How Functional Reviews in the Health Sector Exacerbated Occupational Stress and Burnout Among Clinical Officers at Public Hospitals in Malawi

Main Article Content

Paliani Chinguwo https://orcid.org/0000-0001-8500-3259

Keywords

clinical officers, psychosocial hazards, restructuring, functional reviews, occupational stress and burnout

Abstract

In Malawi, there is a cadre of mid-level health professionals called clinical officers. In the wake of an acute shortage of medical doctors, clinical officers perform tasks conventionally designated for medical doctors. This paper seeks to explain how the implementation of some functional reviews in the health sector, exacerbated occupational stress (OS) and burnout among clinical officers at public hospitals in Malawi. The study adopted a qualitative research design with a case study as a research strategy. The study was conducted at four district hospitals and one central hospital, all of which are state-owned in Malawi. The paper argues that the implementation of some functional reviews, is a psychosocial hazard among clinical officers at public hospitals. The paper demonstrates that the implementation of some functional reviews, has aggravated occupational stress and burnout among clinical officers at public hospitals. The paper concludes that the implementation of some functional reviews, has perpetuated interprofessional conflicts between clinical officers and medical doctors; forms of occupational violence by doctors against clinical officers; loss of power and an identity crisis among clinical officers. The paper, therefore, argues that interprofessional conflicts, occupational violence, loss of power and identity crisis were ultimately drivers of occupational stress and burnout among clinical officers. Finally, the paper recommends that a psychosocial risk assessment, should be conducted to avoid or minimise the risks of occupational stress and burnout among clinical officers that are posed by the implementation of functional reviews in the health sector.


 


 

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References

Anderson, C. & Brion, S. 2014. Perspectives on power in organizations. Annu. Rev. Organ. Psychol. Organ. Behav., 1, 67-97. https://doi.org/10.1146/annurev-orgpsych-031413-091259
Atkinson, S. 1995. Restructuring health care: tracking the decentralization debate. Progress in Human Geography, 19, 486-503. https://doi.org/10.1177/030913259501900403
Baylina, P., Barros, C., Fonte, C., Alves, S. & Rocha, Á. 2018. Healthcare workers: Occupational health promotion and patient safety. Journal of medical systems. https://doi.org/10.1007/s10916-018-1013-7
Bellagamba, G., Gionta, G., Senergue, J., Bèque, C. & Lehucher-Michel, M.-P. 2015. Organizational factors impacting job strain and mental quality of life in emergency and critical care units. International journal of occupational medicine and environmental health, 28, 357. https://doi.org/10.13075/ijomeh.1896.00121
Bennell, P. 1994. Improving the performance of the public sector in LDCs: New approaches to human resource planning and management.
Bhatia, N., Kishore, J., Anand, T. & Jiloha, R. C. 2010. Occupational stress amongst nurses from two tertiary care hospitals in Delhi. Australasian Medical Journal (Online), 3, 731-738. https://doi.org/10.4066/AMJ.2010.289
Bourbonnais, R., Brisson, C., Malenfant, R. & Vézina, M. 2005a. Health care restructuring, work environment, and health of nurses. American journal of industrial medicine, 47, 54-64. https://doi.org/10.1002/ajim.20104
Bourbonnais, R., Brisson, C., Vézina, M., Masse, B. & Blanchette, C. 2005b. Psychosocial work environment and certified sick leave among nurses during organizational changes and downsizing. Relations Industrielles/Industrial Relations, 60, 483-509. https://doi.org/10.7202/012156ar
Bradley, S., Kamwendo, F., Chipeta, E., Chimwaza, W., De Pinho, H. & Mcauliffe, E. 2015. Too few staff, too many patients: a qualitative study of the impact on obstetric care providers and on quality of care in Malawi. BMC pregnancy and childbirth, 15, 65. https://doi.org/10.1186/s12884-015-0492-5
Bradley, S. & Mcauliffe, E. 2009. Mid-level providers in emergency obstetric and newborn health care: factors affecting their performance and retention within the Malawian health system. Human resources for health, 7, 14. https://doi.org/10.1186/1478-4491-7-14
Broadhead, R. L. & Muula, A. S. 2002. Creating a medical school for Malawi: problems and achievements. BMJ, 325, 384-387. https://doi.org/10.1136/bmj.325.7360.384
Chilopora, G., Pereira, C., Kamwendo, F., Chimbiri, A., Malunga, E. & Bergström, S. 2007. Postoperative outcome of caesarean sections and other major emergency obstetric surgery by clinical officers and medical officers in Malawi. Human resources for health, 5, 17. https://doi.org/10.1186/1478-4491-5-17
Chiweza, A. L. 2010. Public-sector reforms and decentralisation of public services: Lessons from Malawi (1994-2006). Reforming the Malawian Public Sector, 29.
Day, A., Crown, S. N. & Ivany, M. 2017. Organisational change and employee burnout: The moderating effects of support and job control. Safety science, 100, 4-12. https://doi.org/10.1016/j.ssci.2017.03.004
Demerouti, E., Bakker, A. B., Nachreiner, F. & Schaufeli, W. B. 2001. The job demands-resources model of burnout. Journal of Applied psychology, 86, 499-512. https://doi.org/10.1037/0021-9010.86.3.499
Dousin, O., Collins, N. & Kaur Kler, B. 2019. Work-life balance, employee job performance and satisfaction among doctors and nurses in Malaysia. International Journal of Human Resource Studies, 9, 306-319. https://doi.org/10.5296/ijhrs.v9i4.15697
Dovlo, D. 2004. Using mid-level cadres as substitutes for internationally mobile health professionals in Africa. A desk review. Human resources for health, 2, 7. https://doi.org/10.1186/1478-4491-2-7
Dragano, N., Verde, P. E. & Siegrist, J. 2005. Organisational downsizing and work stress: testing synergistic health effects in employed men and women. Journal of Epidemiology & Community Health, 59, 694-699. https://doi.org/10.1136/jech.2005.035089
Durevall, D. 2001. Reform of the Malawian public sector: incentives, governance and accountability, Wider Discussion Paper.
Gajewski, J., Borgstein, E., Bijlmakers, L., Mwapasa, G., Aljohani, Z., Pittalis, C., Mccauley, T. & Brugha, R. 2019. Evaluation of a surgical training programme for clinical officers in Malawi. British Journal of Surgery, 106, e156-e165. https://doi.org/10.1002/bjs.11065
Ganster, D. C. & Rosen, C. C. 2013. Work stress and employee health: A multidisciplinary review. Journal of management, 39, 1085-1122. https://doi.org/10.1177/0149206313475815
Goetz, K., Berger, S., Gavartina, A., Zaroti, S. & Szecsenyi, J. 2015. How psychosocial factors affect well-being of practice assistants at work in general medical care. A questionnaire survey. https://doi.org/10.1186/s12875-015-0366-y
Gosseries, O., Demertzi, A., Ledoux, D., Bruno, M.-A., Vanhaudenhuyse, A., Thibaut, A., Laureys, S. & Schnakers, C. 2012. Burnout in healthcare workers managing chronic patients with disorders of consciousness. Brain Injury, 26, 1493-1499. https://doi.org/10.3109/02699052.2012.695426
Grimes, C. E., Mkandawire, N. C., Billingsley, M. L., Ngulube, C. & Cobey, J. C. 2014. The cost-effectiveness of orthopaedic clinical officers in Malawi. Tropical doctor, 44, 128-134. https://doi.org/10.1177/0049475514535575
Hall, G. B., Dollard, M. F. & Coward, J. 2010. Psychosocial safety climate: Development of the PSC-12. International Journal of Stress Management, 17, 353. https://doi.org/10.1037/a0021320
Hall, G. B., Dollard, M. F., Winefield, A. H., Dormann, C. & Bakker, A. B. 2013. Psychosocial safety climate buffers effects of job demands on depression and positive organizational behaviors. Anxiety, Stress & Coping, 26, 355-377. https://doi.org/10.1080/10615806.2012.700477
Harney, B., Fu, N. & Freeney, Y. 2018. Balancing tensions: Buffering the impact of organisational restructuring and downsizing on employee well-being. Human Resource Management Journal, 28, 235-254. https://doi.org/10.1111/1748-8583.12175
Hertting, A., Nilsson, K., Theorell, T. & Larsson, U. S. 2004. Downsizing and reorganization: demands, challenges and ambiguity for registered nurses. Journal of advanced nursing, 45, 145-154. https://doi.org/10.1046/j.1365-2648.2003.02876.x
Hu, X., Zhan, Y., Garden, R., Wang, M. & Shi, J. 2018. Employees’ reactions to customer mistreatment: The moderating role of human resource management practices. Work & Stress, 32, 49-67. https://doi.org/10.1080/02678373.2017.1330836
Ilić, I. M., Arandjelović, M. Ž., Jovanović, J. M. & Nešić, M. M. 2017. Relationships of work-related psychosocial risks, stress, individual factors and burnout-Questionnaire survey among emergency physicians and nurses. Med Pr, 68, 167-178. https://doi.org/10.13075/mp.5893.00516
Jiskoot, P. 2008. On-the-job training of clinical officers in Malawi. Malawi Medical Journal, 20, 74-77. https://doi.org/10.4314/mmj.v20i3.10969
Jones, L. & Arana, G. 1996. Is downsizing affecting incident reports? The Joint Commission journal on quality improvement, 22, 592-594. https://doi.org/10.1016/S1070-3241(16)30267-X
Kalata, N., Kamange, L. & Muula, A. 2013. Adherence to hand hygiene protocol by clinicians and medical students at Queen Elizabeth Central Hospital, Blantyre-Malawi. Malawi Medical Journal, 25, 50-52.
Kalimo, R., Taris, T. W. & Schaufeli, W. B. 2003. The effects of past and anticipated future downsizing on survivor well-being: an equity perspective. Journal of occupational health psychology, 8, 91-109. https://doi.org/10.1037/1076-8998.8.2.91
Kivimäki, M., Vahtera, J., Pentti, J. & Ferrie, J. E. 2000. Factors underlying the effect of organisational downsizing on health of employees: longitudinal cohort study. Bmj, 320, 971-975. https://doi.org/10.1136/bmj.320.7240.971
Lakshminarayanan, R. 2003. Decentralisation and its implications for reproductive health: the Philippines experience. Reproductive Health Matters, 11, 96-107. https://doi.org/10.1016/S0968-8080(03)02168-2
Leka, S. & Lavicoli, S. 2017. The psychosocial work environment in times of change: society and the workplace. Safety science, 100, 1-3. https://doi.org/10.1016/j.ssci.2017.07.013
Li, J., Matouschek, N. & Powell, M. 2017. Power dynamics in organizations. American Economic Journal: Microeconomics, 9, 217-41. https://doi.org/10.1257/mic.20150138
Lin, S., H, Liao, W. C., Chen, M. Y. & Fan, J. Y. 2014. The impact of shift work on nurses’ job stress, sleep quality and self-perceived health status. Journal of nursing management, 22, 604-612. https://doi.org/10.1111/jonm.12020
Loewenson, R. 2001. Globalization and occupational health: a perspective from southern Africa. Bulletin of the World Health Organization, 79, 863-868.
Maguire, M. & Delahunt, B. 2017. Doing a thematic analysis: A practical, step-by-step guide for learning and teaching scholars. All Ireland Journal of Higher Education, 9.
Malawi Government 1987. Medical Practioners and Dentists Act.
Malawi Government 2011. Health Sector Strategic Plan I (2011 - 2016) for Malawi.
Malawi Government 2017. Health Sector Strategic Plan II (2017-2022) for Malawi. Malawi Government.
Malawi Government 2018a. Functional review report on central hospitals autonomy
Malawi Government 2018b. Human resources for health strategic plan (2018–2022) for Malawi.
Malawi Government 2020. Performance contract between the Government of the Republic of Malawi and Ministry of Health.
Mathisen, G. E., Brønnick, K., Arntzen, K. J. & Bergh, L. I. V. 2017. Identifying and managing psychosocial risks during organizational restructuring: It’s what you do and how you do it. Safety science, 100, 20-29. https://doi.org/10.1016/j.ssci.2016.12.007
Mcauliffe, E., Bowie, C., Manafa, O., Maseko, F., Maclachlan, M., Hevey, D., Normand, C. & Chirwa, M. 2009a. Measuring and managing the work environment of the mid-level provider–the neglected human resource. Human resources for health, 7, 13. https://doi.org/10.1186/1478-4491-7-13
Mcauliffe, E., Manafa, O., Maseko, F., Bowie, C. & White, E. 2009b. Understanding job satisfaction amongst mid-level cadres in Malawi: the contribution of organisational justice. Reproductive Health Matters, 17, 80-90. https://doi.org/10.1016/S0968-8080(09)33443-6
Medical Council Of Malawi 2019. Certificate of registration for clinical officer. Medical Council of Malawi.
Mkandawire, N., Ngulube, C. & Lavy, C. 2008. Orthopaedic clinical officer program in Malawi: a model for providing orthopaedic care. Clinical orthopaedics and related research, 466, 2385-2391. https://doi.org/10.1007/s11999-008-0366-5
Mosca, I. 2006. Is decentralisation the real solution?: A three country study. Health policy, 77, 113-120. https://doi.org/10.1016/j.healthpol.2005.07.011
Muula, A. S. 2009. Case for clinical officers and medical assistants in Malawi. Croatian medical journal, 50, 77. https://doi.org/10.3325/cmj.2009.50.77
Muula, A. S. 2016. Personal View: How IMF’s loan freeze will affect health care in Malawi. Malawi Medical Journal, 28, 26-27. https://doi.org/10.4314/mmj.v28i1.6
Muula, A. S., Mulwafu, W., Chiweza, D. & Mataya, R. 2016. Reflections on the first twenty-five years of the University of Malawi College of Medicine. Malawi Medical Journal, 28, 75-78. https://doi.org/10.4314/mmj.v28i3.2
Nwobodo, E. O., Orjiako, R. N., Nwadinigwe, C. U., Anyaehie, U. B., Ugwu, P. I., Nwobodo, N. F., Iyidobi, E. C., Ikwuka, D. C., Nwonye, C. A. & Ekechi, V. C. 2022. Interprofessional Conflict Among Healthcare Teams in Nigeria: Implications on Quality of Patient Care. Frontline Medical Sciences and Pharmaceutical Journal, 2, 10-19. https://doi.org/10.21203/rs.3.rs-904216/v1
Occupational Safety And Health Administration. 2014. Hospital hazards. Available: www.osha.gov/SLTC/etools/hospital/index.html.
Ogbonnaya, L., Ogbonnaya, C. & Adeoye-Sunday, I. 2007. The perception of health prefessions on cause of interprofessional conflict in a tertiary health institution in Abakaliki, southeast Nigeria. Nigerian Journal of Medicine, 16, 161-168. https://doi.org/10.4314/njm.v16i2.37300
Omisore, A. G., Adesoji, R. O. & Abioye-Kuteyi, E. A. 2017. Interprofessional rivalry in Nigeria’s health sector: a comparison of doctors and other health workers’ views at a secondary care center. International quarterly of community health education, 38, 9-16. https://doi.org/10.1177/0272684X17748892
Palmer, D. 2006. Tackling Malawi’s Human Resources Crisis. Reproductive Health Matters, 14, 27-39. https://doi.org/10.1016/S0968-8080(06)27244-6
Physician Assistants Union Of Malawi. 1 September 2020. RE: Open letter to the Minister of Health.
Pikó, B. 1999. Work-related stress among nurses: a challenge for health care institutions. The journal of the Royal Society for the Promotion of Health, 119, 156-162. https://doi.org/10.1177/146642409911900304
Quinlan, M. & Bohle, P. 2009. Overstretched and unreciprocated commitment: reviewing research on the occupational health and safety effects of downsizing and job insecurity. International Journal of Health Services, 39, 1-44. https://doi.org/10.2190/HS.39.1.a
Riany, C. O., Musa, G. H., Odera, O. & Okaka, O. 2012. Effects of restructuring on organization performance of mobile phone service providers. International Review of social sciences and Humanities, 4, 198-204.
Rivera, A. S., Akanbi, M., O’dwyer, L. C. & Mchugh, M. 2020. Shift work and long work hours and their association with chronic health conditions: A systematic review of systematic reviews with meta-analyses. PloS one, 15, e0231037. https://doi.org/10.1371/journal.pone.0231037
Schaufeli, W. B. & Taris, T. W. 2014. A critical review of the job demands-resources model: Implications for improving work and health. In: G.F. BAUER & HÄMMIG, O. (eds.) Bridging occupational, organizational and public health. Dordrecht: Springer. https://doi.org/10.1007/978-94-007-5640-3_4
Shanafelt, T. D. & Noseworthy, J. H. Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout. Mayo Clinic Proceedings, 2017. Elsevier, 129-146. https://doi.org/10.1016/j.mayocp.2016.10.004
Sumah, A. M., Baatiema, L. & Abimbola, S. 2016. The impacts of decentralisation on health-related equity: A systematic review of the evidence. Health Policy, 120, 1183-1192. https://doi.org/10.1016/j.healthpol.2016.09.003
Tetřevová, L. 2007. Concept of corporate reststructuring and reengineering. Scientific papers of the University of Pardubice. Series D, Faculty of Economics and Administration. 11 (2007).
Thetard, R. & Macheso, A. 2004. Clinical officers in Malawi. South African Family Practice, 46, 32-32. https://doi.org/10.1080/20786204.2004.10873045
Tunčikienė, Ž., Skačkauskienė, I. & Grenčiková, A. 2013. Sustainable development of public sector: the state and assumptions of improvement of functional review in public institutions. Journal of security and sustainability issues, 3, 11-21. https://doi.org/10.9770/jssi.2013.3.1(2)
Wescott, C. 1999. Guiding principles on civil service reform in Africa: An empirical review. International Journal of Public Sector Management, 12, 145-170. https://doi.org/10.1108/09513559910263471
Wichert, I. 2002. Job insecurity and work intensification: The effects on health and well-being. In: BURCHELL, B., LADIPO, D. & WILKINSON, F. (eds.) Job insecurity and work intensification. London: Routledge.
World Health Organization 2021. State of health workforce in the WHO Africa region: Survey report World Health Organisation.
Young, R. D. 2002. State Reorganization in South Carolina: Theories, History, Practices and Further Implications, University of South Carolina Institute for Public Service and Policy Research.
Zablah, A. R., Chonko, L. B., Bettencourt, L. A., Allen, G. & Haas, A. 2012. A job demands-resources (JD-R) perspective on new product selling: A framework for future research. Journal of Personal Selling & Sales Management, 32, 73-87. https://doi.org/10.2753/PSS0885-3134320107