gms | German Medical Science

Background: The well-being and performance of hospital physicians are not only of concern to the physicians themselves but are also of concern to many stakeholders, such as the patients or the general public. Poor hospital work environments affect physicians’ work stress and well-being. However, research on the impact and interplay of the physicians’ work environment on well-being and quality of care is inconsistent.

Study objective: This study examined the causal relationships between three job demands (social stressors, patient demands and time pressure), strain and perceived quality of care among hospital physicians. We aimed to test a partial mediation of job strain for the association between job demands and quality of care as proposed by the Job Demands-Resources model. Moreover, building on Conservation of Resources theory, we aimed to investigate reversed effects of job strain on job demands.

Method: Two-wave panel design with a time lag of one year with N=95 hospital physicians (51.6% male, mean age 39.83 years) from two hospitals. A cross-lagged panel design was established for analyses. All study variables were assessed with standardized questionnaires. Tests for panel attritions were conducted prior to the main analyses. Hypotheses were tested using structural equation modelling and controlling for potential confounders (i.e., part-time work, job tenure, seniority).

Results: The results primarily support the hypothesis that job demands directly predict perceived quality of care. Specifically, social stressors and time pressure at Time 1 showed negative lagged effects on quality of care at Time 2. Additional analyses also revealed strong reversed effects from quality of care to time pressure.

Discussion: Drawing on a prospective design we found a relationship between adverse work conditions and inferior quality of care among hospital physicians. Contrary to expectations, physicians strain did not mediate the above relationship, nor were strain-to-stressor effects observed.

Implications: Results demonstrate close relationships between physicians work conditions and diminished quality of care. High work stress environments in hospital care can influence the quality of patient care. Our findings emphasize that further understanding is required of how workplace constraints affect job demands and quality of care.

Acknowledgements: The study was approved by the Committee on Ethics of Human Research of the Medical Faculty, Ludwig-Maximilians-University Munich (124/07). Funding was received from the Munich Center for Health Sciences (MC-Health).