RECRUITMENT AND SELECTION

OCCUPATIONAL STRESS

J Ayub Med Coll Abbottabad 2008;20(3)

OCCUPATIONAL STRESS AND ITS EFFECT ON JOB

PERFORMANCE A CASE STUDY OF MEDICAL HOUSE OFFICERS
OF DISTRICT ABBOTTABAD
Rubina Kazmi, Shehla Amjad, Delawar Khan*
Department of Management Sciences, COMSATS Institute of Information Technology, Abbottabad,
*Department of Forensic Medicine, Ayub Medical College, Abbottabad, Pakistan
 Background: Doctors especially house officers are under a great deal of stress related to a variety
of occupational stressors. Occupational stressors contribute to organizational inefficiency, high
staff turnover, absenteeism due to sickness, decreased quality, and quantity of practice, increased
costs of health care, and decreased job satisfaction. One of the organizational outcomes that
affected by occupational stress is job performance. The purpose of the present study was to
investigate the effect of job stress on job performance. Methods: The universe of the study is
District Abbottabad and the complete population of house officers was targeted which were
present at that time were 55. The data obtained through questionnaire was analyzed using the
statistical methods including descriptive statistics, Spearman’s correlation and multiple regression.
Results: The analysis showed strong support for the hypothesis that there is an inverse
relationship between job stress and job performance indicating that there is high job stress in the
house officers, resulting in low job performance. Conclusion: Correct stress management should
start from improved health and good intrapersonal relationships. The prevention and management
of workplace stress requires organizational level interventions, because it is the organization that
creates the stress. Success in managing and preventing stress will depend on the culture in the
organization. A culture of openness and understanding, rather than of criticism, is essential. Those
house officers who had high level of job stress had low job performance. All the factors affected
male house officers more than the female house officers. Keywords: Occupational Stress, Job
Stress
INTRODUCTION Stress is not always negative or harmful and
The current turbulent environment in the health care indeed, the absence of stress is death.3 Stress is the
field requires doctors and organizations to re- non-specific response of the body to any demand,
examine their practices. Medicine is an inherently positive or negative, made upon it. He indicated that
stressful profession with long working hours, ethical health sector is one of the most stressful professions
dilemmas, difficult patients and conflicting demands. and pointed out the necessity of considering and
investigating occupational stress, since performance
Professionally, in true sense the doctors are on 24-
declines under stressful situations. Nowadays, quality
hour duty. Many physicians and surgeons work long,
productivity is very essential for organizational
irregular hours; over one-third of full-time physicians
worked 60 or more hours a week in 2004. The survival.4 Therefore, stress at workplace becomes a
physical and psychological demands of the concern to organization administrators.
profession often make physicians more vulnerable to Several authors attributed the lack of
high levels of stress. The effects of stress on practice progress in the area of stress research in
are evidenced as increased errors in prescribing, organizations to the fact that stress seemed to be
related to such a large number of conditions which
limited team working, more patients’ complaints and
prevented a systematic focus. 5 Beehr used a very
sickness absence.1
general definition in which ‘anything about an
Stress has been defined in different ways organizational role that produces adverse
over the years. Originally, it was conceived as consequences for the individual’ was called role
pressure from the environment, then as strain within stress. They proceeded to the conclusion that a
the person. The generally accepted definition today is condition termed role overload was viable and this
one of the interactions between the situation and the
correlated positively with job stress. 6 Stress
individual. It is the psychological and physical state
indicators related to role ambiguity in the study
that results when the resources of the individual are
not sufficient to cope with the demands and pressures indicated low motivation to work.7
of the situation. Thus, stress is more likely in some Schuler identified stress in organizations as
situations than others and in some individuals than an increasingly important concern in both
organizational research and practice. 8 An interesting
others.2
finding by Beehr was that even if there was role

http://www.ayubmed.edu.pk/JAMC/PAST/20-3/Rubina.pdf 135
 J Ayub Med Coll Abbottabad 2008;20(3)

strain, people with situational characteristics, support is seen for curvilinear or no relationship. No
especially autonomy, did not suffer as greatly from it. support is found for the positive.16
This study was based on a sample of 651 persons, Pakistan is a developing country with scarce
including 213 from service departments of a resources. In Pakistan health status is characterized by a
hospital.6 The primary sources of stress cited by high rate of population growth and inadequate health
respondents included juggling multiple roles, having facilities. The doctor population ratio is one doctor for
young children, time issues (too much work, too little 5,146 people in NWFP as compared to one doctor for
time) changing practice patterns.1 1,773 people in the rest of the country. One hospital bed
Job performance is the result of three factors for 1,514 persons is available in rest of the country and
working together: skill, effort and the nature of work one bed for 1703 persons in NWFP. This causes work
conditions. Skills include knowledge, abilities and overload on the health sector individuals particularly in
competencies the employee brings to the job; effort is urban areas, implying a high level of patient-doctor ratio
the degree of motivation the employee puts forth toward causing a lot of pressure on the doctors and the
getting the job done; and the nature of work conditions supporting staff.17
is the degree of accommodation of these conditions in
facilitating the employee’s productivity.10
MATERIAL AND METHODS
The documented consequences of stress on The present study targeted the house officers of Ayub
medical trainees include: alcohol and drug abuse, Teaching Hospital, Abbottabad. In order to make
interpersonal relationship difficulties, depression, study more reliable the complete population of house
anxiety, and suicide.10,11 Other studies have also shown officers was targeted (during that particular time
stress can be detrimental to the medical trainees’ or period there were only 55 house officers). All house
professional’s academic achievement, effectiveness in officers (55) working in 7 different departments
delivering health services by decreasing attention span, participated in the study including 24 female and 31
concentration, decision-making skills, and ability to male doctors. Out of the 55 participants, 14 (25%)
establish physician-patient relationships. 11,12 In addition were from surgical ward, 13 (24%) from
to affecting psychological and emotional well being, gynaecology, 14 (25%) from medicine, 9 (16%) from
stress can also result in a decrease in physical health, dentistry, 2 (4%) from paediatrics, 2 (4%) from
such as the development of hypertension, heart disease, dermatology, and 1 (2%) from eye ward. As the
and immune deficiency disorders.13 Quality health care target population was house officers so they had the
is an important goal of the health care system and same experience level and most of them were
practitioners performance has been shown to be closely unmarried. Their mean age was 25 years.
related to the quality of health care patients receive.14 Primary data was gathered through
A study conducted by Abu Al-Rub indicated questionnaire. Individual semi-structured interviews &
a curvilinear (U-shaped) relationship between job observations were also used to collect information about
stress and job performance; nurses who reported the job routine, in order to find out how the work
moderate levels of job stress believed that they patterns have been influenced by environmental factors.
performed their jobs less well than did those who The data obtained was analysed using SPSS
reported low or high levels of job stress.15 12.0. The statistical methods included descriptive
Jamal examined a relationship between job statistics, Spearman’s correlation and multiple
stress and job performance among managers and regressions.
blue-collar workers. Job stress is defined as
individuals’ reactions to the characteristics of the
RESULTS
work environment that appear threatening to them. Analysis of Work Stress and Job Performance The
Four types of relationships are proposed between job house officers experienced moderate level of job
stress and performance: stress. No department experienced high level of
1. curvilinear/U-shaped, stress. The overall job performance of house officers
2. negative linear, was high. About half of the population experienced
3. positive linear, and upper moderate level of stress. Some house officers
4. no relationship between the stress and performance. experienced moderate level of stress and few had
A random sample of 283 blue-collar and 227 lower level of stress. Half of the population had
managerial workers in a large eastern Canadian firm moderate performance and about half has high
are surveyed in questionnaires. Measurement is made performance. Job performance was found to be
of variables relating to job stress, job performance, higher moderate. According to the results, house
and organizational commitment. Results show a officers working in surgical and medicine wards
primarily negative linear relationship between job experienced more job stress than the house officers
stress and measures of job performance. Limited working in other wards. A possible explanation is

136 http://www.ayubmed.edu.pk/JAMC/PAST/20-3/Rubina.pdf
that house officers who work in Medical/Surgical J Ayub Med Coll Abbottabad 2008;20(3)
units are exposed to more workload and deal with
patients with a variety of diseases and problems than
house officers who work in other units, which might this correlation is significant at 0.01 level. Similarly
contribute to increase their level of job stress. lack of communication and comfort with supervisor
There are different factors that cause stress has strong negative correlation with Attitude (-0.581),
in house officers. Different factors have different Effectiveness (-0.669) and overall Performance (-
intensity level in male and female house officers. 0.532) and this correlation is significant at the
Lack of resources, work overload and lack significant level of 0.01 using two tailed test. This
of communication and comfort with supervisor and shows that all these values are highly correlated and
colleagues have contributed to increase stress in the significant.
house officers more than the other factors. Stress The data demonstrate strong support for the
factors affected the male house officers more than the hypothesis that there is an inverse relationship
female house officers. (Table-1) between job stress and job performance. This
Table-1: Means of Gender Specific Factor’s Impact negative relationship between job stress and job
Variable Overall Females Males performance (-0.718) indicates that when there is
Job Stress high job stress in the house officers, there is low job
Job Pressure 52.73 53.75 55.48 performance.
Job Description conflict 51.15 48.05 53.54 Table-3 shows model summary. The co-
Comm. & Comfort with
supervisor and colleagues 55.42 48.33 60.90 efficient of correlation is -R=0.739. The Co-efficient
Job Related Health Concerns 45.96 39.83 50.70 of Determination -R square=0.546 or 0.55 approx-
Work Overload 58.91 52.08 64.19 this statistics gives the ratio of explained variation to
Lack of resources 77.45 71.66 81.93 total variation converting the 0.55 to a percentage, it
Number of Observations 55 24 31 is concluded that approximately 55% of the
According to the matrix in Table-2, the variability of performance is accounted for by the
columns of job description conflict, communication variables in this model.
and comfort with supervisor and Job related health Table-4 presents results of regression
concerns presented strongly negative connections analysis. The regression results show that we could
with all dimensions of job performance. From the expect a decrease of 0.217 in the performance score
table, it is clear that there is strong negative for every unit increase in JHC (Job-related Health
correlation between job description conflicts with all Concerns), assuming that all other variables in the
the dimensions of performance. It has been found that model are held constant. Similarly decrease of 0.232
Job description conflict has strong negative in the performance score for every unit increase in
correlation with knowledge (-0.637), skills (-0.485), JDC (Job description conflict), assuming that all
Attitude (-0.511) and overall job performance (- other variables in the model are held constant. And
0.631) and this correlation is significant at the decrease of 0.101 in the performance score for every
significant level of 0.01 respectively using two tailed unit increase in CCS (Lack of Communication &
test. From the output, it has been found that the comfort with supervisor).
correlation coefficient between job related health In this study, relations were found to exist
concerns and all the dimensions of performance have between work stress and job performance. These
strong negative values. Job-related health concern has included job pressure, job description conflict, lack of
strong negative correlation with Knowledge (-0.421), communication and comfort with supervisor, job
Skills (0.456), Attitude (-0.616), Effectiveness (- related health concerns, work overload and lack of
0.541) and Overall job Performance (-0.625) and resources and overall job performance, which all has
negative relations. The work stress of house officers
can impact strongly and adversely on overall job
performance.

Table-2: The correlation between Work Stress and Job Performance (Spearman’s correlation)
Lack of
Job Communication Job related
Description & Comfort with Health Work Lack of Overall Job
Job Pressure Conflict Supervisor Concerns Overload Resources Stress
Knowledge -0.184 -0.637** -0.346** -0.421** -0.162 -0.370** -0.567**
Skills -0.177 -0.485** -0.353** -0.456** -0.254 -0.328** -0.553**
Attitude/Job Enthusiasm -0.283* -0.511** -0.581** -0.616** -0.315* -0.218 -0.651**
Effectiveness/Job Quality -0.460** -0.271* -0.669** -0.541** -0.392** -0.165 -0.639**
Overall Job Performance -0.267* -0.631** -0.532** -0.625** -0.317* -0.351** -0.718**
*p<0.05, **p<0.01

http://www.ayubmed.edu.pk/JAMC/PAST/20-3/Rubina.pdf 137