Hi I would like you to write me 2 pages reflection paper on stress management. My class called Engineering organization development, and I'm in the third module called " Organization ". In this module

J Ay ub Med Coll Abbottabad 2008 ;20( 3) http://www.ayubmed.edu.pk/JAMC /PAST/20 -3/Rubina.pdf 135 OCCUPATIONAL STRESS AND ITS EFFECT ON JO B PERFORMANCE A CASE STUDY OF MEDI CAL HOUSE OFFICERS O F DISTRICT ABBOTTABAD Rubina Kazmi , Shehla Amjad , De lawar Khan * Department of Management Scien ces , COMSAT S Institute of Information Tech nology, Abbottabad , *Depar tment of Forensic Medicine, Ay ub Medical College, Abbottabad , Pakistan Background: Doctors especially house offic ers are under a great deal of stress related to a variety of occupational stressors. Occ upational stressors contribute to organizational ineffi ciency, high staff turnover, absenteeism du e to sickness, decreased quality, and quantity of practice, inc reased costs of health care, and decr eased job satisfaction. One of th e organizational outcomes that affected by occupational stres s is job performance . The purpose of the present s tudy 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 o fficers was targeted which were present at that time were 55 . The data obtained through que stionnaire was analyzed using the statistical methods including descriptive statistics, Spearman’s correlation and multiple regr ession. Results: The analysis showed strong sup port for the hypothesis that t here is an inverse relationship between job stress and job performance indicatin g that there is high job stres s in the house officers, resulting in lo w job performance. Conclusion: Correct stress management shou ld start from improved health and good intrapersonal relationsh ips. The prevention and manageme nt of workplace stress requires o rganizational level interventi ons, because it is the organiz ation that creates the stress. Success in managing and preventing stres s will depend on the culture i n the organization. A culture of openness and understanding, r ather than of criticism, is es sential. Those house officers who had high le vel of job stress had low job performance . All the factors affected male house officers more than the female house officers. Keywords: Occupational S tress, Job Stress INTRODUCTION The current turbulent environm ent in the health care field requires doctors and org anizations to re - examine their practices. Medicine is an inherently stressful profession with long working hours, ethical dilemmas, difficult patients and conflicting dema nds. Professionally, in true sense the doctors are on 24 - hour duty. Many physicians and surgeons work long, irregular hours; over one -third of full -time physicians worked 60 or more hours a week in 2004. The physical and psych ological demands of the profession often make physicia ns more vulnerable to high levels of stress. The eff ects of stress on practice are evidenced as increased err ors in prescribing, limited team working, more pat ients’ complaints and sickness absence. 1 Stress has been defined in dif ferent ways over the years. Originally, it was conceived as pressure from the environment, then as strain within the person. The generally acce pted definition today is one of the interactions betwee n the situation and the indi vidual. It is the psychologica l and physical state that results when the resource s of the individual are not sufficient to cope with th e demands and pressures of the situation. Thus, stress is more likely in some situations than others and in some individu als than others. 2 Stress is not always negative or harmf ul and indeed, the absence of stress is death. 3 Stress is the non -specific response of the body to any d emand, positive or negative, made upo n it. He indicated that health sector is one of the mo st s tressful professions and pointed out the necessity of c onsidering and investigating occupational str ess, since performance declines under stressful situa tions. Nowadays, quality productivity is very essent ial for organizational survival. 4 Therefore, stress at workplace becomes a concern to organization admini strators. Several authors attributed the lack of progress in the area of stress research in organizations to the fact that stress seemed to be related to such a large number of conditions which prevent ed a systematic focus. 5 Beehr used a very general definition in which ‘anything about an organizational role that produ ces adverse consequences for the individua l’ was called role stress. They proceeded to the conclusion that a condition termed role overlo ad was viable and this correlated positively with job stress. 6 Stress indicators related to role amb iguity in the study indicated low motivation to wo rk.7 Schuler identified stress in o rganizations as an increasingly important conc ern in both organization al research and practice. 8 An interesting finding by Beehr was that even if there was role J Ay ub Med Coll Abbottabad 2008 ;20( 3) http://www.ayubmed.edu.pk/JAMC /PAST/20 -3/Rubina.pdf 136 strain, people with situationa l characteristics, especially autonomy, did not s uffer as greatly from it. This study was based on a samp le of 651 persons, including 2 13 from service departments of a hospital. 6 The primary sources of stress cited by respondents included juggling multiple roles, having young children, time issues (t oo much work, too little time) changing practice patter ns. 1 Job performance is the result of three factors working together: skill, effor t and the nature of work conditions. Skills include kno wledge, abilities and competencies the employee brin gs to the job; effort is the degree of motivation the e mployee puts forth toward getting the job done; and the nature of work condit ions is the degree of accommodation of these conditions in facilitat ing the employee’s productivit y.10 The documented consequences of stress on medical trainees include: alco hol and drug abuse, interpersonal relationship dif ficulties, depression, anxiety, and suicide .10,11 Other studies have also shown stress can be detrimental to t he medical trainees ’ or prof essional ’s academic achievement, effectiveness in delivering health services by decreasing attention span, concentratio n, decision -making skills, and ability to establish physician -patient relationships .11,12 In addition to affecting psychological and emotional well being, stress can also result in a de crease in physical health, such as the development of hyp ertension, hea rt disease, and immune deficiency disorder s.13 Quality health care is an important goal of the he alth care system and practitioners performance has been shown to be closely related to the quality of health care patients receiv e.14 A study conducted by Abu Al -Rub indicated a curvilinear (U -shaped) relationship between j ob stress and job performance; nu rses who reported moderate levels of job stress believed that they performed their jobs less well than did those who reported low or high levels of job stress .15 Jamal examined a relationship between job stress and job performance amo ng managers and blue -collar workers. Job stress is defined as individuals ’ reactions to the characterist ics of the work environment that appear t hreatening to them. Four types of r elationships are proposed betw een job stress and performance: 1. curvilinear/U -shaped, 2. negative linear, 3. positive linear, and 4. no relationship between the stress and performance . A random sample of 283 blue -collar and 227 managerial workers in a large east ern Canadian firm are surveyed in questionnaires . Measurement is made of variables relating to job s tress, job performance, and organizational commitment. Results show a primarily negative linear rela tionship between job stress and measures of job per forma nce. Limited support is seen for curvilinea r or no relationship. No support is found for the posit ive. 16 Pakistan is a developing count ry with scarce resources. In Pakistan health status is characterized by a high rate of population grow th and inadequate h ealth facilities. The doctor population ratio is one doctor for 5,146 people in NWFP as compar ed to one doctor for 1,773 people in the rest of th e country. One hospital bed for 1,514 persons is avail able in rest of the country and one bed for 1703 persons in NWFP. This causes work overload on the health se ctor individuals particularly in urban areas, i mplying a high level of patient -doctor ratio causing a lot of pressure on the doctors and the supporting sta ff.17 MATERIAL AND METHODS The present study targe ted the house officers of Ayub Teaching Hospital, Abbottabad. In order to make study more reliable the comple te population of house officers was targeted (during that particular time period there were only 55 hous e officers ). All house officers (55) workin g in 7 different departments participated in the study incl uding 24 female and 31 male doctors. Out of the 55 participants, 14 (25 %) were from surgical ward, 13 (2 4%) from gyn aecology, 14 (25 %) from medicine, 9 (16 %) from dentistry, 2 (4%) from paed iatric s, 2 (4 %) from dermatology, and 1 (2%) from eye ward. As the target population was house of ficers so they had the same experience level and most of them were unmarrie d. Their mean age was 25 years . Primary data was gathered thro ugh questionnaire. Individual semi -structured interviews & observations were also used to collect information about the job routine, in order to f ind out how the work patterns have been infl uenced by environmental factor s. The data obtained w as analy sed using SPSS 12.0. The st atistical methods included des criptive statistics, Spearman’s correlation and multiple regressions . RESULTS Analysis of Work Stress and Jo b Performance The house officers experienced moderate level of job stress. No department experien ced high level of str ess. The overall job performan ce of house officers was high. About half of the po pulation experienced upper moderate level of stress . Some house officers experienced moderate level of stress and few had lower level of stress. Half of the population had mod erate performance and about ha lf has high performance. Job performance w as found to be higher moderate. According to the results, house officers working in surgical a nd medicine wards experienced more job stress th an the house officers working in other war ds. A possible explanation is J Ay ub Med Coll Abbottabad 2008 ;20( 3) http://www.ayubmed.edu.pk/JAMC /PAST/20 -3/Rubina.pdf 137 that house officers who work i n Medical/Surgical units are exposed to more work load and deal with patients with a variety of dis eases and problems than house officers who work in oth er units, which might contribute to increase their level of job stress. There a re different factors that caus e stress in house officers. Different f actors have different intensity level in male and fe male house officers . Lack of resources, work overlo ad and lack of communication and comfort w ith sup ervisor and colleagues have contributed to increase stress in the house officers more than the o ther factors. Stress factors affected the male hous e officers more than the female house officers. (Table -1) Table -1: Means of Gender Specific Factor’s Impact Variable Overall Females Males Job Stress Job Pressure 52.73 53.75 55.48 Job Description conflict 51.15 48.05 53.54 Comm. & Comfort with supervisor and colleagues 55.42 48.33 60.90 Job Related Health Concerns 45.96 39.83 50.70 Work Overload 58.91 52.08 64.19 Lack of resources 77.45 71.66 81.93 Number of Observations 55 24 31 According to the matrix in Tab le-2, the columns of job description con flict, communication and comfort with supervisor an d Job related health concerns presented strongly ne gative connections with all dimensions of job per formance. From the table, it is clear that there is strong negative correlation between job descri ption conflicts with all the dimensions of performance. It has been found that Job description conflict has s trong negative correlation with knowledge (-0.637), skills ( -0.485), Attitude ( -0.511) and overall job perform ance (-0.631) and this correlation is significant at the significant level of 0.01 resp ectively using two tailed test. From the output, it has been foun d that the correlation coefficient betwee n job related health concerns and all the dimension s of performance have strong negative values. Job -related health concern has strong negative correlation wi th Knowledge ( -0.421), Ski l l s (0. 456), At ti t ude ( -0.616), E ffe ct i ven ess (-0.541) and Overall job Perform ance ( -0.625) and this correlation is significant at 0.01 level. Similarly lack of communication and comf ort with supervisor has strong negative correlation with Attitude (-0.581), Effectiveness ( -0.669) and o verall Performance ( -0.532) and this correlation is significant at the significant level of 0.01 using two tailed test. This shows that all these valu es are highly correlated and signific ant. The data demonstrate strong su pport for the hypothesis that ther e is an inverse relationship between job stress and job per formance. This negative relationship between job stress and job performance (-0.718 ) indicates that when there is high job stress in the house o fficers, there is low job performance. Table -3 shows model summary. The co - efficient of correlation is -R=0.739. The Co -efficient of Determination -R square= 0.546 or 0.55 approx - this statistics gives the rati o of explained variation to total variation converting the 0.55 to a perce ntage, it is concluded th at approximately 55% of the variability of performance is accounted for by the variables in this model. Table -4 presents results of regressi on analysis. The regression resul ts show that we could expect a decrease of 0.217 in the performance score for every unit increase in JHC (Job -related Health Concerns), assuming that all o ther variables in the model are held constant. Simil arly decrease of 0.232 in the performance score for e very unit increase in JDC (Job description conflict) , assuming that all other v ariables in the model are held constant. And decrease of 0.101 in the perfo rmance score for every unit increase in CCS (Lack of Communication & comfort with supervisor). In this study, relations were found to exist between work stress and job pe rformance. These included job pressure, job des cription conflict, lack of communication and comfort with supervisor, job related health concerns, work overload and lack of resources and overall job perf ormance, which all has negative relations. The work s tress of hou se officers can impact strongly and advers ely on overall job performance. Table -2: The correlation between Work Stress and Job Performance (Spearman ’s correlation) Job Pressure Job Description Conflict Lack of Communication & Comfort with Supervisor Job related Health Concerns Work Overload Lack of Resources Overall Job 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 J Ay ub Med Coll Abbottabad 2008 ;20( 3) http://www.ayubmed.edu.pk/JAMC /PAST/20 -3/Rubina.pdf 138 Table -3: Model Summary R R Square Adjusted R Square Std. Error of the Estimate 0.739 0.546 0.519 6.61150 Predictors: (Constant), CCS, J DC, JHC Table -4: Coefficients Non - standardized Coefficients Standardized Coefficients t p-value B Std. Error Beta (Constant) 98.87 8 3.656 27.044 0 Job related health concerns -0.217 0.082 -0.308 -2.665 0.010 Job description conflict -0.234 0.065 -0.402 -3.629 0.001 Lack of Communication & comfort with supervisor -0.101 0.057 -0.199 -1.750 0.046 Dependent Variable: Performanc e DI SCUSSION The principle purpose of the s tudy was to investigate the Stress Performance relatio nship. The literature reinforced the need for the pr esent study by indicating that medicine is on e of the highest stressful professions and by showing the lack of consistency of findings regarding the impa ct of job stress on job performance. The data demonstrates strong s upport for the hypothesis that there is an inverse relationship between job stress and job per formance. Our results agree with those of the studie s conducted by Jamal and Hsiow -Lin g showing the inverse stress performance relationship. 16–18 Lack of resources, work overlo ad and lack of communication and comfort w ith supervisor and colleagues have contributed to increase stress in the house officers mor e than the other factors. All the factors affected male house of ficers more than the female house officers. Reason being this that Surgical and Medicine units are more st ressful than the rest of the units, and most of the mal e house officers are working in those departments. The major stress factors in male house officers were lack of resources, work overload and lack of comm unication and comfort with supervisors and c olleagues. Lack of resources was the factor obser ved in all the departments. Female house officers do not experience much stress compare to males a s they have support from their supervisors and col leagues. So the support from supervisor and colleagues is the major factor to reduce the stress level and ma ke an individual to perform at his/her be st. A possible explanation is that employees usually look up to t heir supervisors and if they do receive their support, they might feel that their work is appreciated and become more secure in regard to their job which migh t decrease their stress level. CONCLUSION The results of the study indic ate that there is a negative relationship between job stress and job performance. Those house offic ers who had high level of job stress had low jo b performance. All the factors affected male house officers more than the female house officers . RECOMMENDATIONS Based on the major findings, t he following recommendations are provided. Since the stress from lack of communication and comf ort with supervisor, job description conflict and j ob related health concerns is highe st for house officers, hospita l administration should pay atte ntion to solve these issues. Lack of resources incl udes inadequate staff, lack of equipment/machinery an d medicines. So it must be advocated by the head of the unit, not only for the benefit of house officers but their patie nts as well. Performance is hindered by job description conflict because with it the i ndividual faces either a lack of knowledge about the mo st effective behavio urs to engage in or an almost i mpossible situation for doing ever ything expected. Therefore, increasing formal organization al communication with employees reduces the uncertai nty by lessening the role ambiguity and role confli ct. Open Communication has an advantage of resolving conflicts between supervisors and sub ordi nates. Lack of effective communication cou ld cause unresolved conflicts that will increase t he stress level. Support from the supervisor an d colleagues are the major factor. The supe rvisors need to recognize the good work and ou tstanding contributions of h ouse officers to keep them motivated to do their best. Pr omoting a culture of support will set the example a nd it will make them realize that co -worker support is very importa nt. Correct stress management shou ld start from improved health and good intraper sonal relationships. An individual n eeds to maintain good level of personal health. The prevention and management of workplace stress requires organizational level intervent ions, because it is the organization that creates the stress. A culture of openness and understanding, rather tha n of criticism, is essential. J Ay ub Med Coll Abbottabad 2008 ;20( 3) http://www.ayubmed.edu.pk/JAMC /PAST/20 -3/Rubina.pdf 139 REFERENCES 1. Niaz U, Sehar H, Ali S. 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