How do doctors experience the interactions among professional fulfilment, organisational factors and quality of patient care? A qualitative study in a Norwegian hospital

Abstract

ObjectivesDoctors increasingly experience high levels of burnout and loss of engagement. To address this, there is a need to better understand doctors’ work situation. This study explores how doctors experience the interactions among professional fulfilment, organisational factors and quality of patient care.DesignAn exploratory qualitative study design with semistructured individual interviews was chosen. Interviews were transcribed verbatim and analysed by a transdisciplinary research group.SettingThe study focused on a surgical department of a mid-sized hospital in Norway.ParticipantsSeven doctors were interviewed. A purposeful sampling was used with gender and seniority as selection criteria. Three senior doctors (two female, one male) and four in training (three male, one female) were interviewed.ResultsWe found that in order to provide quality care to the patients, individual doctors described ‘stretching themselves’, that is, handling the tensions between quantity and quality, to overcome organisational shortcomings. Experiencing a workplace emphasis on production numbers and budget concerns led to feelings of estrangement among the doctors. Participants reported a shift from serving as trustworthy, autonomous professionals to becoming production workers, where professional identity was threatened. They felt less aligned with workplace values, in addition to experiencing limited management recognition for quality of patient care. Management initiatives to include doctors in development of organisational policies, processes and systems were sparse.ConclusionThe interviewed doctors described their struggle to balance the inherent tension among professional fulfilment, organisational factors and quality of patient care in their everyday work. They communicated how ‘stretching themselves’, to overcome organisational shortcomings, is no longer a feasible strategy without compromising both professional fulfilment and quality of patient care. Managers need to ensure that doctors are involved when developing organisational policies, processes and systems. This is likely to be beneficial for both professional fulfilment and quality of patient care.

Clinicians’ Experience of Providing Care: A Rapid Review

“…The literature indicated there was overlap between, 1) clinician experience of delivering care, 2) health workforce job satisfaction and 3) clinician engagement. It was apparent that self-reported experiences of providing care were closely linked to both resulting job engagement and satisfaction (18,(24)(25)(26)(27)(28). The nature of this relationship was not sufficiently examined to draw conclusive findings regarding the relationships between these variables.…”

“…Indicators of negative clinician experiences included tensions when balancing professional responsibilities and quality of patient care. Clinicians reported that complex arrangements in which professional responsibilities were unclear negatively impacted the quality of the care they could provide and their experience of providing care (26). In addition to this, there was a discussion on the impact of a fragmented system of care in which interprofessional members constituted a team or that multiple teams were responsible for patient care.…”

Mellanmänsklig resonans

“…Det förefaller viktigt att vårdens medarbetare, ledare och chefer får tillgång till träning och utbildning som stödjer arbetet med uthållig organisering där delaktighet, engagemang och mellanmänsklig resonans får ökat utrymme. Ny forskning pekar på att detta är aktuellt även i norsk vårdkontext (6).…”

Clinicians’ Experience of Providing Care: A Rapid Review

“…The literature indicated there was overlap between, 1) clinician experience of delivering care, 2) health workforce job satisfaction and 3) clinician engagement. It was apparent that self-reported experiences of providing care were closely linked to both resulting job engagement and satisfaction (18,(24)(25)(26)(27)(28). The nature of this relationship was not su ciently examined to draw conclusive ndings regarding the relationships between these variables.…”