Lovell Brenda L, Lee Raymond T, Frank Erica
University of Manitoba, Department of Business Administration, Manitoba, Canada.
BMC Fam Pract. 2009 Feb 24;10:18. doi: 10.1186/1471-2296-10-18.
The development of best practices to promote physician wellbeing at the individual and organisational levels is receiving increased attention. Few studies have documented how physicians perceive their wellbeing in these contexts. The purpose of this qualitative study is to identify and discuss the reported factors that hinder wellbeing, as well as the reported factors that would promote wellbeing among physicians.
There were 165 physicians from a province of Canada who wrote their open-ended responses to two questions, as part of a larger self-report questionnaire. The questions asked what causes them stress, and what interventions should be implemented at organisational/institutional levels. The largest specialty was family medicine, followed by internal medicine, and surgical disciplines, with 58% of participants male. A general inductive approach was used to analyze the data and themes and sub-themes were discovered using the socio-ecological model as the framework.
Reponses were both personal and professional which resulted in the emergence of four major themes to reflect this diversity. These themes were external constraints on the practice of medicine, issues at the professional/institutional levels, issues at the individual practice level, and work/life balance. The work/life balance theme received the highest number of responses followed by external constraints on the practice of medicine. In the major theme of work-life balance, work-life conflict received the most responses, and in the major theme of external constraints on practice of medicine, lack of resources (human and material) and restrictions to autonomy received the most responses. Ideas for interventions in the work/life balance theme were health promotion, and healthy workplace initiatives. In the second largest theme, suggested ideas for interventions were collegiality/professionalism and policy formulation at the health care system.
Our findings have implications for governance and health policy, health human resources and education. In particular, the socio-ecological framework was a useful framework to analyse physician wellbeing due to its applicability for issues at the structural, organisational, and individual levels. Future research should target interventions at the organisational and institutional levels to address work-life conflict and job dissatisfaction.
在个人和组织层面促进医生福祉的最佳实践方法正受到越来越多的关注。很少有研究记录医生在这些背景下如何看待自己的福祉。这项定性研究的目的是识别和讨论那些被报告的阻碍福祉的因素，以及那些被报告的能够促进医生福祉的因素。
来自加拿大一个省份的165名医生针对两个问题撰写了开放式回答，这是一份更大的自我报告问卷的一部分。问题是询问什么给他们带来压力，以及在组织/机构层面应实施哪些干预措施。最大的专业领域是家庭医学，其次是内科和外科学科，58%的参与者为男性。采用一般归纳法分析数据，并以社会生态模型为框架发现主题和子主题。
回答既有个人方面的，也有职业方面的，从而出现了四个主要主题来反映这种多样性。这些主题是医学实践的外部限制、专业/机构层面的问题、个人实践层面的问题以及工作/生活平衡。工作/生活平衡主题的回答数量最多，其次是医学实践的外部限制。在工作-生活平衡的主要主题中，工作-生活冲突的回答最多，而在医学实践外部限制的主要主题中，资源（人力和物力）缺乏以及自主权受限的回答最多。工作/生活平衡主题中的干预措施想法是健康促进和健康的工作场所倡议。在第二大主题中，建议的干预措施想法是医护人员之间的合作/职业精神以及医疗保健系统的政策制定。
我们的研究结果对治理和卫生政策、卫生人力资源及教育具有启示意义。特别是，社会生态框架是分析医生福祉的有用框架，因为它适用于结构、组织和个人层面的问题。未来的研究应针对组织和机构层面的干预措施，以解决工作-生活冲突和工作不满意问题。
