints Increased demands for a second opinion from hospital specialists Coping with journals and newsletters Practice administration Dealing with the terminally ill and their relatives Hospital referrals and paper work Lack of emotional support at home taking work at home conducting surgery Daily contact with dying and chronically ill patients No appreciation of your work by patients Conflict with partners in a group practice Driving Taking several samples in a short time Examining patients of the opposite sex Working environment Mean Rank 2.77 15 4.23 4 2.52 17 3.85 6 4.79 1 2.33 18 1.64 31 4.22 5 4.29 3 3.83 7 2.13 22 2.23 21 1.70 29 1.89 25 3.75 9 1.69 30 3.69 10 1.82 28 2.91 13 4.32 2 3.05 12 3.82 8 2.59 16 2.27 20 2.88 14 3.64 11 1.89 26 1.87 27 1.31 32 2.06 24 2.13 23 2.30 19

RANK WISE SOURCES OF STRESS

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Sl.No: 5 20 9 2 8 4 10 22 15 17 26 21 19 25 1 23 3 6 32 24 12 11 31 30 14 27 28 18 13 16 7 29

Sources of Stress Demands of job on family life Practice administration Dividing time between spouse and patients coping with phone calls during night and early morning Demands of job on social life Dealing with problem patients 24 hour responsibility for patients Hospital referrals and paper work Adverse press publicity Worrying about patients' complaints Daily contact with dying and chronically ill patients Dealing with the terminally ill and their relatives Coping with journals and newsletters conducting surgery Emergency calls during surgery hours Lack of emotional support at home Night Calls Interruption of family life by telephone Working environment taking work at home Dealing with relatives as patients Remaining alert when on calls Examining patients of the opposite sex Taking several samples in a short time Dealing with friends as patients No appreciation of your work by patients Conflict with partners in a group practice Increased demands for a second opinion from hospital specialists Arranging admissions Home visits Fear of assault during night visits Driving

Mean Rank

4.79 4.32 4.29 4.23 4.22 3.85 3.83 3.82 3.75 3.69 3.64 3.05 2.91 2.88 2.77 2.59 2.52 2.33 2.30 2.27 2.23 2.13 2.13 2.06 1.89 1.89 1.87 1.82 1.70 1.69 1.64 1.31

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32

SOURCES OF STRESS FACTOR WISE

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Factor 1: Interruptions Weight 11 2 6 1 8 3 5 4 Remaining alert when on call coping with phone calls during night and early morning Interruption of family life by telephone Emergency calls during surgery hours Demands of job on social life Night Calls Demands of job on family life Dealing with problem patients (Eigen value 7.42; Variance 23.2%) Factor 2: Emotional Involvement 14 Dealing with friends as patients 17 Worrying about patients' complaints 21 Dealing with the terminally ill and their relatives 15 Adverse press publicity 27 No appreciation of your work by patients 18 Increased demands for a second opinion from hospital specialists 26 Daily contact with dying and chronically ill patients 31 Examining patients of the opposite sex (Eigen value 2.97; variance 9.3%) Factor 3: Administrative workload and work/home interface 22 Hospital referrals and paper work 9 Dividing time between spouse and patients 24 taking work home 20 Practice administration 23 Lack of emotional support at home 32 Working environment 19 Coping with journals and newsletters 28 Conflict with partners in a group pracitce (Eigen value 2.76; variance 8.6%) Factor 4: Routine medical work 16 Home Visits 25 Conducting Surgery 13 Arranging admissions 24 24 hour responsibility for patients 29 Driving 30 Taking several samples in a short time 7 Fear of assault during night visits 12 Dealing with relatives as patients (Eigen value 2.28; variance 7.1%)

1 (5) 12 95 15 5 81 15 135 66

Ranks 2 3 4 (4) (3) (2) 12 15 56 20 15 15 20 10 60 25 70 30 45 10 4 36 15 30 5 5 4 33 24 17

5 (1) 55 5 45 20 10 54 1 10

2 46 22 4 3 36 19

13 49 15 19 2 44 10

13 30 65 22 5 54 10

60 12 45 16 95 12 43

62 13 3

63 32 20 25

10
89 45 4 68

62 101 12 94 21 13 2

25 20 14 33 11 11 12

45 9 8 10 35 30 16

10 12 84 3 51 50 54

8 8 32 10 32 46

25 26 47 15

37
66

1 27 1 58

5 49 2 41

2 8 23 30

80 11 49 10

62 55 75 11

2 3 5 20 120 12 15 28 10 85
5 10 6 5 9 25 40 80 90 30

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Results: Factor analysis Factor analysis was carried out on all 32 sources of stress. It is usual to report factors whose eigenvalues exceed 1.0 and variables whose factor loadings are greater than 0.3. Using this criterion for eigenvalues, 10 factors were extracted. However, because this was a pilot study only the four factors with eigenvalues greater than 2.0 and items with loadings greater than 0.4 are reported (Table 3). For factor 1 all the items are characterized by their unpredictable nature or by a problem associated with such an event, with the exception of dealing with problem patients (the item with the lowest loading). Explaining slightly less than 50%! of the variance, this is the most important factor in the present study. Although factor 2 is the second most important factor, the proportion of variance explained by this factor is well behind that explained by factor 1. The variables with the highest loading for factor 2 concern emotional involvement and the two items with the highest loading involve medical relationships where there is also likely to be a strong affective attachment. The variables loading heavily on factor 3 divide fairly evenly between those of routine paperwork and reconciling the demands of home and patients. For factor 4 the variables that load heavily are those medically related tasks that general practitioners take for granted.
TotalWeigh t Ri.Wi
i 1 5

Where Ri = Rank of sources of stress Wi = assigned weighted to the concerned ranks For Rank 1 = weight 5 Rank 2 = Weight 4 Rank 3 = Weight 3 Rank 4 = Weight 2 Rank 5 = Weight 1
MeanWeight TotalWeith / No.of Re spondents

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CONCLUSIONS Stress is normal. Everyone feels stress related to work, family, decisions, their future and more. Stress is both physical and mental it is caused by major life events such as illness, the death of a loved one, a change in responsibilities or expectations at work, job promotions, loss, or changes. Correct stress management should start from improved health and good intrapersonal relationships. As is evident from the mean ratings of various factors promoting occupational stress across different professional categories of Government Hospital employees Organisation ability to optimize human resources have found highest mean score among physician. This calls due consideration in order to meet the expectations of the future generation. The prevention and management of workplace stress requires organizational level interventions because it is the organization that creates the stress. Success in managing and preventing stress will depend on the culture in the organization. A culture of openness and understanding, rather than of criticism, is essential. Based on the major findings, the following recommendations are provided. Lack of resources includes inadequate staff, lack of equipment/machinery and medicines. So it must be advocated by the head of the unit, not only for the benefit of doctors but their patients as well.

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