Stress is defined as a complex process, in which a person tends to respond towards the current environmental demands/stressors. These demands have an ability to threaten any individual involved. Stressors are said to be either environmental demands or situations eliciting response patterns from the organisms. The responses patterns can be: psychological, behavioral, cognitive, emotional, or either a combination of the listed above. The stressors evident in the real life can be death of a spouse or a divorce. Hence, stress can be described as a response mostly in an emergency case that requires one to cope with dangers of a challenging situation. Stress can be manifested by various illnesses, such as panic attacks, phobic states, anxiety, and diabetes (Rout, Rout, 2002).
How Stress Affects the Quality of Patient Care
The consequences of stress have proved to have inherent problems to individual suffering, his family, and the organization he or she is working for. Stress leads to mentally and physically bad health conditions. This can have adverse effects on the job satisfaction, absenteeism, and burnout of the medical practitioners. Stress also has negative effects on both individual and organization costs impacting the quality of the patient’s care to be delivered (Rout, Rout, 2002). Basically, stress can occur in the following three phases: alarm phase that prepares a person for an immediate action; resistant phase, which is the second stage, where a person becomes adapted to stress; and the final third stage, where a patient becomes exhausted (Rakovec, 1991).
Effects of Stress in the Health Care Industry
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According to the (Claybon, 2008) case study, burnout research of 1980s-90s tried to address the population of individuals employed in the public-oriented professions based on the public sector. This study covered doctors, nurses, teachers, social workers, and police personnel. The case study showed that these people working in the people-oriented professions used to extend tremendous amount of energy on emotional, cognitive, and physical issues, while providing their clients with the corresponding services. This has led to the implementation of Malach Burnout model and inventory (Malach & Jackson, 1981; Malach et al., 1982 & Malach and Leiter, 1997), which viewed the effects of these people’s emotional exhaustion, depersonalization, and reduction in personal commitment (Claybon et al., 2008).
Depersonalization caused by the effects of stress has led to negative and cynical responses to other workmates. This means that in such cases interpersonal communication between different healthcare practitioners becomes ineffective. This can ruin the quality care that a patient ought to obtain from a medical facility. Depersonalization forms a component of burnout affected by stress. The health care stress can also cause reduced health care practitioner’s personal accomplishment. Reduced personal accomplishment refers to the feelings that tend to decline one’s competence and ability to deliver the necessary services. This results to a medical health care provider’s self-efficacy to be lowered, having negative effects on the quality of the delivered patient care services. Reduced personal accomplishment in the burnout represents self-evaluation component of stress (Claybon et al., 2008).
The patient care quality can also be affected by general practitioner’s stress. When he or she is under stress caused in his/her work area, the performance quality of service he/she delivers reduces. This is evident in a case of a practitioner, who gets sued by a patient because of failing to offer him morphine injection, because it was unavailable. The practitioner had advised the patient to get alternative pethidine, which was also a pain killer. Her cousin insisted on morphine making the patient leave without medication. The practitioner was forwarded a letter from FHSA making him appear in court for charges. He was alleged of an unsympathetic attitude with hearing taking place the following month causing stress to him. This has made him loose concentration during the following surgery consultations. The patient care is undermined, as he takes no time to listen to the patients’ symptoms. He suffers various disturbing moments about the outcome of the case, and he finds it difficult to share his problems with other people. This shows that practitioner’s health care stress lowers the quality of patient care (Rout, Rout, 2002).
Also stress of nurses can cause job dissatisfaction. In R. Rout and K. Rout (2002), a case of a district nurse is presented, where she returns from leave. She finds a new manager, who changed her position three times in a record of three months. This frustrated her, as she felt undervalued, which in turn has caused job dissatisfaction. She suffered stress and weight loss. This is likely to be reflected in the patient’s quality care services. She is likely to deliver poor services towards patient care, since her job status does not fulfill her ego. Moreover, the workload pressure of the community psychiatric nurses presented in the same book makes them lack food appetite. On the other hand, the stress they gain makes them lose their sense of humor. This has made their social lives difficult, since some rarely get free time (Looker, 2007).
On the other hand, stresses in the Health Care Industry can have positive effects; the stress gained in this field can be used to increase the workload fervor. This encourages health care providers with an opportunity to enhance their creativity to solve their emerging issues and activities. This, in turn, can facilitate better quality patient care according to Treven (2005, p. 43). Stress can also be used positively as an individual experience. A threat that a patient experiences can be perceived by another person as a challenge and more so, as a motivation factor. This, therefore, means that stress is not an unpleasant phenomenon according to Ivanko in Stare. The positive stress results to good influence in terms of physical and mental abilities. A well-prepared patient under stress is able to recover both physically and mentally. This builds confidence in him and makes him stronger to handle and even control his stress in the easier way (Looker, 2007).
Management of Stress to Enhance Quality of Patient-Care Services
Stress has been identified as a major contributor factor in the ill-health; especially, in psychological health. Due to this reason among others, stress management intervention measures have been formulated in order to counter the stress levels. The management intervention levels have been aiming at reducing stress levels, helping employees to cope effectively with experienced stress to reduce sickness absenteeism cost. These interventions define the organizational care and concern about its employees, which boosts their morale.
The stress that is undergone by individuals on a positive note can be fully recovered. The scientific researches show that individual strategies are the most successful ones. Physical activities of meditation, relaxing, healthy life style, and time management strategies are among the most favored methods (Treven, 2005, 61).
Meditation stress management is mostly recommended by the doctors. This is because it helps the patient’s body to relax completely. This is supported by the argument that meditation helps to improve our body stage. Meditation ensures that an inner balance is attained. This, in turn, helps the patient to see the circumstances he or she is undergoing in a more optimistic way. Healthy way of living is also among the best ways of preventing stress. Healthy eating patterns and drinking enough liquids is among the most helpful ways of avoiding stress. People, who are working, are advised to take time for them, especially when drinking tea or maybe smoking. In addition, getting enough sleep reduces chances of having stress. Enough sleep allows the body to relax and to prepare for the new negative situations (Huzjak, 2009).
Time management factor can also be used as the stress reducing factor. Employees and patients should be able to cope with stress by planning enough time for what they want to do. Planning helps to avoid stress impacts by falling short on deadlines. Stress due to the time constrains can occur only in case, if one never succeeded in planning from the beginning (Trevon, 2005). Flexibility in working times allows the employees to make decisions regarding the quantity of the time required for them to accomplish a certain job. Health practitioners should not be forced to work under the deadlines in order to enhance stress-free working conditions. If they are allowed working at their own appropriate limits, they are likely to deliver quality care. This motivates them, as they are able to combine their personal interests and their health care job (Huzjak, 2009).
Psychological stress including Hospital Anxiety and Depression Scale (HADS) can also be managed using suitable skilled nurses to handle the reaction to stress in a clinical practice. This test measures the levels of anxiety, in which the patient behaves. This checks the way the patient dresses and his anxiety levels forming a base of treatment. If the patient is under pain, stressors have a potential of causing wounds healing delay. This case may be worse, if poor assessment of stress leads to the lower rates of the patient’s recovery, as compared to those, who are under nurses’ care.
Stress also has certain effects on healing of the wounds, as many studies reveal. Patients under stress and pain should be assessed and managed during the wound care processes in order to prevent patients’ discomfort (Solowiej, Dominic, 2010). Another way to manage stress is by employing the delegation of some of one’s responsibilities to someone else. This reduces one’s commitment to the jobs that can make him undergo stress (Mayo Clinic Staff, 2013).
At the organizational level, a business can help its employees by advising the ways to handle their stress using scientific strategies that control stress on the first place. Any organization has to ensure better working habits, flexible planning, better communication, formal careers progress, and good working partnership. This will ensure that the root causes of stress in an organization are taken care of. Transformation of work, as the stress management strategy, will allow employees themselves to transform their work setting towards their comfort zone preferences, while attaining health care goals. This improves the quality of patient care, as medical practitioners are able to articulate in their job setting without any stress. Health care providers, thus, feel that their work is important; thus, it improves the quality of the health care services that they are able to offer (Huzjak, 2009).
The organization can also embark on using the strategies that shape the work setting, and at the same time reduce stress among the health care practitioners. The healthcare manager should be able to unite the small tasks into the bigger ones. This will provide medical practitioners with an opportunity to acquire more genuine working habits that will raise quality of the customer care provided. Working on old connections re-establishment allows the practicing health providers to interact with their retired medical colleagues, which can enhance the stress management. Sharing of experiences with people from the same field provides challenges and efforts, which leads to the increased quality of the provided health care services.
Planning and development of the career programs in the healthcare sector should be implemented in order to prevent the arousal of the stressful events. All healthcare providers wish to be promoted in order for them to gain self-accomplishment and personal growth. The health care manager should listen to the ideas provided by the workforce, which will allow employees to compete with themselves and at the same time increase the organization’s productivity. Forcing an employee to perform duties, which he or she is not interested in, increases his chances of stress (Huzjak, 2009).
Organizational Theory and Supporting Evidence in the Day-to-Day Operations of a Health Care Facility
An organization can be defined as a system that divides labor with each member, designed to perform certain specialized activity that is coordinated with other specialist activities (Mott, 1965, p. 14). It can also be defined as the shape that the energy takes, when human beings make up enterprises that blend their collective skills (Johansen, Swigart, 1994, p. 13). According to the two definitions, they highlight the importance of a common collective goal, which acts as a motivating factor in an organization.
The history of the organizational theory is said to be stimulated by the industrial revolution. This started from a single craftsman, who offered to other workers to operate together in order to enhance mass production. Mass production was first studied in 1776 in a pin factory, as written by Adam Smith (1995). Smith through this observation formulated division of labor and explained this factor as wealth of the nations. Division of labor based on specialization increases productivity. This concept of labor division formed a powerful administrative approach, which reduced costs, while increased productivity. This enhanced profit maximization.
The study of organizational behavior in health care is mandatory, because the largest industry in the United States is health care employing 13 million people and having had a projected growth of 25% in 2010. This growth is said to be 9% more than that of all other industries combined (Bureau of Labor Statistics, 2004). The healthcare industry is composed of the highly skilled licensed professionals and those on the job training, both in profit and nonprofit-making entities. This makes modern managers to acquire organizational behavior skills that will ensure that they communicate to their subjects in an effective manner, motivate them, and are capable of leading large diverse groups of people in a large, dynamic, and complex industry in general. Organizational behavior in healthcare enables management to understand workplace problems, such as low performance, employees’ turnover, conflict measures, and stress management methods. This enables them to be able to escape unnecessary negative outcomes that may affect the quality of the provided health care services (Borkowski, 2005).
The organizational theory in a classical modified organization may be obtained from Henri Fayol. Fayol (1841-1925), formulated 14 principles that have been adopted by management for an organization in order to operate in an effective manner. These principles bring a real sense of practical realism.
Henri Fayol in the classical organizational theory stated that there should be division of work in an organization; he insisted that specialization can contribute to the higher accuracy of output. In reference to the health care services, repetition of nursing practices enhances speed and accuracy. This can raise the quality of patient care, if well adopted. Work division according to skills and technical expertise enhances the quality of services in the patient care. The principle of work division was formulated. The essence of authority is termed as the right to give orders and powers to exact obedience. Fayol suggested that authority must be accompanied with responsibility. This principle in the healthcare is applicable in case, where the major decisions are made by the senior medical personnel to their subordinates. If this is followed, the quality of patient care will increase. This is because the juniors will follow already laid procedures towards patient care. This increases judgment efficiency in the health care industry. He concluded that responsibility is feared as much as people seek authority after. The fear of authority in the health care can destroy the patient quality service provided (Fayol, 1949).
Henri Fayol had also introduced the discipline principle. This is defined as obedience that exists in the health care. It can also be termed to be an outward mark for respect, which is required at the health care providing industry for quality patient care. Good discipline can be attributed to a good leadership. He also introduced the principle of unity of command to be adopted in the organizations. Fayol emphasized the fact that employees should receive orders from one supervisor. In the health care facilities, junior practitioners should be subjected to one superior order. This, in turn, will improve the services of patient care. If this principle is violated, then the health authority is undermined, discipline is jeopardized, and order is disturbed, threatening the entire stability of the health care facility or organization. Dual command should not exist in health care, as it can bring confusion. The uncertainty subjected to the junior practitioners can cause hesitation between subordinates and managers. This can undermine the quality of the patient care, which is deemed to be delivered. Conflicts in an organization can cause inefficiency and tension among the team members; thus, should be avoided (Fayol, 1949).
Unity of direction principle was introduced by Fayol to guide the entire organization. Heath care providers should ensure that the organization is run by one head. Moreover, there should be a guiding plan for the group having the same objectives. Despite the health practitioners working in the different fields and places, they should work towards a common interest. He further emphasized the importance of subordination of an individual interest to the general interest of the firm. In the health care, there should be no conflict of interests between individual goals and patient heath care goals and the entire organization’s wellbeing. Firm leaders in the health care ought to be elected to always supervise the subordinates. These leaders should lead by example (Fayol, 1949).
Remuneration is a principle that was advocated by Fayol as a method of paying employees, which was meant to be contentious. The heath care should adopt this method of remuneration, as it allows fairness. Remuneration encourages keenness by rewarding well-directed efforts. The fair remuneration limits in the health care should not exceed reasonable rates. The principle of scalar chain has also been formulated. It’s also referred to as the principle of authority line. This principle holds that the hierarchy existing in an organization should be communicated through their respective heads. This implies that the department communications should come through their heads. He commanded the authority to be branched according to the hierarchy level in order to enhance better management. Centralization principle insists on the natural order. Centralization in the health care should exist in order for the subordinates to acquire general solid laid power authority structure, which will then be translated to better patient care (Fayol, 1949).
Order principle formulated advocates for all structures needed to be in their respective places. This was in the reference that good managerial activities have to be accountable. In this sense, good organization and selection of both workforce and equipment should be able to balance the organization’s requirements at the best optimum cost. When adopted in the patient care, quality services are to be delivered, as every unit of personnel is assigned with his duties and responsibilities. The principle of equity in the health care system should be enhanced for the quality services to be obtained. Equity principle advocates for all employees to be treated in an equal and fair manner. Fair treatment of all employees reduces biases that would otherwise ruin the quality of care provided to the patients. Stability of tenure principle in the healthcare ought to be enhanced in order to promote quality patient care. When health care practitioner’s job is secured, the research indicates that workers tend to be more productive. Hence, the health care industry should embark on stability of tenure for its personnel (Fayol, 1949).
Initiative principle can be used in the health care industry in order to allow the stakeholders to think about the arising issues and to formulate a solution for them. This will increase motivation rates of raising the quality standards of the patient care. Health care managers ought to be cautious to act against personal vanity, which discourages opportunities for subordinates, which may have negative effects on the quality of patient care delivered. The spirit of team work, ‘esprit de corps’ principle forms the overall principle. If health care adopts this principle, the quality services are likely to be delivered. Also the productivity increases as teamwork is enhanced (Fayol, 1949).
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