Psychosocial demands and resources for working time organization in GP practices. Results from a team-based ethnographic study in Germany

Christine Preiser,Monika A Rieger,Sigrid Hartmann,Elena Tsarouha,Florian Junne,Markus Bleckwenn,Tanja Seifried-Dübon,Esther Rind,Birgitta Weltermann

doi:10.1186/s12995-021-00336-w

Abstract

BackgroundGeneral practitioners (GPs) are challenged, e.g. by long working hours, and as employers they are responsible for the creation of working conditions that prevent work-related psychosocial risks. Leadership behaviour plays an important role within the working conditions of employees, thus we focused on two research questions: To what extent and how do GPs fulfil their role as entrepreneurs and leaders responsible for occupational safety and health of the team members in the organization of working time of the employees? What psychosocial factors result from the way of organization of working time for the practice team?MethodsData was collected by participant observations, individual interviews with six GPs, and five focus group discussions with 19 members of the practice staff in total. We gained access to five general practices through a teaching network associated with the Institute for General Medicine, University Hospital Essen (Germany). The analysis was carried out according to the Grounded Theory approach.ResultsGPs have several roles and related tasks to fulfil in the organization of working time. This can lead to perceived psychological stress. With regard to the organization of predictable working hours, vacations and sickness absence, the GPs determined the scope of action of the practice assistants. The delegation of these tasks took place to varying degrees and resulted in different work-related resources and stressors.ConclusionWe described transactional and transformational leadership behaviours which are all related to specific psychosocial demands and resources and may overlap on site. Leadership training seems recommendable as part of the training of GPs and other future leaders of micro-enterprises to promote self-reflection by the entrepreneurs and leaders and strengthen occupational health of leaders and staff.

Highlights

General practitioners (GPs) are challenged, e.g. by long working hours, and as employers they are responsible for the creation of working conditions that prevent work-related psychosocial risks
We will present how overall working time is organized in GP practices and how specific aspects such as breaks, sick leave and vacations are organised
GPs in single and in group practices alike had long consultations hours, but it remained unclear whether there was a difference between the number of patients treated per GP in single practices compared to group practices

Summary

Introduction

General practitioners (GPs) are challenged, e.g. by long working hours, and as employers they are responsible for the creation of working conditions that prevent work-related psychosocial risks. In general practices in Germany, general practitioners (GPs) are entrepreneurs of small or rather micro enterprises, employers, leaders and healthcare professionals at the same time As employers, they are responsible for all aspects of occupational health and safety of their practice staff including working conditions, but may delegate these tasks to personnel. During medical studies and postgraduate medical training, GPs in Germany are usually well-trained in all aspects of the diverse roles of physicians as described e.g. by the CanMEDS framework [4, 5] adapted to the German situation [6] They have to continuously extent their skills regarding all of these roles and tasks, including their skills as entrepreneurs and leaders of small and medium-sized enterprises (SMEs) [7]

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Results

Discussion

Conclusion