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Time flies in primary care: a study on time utilisation and perceived psychosocial work environment
Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primärvårdscentrum, Vårdcentralen Mantorp.
2019 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Time utilisation among primary care professionals has been affected by structural changes and reorganisation performed in Swedish primary care over several decades. The work situation is complex with a heavy administrative work load. The overall aim with this thesis was to describe time utilisation among staff in Swedish primary care and to investigate associations with perceived psychosocial work environment and legitimacy of work tasks.

Methods: A multicentre, descriptive, cross-sectional study design was used including all staff categories in primary care i.e. registered nurses, primary care physicians, care administrators, nurse assistants and allied professionals (physiotherapists, occupational therapists, psychologists, counsellors, dieticians and chiropodists) at eleven primary care centres located in southeast Sweden. The data collection consisted of a questionnaire including a subjective estimate of workload, the Bern Illegitimate Tasks Scale (BITS) and the Copenhagen Psychosocial Questionnaire (COPSOQ). Also, a time study was performed, where the participants reported their work time based on three main categories; direct patient work tasks, indirect patient work tasks and other work tasks, each with a number of subcategories. The participants reported time spent on different work tasks, day by day during two separate weeks. Response rates were 75% for the questionnaire and 79% for the time study.

Results: In paper I the time study revealed that health professionals at the primary care centres spent 37% of their work time with direct patient work tasks. All professions estimated a higher proportion of time spent directly with patients than they reported in the time study. Physicians scored highest on the psychosocial scales of quantitative demands, stress and role conflicts. The proportion of administrative work tasks was associated with role conflicts, the more administration the more role conflicts. Findings in paper II were that more than a quarter of physicians scored above the cut-off value for BITS regarding unnecessary work tasks, which was significantly more than the proportion observed in all other professions in the survey. Across all staff groups, a perception of having to perform illegitimate work tasks was associated with experiencing negative psychosocial work environment and with high proportion of administrative-related work tasks.

Conclusions: Swedish primary care staff spend a limited proportion of their work time directly with patients and primary care physicians perceive the psychosocial work environment in negative terms to a greater extent than all other staff members. Allocation of work tasks has an influence on the perceived psychosocial work environment. The perception of having a large number of illegitimate work tasks affects the psychosocial work environment negatively, which might influence the perception the staff have of their professional roles. Perception of high proportion of unreasonable work tasks is associated with a high proportion of non-patient-related administration.

This thesis illuminates the importance of decision makers thoroughly considering the distribution and allocation of non-patient related work tasks among staff in primary care, in order to achieve efficient use of personnel resources and favourable working conditions. Hopefully, the results of this study will contribute to further development of primary care so that medical competence will benefit patients as much as possible.

Abstract [sv]

Bakgrund: Under de senaste decennierna har det i svensk primärvård varit omfattande omorganisationer, vilket har påverkat arbetstidens innehåll. Arbetssituationen är komplex och omfattningen av administration har ökat. Det övergripande syftet med föreliggande studie var att beskriva arbetstidens innehåll bland personal i svensk primärvård och att undersöka samband mellan upplevd psykosocial arbetsmiljö och arbetsuppgifternas legitimitet.

Metod: Studien har genomförts som en deskriptiv multicenterstudie med tvärsnittsdesign och inkluderade sjuksköterskor, läkare, vårdadministratörer, undersköterskor och övriga professioner (fysioterapeuter, arbetsterapeuter, psykologer, kuratorer, dietister och fotvårdsspecialister) vid elva vårdcentraler i sydöstra Sverige. Studien inleddes med att deltagarna ombads att besvara ett frågeformulär vars första del bestod av en skattning av hur arbetsuppgifterna var fördelade. Frågeformuläret innehöll också frågor om illegitima arbetsuppgifter; Bern Illegitimate Tasks Scale (BITS) och psykosocial arbetsmiljö; Copenhagen Psychosocial Questionnaire (COPSOQ). Därefter gjordes en tidsstudie där deltagarna fick registrera tidsåtgången för olika arbetsuppgifter, varje dag under två separata veckor. Arbetsuppgifterna delades upp i tre huvudkategorier; direkt patientarbete, indirekt patientarbete och övrigt arbete. Varje huvudkategori hade flera underkategorier. Svarsfrekvensen var 75% för frågeformuläret och 79% för tidsstudien.

Resultat: Resultatet från delarbete I visar att personal i primärvård ägnade 37% av arbetstiden direkt med patienter. Alla professioner skattade den direkta patienttiden till större andel än vad tidsstudien visade. Läkare upplevde sämst psykosocial arbetsmiljö avseende kvantitativa krav, stress och rollkonflikter. Det förelåg ett samband mellan andelen administrativa arbetsuppgifter och rollkonflikter, ju mer administration desto mer rollkonflikter. I delstudie II visade resultatet att mer än en fjärdedel av läkarna upplevde en hög nivå av illegitima arbetsuppgifter avseende onödiga arbetsuppgifter, vilket var signifikant mer jämfört med andra professioner. För personalgruppen som helhet framträdde ett samband mellan upplevelsen av att ha mycket illegitima arbetsuppgifter och upplevelse av negativ psykosocial arbetsmiljö samt med hög andel administrationsrelaterade arbetsuppgifter.

Konklusion: Personal i primärvård ägnar en begränsad andel av arbetstiden åt direkt patientarbete och läkare upplever sämre psykosocial arbetsmiljö än övriga professioner. Arbetstidens fördelning mellan olika arbetsuppgifter påverkar den psykosociala arbetsmiljön. Upplevelsen av att utföra en stor andel illegitima arbetsuppgifter påverkar den psykosociala arbetsmiljön negativt, vilket kan ha inverkan på hur personalen uppfattar sin professionella roll. Upplevelsen av att ha mycket oskäliga arbetsuppgifter har samband med hög andel icke patientrelaterad administration.

Avhandlingen belyser vikten av att beslutsfattare noga överväger fördelningen av icke patientrelaterade arbetsuppgifter bland personal i primärvård, för att möjliggöra effektiv användning av personalresurserna och för att främja goda arbetsförhållanden. Förhoppningen är också att studiens resultat ska bidra till fortsatt utveckling av primärvården så att den medicinska kompetensen kommer patienterna till nytta i så stor omfattning som möjligt.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2019. , p. 60
Series
Linköping Studies in Health Sciences. Thesis, ISSN 1100-6013 ; 136
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:liu:diva-156119DOI: 10.3384/lic.diva-156119ISBN: 9789176852033 (print)OAI: oai:DiVA.org:liu-156119DiVA, id: diva2:1302279
Presentation
2019-04-26, Linden, Campus US, Linköping, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2019-04-04 Created: 2019-04-04 Last updated: 2019-05-02Bibliographically approved
List of papers
1. Time utilization and perceived psychosocial work environment among staff in Swedish primary care settings
Open this publication in new window or tab >>Time utilization and perceived psychosocial work environment among staff in Swedish primary care settings
2018 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 18, article id 166Article in journal (Refereed) Published
Abstract [en]

Background: Over the past decades, reorganizations and structural changes in Swedish primary care have affected time utilization among health care professionals. Consequently, increases in administrative tasks have substantially reduced the time available for face-to-face consultations. This study examined how work-time was utilized and the association between work time utilization and the perceived psychosocial work environment in Swedish primary care settings. Methods: This descriptive, multicentre, cross-sectional study was performed in 2014-2015. Data collection began with questionnaire. In the first section, respondents were asked to estimate how their workload was distributed between patients (direct and indirect patient work) and other work tasks. The questionnaire also comprised the Copenhagen Psychosocial Questionnaire, which assessed the psychosocial work environment. Next a time study was conducted where the participants reported their work-time based on three main categories: direct patient-related work, indirect patient-related work, and other work tasks. Each main category had a number of subcategories. The participants recorded the time spent (minutes) on each work task per hour, every day, for two separate weeks. Eleven primary care centres located in southeast Sweden participated. All professionals were asked to participate (n = 441), including registered nurses, primary care physicians, care administrators, nurse assistants, and allied professionals. Response rates were 75% and 79% for the questionnaires and the time study, respectively. Results: All health professionals allocated between 30.9% - 37.2% of their work-time to each main category: direct patient work, indirect patient work, and other work. All professionals estimated a higher proportion of time spent in direct patient work than they reported in the time study. Physicians scored highest on the psychosocial scales of quantitative demands, stress, and role conflicts. Among allied professionals, the proportion of work-time spent on administrative tasks was associated with more role conflicts. Younger staff perceived more adverse working conditions than older staff. Conclusions: This study indicated that Swedish primary care staff spent a limited proportion of their work time directly with patients. PCPs seemed to perceive their work environment in negative terms to a greater extent than other staff members. This study showed that work task allocations influenced the perceived psychosocial work environment.

Place, publisher, year, edition, pages
BIOMED CENTRAL LTD, 2018
Keywords
Work-time allocation; Primary care; Occupational health; Organization and administration; Stress
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-147117 (URN)10.1186/s12913-018-2948-6 (DOI)000426855700008 ()29514637 (PubMedID)
Note

Funding Agencies|Medical Research Council of Southeast Sweden; Sodertorn University Sweden

Available from: 2018-04-20 Created: 2018-04-20 Last updated: 2019-05-01

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