Work Pressure and Challenges among Medical Doctors in Private Clinic in Hong Kong - Dissertation Example

? Work Pressure and Challenges among Medical Doctors in Private Clinic in Hong Kong: Case Study Introduction The quality of healthcare services offered by the hospitals as well as healthcare centers in Hong Kong is considered to be quite noteworthy by international standards. The country has nearly 13 private hospitals that have been associated with the United Kingdom in order to offer international healthcare authorization to the local communities. The healthcare system of Hong Kong is considered to be almost similar with the best hospitals in Asian region such as Singapore, Malaysia as well as Thailand. Primary as well as secondary medical services are offered to the patients by these hospitals. Most of the people tend to access these facilities primarily via their medical insurance, either held by them personally or by means of their employment (Taylor, 2012). It has been observed that the stressful life of doctors and nurses in Hong Kong makes them prone to psychological exhaustion in terms of depression, especially in the private sector. Depression is considered to be one of the most significant health issues because of its associated result. As per the anticipation of the World Health Organisation, by the end of the year 2020, depression is likely to become the second main reason behind dysfunction within workplaces, including the healthcare sector, playing a major role towards the increasing ratio of psychological ill-health in the world population owing to the fact that traumatic life events normally lead to psychological indications. Hence, it can be affirmed that if the level of stress is quite high then in such circumstances, there are greater chances of psychological indications (Bayati, Beigi & Salehi, 2009). The chief objective of the paper has been to evaluate the work pressure and challenges faced by the medical doctors in private clinics in Hong Kong. It also aims to gauge the levels of occupational stress among the doctors who are working at private clinics followed by the analysis of their depression levels owing to high work pressure impacting their job performance and satisfaction level. The study also attempts to measure the adverse effects of intensive workload on doctors working in private clinics by means of evaluation of the depressive disorders caused by extensive workloads. In this regards, the paper further elaborates on The Karaek Job-Demands Control Model (1979), The Effort-Reward Imbalance Model and Job Demands-Resources Model. Level of Care Offered By Private Sectors Hong Kong has about 12 major private hospitals among which 4 hospitals are featured as profit making hospitals while 8 hospitals are regarded to be functioning as non-profit making concerns. One of the common characteristics among these healthcare concerns is that all the private hospitals primarily tend to rely upon outside doctors for rendering high quality services to the admitted patients (Gauld & Gould, 2002). It can be mentioned in this regards that the private hospitals of Hong Kong do not have spare capacity in order to meet the additional demands. The reason behind this fact is that the ‘bed occupancy rates’ of these hospitals is quite high (Industry HK, 2012). In the recent years, lack of manpower in the private hospitals of Hong Kong was found to be a significant problem that forced the hospital authorities to take several measures in terms of costs and quality services. According to the evaluation done by the Public Doctor Association, the major causes of the problem include heavy workload pressures on the professionals, poor promotion prospects along with the inconsistency in the financial reward system taking place amid the public institutions. This in turn leads to excessive flow of the doctors in the private sector. Such issues are further observed to cause stress among the doctors, ultimately giving rise to depression which in turn hampers the quality of service or rather medical support rendered by them (Wong, 2008). Contextually, it can be revealed that private healthcare sector professionals in Hong Kong are often observed to be dissatisfied with the pay as well as lack of career developmental opportunities, thus hampering their perceived degree of work satisfaction which is characterised as an important part in ensuring high quality services. It is owing to the fact that when the level of stress among the healthcare professionals tends to be increasing, the rate of dissatisfaction also increases among the patients indicating a fall in the overall quality of services (Private Hospitals, 2012). Furthermore, dissatisfaction among the professionals including the doctors often lead to stress as well as frustration that further gives rise to physical, behavioural as well as emotional problems. In this respect, the chief dissatisfactory elements comprises of non-supportive work environment accumulated with high workload pressure (Pillay, 2009). The Department of Health in Hong Kong supervises the regulation of the medical bodies as well as health promotion programmes with the economy. It has been noted that the Department of Health of Hong Kong tends to implement stringent licensing along with professional registration on its healthcare associates (Leung, Tse & Yeung, 2012). Reasons for Preferring Private Healthcare In comparison to the public healthcare organisations, it has been noted that the degree of quality rendered by the private sector healthcare organisations are better along with the costs charged. Moreover, the waiting times are quite low owing to which the patients obtain greater comfort with the virtues of time-efficient and well-organised governance. It is because of these aspects that most of the locales in Hong Kong prefer to make use of the private healthcare sectors (Tin, 2009). For instance, in Hong Kong, nearly 80 percent of the patients are learnt to prefer consuming services from the private sector in comparison to the public healthcare organisations. In most instances, the private healthcare organisations operating in Hong Kong is learnt to lure patients suffering from chronic illness needing frequent medical visits. In this regards, the hospitals are often observed to consider rendering insurance facilities or age concessions along with funding opportunities in terms of loans and donations (Armstrong, 2012). Thus, from an overall point of view, it can be stated that these supporting factors, not only in monetary terms but also in terms of high quality medical care, tend to persuade the common people in Hong Kong to prefer the private sector healthcare organisation by a larger proportion that the public sector service providers. Professional Attitude of Medical Practitioners at Private Medical Clinics It is vital for the doctors to be well conscious of the health attitudes of their patients from multifarious ethnic backgrounds. This is likely to improve the patient as well as doctor relation and thus might as well as better observance treatment (Lim, Sadarangani, Chan & Heng, 2005). It can be viewed that in Hong Kong the medical graduates working in the public as well as private sectors have been honoured with reliance as well as admiration in the community. The people of the community show high respect towards the healthcare professionals for their commitment as well as devotion to caring for the life as well as health of the people. Furthermore, the doctors of Hong Kong have been successful in creating professionalism among the practitioners combining Western ethics along with Chinese values (University of Hong Kong, 2002). Private Doctors in Hong Kong acquire their income generally from the consultation fees that is paid by the patients for the service that is offered by the private doctors. It can be observed that unlike some of the countries such as United Kingdom, New Zealand as well as Australia possessing national health systems, the government of Hong Kong does not reimburse the private practitioners for delivering their services. Furthermore, the patients also do not obtain any reimbursement or any kind of subsidisation related to their consultation fees from the government. Furthermore, there is no restriction or any sort of wide difference between the fees that is charged by the private practitioners. The fees charged by the private practitioners are generally depends upon the image of the doctor and location of the clinic. It can be mentioned that such factors are generally understood by the patients as an indication of the doctor’s professional quality. Among the doctors in private healthcare setting, it has been noted that there is role ambiguity. Quite a few doctors of Hong Kong are trained as experts in the context of family medicine and some of them function in collaboration with the family practitioners. Hence, it can be asserted that there is no formalised gatekeeper role performed by the doctors in the private sectors (Yam, Liu, Huang, Yeoh & Griffiths, 2011). In the current day context, it has been identified that nearly 70 % of the healthcare service providers perceive that the patients’ agreement is one of the main reasons behind several troubles related to stress among the doctors in the private healthcare clinics of Hong Kong. This particular aspect can in turn be identified as causing various complaints against the services from the customers’ end. It is due to the reason that the patient’s charter, which was supported by the Hospital Authority in Hong Kong in the traditional period, is often disregarded to be important at present times. It is generally the duty of the doctor to explain the patients regarding their medical conditions along with the side-effects of the therapy or the treatment methods maintaining a degree of transparency. In this regards, one of the challenges for the doctors is to maintain the association between the doctor-patients. Hence, it is also crucial for the healthcare practitioners to discuss the medical ethics which are beyond legal methods in order to maintain professionalism in the private healthcare clinics (Lo, Lam, Mercer, Fong, Lee, Lam, Lee, Chiu, Tang, Chui, Chao, Lam & Chan, 2011). Evaluation of Occupational Stress among the Doctors Working At Private Clinics Occupational stress, encouraged by effort-reward imbalance, is independently related to the depression among the healthcare practitioners. Occupational stress is thus considered to be an explanatory factor which attempts to provide significant considerations to the working hours for evaluating the degree of depression among the healthcare practitioners. Hence, it becomes quite essential to manage the occupational stress in order to manage the level of depression among the healthcare practitioners (Wang, Chen, Hsu, Lee, Wang & Yeh, 2011). It is a well known fact that heavy workload along with high stress may diminish the quality of care offered to the patients by the healthcare practitioners. Excessive workloads tend to possess a severe impact and may as well threaten the security of the patients. The healthcare workers in the private sectors are supposed to work for enduring hours during emergency cases. They confront the issues related to sleep apnoea because of excessive workloads that further tends to lead to stress among the doctors dealing with critical cases (Sveinsdottir, Biering & Ramel, 2010). It has been apparent that a certain degree of lack of information regarding the outcome of medical services along with the performance of the service providers prevails within the private sector of the nation which again tends to hamper the overall quality of healthcare services. In this context the private healthcare patients are required to maintain their quality that leads to stress among the workers (Leung & Bacon-Shone, 2006). Additionally, excessive occupational stress can also lead to burnouts that can be comprehended as a tiredness arising from high demand of energy as well as resources. Burnouts tend to have characteristics such as combination of emotional tiredness, depersonalisation along with reduced sense of personal attainment. Such tiredness among the doctors can be identified as associated to their response towards the need of offering high standard medical care influenced by their personality traits as well as level of authority over their work environment. Furthermore, such stresses generally results to lack of job commitment and performance, difficult patient care and health problems associated with stress along with depression. Burnout also leads to high degree of absenteeism, minimised output and propensity for alteration in job (Siu, Yuen, & Cheung, 2010). Since the people of Hong Kong are living in a westernised city having a competitive culture, they are often regarded as used to stressful lifestyles. The surmounting public expectations for quality services along with disparity between the public as well as private healthcare facilities are generally applicable for local medical professionals. Excessive stress because of global workloads is also considered to be one of the causing factors of burnouts amid the Hong Kong private healthcare sector professionals. The doctors who are moderately experienced and might not obtain proper professional recognition are likely to be vulnerable to burnouts, in case they feel that their work is not being delighted by others. However, it should be mentioned in this regards that burnouts among the doctors are obvious because of the complex interface of the factors comprising physical tiredness, extreme patient calls, shift duties as well as detrimental sleep patterns. In this regards, it can be stated that the views of low work value along with poor job contentment are mainly associated with burnouts. Hence, it is quite important to minimise the stress level experienced by the doctors, especially in the private sector, in order to prevent from burnouts and depressions. A few of the strategies that has been proved to be quite effective are corporate initiatives aimed towards minimisation of stress related global workloads, acknowledgment of junior doctor’s participation and thus provision of good job security to the doctors (Siu, Yuen, & Cheung, 2010). In Hong Kong, it has been noted that stress among the doctors is considered to be a prevailing problem. It is for this reason a Center for Personal Growth and Crisis Intervention was developed in the year 2002 by the Hospital Authority with the primary responsibility to offer treatments for the doctors in situations comprising the occurrence of a medical error. There are different causes of stress among the doctors. A few of these causes can be identified as un-related to work such as the personal traits of the doctors or disagreements in their personal life which do not necessarily link with their job responsibilities. However, in the current phenomenon, it has been identified that majority of these causes, especially in relation to medical practitioners, include views of meagreness and non-performance according to potential, shortage of staffs and ill working condition, complex dynamics in workplace associations, along with eccentric reactions to the death of the patient (Richards, 2003). Examination of the Depression Levels among the Doctors at Private Clinics Depression level prevailing among the healthcare practitioners is considered to be one of the most crucial problems in the context of occupational health. The reason behind this fact is that it tends to impose greater risks upon the medical practice. Physicians are supposed to work for long hours and hence it has been found that such lengthy working hours might lead to depression among the healthcare practitioner. There are various stressors that the healthcare practitioners are generally exposed to. Healthcare practitioners are supposed to demonstrate high degree of professionalism which imposed a burden upon them. They are accountable for the welfare of the patients and are supposed to maintain proper relation with them as well as with the health workers. They are also concerned regarding the medical errors along with unprofessional conduct proceedings which give rise to stressors. It has been asserted by the researchers that such occupational stresses gives rise to depression among the physicians (Ghaderi, Venkatesh & Kumar, 2009). It is well known fact that contentment with the job impacts not only inspiration level at the workplace but also the career related decisions, personal health as well as link with others. The healthcare executives working in demanding and unpredictable work environment are confronted with the feeling of uncertainty as well as job satisfaction. Job satisfaction related to the healthcare workers is quite crucial part in ensuring the quality of care offered to the patients. The workers who are dissatisfied will not only offer poor quality as well as less efficient care, however there are facts of close link between job contentment as well as patient satisfaction. Provided the significant role played by the healthcare professionals in recognising the efficacy and sustainability of the healthcare system, it is quite important to comprehend what motivates and encourages them to perform effectively in the attainment of the goals of the organisations. It is significant to enhance the work environment so that it offers a context in line with the objectives of the healthcare professional will assist in recuperating the level of contentment among the healthcare workers. It is also likely to have a favourable impact upon the individuals, organisation and will perk up the quality of the services offered to the patients (Ramasodi, 2010). Adverse Effects of Intensive Work Load on Doctors Working In Private Clinics: Depressive Disorders Depressive disorder can be explained as a kind of psychological disarray typified by unrelenting feeling of sadness and irrelevance or lower degree of self-esteem within the sufferer. It generally leads to lack of desire to involve in any kind of pleasurable activities. A depressive disorder takes into consideration the body, mood as well as thoughts of a person and is often categorised as an illness that hampers the day to day functioning of the person and thus causes pain for the sufferer as well as the person responsible for nursing the patient (Psychology Today, 2012). With an increasing trend in the global arena, the diagnosis for depressive disorder, its treatment along with the identification of its causes, have emerged as a vital concern for medical science. It is in this context that greater degree of work pressure has been identified as one of the most common causes for depressive disorder in the modern day period. Considering these aspects, doctors in the private clinics have often been identified to suffer from such disorder owing to their immense work load and responsibilities (Tennant, 2001). Depressive disorders are featured as a blend of symptoms interfering or rather obstructing the capability of an individual to conduct the regular activities and attain the benefits of recreational doings. Hence, it can be affirmed that depression generally averts the person from functioning normally and lead a contented life. There are several forms of depressive disorders such as major depression, dysthymia and manic depression. Major depression is also referred to as unipolar or clinical depression which might take place once, twice or even several times in a lifetime. In dysthymia, the symptoms of illness might last for at least 2 years. People suffering with dysthymia are generally observed to lack eagerness and lead a joyless life, continuously experiencing tiredness with high probability to confront ‘major depressive episodes’. However, manic-depression does not necessarily typify a continuous or consistent experiencing of low-mood but indicates an apparent fluctuation in the behaviour of the sufferer. For instance, a sufferer of manic-depression can become excessively active and joyous at times which sudden change in their behaviour deciphering irritableness, tiredness and other low-mood qualities (National Institute of Mental Health, 2012). With reference to the contemporary era, greater workloads demands has been one the major source of most of the chronic illnesses such as depressive disorders among the doctors in the private clinics (Tennant, 2001). The results of the work-related stress include a negative impact over the degree of work satisfaction as well as output produced by the doctors in terms of their service efficiency along with adversely affecting their mental as well as physical health. This in turn tends to result in high rate of absenteeism among the doctors which again indicates a decline in the overall quality of the medical services rendered. It is majorly owing to the fact that healthcare workers possess higher level of mental morbidity in comparison to the general populations. Among the healthcare workers, burnout related malingering is caused because of confusion about power and lack of support at work (Li-Ming, 2002). The Karasek Job-Demands Control Model (1979) The Karasek Job-Demand Control Model has been one of the popular models related to occupational stress. The philosophy of the job demand-control model states that control tends to shield the influence of job demands on tension. It further can assist in improving the job satisfaction perceived by the employees with the opportunity to get involved with challenging tasks and thus learn new skills. The model has often been regarded to depict an apparent and rational relationship amid the job demands signifying the requirements of the assigned tasks and the decision latitude or rather control, enjoyed by the professionals. In order to take account of these concerns, i.e. control and job demands, multiple aspects are considered in the model in terms of integrating resources, active coping, self-efficacy as well as social support. However, the model has also been criticised on the grounds that lacks in taking into consideration the individual characteristics of the workers which can also have a deep impact over the stress level persisting within the working environment (Yperen & Snijders, 2000). It is to be mentioned that in a job demand-control model, ‘job demands’ are generally evaluated as quantitative workload or role conflicts. On the other hand, the dimension of ‘control’ is generally evaluated as the capability to make decisions regarding how to accomplish the job tasks indicating a qualitative rationalisation. These two components, i.e. control and job demands, are further assumed to influence the degree of strain along with the passive or active behaviour of the professional. Strain is evaluated in terms of physiological as well as psychological symptoms depicting anxiety, depression and exhaustion. Based on these assumptions, the model generally classifies jobs into four types emphasising upon distinct combinations of demands and control. The other noteworthy presumption of the model states that the employees tend to suffer greater tensions and strain in case of highly stressful jobs or in jobs where the employees confront high demands at work and simultaneously possess meagre control over how to perform their assigned tasks. This in turn tends to increase the degree of perplexity amid the professionals which again creates an adverse effect over the capability of those workers. Stating precisely, in such circumstances, the sufferers experience high degree for physiological arousal along with elevated cardiovascular and nervous system stress which further tends to hamper the productivity of the employees in an organisation (Proost, 2010). On the contrary, the workers who tend to experience high demand for work along with a higher degree of control over the resources can be assumed to enjoy greater job contentment which can be termed as active jobs. One of the major reasons behind this phenomenon can be regarded as the ownership enjoyed by the employees in terms of intellectual demand offering them the scope to enhance their competencies, self-efficacies, personal growth prospects and skill development needs. The workers who are in passive jobs are characterised to experience low demand as well as low control in their workplace. They are generally observed to face issues related to reduction in the problem-solving capability, elevated boredom and thus experience job discontentment due to the continuous repetition of the tasks leading towards the decline in terms of ability for rational challenge (Proost, 2010). The ‘job demand-control model’ propagated by Karasek can be linked with the healthcare setting and burnouts. Though the model has been generally applied to research on occupational stress as well as psychological well-being, the model has also been utilised in context of burnouts which has obtained tremendous attention since the late 1970s in the context of human service profession. Burnout generally leads to dysfunctional consequences such as high turnover, reduced output and absenteeism leading to substantial costs for the individuals and members of the society at large. It can be identified as a process which generally begins from emotional tiredness resulting to the feeling of personal non-attainment. In relation to medical services, it has been learnt that burnout among the doctors are quite likely to lead to numerous health issues, higher turnover intentions as well as lower dedication towards the organisation. According to the ‘job demand-control model’, when a degree of disparity exists between the resources used to gain control as well as the experienced demands, emotional exhaustion might take place within the workplace. Simultaneously, as a defensive coping strategy, it is observed that the healthcare professionals might develop a set of negative attitudes that can hinder the involvement of doctors with their patients. They further try to amplify the distance among themselves in psychological terms, thus channelising a feel of un-cooperativeness amid the patients. Creation of such negative feelings among the stressed doctors in the private healthcare setting might lead to the fact that they are not willing to, or are not capable of performing in an efficient manner that further leads to the perception of minimised personal attainment (Proost, 2010). Effort Reward Imbalance Model (ERI Model) The ‘effort-reward imbalance model’ (ERI Model) is featured by the assessment of the rewards and examination of the intrinsic characteristics of coping with numerous job demands as a major influencing factor. It can further be stated that the ERI model is found to be effective in examining the stress among the professionals who are supposed to interact on an individual level. In comparison to the demand-control model, the ERI model tends to have higher explanatory power. Therefore, it can be mentioned that the ERI model is quite significant for assessing occupational stressors among the physicians. As suggested by the model, social support acts as a safeguarding factor in case of stress reactions and occupational stressors along with the concept of depression (Ghaderi, Venkatesh & Kumar, 2009). The chief assumptions related to both the models such as ‘demand-control model’ as well as ‘effort-reward imbalance model’ is related to the fact that job demand leads to job stress where a lack of resources can be witnessed, signifying a lower degree of control. To be illustrated, the ‘demand-control model’ attempts to signify the phenomenon as independence or ‘decision latitude’, where on the other hand, the ‘effort-reward imbalance model’ treats the phenomenon with relation to salary and career opportunities. It can be established that one of the major strengths of both the models generally lies in their simplicity to relate the components which constitute as causing and resulting factors of occupational stress as well as depressive disorders. However, this strength of simplicity can also be viewed as a crucial weakness owing to the increasing intricacy organisations, including healthcare, in the modern day context (Rehman, Rasli & Alharthey, 2010). Job Demands-Resource Model (JD-R Model) The ‘job demands-resource model’ (JD-R Model) principally attempts to enhance the overall organisational functioning by reducing the work-related stress level experienced by the employees irrespective of the industry classifications. JD-R model is associated with the pre-supposition that while each job has its own reasons behind the degree of contentment enjoyed by the employees, these aspects can be divided into two classes in terms of ‘job demands’ as well as ‘job resources’. It comprises an overarching model that can be easily implemented in numerous occupational settings such as healthcare, being irrespective of the demands as well as resources involved in it. Another grounded theory of this model elaborates on the phenomenon that when a high degree of job demands prevail within the employee, their mental as well as physical resources tend to be exhausted. This in turn gives rise to diminution of energy as well as several health disorders and thus is understood as health impairment process. On the other hand, job resources, encourage the involvement of the employee in the assigned tasks, thus leading to improved performances and is known as motivational processes. According to the assumptions defined in the model, job resources are likely to shield the influence of job demands on the way in which the stress reacts. In other words, in case the job demands are quite high, the job resources tend to act as a tool of motivating the employees within an organisation (Arnold Bakker, 2012). The assumptions of the model further denotes that job stressors tend to minimise the capability of the individuals to impose any authorisation in the work environment which in turn can unfavourably influence the capability of the individual to operate in an effectual way. Owing to the inconsistencies found in the relationship between the stressors as well as job performance, the model assists in seeking for moderators of the associations in order to make use of the mediators in relationship between the stressors and job performance (Bakker, Demerouti & Verbeke, 2004). Conclusion Stress in the workplace is considered to be one of the most complex issues which can hamper the overall productivity of an organisation. It is worth mentioning in this context that the doctors are confronted with high job burnouts. It is because of high stress and burnouts that has unfavourable impact upon their satisfaction level and likewise develop an adverse impact over their performance. For instance, burnouts along with physical fatigue tend to lead towards a feeling of failure in relation to the individual attainments within an individual. Hence, most of the doctors fail to consider their occupation as offering them success and satisfaction which in the long-term can cause occupational stress and depressive disorders immensely hampering the service quality. With due consideration to the fact, it can be affirmed that it is the responsibility of the healthcare organisation to intervene and take remedial actions to remove the stressors from the workplace and thus enhance the overall service efficiency (Oubina, Calvo, Fernandez-Rios, 1997). From an in-depth point of view, in order to reduce the stressors among the individuals it would be significant to focus upon the creation of certain strategies so that the private healthcare clinicians can improve their performances. A suitable reward system can be created in order to motivate the staffs to work towards the attainment of the objectives determined by the organisation. It would also be vital for the healthcare organisations of private clinics at Hong Kong to create stress coping committees and thus conduct ‘goal-directed staff meetings’ at frequent intervals so as to maintain the stress level at the lowest degree. Training can also be considered as one of the most significant tools to minimise the degree of stress among the doctors and nurses in private clinics in Hong Kong. When the level of stress decreases, the level of depression also tends to decline eventually. Decrease in stress would also lead to high job performance resulting from a higher degree of satisfaction. However, it is worth mentioning in this regards that the Hospital Authority should focus on rationalising its hospital services along with streamlining their working methods maintaining a continuous evaluation of the stress level amid the doctors, especially them assigned in the private sector. It is also significant for the Hospital Authority to encourage multi-disciplinary integration in healthcare delivery and creation of the service networks across various healthcare groups, in order to offer highly sub-specified services where required. This would subsequently reduce the workload of the doctors and therefore assist in enhancing their service quality (Hospital Authority, 2012). References Armstrong. N. (2012). The Sociology of Medical Screening: Critical Perspectives, New Directions. New York: John Wiley & Sons. Arnold Bakker. (2012). Job demands-resources model. Retrieved from http://www.arnoldbakker.com/jdrmodel.php Bakker, A. B., Demerouti, E. & Verbeke, W. (2004). 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