Dataset Information

Work-Related Psychosocial Demands and Resources in General Practice Teams in Germany. A Team-Based Ethnography.

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.

SUBMITTER: Tsarouha E

PROVIDER: S-EPMC7579545 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Work-Related Psychosocial Demands and Resources in General Practice Teams in Germany. A Team-Based Ethnography.

Tsarouha Elena E Preiser Christine C Weltermann Birgitta B Junne Florian F Seifried-Dübon Tanja T Stuber Felicitas F Hartmann Sigrid S Wittich Andrea A Rieger Monika A MA Rind Esther E

International journal of environmental research and public health 20200928 19

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 car ...[more]

PMID: 32998397

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Project description:BackgroundMicro, small and medium-sized enterprises (SMEs) represent the majority of businesses in the EU. Little is known about psychosocial demands faced by company owners, managers, and employees in SMEs, especially in the health and service sector. The current study aimed to identify which psychosocial demands related to work organization are reported by managers and employees in the health and service sector, and if managers and employees differ in their perspective on these psychosocial demands.MethodsWe conducted nine single interviews and two focus group discussions with seven company owners and managers as well as eleven employees from six different German companies between January and February 2020. The psychosocial factors of the psychosocial risk assessment of the Joint German Occupational Safety and Health Strategy (GDA) served as a framework for data collection and analysis. The interview material was analysed using Mayring's method of qualitative content analysis.ResultsWe identified four prevailing work-related psychosocial demands related to work organization among managers and employees: (1) possibilities and time for recovery after work, (2) communication and cooperation, (3) work intensity, and (4) interruptions, and prioritization. According to the managers, they were confronted with a lack of possibilities and time for recovery after work. They report issues related to inadequate communication and cooperation affecting the entire company team, and also face high work intensity and frequent interruptions and prioritization. Employees reported a clearer division between work and private life. However, they also face periods of high work intensity, frequent interruptions and the need for prioritization.ConclusionManagers and employees in SMEs in the health and service sector would benefit from evidence-based and evaluated tailored interventions and approaches for improved work organization. Further studies are needed to support managers and employees in SMEs in the health and service sector in facing and handling work-related psychosocial demands like lack of possibilities and time for recovery after work, high work intensity or frequent interruptions.

Project description:Complex problem solving is challenging and a high-level cognitive process for individuals. When analyzing complex problem solving in teams, an additional, new dimension has to be considered, as teamwork processes increase the requirements already put on individual team members. After introducing an idealized teamwork process model, that complex problem solving teams pass through, and integrating the relevant teamwork skills for interdependently working teams into the model and combining it with the four kinds of team processes (transition, action, interpersonal, and learning processes), the paper demonstrates the importance of fulfilling team process demands for successful complex problem solving within teams. Therefore, results from a controlled team study within complex situations are presented. The study focused on factors that influence action processes, like coordination, such as emergent states like collective orientation, cohesion, and trust and that dynamically enable effective teamwork in complex situations. Before conducting the experiments, participants were divided by median split into two-person teams with either high (n = 58) or low (n = 58) collective orientation values. The study was conducted with the microworld C3Fire, simulating dynamic decision making, and acting in complex situations within a teamwork context. The microworld includes interdependent tasks such as extinguishing forest fires or protecting houses. Two firefighting scenarios had been developed, which takes a maximum of 15 min each. All teams worked on these two scenarios. Coordination within the team and the resulting team performance were calculated based on a log-file analysis. The results show that no relationships between trust and action processes and team performance exist. Likewise, no relationships were found for cohesion. Only collective orientation of team members positively influences team performance in complex environments mediated by action processes such as coordination within the team. The results are discussed in relation to previous empirical findings and to learning processes within the team with a focus on feedback strategies.

Project description:BackgroundExpected growth in the demand for health services has generated interest in the more effective deployment of health care assistants. Programs encouraging German general practitioners (GPs) to share responsibility for care with specially qualified health care assistants in the family practice (VERAHs) have existed for several years. But no studies have been conducted on the tasks German GPs are willing to rely on specially qualified personnel to perform, what they are prepared to delegate to all non-physician practice staff and what they prefer to do themselves.MethodsAs part of an evaluation study on the deployment of VERAHs in GP-centered health care, we used a questionnaire to ask about task delegation within the practice team. From a list of tasks that VERAHs are specifically trained to carry out, GPs were asked to indicate which they actually delegate. We also asked GPs why they had employed a VERAH in their practice and for their opinions on the benefits and limitations of assigning tasks to VERAHs. The aim of the study was to find out which tasks GPs delegate to their specially qualified personnel, which they permit all HCAs to carry out, and which tasks they do not delegate at all.ResultsThe survey was filled in and returned by 245 GPs (83%). Some tasks were exclusively delegated to VERAHs (e.g. home visits), while others were delegated to all HCAs (e.g. vaccinations). About half the GPs rated the assessment of mental health, as part of the comprehensive assessment of a patient's condition, as the sole responsibility of a GP. The possibility to delegate more complex tasks was the main reason given for employing a VERAH. Doctors said the delegation of home visits provided them with the greatest relief.ConclusionsIn Germany, where GPs are solely accountable for the health care provided in their practices, experience with the transfer of responsibility to other non-physician health care personnel is still very limited. When HCAs have undergone special training, GPs seem to be prepared to delegate tasks that demand a substantial degree of know-how, such as home visits and case management. This "new" role allocation within the practice may signal a shift in the provision of health care by family practice teams in Germany.

Project description:BackgroundAcross healthcare systems, current health policies promote interprofessional teamwork. Compared to single-profession general practitioner care, interprofessional primary healthcare teams are expected to possess added capacity to care for an increasingly complex patient population. This study aims to explore patients' experiences when their usual primary healthcare encounter with general practice shifts from single-profession general practitioner care to interprofessional team-based care.MethodsQualitative and quantitative data were collected through interviews and a survey among Norwegian patients. The interviews included ten patients (five women and five men) aged between 28 and 89, and four next of kin (all women). The qualitative analysis was carried out using thematic analysis and a continuity framework. The survey included 287 respondents, comprising 58 per cent female and 42 per cent male participants, aged 18 years and above. The respondents exhibited multiple diagnoses and often a lengthy history of illness. All participants experienced the transition to interprofessional teamwork at their general practitioner surgery as part of a primary healthcare team pilot.ResultsThe interviewees described team-based care as more fitting and better coordinated, including more time and more learning than with single-profession general practitioner care. Most survey respondents experienced improvements in understanding and mastering their health problems. Multi-morbid elderly interviewees and interviewees with mental illness shared experiences of improved information continuity. They found that important concerns they had raised with the nurse were known to the general practitioner and vice versa. None of the interviewees expressed dissatisfaction with the inclusion of a nurse in their general practitioner relationship. Several interviewees noted improved access to care. The nurse was seen as a strengthening link to the general practitioner. The survey respondents expressed strong agreement with being followed up by a nurse. The interviewees trusted that it was their general practitioner who controlled what happened to them in the general practitioner surgery.ConclusionFrom the patients' perspective, interprofessional teamwork in general practice can strengthen management, informational, and relational continuity. However, a prerequisite seems to be a clear general practitioner presence in the team.

Project description:Teachers' healthy and effective functioning at work is impacted by the demands they face and the resources they can access. In this study, person-centered analysis was adopted to identify distinct teacher profiles of demands and resources. We investigated teachers' experiences of two job demands (barriers to professional development and disruptive student behavior), two job resources (teacher collaboration and input in decision-making), and one personal resource (self-efficacy for teaching). Using data from the Teaching and Learning International Survey (TALIS) 2013, the study involved 6,411 teachers from 369 schools in Australia and 2,400 teachers from 154 schools in England. In phase one, latent profile analysis revealed five teacher profiles that were similar across the two countries: the Low-Demand-Flourisher (12%), Mixed-Demand-Flourisher (17%), Job-Resourced-Average (34%), Balanced-Average (15%), and Struggler (21%). The profiles were differently associated with two background characteristics (teacher gender and teaching experience) and two work-related well-being outcomes (job satisfaction and occupational commitment). In phase two, we extended our analysis to the school-level to identify school profiles based on the relative prevalence of the five teacher profiles within a school. Indeed, a yield of large scale datasets such as TALIS is that there are sufficient units at the school-level to enable institutional insights, beyond insights garnered at the individual teacher-level. Two school profiles that were similar in both countries were revealed: the Unsupportive school profile (58%) and the Supportive school profile (42%). The Supportive school profile was associated with higher school-average teacher job satisfaction and occupational commitment than the Unsupportive school profile. Taken together, the findings yield knowledge about salient teacher and school profiles, and provide guidance for possible interventions at the teacher- and school level.

Dataset Information

Work-Related Psychosocial Demands and Resources in General Practice Teams in Germany. A Team-Based Ethnography.

Publications

Work-Related Psychosocial Demands and Resources in General Practice Teams in Germany. A Team-Based Ethnography.

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