Volume-5, Issue-3, June-2015 International Journal of Engineering and Management Research Page Number: 242-247 Comparative Study of Occupational Stress among Health Care Professionals in Government and Corporate Hospitals K. Vijaya Nirmala 1, M. Suresh Babu 2 1,2 Department of Management Studies, Sri Venkateswara University, Tirupati, Andhra Pradesh, INDIA ABSTRACT The occupational stress among the health care professionals is currently a major concern in all over the world. The main aim of the present study has been to investigate the levels of stress among doctors, nurses and supporting staff in corporate and government hospitals in different locations of the psychosocial and organizational characteristics of their job. The cross-sectional survey of health care professionals were (n=1200) chosen at random from government and corporate hospitals from four different places of major and minor cities in India. A selfadministered questionnaire was the method used for data collection: this questionnaire contained various items on psychosomatic symptoms, self-perceived health, socio demographic data, job satisfaction, health risk and emotional load. The findings suggest that the government hospital doctors feel high level of stress and it is highly significant (p < 0.01) when compared to nurses and supporting staff working in corporate hospitals. Furthermore, based on the location, the health care professionals feel significantly (p < 0.01) high level of stress working at government hospitals in Hyderabad and Tirupati. The results suggest that the doctors working in government hospitals feels more stress when compared to other health care professionals. The occurrence of high stress levels among doctors, leading the author to conclude that social support and the psychosocial work climate should be improved in health care institutions. Keywords---- Stress, Health care professionals, Government and Corporate hospitals I. INTRODUCTION Work stress has been a long standing concern of the health care organizations. Work related stress affects a person s life and has implications on the person s mental and physical well being (Shreedevi, 2013). Several studies indicate that health care workers have higher rates of substances abuse and suicide than other professions and elevated rates of depression and anxiety linked to the job stress. Health care workers are exposed to the number of stressors, ranging from work overload, time pressures, and lack of role clarity to deal with infectious diseases and difficult for ill and helpless patients. Stress as a result of a transaction between person and environment (Lazarus, 1980). Zimbardo (1988) defined stress as the pattern of specific and non-specific responses an organism makes to stimulus events that disturbs its equilibrium and exceed its ability to cope. In addition to psychological distress of health care professionals, other outcomes of job stress include burnout, absenteeism, employee intent to leave, reduced patient satisfaction, and diagnosis and treatment errors. The focus of the present study is to understand stress in health care professional s life in related to corporate and government sector hospitals in major and minor cities in India. II. REVIEW OF LITERATURE Recently there is an increasing interest in research studies on stress among health care professionals in world wide. A number of studies have been undertaken in other countries as well as in India investigating the problem of stress among health care workers. These studies have indicated that job of health care workers is highly stressful (Irfana Baba, 2012). In western countries there is a greater awareness and sensitivity to the problems which are faced by health care professionals. Several studies have been conducted on stress among general practitioners in UK (Cooper et al., 1989; Howie et al., 1989; Rout & Rout, 1993; Sutherland & Cooper, 1992). Medical practitioners experience appreciable stress (Burke and Richardson, 1991), comparatively high suicide rates (Gestal, 1987). The main 242 Copyright 2011-15. Vandana Publications. All Rights Reserved.
sources of stress have been identified as: problems with practice administration, interruptions, patient s expectations and demands, emergencies, heavy workload, constant time pressures and work/home conflict (Cooper et al., 1989; Howie et al., 1989; Morrell et al., 1986; Porter et al., 1985). Swanson & Power (1999) conducted a comparative study between perceived stress, satisfaction and conflict for professional male and female doctors in National Health Service in Scotland. The study came with the result that the work of male doctors is more stressful and less satisfying than females. Rees, D. W. and Cooper (1992) conducted a comparative study between different occupational groups. The most important part of the study is that the health care professionals, comparing with nonhealth care employees have gotten significantly higher levels of pressure within their workplace. Work stress is increasingly recognized as one of the most serious occupational health hazards reducing workers satisfaction and productivity, and increasing absenteeism and turnover (Gianakos, 2001). Hirak Dasgupta and Suresh Kumar (2009) surveyed one hundred and fifty doctors in a government hospital in Shimla and examined the stress level among male and female doctors in the hospital. The study found that there is no difference between the stress levels among male and female doctors except in case of the factors- Inter-role distance and Role inadequacy. And in these factors, the stress level among female doctors is much more than male doctors. Based on these studies, it is identified that stress affects the performance, efficiency and effectiveness of the healthcare professionals working in government and corporate hospitals. The physical stress is more for nurses and supporting staff whereas coming to the doctors, the mental stress is high among them. The physical stress can be reduced for some time but the mental stress will be harmful to health. That is the reason why doctors feel high level of stress when compared to other professionals. Attractive working conditions must be provided to the doctors so that the stress can be minimized and their efficiency may be increased. III. RESEARCH METHODOLOGY The research is descriptive in nature. The data was collected from government and corporate hospitals doctors, nurses and supporting staff in Hyderabad, Bangalore, Tirupati and from Nellore through a standard questionnaire, known as Hari, S. (2005) Stress Inventory. IV. TOOL USED The stress inventory was developed by Hari, S. (2005) is a tool to measure the amount of stress experienced in daily life. It is a 66 item scale with five alternatives ( 5 point scale), fully agree agree, undecided, disagree fully disagree. This Stress inventory is based on the writing of James (1982), Sutherland and Cooper (1990) and Pohorecky (1991). V. RELIABILITY OF THE SCALE SAMPLING Convenient sampling method was used to select the sampled units within the hospitals for the study. Twelve hundred (1200) questionnaires were collected from doctors, Nurses and Supporting staff from eight hospitals and identified the difference between government and corporate hospitals. These eight hospitals were taken from four different cities. Two are from major cities and two are from minor cities respectively. Statistical data analysis: Data were analyzed using appropriate statistical techniques viz., frequency tables, cross tables and Chi-square tests (SPSS software, version 20) VI. LIMITATIONS The study was carried out on a very small sampling size and therefore does not give clear idea of the actual stress levels among healthcare professionals. The reluctance of respondents to fill the questionnaire was felt the major difficulty. As 1500 questionnaires were distributed and 1222 filled questionnaires were received. Most of them were not in a time to complete the questionnaire among them 22 questionnaires didn t furnish the required information, so they were rejected and rest 1200 questionnaires were considered for the study. VII. RESULTS AND DISCUSSION Findings of the present study revealed that health care professionals are suffering with stress. 243 Copyright 2011-15. Vandana Publications. All Rights Reserved.
Table 1: Analysis on the level of stress by using chi-square test compared to government and corporate hospitals Type of Level of Stress Hospital Total Chi-square Low Moderate High value Government 160 159 281 600 Hospital 26.447** 26.7% 26.5% 46.8% 100.0% Corporate Hospital 149 254 197 600 24.8% 42.3% 32.8% 100.0% (** P< 0.01) Fig: 1: Stress level percentages of health care professionals compared to government and corporate hospitals 100% 90% 80% 70% 60% 50% 40% 30% 46.80% 26.50% 42.30% 32.80% High Stress Moderate Stress Low Stress 20% 10% 26.70% 24.80% 0% Government Hospital Corporate Hospital Chi-square test is conducted to observe whether there is any association between Management (Govt and Pvt hospitals) and Level of stress among healthcare professionals. The observed p-value (<0.01) for the corresponding chi-square value 26.447 is significant at 1% level (Table:1). This means level of stress among health care professionals at government and corporate hospitals is significantly differ from one another. Fig 1 shows that 46.8 percent of government professionals have high level of stress whereas this percentage in corporate hospitals is only 39.4 percent. This is because of the less equipment and low staff in the government hospitals. Also, the emergency cases are admitted only in the government hospitals. That is the reason why the government hospitals feel high stress. In corporate hospitals, there will be fully fledged staff and the more equipments are available when needed. These facilities can t be maintained in the government hospitals. Table 2: Analysis on level of stress among health care professionals based on location by using chi-square test Location Bangalore Level of Stress Low Moderate High Total 114 134 52 300 38.0% 44.7% 17.3% 100.0% Chi-square value 244 Copyright 2011-15. Vandana Publications. All Rights Reserved.
Hyderabad Tirupati Nellore (** P< 0.01) 44 138 118 300 14.7% 46.0% 39.3% 100.0% 25 166 109 300 8.3% 55.3% 36.3% 100.0% 126 140 34 300 42.0% 46.7% 11.3% 100.0% 168.39** Fig: 2: Stress level percentages of health care professionals compared to based on major and minor cities hospitals Level of stress by different Locations Percentages 100% 90% 80% 70% 60% 50% 40% 30% 20% 17.30% 44.70% 38.00% 39.30% 36.30% 46.00% 55.30% 11.30% 46.70% 42.00% High Stress Moderate Stress Low Stress 10% 0% 14.70% 8.30% Bangalore Hyderabad Tirupati Nellore Different Locations Chi-square is conducted to observe whether there is any association between Locations (Bangalore, Hyderabad, Tirupati & Nellore) and Level of stress among Healthcare professionals. The observed p-value (<0.01) for the corresponding Chi-square value 168.39 is significant at 1% level (Table:2). This means level of stress among healthcare professionals at various locations differ significantly from one another in which Hyderabad is facing high level of stress. Fig 2 reveals that 39.3 percent and Tirupati is having 36.3 percent of stress where as the level of stress is low at Bangalore and Nellore. Bangalore and Hyderabad comes under major cities and Tirupati and Nellore comes under minor cities. Among Bangalore and Hyderabad, Hyderabad feels more stress when compared to Bangalore. This, is because in Andhra Pradesh there is a provision of Aarogyasri scheme. Due to that scheme, the persons who have white cards apply for Aarogyasri and do their treatment in major hospitals. Here, all level of people comes together for treatment. The patients may not be in a position to understand the professionals and the professionals feel more stress in satisfying the patients. This is one of the reasons for more stress in Hyderabad. And also, Hyderabad is a developing area and it is starting as club for medical treatment. Now, they have to prove themselves. Also, the traffic system is not good in Hyderabad. By this, there is a chance of Accident cases. The emergency cases are more in Hyderabad. So, the stress is more for healthcare professionals in Hyderabad. When compared to Bangalore, there is no such type of schemes and also it is a well developed city in all the aspects. Here, the traffic system is very good and there is a less chance of accident cases. Bangalore is mainly famous for Research Oriented Hospitals and the Medical colleges are more. By this, there 245 Copyright 2011-15. Vandana Publications. All Rights Reserved.
is a chance of more qualified professionals in the hospitals. By this, the stress is less in Bangalore. And also, Bangalore is mainly famous for neurosciences. Also, Tirupati is famous for hospitals in minor cities. Nellore is a developing city and the hospitals are very less. Hence, the professionals working at government hospital in Tirupati feels high stress when compared with the professionals working at Nellore government hospitals. Table 3: Analysis on level of stress among health care professionals in related to nature of the job by using chi-square test (** P< 0.01) Nature of Job Doctors Nurses Supporting Staff Level of Stress Low Moderate High Total 106 157 137 400 26.5% 39.3% 34.3% 100.0% 107 189 104 400 26.8% 47.3% 26.0% 100.0% 65 232 103 400 16.3% 58.0% 25.8% 100.0% Chi-square value 40.145** Fig: 3: Stress level percentages among health care professionals according to nature of job 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 34.30% 26.00% 25.80% 39.30% 47.30% 58.00% 26.50% 26.80% 16.30% Doctors Nurses Supporting Staff High Stress Moderate Stress Low Stress Chi-square test is conducted to observe whether there is any association between nature of the job (Doctors, Nurses & Supporting staff) and level of stress among healthcare professionals. The observed p-value (<0.01) for the corresponding chi-square value 40.145 is significant at 1% level (Table 3). This means level of stress among the healthcare professionals depending upon nature of the job (Doctors, Nurses and Supporting Staff) differ significantly from one another. Fig 3 reveals that 34.3 percent of Doctors feel high stress when compared to Nurses and Supporting staff and among Nurses it is 26 percent and it is only 25.8 percent in Supporting staff. The mental pressure among Doctors is more than physical strain. The physical pressure will be only sometime at the time of work. When the duty is completed they will be relaxed from the pressure. But mental pressure will be for most of the time. Hence, among all the health care professionals, Doctors feel more stress. 246 Copyright 2011-15. Vandana Publications. All Rights Reserved.
VIII. FINDINGS AND CONCLUSION Based on the analysis carried out during the study and the results obtained, the following conclusions may be drawn: 1. By using the chi-square test (Table 1), the overall respondents among the healthcare professionals agreed that there is a significant difference between the government and corporate hospitals at 1% level of significance with the chi-square value 26.447 in which 46.8 percent of healthcare professionals who are working in the government hospitals feel high stress. 2. The overall respondents among the healthcare professionals agreed that there is a significant difference based on the location at 1% level of significance by using chi-square test (Fig 2) with the value 168.39 in which the healthcare professionals working in Hyderabad and Tirupati feels more stress. 3. Among the Doctors, Nurses and Supporting staff, these healthcare professionals agreed that there is significant differences at 1% level of significance with the chi-square value 40.145 in which (Fig 3) 34.3 percent of Doctors feel more stress. The healthcare professionals among the government hospitals feel high stress when compared to corporate hospitals. The professionals working in Hyderabad and Tirupati feel high stress. Among the various healthcare professionals like doctors, nurses and supporting staff, the doctors face high stress when compared to other professionals. In government hospitals, the professionals working in Hyderabad and Tirupati, especially doctors face high stress when compared to other health care professionals. REFERENCES [1] Shreedevi. D (2013) Stress management among health care professionals its not stress that kills us, it is our reaction to it -Hans Selye. International Journal of Research in Business Management. ISSN 2321-886X, Vol. I, Issue 3, 37-48. [2] Lazarus, R.S. 91980). The stress and coping paradigm. In Eisdorfer, C., Cohen, D., and Kleinman, A. (eds.), Conceptual Models for Psychopathology, Spectrum, New York, pp. 173-209. [3] Zimbardo, P.G. (1988). Psychology and life (12th Ed.), Glenview. Y.L.: Scott. Foresman. [4] Irfana Baba (2012) Workplace stress among doctors in government hospitals: An empirical study. International journal of multidisciplinary research, Vol 2, Issue 5, ISSN 2231 5780. [5] Cooper, C.L., Rout, U. & Faragher, B., 1989. Mental health, Job Satisfaction, and Job Stress among general practitioners. British Medical Journal, 298, pp. 366-370. [6] Rout, U., & Rout, J.K., 1993. Stress and general practitioners. British Medical Journal, 298, pp. 476-481. [7] Sutherland, V.J.,&Cooper, C.L.,1992. Job Stress, Satisfaction and Mental health among general practitioners before and after the new contract. British Medical Journal, 304, pp. 1545-1548. [8] Burke, RJ.& Richardson, AM., 1991. Sources of satisfaction and stress among Canadian physicians.psychol Rep, 67, pp. 1335-1344. [9] Gestal,JJ., 1987. Occupational hazards in hospitals: accidents, radiation, exposure to noxious chemicals, drug addiction and psychic problems and assault. BMJ, 44, pp. 510-520. [10] Morrell, D.C., Evans, M.E.,& Roland, M.O., 1986. The five-minute consultation: effect of time constraint on clinical content and patient satisfaction. British Medical Journal, 292, pp. 870-873. [11] Porter, A.M.D., Howie, J.G.R.,& Levinson, A., 1985. Measurement of stress as it affects the work of the general practitioner. Family Practice, 2, pp. 136-146. [12] Rees, D. W., & Cooper, C.K., 1992. Occupational stress in health service workers in the UK. Stress Medicine, 8, (2), pp. 79-90. [13] Hari S., D. (2005). Stress Inventory. http://ezinearticles.com/?stress-inventory&id=48173. [14] James, CN, (1982). Stress at work. Introduction to medical Psychology New York; Free press. [15] Sutherland.V.J and Cooper.C.L, (1990). Understanding stress: A Psychological perspective for Health professionals, London: Chapman and Hall. [16] Gianakos, I. (2001). Gender Roles and Coping with work stress. Sex Roles. A journal of Research (6), PP. 1-13. [17] Pohorecky.L.A, (1991). Stress and alcohol interaction, an update Human Research, Journal of Alcoholism, Clinical and Experimental Research (3) 438-59. [18] Hirak Dasgupta & Suresh Kumar., 2009. Role stress among Doctors working in a Government Hospital n Shimla (India). European Journal of Social Sciences 9(3), PP. 356-370. [19] Swanson. V and Power K.G (1999). Stress, satisfaction and role conflict in dual- doctor partnerships, Community, Work and Family, 2(1), pp. 67-88. [20] Howie, J.G.R. Porter, A.M.D. & Forbes, J.F., 1989. Quality and use of time in general practice: Widening the discussion. British Medical Journal, 298, pp.1008-1010. 247 Copyright 2011-15. Vandana Publications. All Rights Reserved.