Quality care, public perception and quick-fix service management: a Delphi study on stressors of hospital doctors in Ireland

Abstract

ObjectivesTo identify and rank the most significant workplace stressors to which consultants and trainees are exposed within the publicly funded health sector in Ireland.DesignFollowing a preliminary semistructured telephone interview, a Delphi technique with 3 rounds of reiterative questionnaires was used to obtain consensus. Conducted in Spring 2014, doctors were purposively selected by their college faculty or specialty training body.SettingConsultants and higher specialist trainees who were engaged at a collegiate level with their faculty or professional training body. All were employed in the Irish publicly funded health sector by the Health Services Executive.Participants49 doctors: 30 consultants (13 male, 17 female) and 19 trainees (7 male, 12 female). Consultants and trainees were from a wide range of hospital specialties including anaesthetics, radiology and psychiatry.ResultsConsultants are most concerned with the quality of healthcare management and its impact on service. They are also concerned about the quality of care they provide. They feel undervalued within the negative sociocultural environment that they work. Trainees also feel undervalued with an uncertain future and they also perceive their sociocultural environment as negative. They echo concerns regarding the quality of care they provide. They struggle with the interface between career demands and personal life.ConclusionsThis Delphi study sought to explore the working life of doctors in Irish hospitals at a time when resources are scarce. It identified both common and distinct concerns regarding sources of stress for 2 groups of doctors. Its identification of key stressors should guide managers and clinicians towards solutions for improving the quality of patient care and the health of care providers.

Doctor, how can we help you? Qualitative interview study to identify key interventions to target burnout in hospital doctors

“…The overwhelming emphasis on issues of staffing, cover and leave in our study is in line with other studies and not surprising, given the current doctor shortage and growing patient population in Ireland 34 38. The shortage of doctors is a global phenomenon predicted to reach crisis levels by 2030 39–42.…”

What’s up doc? A national cross-sectional study of psychological wellbeing of hospital doctors in Ireland

“…44 As longer working hours were found to contribute to poor personal well-being in this study and were particularly evident in trainees, we encourage employers to continue working towards achieving compliance with EWTD while also monitoring the unintended consequences such as the break-up of teams and poor-quality handover with its implications for patient care. 44 There is a need for further research to identify strategies to improve physician wellness with particular emphasis on organisational responsibility to create an environment and culture conducive to health, efficiency and meaning in work. 58 An exploration of doctors' own views on pathways to mental healthcare would help to elucidate what might be favoured by potential users.…”

“…However, simply implementing the EWTD, without consideration of how it is implemented, may not be of great benefit to doctors' well-being as we know that reducing hours in a manner that compromises continuity and quality of care is a significant stressor for hospital trainees in Ireland. 44 Furthermore, as a group, doctors tend to be conscientious and expect hard work and long hours. 45 Overall, self-rated health was very good or excellent in just over half of respondents, while 50.5% rated their personal well-being as normal.…”

Doctors don’t Do-little: a national cross-sectional study of workplace well-being of hospital doctors in Ireland

“…At the time of the survey, the majority of the consultants were employed on a contract which had been in existence since 1998, with a new, less favourable, contract introduced for new recruits in 2012,43 2 years before this study. It remains to be seen whether these changes affect the perceived reward in the group, as the contract did not just have an impact on pay, but also curtailed the rights to engage in private practice, thus affecting autonomy 17. To date, there are few studies reported on doctors that have used the ERI, so there is little opportunity for comparison.…”