OCCUPATIONAL STRESS: A COMPARATIVE

STUDY AMONG DOCTORS OF HOSPITALS OF

HARYANA

A Research Proposal

By
Jaiwati
Roll No.

Submitted To
Faculty of Commerce and Management
Bhagat Phool Singh Mahila Vishvawidhalya
Khanpur Kalan, Sonipat

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INTRODUCTION

Stress rarely occurs in isolation or to one individual. When someone begins to feel
stressed, there is a ripple effect spreading out from him. Stress is likely to create problems
within the organization, which will have the direct or indirect effect on the bottom line. The
most obvious impact can be loss of business, may be because of poor service or poor quality.
The operating costs certainly rise because of lower productivity, incorrect or random work
and mistakes. The employer needs to pay attention on stress factors at the workplace (Yemn
and Graham, 2007). When an employee of the organization experiences depression both at
home and office, it will affect the human relationships with co-workers, work productivity
and personal health (William, 2007). Balancing of work and life through time management is
highly essential to reduce stress (Leslie, 2007). It may be noted in addition to cost and benefit
earnings, stress is an additional burden for humanity. Moral distress affects work performance
of the staff (Broadmore and Ian, 2006). A good work life balance is important. The gap
between work life balance leads to greater pressure and stress (Hanna and Romana, 2007).
Stress therefore, is a dynamic condition in which an individual is confronted with an
opportunity, constraint or demand related to what the individual desires and for which the
outcome is perceived to be both uncertain and important.
Stress in the workplace is a growing problem, with extensive costs to individuals,
Organizations and society. A national Survey conducted in the USA indicated that the
proportion of workers who reported feeling highly stressed had more than doubled between
1985 and 1990 (Spiel Berger & Reheiser, 1994). In Britain, a national survey conducted by
the Policy Studies Institute (1993) noted that almost one-third of respondents reported
significant levels of stress as a result of their work, and more than half felt that their levels of
stress had increased over the last five years.
The financial costs of occupational stress to business and industry are well
documented. It has been estimated by the Health and Safety Executive that at least half of all
absences from work are, in some manner, stress related (Cooper & Cartwright, 1994). A
recent report published by the Institute of Management (1996) estimated that 270,000 people
in Britain take time off work every day because of work-related stress; this represents a
cumulative cost in terms of sick pay, lost production and NHS charges of around £7 billion
annually.

Impact of Occupational Stress

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 To some degree stress is an unavoidable characteristic of life and work and, as such, is
neither inherently bad nor necessarily destructive. There is, however, a clear difference
between being ‘under pressure’ at work and being subjected to the kind of chronic stress that
is potentially damaging to physical and psychological well-being.
Workplace stress can have a wide-ranging and negative impact on the well-being of
the individual and his or her day-to-day functioning. This is observable at a physical level
(e.g. exhaustion, headaches, high blood pressure), a psychological level (e.g. depression,
anxiety, low self-esteem), a cognitive level (e.g. absent-mindedness, failure of attention and
memory), and a behavioural level (e.g. absenteeism, substance abuse, aggressive behavior).
Occupational stress is now considered to be amongst the top five work-related health
problems in the USA (Blix, Cruise, Mitchell & Blix, 1994). In the UK, a recent survey of
workplace health and safety representatives by the Trades Union Congress (TUC, 1996) has
named overwork and stress the primary workplace hazard.

The nature of work is changing. Many organizations are experiencing radical

transformations as a result of the need to realign their strategies and structures in response to
the rapidly changing environmental and commercial pressures of the 1990s.
The individuals who work for these organizations are now commonly thought to be
facing highly demanding and rapidly changing work environments that challenge both
competency and established behavioral repertoires. Studies on occupational stress have
concluded that a faster pace of work, a general intensification of work effort and an increased
rate of change are all major contributory factors to the new stress ‘epidemic’.
The 1993 Health survey for England found that the respondents with a faster pace of
work were likely to suffer from higher levels of occupational stress than those with a slower
pace (DoH, 1993).
Stress has now become an area of concern for all types of occupation. There is little
doubt, however, that some professions have fared worse than others. It has long been argued
that workers involved in high levels of personal interaction, such as nurses and teachers, are
more vulnerable to occupational stress and professional ‘burnout’ than those in product-
oriented organizations. This belief has been strongly supported by several recent studies. For
example, the survey conducted by the TUC in 1996 concluded that people working in the
voluntary sector, and in education, constituted occupational groups most affected by
occupational stress. Eighty-nine per cent and 80 per cent respectively of respondents from
those sectors cited overwork and stress as the main area of concern in their workplaces.

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Studies of the teaching profession, in particular, commonly reveal high levels of stress which
often manifest themselves as exhaustion, anxiety, depression, irritability and increased levels
of stress-related illness. Travers & Cooper (1991) found teachers to be in significantly poorer
mental health in comparison with other highly stressed occupational groups.

Stress is the emotional and physical strain caused by our response to pressure from the
outside world. Common stress reactions include tension, irritability, inability to concentrate,
and a variety of physical symptoms that include headache and a fast heartbeat.

It's almost impossible to live without some stress. And most of us wouldn't want to,
because it gives life some spice and excitement. But if stress gets out of control, it may harm
your health, your relationships, and your enjoyment of life.

Managing stress involves learning about:

 How stress affects the mind and body?

 How to identify the warning signs of stress?
 How to develop good stress-management techniques?
 When to seek professional help?

Symbols of Stress

Stress can cause both mental and physical symptoms. The effects of stress are
different for different people.

The mental symptoms of stress include:

 Tension
 Irritability
 Inability to concentrate
 Feeling excessively tired
 Trouble sleeping

The physical symptoms of stress include:

 Dry mouth
 A pounding heart

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  Difficulty breathing
 Stomach upset
 Frequent urination
 Sweating palms
 Tight muscles that may cause pain and trembling

Stress Management- Stress management is one of the offshoot tools of the

management to reduce stress associated with the business and working environment. The
stress management program will help to reduce the stress and cerate job effectiveness in
service sectors. Work managers without stress management skills may experience feeling of
being let down, unable to cope with the additional stress suffer loss of confidence and self-
esteem and a sense of failure. A positive mood leads to increased risk taking tendency
conservative and self protective in choice tasks (Spiers and Carole, 2006). The majority of
employers have noticed an increase in stress related absence are identified as workload,
management style, relationships at work, organizational change, pressure to meet targets,
poor time management and improper work life balance. Time management plays a significant
role in achieving the right balance, which is different for everyone (Business News Update
2005; and Ben Wilmot, 2004). Stress management studies will identify factors that induce
stress and the measures to be initiated to reduce it.

Main factors that create stress among doctors

 Long hours of work
 Non-regular sleeping/working hours
 Time pressure
 High patient volume, expectations & work targets
 Job dissatisfaction
 Handling of critical patients
 Job repetition and Job dissatisfaction
 Seniors pressures on junior doctors and residents
 External and political interference
 Lack of facilities
 Excessive time away from home and family.
 Results of stress among doctors

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  Anxiety
 High turnover rate
 Work related illness
 Low morale
 Reduce patient satisfaction
 Decrease productivity

REVIEW OF LITERATURE
This section contains an exhaustive review of the existing literature available on the
subject. The studies have been presented in chronological order so that the latest studies are
presented first followed by the subsequent studies. Research gaps have been identified and a
case for the present study has been built in the end.
Farbep (1983) suggested that work-related stress should be conceptualized and
stqdied as5a multifaceted problem involving personal characteristics of the individual,
situational factors, and the opganizational and cultural context in ghich such spress occurs.
He had identified number personal characteristics associated with a. indibidual’s beihg
particularly vulnerable to high levels of stress, which were being too idealistic, septing
unrealistic goals for self and clients, over-identifying with others, high need for self-
affirmation, and high work orientation.
Pareek (1983) concluded that effective coping strategies were ‘ approach’ strategies;
to confront the problem of stress as a challenge and to enhance the capability of dealing with
it and the ineffective and unpleasant strategies are avoidance or escape strategies. According
to his study social support moderates the negative effects of stress on personal wellbeing. He
further suggested that organizational stress could best be managed by creating a person- work
environment fit.
Mason (1984) tired to found out stress problem with the executive while they are at
job. According to his study we were all born with a primitive survival mechanism called the
“Flight/fight Response.” This ancient survival response has been inherited from billions of
years of evolution. 5,000 years ago, if a man was confronted by a threat, he could either run
away or stand his ground and physically fight against his attacker. His body would
automatically prepare for the action required to survive. His heart beat would increase, his
blood pressure would go up, his breathing would become more rapid, muscles would tense to
prepare for the fight or to flee, his hands would get cool and clammy, digestion and libido

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would be reduced, and the primitive brain would take over reducing his ability to think
clearly, instead making him more reactive to his fear or anger. These “hard-wired” responses
that are triggered when we are threatened. The threats today are usually not as life
threatening as 5,000 years ago but our sub-conscious perceptions believed that an upset client
or a poor contract negotiation are as serious as a life and death confrontation. We only have
one way to respond to the stress of change. Even if the change was a positive experience our
body responds in part, if not all, the “Flight/Fight Response.”
Repetti (1987): His research suggested that a supportive social environment at work
might be associated with higher self-esteem in employees and the reporting of fewer anxious
and depressive symptoms. In particular, a supportive supervisor may buffer or compensate for
negative work conditions. According to him employees in a stressful work situation were less
likely to report negative mental health indicators (depression, anxiety) if they perceived
themselves to have a supportive supervisor.
Theorell (1990): According to his study researches had linked job strain with higher
rates of heart disease and other physical ailments and had explored the psychological effects
of working long hours or being disenchanted with a job. According to him one specific
physical problem associated with job strain is hypertension. Hypertension was considered as
the world’s number one disease, with an estimated 500 million people worldwide currently
afflicted. In the United States, 50 million people were having high blood pressure and
estimates are that another 50 million are on their way to acquiring the condition. Ironically, in
95% of hypertensive cases the cause was unknown (American Heart Association). While
estimates of proportion to heart disease, possibly due to job stresses are great. He had
calculated that nearly a quarter of all heart disease could be prevented if we reduced the
levels of job strain.
Williams (1997): He demonstrated that certain psychosocial factors known to predict
increased risk of cardiovascular disease were higher among women who reported higher
levels of job stress. In his study, he measured the job stress and psychosocial risk factors (i.e.
depression and anxiety) from 152 female employees. The results showed that perceptions of
low 'control' in women were correlated with increased levels of anxiety, anger and depression,
reduced levels of social support and a preponderance of negative feelings, compared with
positive feelings in working with colleagues and supervisors. Using a canonical correlation,
Williams found that 70% of the women were depressed; 70% were anxious; and 83%
reported low decision capabilities.

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 Moniz (1999): According to Moniz the major sources of stress were family,
relationships, inflexible work environment, chemical and nutrition's (Caffeine, Bursts of
sugar from sweets or chocolate, too much salt), lack job security, role ambiguity, conflicting
demands, excessive job requirements, Fatigue and Overwork, Stress due to Change,
Internally Generated Stress, Survival Stress. According to him family is a system, which is
created by sub system. When one system is in problem then it will affect other system
because each system is related to each other.
Bunker, Colquhoun (2003): An Expert Working Group of the National Heart
Foundation of Australia under took a review of systematic reviews of the evidence relating to
major psychosocial risk factors to assess whether there were independent associations
between any of the factors and the development and progression of coronary heart disease
(CHD), or the occurrence of acute cardiac events. The expert group concluded that (i) there
was strong and consistent evidence of an independent causal association between depression,
social isolation and lack of quality social support and the causes and prognosis of CHD; and
(ii) there was strong or consistent evidence for a causal association between chronic life
events, work-related stressors (job control, demands and strain), Type A behaviour patterns,
hostility, anxiety disorders or panic disorders and CHD.

NEED FOR THE STUDY

With the help of present study we will be able to understand and evaluate the causes
of stress among different levels of doctors and will be able to find out the effective strategies
of stress management.

RESEARCH OBJECTIVES

1. To understand and evaluate the causes of stress.

2. To understand and evaluate the stress at different levels of doctors.
3. To find out the effective strategies of stress management.

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RESEARCH METHODOLOGY
This part discusses the research design, defines the population, the sample size and
sampling techniques, the instruments for the data collection, validation, data collection
procedure and data analysis procedures.

APPROACH/METHODS
The research will examine the impact of occupational stress among doctors .
Secondary data from books, articles, internet, and newspapers will be consulted to get the
meaning of satisfaction and perception. Findings will be compared with the results of this
research after which recommendations will be offered.
With this research, the researcher will interview the hospital administrators, doctors,
nurses, patients to gather information on satisfaction, patient’s perception and care, and the
level of awareness of the availability of services, problems preventing better performance etc.

RESEARCH DESIGN
This study is essentially a comparative study, which compares the occupational stress
among different levels of doctor’s and between male and female doctor’s working at the same
level.

POPULATION
The respondents will be the doctor’s working in various departments of PGIMS
Rohtak.

SAMPLING PROCEDURE/TECHNIQUE

Random Sampling
A random sample is obtained by using methods such as random numbers, which can
be generated from calculators, computers, or tables. In random sampling, the basic
requirement is that for a sample of a size n, all possible sample of this size must have an
equal chance of being selected from the population.
The correct method of obtaining a random sample include
1 Systematic sampling
2 Stratified sampling
3 Cluster sampling
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Systematic sampling
A systematic sampling is a sample obtained by numbering each element in the
population and then selecting every third or fifth or tenth, etc., number from the population to
be included in the sample. This is done after the first number is selected at random.

Stratafied sampling
A stratafied sample is a sample obtained by dividing the population into subgroups,
called strata, according to various homogeneous characteristics and then selecting members
from each stratum for the sample. For example if one were conducting a poll designed to
assess opinions on a certain issue, it might be advisable to subdivide the population into
groups.

Cluster sampling
A cluster sampling is a sample obtained by selecting a pre-existing or natural group,
called a cluster for the sample.
Stratified Sampling was used in the collection of the data from the hospital for this study. The
entire hospital was divided into strata consisting of the directorates. Each directorate was
subdivided into groups of Senior residents, PG students, Professors, Assistance Professors etc
Within each group a random selection will be done to select those we interview.
The researcher choice of this method will be informed by the uniform nature of the
population. This method also gives each member of the population (subdivision) equal
chance of being selected, thus making the final result truly representative of the entire
population.

INSTRUMENTS
As a social research, the researcher will use the following instruments:
Observation
Questionnaires

OBSERVATION
The researcher will personally observe the doctors and their interaction with patients.
The researcher will also observe the environment of the hospital. In this effort, the researcher

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will be able to develop a mental picture of the entire set-up that enabled me to interpret
correctly the responses of the population.

QUESTIONNAIRES
Senior residents and PG students will be given Questionnaires to answer. This will
be decided because of their busy schedule. This will afford them the chance to answer the
questions at their own convenient time.

DATA ANALYSIS
The data collected will be analysed with the use of appropriate statistical tool.

PROPOSED CHAPTER SCHEME

The study will be confined to the following chapters:
Introduction objective of research & review of literature: This part of the study
will includes the understanding of the concept Occupational stress among doctor’s . This part
also includes review of literature & objective of research.
Research methodology: In this part of the study the methods for the data collection,
sampling, sample size survey & survey area, shall be defined.
Data analysis & implication of research: In this part includes the appropriate tools
to analyse the data & solve the study problem.
Findings, suggestions & recommendations: This part will include conclusion &
suggestions of the study. The conclusion based on the collected data &inferences, which will
be drawn from such information. The suggestion will explain the inferences to guide the
performance assessment of health delivery services in haryana.
Bibliography & Appendices: This part includes the quoted references of articles
published in Journals & periodicals, news papers, websites, research report, books etc.

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References
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accident and emergency medicine: a national survey of levels of stress at work. Emerg
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3. Lindeman S, Laara E, Hakko H, Lonnqvist J. A systematic review on gender- specific
suicidal mortality in medical doctors. Br J Psychiatry 1996; 168: 274-9.
4. Murray RM. Alcoholism amongst male doctors in Scotland. Lancet 1976; 729-33.
5. Caplan RP. Stress, anxiety, and depression in hospital consultants, general
practitioners, and senior health service managers. BMJ 1994; 309: 1261-3.
6. Firth-Cozens J. Emotional distress in junior house officers. BMJ 1987; 295: 533-6.
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