Research Department, Royal College of Physicians of Ireland, Dublin, Ireland
Research Department, Royal College of Physicians of Ireland, Dublin, Ireland.
BMJ Open. 2021 Aug 9;11(8):e050358. doi: 10.1136/bmjopen-2021-050358.
COVID-19 has prompted the reconfiguration of hospital services and medical workforces in countries across the world, bringing significant transformations to the work environments of hospital doctors. Before the pandemic, the working conditions of hospital doctors in Ireland were characterised by understaffing, overload, long hours and work-life conflict. As working conditions can affect staff well-being, workforce retention and patient outcomes, the objective of this study was to analyse how the pandemic and health system response impacted junior hospital doctors' working conditions during the first wave of COVID-19 in Ireland.
Using a qualitative study design, the article draws on semi-structured interviews with 30 junior hospital doctors. Informed by an abductive approach that draws iteratively on existing literature and empirical data to explain unexpected observations, data were analysed using inductive and deductive coding techniques to identify the key themes reflecting the experiences of working in Irish hospitals during the first wave of COVID-19. We use the Consolidated Criteria for Reporting Qualitative Research to present this research.
Our analysis generated three themes which demonstrate how COVID-19 prompted changes in medical staffing which in turn enhanced interviewees' work environments. First, interviewees felt there were more doctors staffing the hospital wards during the first wave of the pandemic. Second, this had positive implications for a range of factors important to their experience of work, including the ability to take sick leave, workplace relationships, collective workplace morale, access to senior clinical support and the speed of clinical decision-making. Third, interviewees noted how it took a pandemic for these improvements to occur and cautioned against a return to pre-pandemic medical staffing levels, which had negatively impacted their working conditions and well-being.
Interviewees' experience of the first wave of COVID-19 illustrates how enhanced levels of medical staffing can improve junior hospital doctors' working conditions. Given the pervasive impact of staffing on the quality of interviewees' work experience, perhaps it is time to consider medical staffing standards as a vital job resource for hospital doctors and a key policy lever to enhance medical workforce retention. In a global context of sustained COVID-19 demands, pressures from delayed care and international health worker shortages, understanding frontline experiences and identifying strategies to improve them are vital to the development of more sustainable work practices and to improve doctor retention.
COVID-19 促使全球各国医院服务和医疗人员结构发生变化，给医院医生的工作环境带来了重大变革。在大流行之前，爱尔兰医院医生的工作条件以人手不足、工作负荷过重、工作时间长和工作与生活冲突为特征。由于工作条件会影响员工的健康、劳动力保留和患者的预后，因此本研究的目的是分析大流行和卫生系统应对措施如何在爱尔兰 COVID-19 第一波期间影响初级医院医生的工作条件。
本研究采用定性研究设计，对 30 名初级医院医生进行半结构化访谈。本研究受归纳法和演绎法的启发，利用现有文献和经验数据来解释意外观察结果，通过归纳和演绎编码技术对数据进行分析，以确定反映 COVID-19 第一波期间在爱尔兰医院工作经历的关键主题。我们使用《定性研究报告的统一标准》来展示这项研究。
我们的分析产生了三个主题，这些主题表明 COVID-19 如何促使医疗人员配置发生变化，进而改善了受访者的工作环境。首先，受访者认为在大流行的第一波期间，医院病房有更多的医生。其次，这对一系列对他们工作体验很重要的因素产生了积极影响，包括请病假的能力、工作场所关系、集体工作士气、获得高级临床支持的机会以及临床决策的速度。第三，受访者注意到，只有在大流行期间才会出现这些改善，并警告不要回到大流行前的医疗人员配置水平，因为这会对他们的工作条件和健康产生负面影响。
受访者对 COVID-19 第一波的体验表明，增加医疗人员配置可以改善初级医院医生的工作条件。鉴于人员配置对受访者工作体验质量的普遍影响，也许现在是时候将医疗人员配置标准视为医院医生的重要工作资源，并将其作为提高医疗劳动力保留率的关键政策杠杆了。在全球持续面临 COVID-19 需求、延迟护理压力和国际卫生工作者短缺的背景下，了解一线经验并确定改善这些经验的策略对于制定更可持续的工作实践和提高医生保留率至关重要。
