Stress and Its Effect on Job Satisfaction

STRESS AND ITS EFFECT ON JOB SATISFACTION

High Level of Stress in an Organization Reduces

Employee Job Satisfaction   

Ahmed Z., Anum A., Mavish S., Mubeen L., Iqra H., Mudassir N.

University of Central Punjab             

Part 1

Research Background and Organization 

Research Background

       Stress is the psychological and physical state that results when the resources of the individual are not sufficient to cope with the demands and pressure of the situation. Level of job satisfaction and stress can affect both individuals and organization. Stress seems to become even more serious at an alarming rate in many organizations. Job stress is a recognized problem in health care workers and doctors are considered to be at particular risk of stress and stress related psychosocial problems. If stress happens too often or lasts too long, it can have bad effects. It can be linked to headaches, an upset stomach, back pain, and trouble sleeping. It can weaken your immune system, making it harder to fight off disease. If you already have a health problem, stress may make it worse. It can make you moody, tense, or depressed. Your relationships may suffer, and you may not do well at work. 

Individuals with lower status jobs are suffering more these days due to high levels of stress and they are prone more to high blood pressure and anxiety. Stress can be considered to be a key determinant of job satisfaction.

Components of job stress include factors like role conflict, role ambiguity, role overload inflexible working hours, unhealthy work environment, etc. In Pakistan, an important segment of work professionals which is more likely to experience stress then others are doctors.

Doctor to patient ratio is 1: 1400 in Pakistan which means that on average a doctor has to deal with 1400 patients. This heavy burden of patients is likely to create stress among doctors. Current security crisis in Pakistan has increased the frequency of emergencies in hospitals. Because of these crises hospitals remain on high alert at times and causes stress to the doctors. 

Another factor which causes stress to the doctors is the attitude of the patients.  Patients quarrel at times with the doctors and doctors don’t get the actual problem which patients are facing and this factor causes stress to the doctors.    

Research Objective:

   The aim of study is to find the negative relationship between stress and Job satisfaction. According to Sherry & Rabi(1992) “Under conditions of high life stress, highly competent individuals reported greater satisfaction with work, co-workers and supervision, less emotional exhaustion, and less feelings of depersonalization than did individuals who perceived themselves to be less competent.”  So another purpose of the study is to look into this perspective and see if this applies in general to the organizations in Pakistan. “Job dissatisfaction and stress among doctors affect the quality of health care.” (Ali, Riaz, Marie, Zafar & Nadya., 2004). The high stress level resulting from employee intraorganizational and extraorganizational interactions is a serious problem reducing satisfaction and motivation level. 

          The major stressors in an organization are intrinsic to the job, relationship at work, career development, home/work interference, role in organization and high work volume. They affect the individual by causing low job satisfaction, blood pressure problems, depressed mood which in turn will effect the organization by high absenteeism, poor quality control, high labor turnover and thus affecting the organization adversely.   

Operational Definitions:

    Here are definitions of the key terms in accordance with the aim of our research:

Stress

      The stress in general is psychological and physical alarm system of human body when it corresponds to high external pressure. For an employee the stress sources may be intra-organizational or extra-organizational. However in our study ‘stress’ means only intra-organizational stress.

Job Dissatisfaction

     By job dissatisfaction in our study, we mean the dissatisfaction resulting from stress causing factors and which results in bad performance of the employee.   

Organizational Background

Organization: ‘Services Hospital’

Origin and History:

    In 1958, a separate outpatient department of Mayo Hospital, Lahore was setup for the use of government employees. In 1960, this was converted into 55-bedded and name as Wahdat Hospital; it had medical and surgical facilities, together with laboratory and X-Rays unit. It was later renamed " Services Hospital ".

    The bed strength was gradually increased and Services hospital was named ‘Autonomous Institution’ in 1999. The Emergency and Trauma Centre was setup in 2002 and is now being upgraded and modernized under the Chief Minister's initiative of "Strengthening of Emergency Medical Services" (SEMS). This scheme has been approved by the Board of Management, at a total cost of Rs. 80 million. Construction work is being carried out by the Communication and Works Department. Equipment worth Rs. 9.9 million is also being purchased under SEMS. 

    In 2003, the Government of Punjab has established a unique, self financing Services Institute of Medical Sciences (SIMS) for undergraduate medical students and attached to services Hospital. 

Size:

    Initially the organizations size was limited to 55 bed and today after expansion the size has increased to 1096 beds plus the Trauma and Emergency Department. There are 33 departments comprising more than 250 doctors.  

Location:

    Services Hospital, Jail Road, Lahore, Punjab, Pakistan 

Charter:

    Approval for research has been granted by House Officer, General Surgery, Dr. Amir Zaheer Shakoori. MBBS, part 1.  

Relation with Other Organizations:

    Services Hospital has been initially associated with Allama Iqbal Medical College in 1977, then with Postgraduate Medical Institution (PMGI) in 1995. Today it is associated with SIMS Services Institute of Medical Sciences.  

    Since it is a government organization, the relations with other hospitals is not competitive in nature. However the doctors still feel a sense of competition among their hospitals Services also refers patients to other hospital like Mayo Hospital and Vice versa. So they don’t compete for getting all the patients, rather share the burden in emergency situations.      

              Resources and Financial Position:

    The government allocates annual budget of the Services hospital. The budget of services is the part of the 2% of the total government’s budget for a fiscal year. In addition to this the government provides project based funds to the hospital. E.g. in 2002 the chief minister allocated Rs.80 million for "Strengthening of Emergency Medical Services" (SEMS). Equipment worth Rs.9.9 million is also being purchased under SEMS. As per Chief Minister's initiative, the emergency staff is receiving an additional allowance equivalent to 50% of their basic pay. The financial position of the government hospital is therefore stable.  

     Inclusion and Exclusion Criteria for Respondants:

    Inclusion Criteria

The age of doctor is between 22 and 30. The doctor has at least worked for 2 months at services hospital. The doctor is in a good socio-economical condition. Family of doctor is not primarily dependant on his or her income.

Exclusion Criteria

The doctor is a patient of stress induced disease.

- He/she is going through a family or personal dispute during the time of survey.

The doctor has a poor background. The doctor is also working under another hospital or doing multiple jobs.

Part 2

Literature Review 

Literature Review

    The purpose of Nazanin’s (1999) the study was to determine whether there is a causal relationship between stress and job satisfaction. Stress management is very significant issue these days. Various techniques are suggested to reduce stress. A pre test was conducted on a sample of 11 employees. Then they were divided and one group was made to use stress management techniques and the other one did not. Then post tests were conducted to see the effects. “Although other researchers have shown a strong correlation between stress level and job satisfaction, a causal relationship has not been discussed. The purpose of this study was to determine whether or not a causal relationship exists. The results, though not statistically significant, did support a directional change in stress level: stress levels were reduced with stress management techniques”. (Discussion section para. 1).   

    Eva et. Al (2000) carried out the study to measure prevalence of burnout, job satisfaction and job stress and to understand the relation between consideration of alternative work situations and burnout, psychological morbidity, job satisfaction and job stress among medical oncology personnel. “There has been growing concern about anecdotal reports of burnout, high levels of stress and staff leaving or decreasing their

work hours. However, no research has systematically determined whether there is evidence to support or refute these reports.” (Background section para. 1). A questionnaire used and designed by Ramirez and associates was used to measure job stress and satisfaction. In the responses received majority said that the stress sources were factors like high work volume, inadequate staffing, feeling under pressure to make deadlines and having hoe life disrupted because of long working hours.           Dowell, Westcott, McLeod, Hamilton (2000) conducted the study “To assess job satisfaction, job-related stress and psychological morbidity among New Zealand physicians, surgeons and community pharmacists and provide a comparison with New Zealand general practitioners (GPs)”. (AIM section para. 1). General Health questionnaire and job satisfaction by the Warr Cook Wall scale were distributed among 1041 doctors practitioners and others. “Job satisfaction varied according to gender, the relative amount of time spent in public practice and the perceived ill effects of work on health. Pharmacists had the highest number of cases with significant scores on the GHQ-12 scale, with physicians and surgeons scoring similar to GPs.” (Result section). The groups were generally satisfied with their jobs except the pharmacists were less satisfied. 

         Khuwaja, Qureshi, Andrades, Fatmi, Khuwaja (2002) studied the comparison of job satisfaction and stress among male and female doctors at teaching hospitals. The study is very significant since “job dissatisfaction and stress among doctors affect the quality of health care” (Background section para. 1) The ten most frequently identified workplace characteristics, by selected doctors, relating to job satisfaction were included in a five point Likert Scale format questionnaire. Out of 270 postal surveys 189 responses were

received out of which 182 were found complete for analysis. “Majority (68%) of the doctors were not satisfied with their jobs, females more than males (males 65% and females 72%; p = > 0.05)” (Results section para. 2). The mean stress score was 3.32 which were mainly affecting their personal lives as it was deteriorating their physical and mental health. Thus majority of doctors are suffering from high levels of stress and job dissatisfaction in teaching hospitals of Karachi and these results in poor health care performance and negative impact on health of an individual.  

    The study of Mario (2002) was conducted to see the relation between job satisfaction and high stress at work. The findings of a previous research, that Italian workers in an organization were satisfied with their job but complained about high stress level at work were to be proved in this study. Democratici di Sinistra (DS) survey was conducted. Internal factors like internal bureaucracy and pressure of management demands, differences in occupational status, job insecurity and Poor economic reward,  lack of opportunity to participate in work organization, and difficulty in maintaining a good work-life balance were main sources of stress for both male and female workers. “Companies have not updated their organization and human resource policies to meet the new competitive environment, which may partly explain Italy’s current economic decline.” (Commentary section para. 2).       Monson, Walker, Sharp, Sharma (2008) studied the high stress and its influence of burnout and morbidity. A booklet of questionnaire was sent to all the doctors containing questions relating cancer-related and specialty-specific work load, job satisfaction and socio-demographics. It also included the General Health Questionnaire (GHQ). 77% of the surgeons stated they would retire as soon as possible. Thisa was because they were burned out and suffering morbidity. “Work satisfaction was negatively correlated with psychiatric morbidity and all three burnout scales.” (pg. 574). “Levels of psychiatric morbidity, burnout and work dissatisfaction are worryingly high in colorectal and vascular surgeons and are likely to impact adversely on patient satisfaction and service quality.” (pg. 576).    

    Jamal (2008) in his study examined the relation between stress at work job satisfaction, burnout and health problems. Job stress is considered as one of the most serious occupational hazards of modern time in industrialized countries; it is also increasing the work-stress cost of the organizations. Job stress and its effects had been empirically tested only in developed countries and not in developing countries like Pakistan and Malaysia. “Bivariate multiple regression and hierarchical multiple regression analyses were used to test the nature of the relationship between the measures of job stress and the dependent variables.” (Abstract Section para. 1). The overall relation between job stress and dependant variables was linear and job satisfaction was found to be negatively proportional.            According to Sehlen, et al. (2009) “The impetus for the study was to analyze factors for stress and job satisfaction of cancer care workers within the context of different

radiotherapy departments in Germany and Austria.” (Background section, para. 4). The increase in complexity of cases and available treatment options especially the radiation oncology treatment has become more complex than before. 8 universities and 3 general hospitals were given 42 item FBAS format questionnaire to fill. 534 complete responses were collected. “Nurses and physicians showed the highest levels of job stress (mean FBAS total score 2.2 and 2.1, respectively” (Results section, para 1). “Increasing evidence suggests that physician distress can lead to erosion of physician compassion, patient compliance and the quality of care physicians deliver.” (Discussion section, para.4). “Current workplace environments have a negative impact on stress levels and the satisfaction of radiotherapy staff.” (Conclusion section, para 1)            “Looking at the ways in which an organization can create stress for employees, how much it is costing industry and what can be done to minimize the adverse effects.” (pg. 146). The stress causes harmful effects to individual and his or her organization adversely. “The cost is widespread: it includes the expense of days lost to illness, lost opportunities and, more recently, a massive increase in claims for worker compensation based on stress at work.” (pg. 147) In order to deal with stress to reduce it managers must be able to identify them accurately. Recognition of possible sources of management stress will help minimizing its negative impact.(pg. 148). Stress from work overload, role ambiguity, role conflict, relationship at work, job security, climate and work/home interference can cause job dissatisfaction, absenteeism, low motivation, depressed mood and many other problems to individual and eventually to organization. 

    Duane (2004) in his book studied the effects of stress on managers, staff and those in operation positions to see its effect on health and productivity. “Stress at work exerts a dramatic effect on employee health and productivity.”(pg. 453).  The stress levels of large organization’s employees were measured after the company had gone under a sweeping organizational change. The employees were 2000 in number. “The most striking finding is that managers showed a very low incidence of stress reactions compared to those in staff and operations positions.” (pg. 447). Stress can be dealt with elimination of work overload, provision of social support, emotional climate control etc.                  

Part 3 

Research Methodology 

Theoretical Framework:

According to the literature review and the interview from some doctors at the hospital we concluded the following theoretical frame work: 

Figure giving the Independent variables affecting the Stress. 

                                             Figure giving the Independent variables affecting the Stress

There are other factors as well which affect stress and satisfaction level but for our research we chose the above variables only.

    Research Design:

         How important do you think standardized test scores are to a fifth-grader's education (circle one number):Not very important

                  Extremely  important

    1     2     3     4     5

    The research will be a ‘closed-ended survey’ because this type of survey requires lesser resources and gives quantitative and easily measureable results. The survey will be a ‘Likert Scale’ method. This is because when we want to know feelings of our subject we use ‘Likert Scale’ method.    

    Population:

    The population selected for the research was composed of doctors of three departments of Services hospital i.e. Medicine, Gynae and Surgery. The population size is 113 doctors. 

    Sample

The sample was taken of 30 doctors out of the total population of these departments. Ten doctors from each department were selected for survey. 

      Sampling Technique:

We used ‘quota sampling’ to select the respondents according to own ratio of gender and designation.

Response Received:

Out of the 30 surveys that were distributed 25 were complete responses. The rest five were either incomplete or they were misplaced by respondents.

Interferences:

There was minimal interference by the researchers since the questionnaires were dropped off at the site and collected later. Filing instructions were given on the front page for the respondents to follow.

Part 3

Data Analysis and Interpretations

Introduction to Data Analysis:

The data collected from 25 respondents was analyzed via SPSS statistics data editor. We used various tables and analysis techniques like ANOVA, Correlation and Cross tabulation to analyze various categorical and quantitative data in the research. The application of various methods is given in figure below:

Results and Interpretations:

We take value of alpha= 0.05

Gender and Stress:

Ho: The stress experienced by doctors is same for different doctors of different genders.

H1: The stress experienced by doctors is different for different doctors of different genders.

  ANOVAStress

  Sum of Squares df Mean Square F Sig.

Between Groups 44.518 1 44.518 1.425 .245Within Groups 718.442 23 31.237    Total 762.960 24       

p= 0.245

The value of p is above the value of alpha therefore Ho will be accepted that the level of stress does not vary due to gender differences among the doctors in the hospitals.

 Stress and Departments: 

Ho: Stress level is same in all departments.

H1: Stress level is different in different departments.

 ANOVAStress

  Sum of Squares df Mean Square F Sig.

Between Groups 122.471 2 61.236 2.103 .146Within Groups 640.489 22 29.113    Total 762.960 24       

p = 0.146

Since value of p is greater than alpha the Ho will be accepted and thus there is no significant difference in the stress level experienced by the doctors belonging to different departments. Thus the stress level is almost same in medicine, gynae and surgery of Services hospital.

Stress and Designation:

Ho: The stress level is different for various designations of doctors.

H1: The stress level is same for various designations of doctors.

   ANOVAStress

  Sum of Squares df Mean Square F Sig.

Between Groups 91.853 2 45.926 1.506 .244Within Groups 671.107 22 30.505    Total 762.960 24      

p= 0.244

The level of stress is thus same for all designations. One reason for this could be the unspecified tasks of all the doctors at the hospital and the high percentage of patients in general and emergency. 

Satisfaction & Gender:

Ho: The satisfaction level is same for both males and females doctors.

H1: The satisfaction level is different for male and female doctors.

ANOVA

Satisfaction

  Sum of Squares df Mean Square F Sig.

Between Groups 9.083 1 9.083 1.171 .290

Within Groups 178.357 23 7.755    Total 187.440 24      

p= 0.290

Since the value of p is greater then alpha thus the satisfaction level does not vary with the gender of the doctors, it is rather dependant on other factors like salary, motivation etc.

Satisfaction & Departments:

H1: The satisfaction level of different departments varies accordingly.

Ho: The satisfaction level of different departments is the same and does not vary accordingly.

  ANOVASatisfaction

  Sum of Squares df Mean Square F Sig.

Between Groups 15.040 2 7.520 .960 .398Within Groups 172.400 22 7.836    Total 187.440 24      p= 0.398  

Satisfaction & Designation:

H1: The satisfaction level is different among different designations of doctors.

Ho: The satisfaction level does not vary with different designations of doctors.

  ANOVASatisfaction

  Sum of Squares df Mean Square F Sig.

Between Groups 9.011 2 4.506 .556 .582Within Groups 178.429 22 8.110    Total 187.440 24       

P= 0.582

The H1 will be rejected and thus the level of designation has no effect on satisfaction of the doctors.

Experience and Stress:

Correlations

    Years in hospital Stress

Years in hospital Pearson Correlation 1 -.317Sig. (2-tailed)   .122

N 25 25Stress Pearson Correlation -.317 1

Sig. (2-tailed) .122  N 25 25

The results show that stress is highly negatively correlated with the experience of doctors i.e. the number of years spent by the doctors at the hospital.

Cross Tabulation:

 Department of the respondent * No one has to do other's duties Cross tabulation

      No one has to do other's duties Total

      strongly disagree

disagree not sure

agree strongly agree

Department of the respondent

Medicine Count 0 6 2 1 0 9% within Department of the respondent

.0% 66.7% 22.2% 11.1% .0% 100.0%

surgery Count 1 4 0 4 1 10% within Department of the respondent

10.0% 40.0% .0% 40.0% 10.0% 100.0%

gynae Count 1 1 2 2 0 6% within Department of the respondent

16.7% 16.7% 33.3% 33.3% .0% 100.0%

Total Count 2 11 4 7 1 25% within Department of the respondent

8.0% 44.0% 16.0% 28.0% 4.0% 100.0%

Department of the respondent * Duties are fixed Cross tabulation

      Duties are fixed Total

      strongly disagree

disagree not sure agree strongly agree

Department of the respondent

Medicine Count 2 3 2 1 1 9% within Department of the respondent

22.2% 33.3% 22.2% 11.1% 11.1% 100.0%

surgery Count 1 3 0 4 2 10% within Department of the respondent

10.0% 30.0% .0% 40.0% 20.0% 100.0%

gynae Count 1 1 1 2 1 6% within Department of the respondent

16.7% 16.7% 16.7% 33.3% 16.7% 100.0%

Total Count 4 7 3 7 4 25% within Department of the respondent

16.0% 28.0% 12.0% 28.0% 16.0% 100.0%

Designation of the respondents * Salary  Cross tabulation

      Salary Total

      strongly disagree

Disagree agree strongly agree

Designation of the respondants

House officer

Count 5 1 6 0 12% within Designation of the respondents

41.7% 8.3% 50.0% .0% 100.0%

Medical officer

Count 4 3 0 0 7% within Designation of the respondants

57.1% 42.9% .0% .0% 100.0%

Registrar Count 3 2 0 1 6% within Designation of the respondants

50.0% 33.3% .0% 16.7% 100.0%

Total Count 12 6 6 1 25% within Designation of the respondants

48.0% 24.0% 24.0% 4.0% 100.0%

Designation of the respondants * Incentives Crosstabulation

      Incentives Total

      strongly disagree

disagree not sure

agree

Designation of the respondants

House officer Count 10 2 0 0 12% within Designation of the respondants

83.3% 16.7% .0% .0% 100.0%

Medical officer

Count 5 1 1 0 7% within Designation of the respondants

71.4% 14.3% 14.3% .0% 100.0%

Registrar Count 4 1 0 1 6% within Designation of the respondants

66.7% 16.7% .0% 16.7% 100.0%

Total Count 19 4 1 1 25% within Designation of the respondants

76.0% 16.0% 4.0% 4.0% 100.0%

Designation of the respondents * Supportive seniors Cross tabulation

      Supportive seniors Total

      strongly disagree

disagree not sure agree strongly agree

Designation of the respondents

House officer Count 2 0 0 8 2 12% within Designation of the 16.7% .0% .0% 66.7% 16.7% 100.0%

respondentsMedical officer

Count 0 1 3 3 0 7% within Designation of the respondents

.0% 14.3% 42.9% 42.9% .0% 100.0%

Registrar Count 0 0 2 3 1 6% within Designation of the respondents

.0% .0% 33.3% 50.0% 16.7% 100.0%

Total Count 2 1 5 14 3 25% within Designation of the respondants

8.0% 4.0% 20.0% 56.0% 12.0% 100.0%

Department of the respondent * Patients are cooperative Cross tabulation

      Patients are cooperative Total

      strongly disagree

disagree not sure agree

Department of the respondent

Medicine Count 0 6 3 0 9% within Department of the respondent

.0% 66.7% 33.3% .0% 100.0%

surgery Count 1 5 1 3 10% within Department of the respondent

10.0% 50.0% 10.0% 30.0% 100.0%

gynae Count 3 3 0 0 6% within Department of the respondent

50.0% 50.0% .0% .0% 100.0%

Total Count 4 14 4 3 25% within Department of the respondent

16.0% 56.0% 16.0% 12.0% 100.0%

Department of the respondent * Emergencies  Cross tabulation

      Emergencies Total

      disagree not sure agree strongly agree

Department of the respondent Medicine Count 0 0 1 8 9% within Department of the respondent .0% .0% 11.1% 88.9% 100.0%

surgery Count 1 1 5 3 10

% within Department of the respondent 10.0% 10.0% 50.0% 30.0% 100.0%gynae Count 1 0 3 2 6

% within Department of the respondent 16.7% .0% 50.0% 33.3% 100.0%Total Count 2 1 9 13 25

% within Department of the respondent 8.0% 4.0% 36.0% 52.0% 100.0%

Interpretations of Correlations:

44% of the respondent doctors agree that they have to do the tasks of other doctors on their departments.

On the question of duties given to the doctors the response is mix 28% agree with fixed duties while 28% also disagree with it.

48% of the respondents say that they are not satisfied with the salary being given according to their posts.

Majority doctors say that they are not being given any sort of incentive by the hospital which is a crucial point with regard to satisfaction of doctors.

56% doctors agree that their superiors are supportive which is good for motivation and satisfaction of the doctors.

The doctors highly responded in disagreement when asked about the level of cooperation of patients.  

52% doctors say that the level of emergencies is increasing. The main reason for this would be the increasing accidental rates.

Frequencies

 Statistics

    Stress Satisfaction

N Valid 25 25Missing 0 0

Mean 40.0400 12.3200

The highest score of stress in Questionnaire = 65

The lowest score of stress in Questionnaire = 13

Score of stress in result = 40.04

Comment: Therefore the mean level of stress is high in the hospital in all the three departments.

The highest score of satisfaction in Questionnaire = 25

The lowest score of satisfaction in questionnaire = 5

The score of satisfaction in result = 12.32

Comment: The mean level of satisfaction is closer lowest limit of satisfaction therefore the overall satisfaction of doctors in the hospital is low.

Part 4

Conclusion               

Conclusions:

From the above results and interpretations we see that when the stress level is high which is 40.04 but the stress level is not very low (12.03). Thus we can conclude that the effect of stress on satisfaction is negative, but the effect is not very prominent.

However the results above do support the general statement and hypothesis that high stress effects the satisfaction of employees in an organization but only to a limited extent. 

The level of stress & satisfaction is not affected by the designation, department and gender of doctors. They depend on other factors like salary, patients quarreling, improper job design etc.

  The doctors’ greatest stress causing source would be the patients’ and their

attendants constant quarreling and no cooperation with the doctors. The patients being illiterate most of the time do not know how to manage and follow rules and procedures without questioning. So doctors have to guide them in every small detail.

  Incentives are almost extinct with the doctors. This affects the satisfaction and

thus reduces motivation to work. The doctors are not given transport or bonuses as incentives.

  Majority of our respondents had an experience of less than a year and they

allowed higher level of stress as compared to the doctors with 2 to 3 years of experience. Thus we can conclude that greater the experiences lesser is the stress level due to increase in ability to handle situations smartly and efficiently.

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