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

• Published in: Journal of occupational medicine and toxicology (London, England) Vol. 16; no. 1; pp. 1 - 47
• Main Authors: Preiser, Christine, Tsarouha, Elena, Weltermann, Birgitta, Junne, Florian, Seifried-Dübon, Tanja, Hartmann, Sigrid, Bleckwenn, Markus, Rieger, Monika A, Rind, Esther
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 18-10-2021; BioMed Central; BMC
• Subjects: Collaboration; Confidentiality; Data analysis; Data collection; Employees; Employers; Entrepreneurship; Ethnography; Family physicians; Field study; Focus groups; General practice; Grounded theory; Health aspects; Health services; Influence; Interviews; Leadership; Leadership styles; Medicine; Occupational health; Occupational safety; Occupational stress; Patients; Physicians (General practice); Practice; Primary care; Primary care practice teams; Psychological stress; Risk taking; Sociology; Stress; Surveys; Teams; Training; Transformational leadership; Work environment; Work-related psychosocial factors; Work-related stress; Working conditions; Working hours; Germany
• ISSN: 1745-6673; 1745-6673
• DOI: 10.1186/s12995-021-00336-w

Abstract
Background
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. 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?
Methods
Data 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.
Results
GPs 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.
Conclusion
We 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.