Junior doctors squeezed by working conditions

How do junior doctors experience current working conditions? Pressures on public sector spending in many countries have put the squeeze on their health services, and this strata of the workforce - already renowned as being under pressure - seem to be feeling extra strain. This is the suggestion of a recent study that investigates the experiences of twenty junior doctors in the Irish medical system.

The participants provided their experiences through qualitative interviews with the researchers, working from the ground up to collect their perspectives and identify the common themes that emerged. Those interviewed were just about to transition into roles as clinical tutors, a hybrid role that involves both clinical practice and academic teaching of medical students. The shape of these individuals' careers to date mirrors what is typical for junior doctors: working as temporary employees on a 3-, 6-, or 12-month basis.

The first theme that emerged was one of staffing shortages. The interviewees saw shortages as contributing to longer hospital stays for patients, whose problems were not getting detected as quickly. In addition, they complained that lean workforces often meant that a senior perspective was not available as much as they would like, which would normally provide an expert viewpoint to benefit both diagnosis and the junior doctor's understanding. Because of staffing shortages, there were also fewer opportunities to take leave for training. As one interviewee remarked, 'Training isn’t the best. It’s very much ‘see one, do one, teach one’'

The next theme was how unrealistic workloads had become. Some of this was due to wider societal factors: as healthcare developments both extend lifespan and increase detection of multiple conditions, patients' problems can be more acute and involve multimorbidity (multiple diagnoses), making treatment a more complex matter. But workload issues also related to the first issue of shortages, which contributed to long hours, interrupted breaks, and pressure to complete tasks quickly: 'I have a sense of dissatisfaction with being able to give each patient on a round just 90 seconds on average.' Another interviewee noted the personal consequences of this overworking: 'When you do something wrong, not out of malice or incompetence, because you’re too tired, then you have to live with it.'

As well as these themes, interviewees reported issues with unpredictability of their work. Their schedules as well as lengthy (80-90 hour weeks) were subject to change, leading one to comment 'It is the not knowing. I have missed christenings and birthdays and let people down'. The high workloads also forced the work-home divide to become porous, with paperwork often taken home to be completed outside of 'work'. And within the hospital,  cuts meant doctors could not rely on having the needed equipment to hand, but at times had to devote time to hunting it down elsewhere.

Despite all these challenges, respondents tended to give less attention to how the conditions affected their own wellbeing, framing issues more in terms of problems for patients or the smooth running of the system. The authors reflect that this tendency to soldier on may be because doctors see their role as evaluating stress and illness in others, and so are reluctant to see themselves as the ones who may at times be in need. Previous research also suggests that doctors are reluctant to seek health care from other doctors due to embarrassment, especially for less-defined illnesses such as stress. This is despite the fact that doctors display higher levels of stress than those found in the general population.

'The challenges currently faced by junior doctors in Ireland identified within this study are likely to be illustrative of problems faced by junior doctors in many countries where government spending is decreasing and deficits are rising.' Overextension of this layer of the medical profession is bound to have consequences for patients - US figures estimate medical error contributes to 180-195,000 patient deaths annually - and also, whether they like to admit it, to the wellbeing of the junior doctors on whose shoulders so much rests.

McGowan, Yvonne, Humphries, Niamh, Burke, Helen, Conry, Mary, & Morgan, Karen (2013). Through doctors’ eyes: A qualitative study of hospital doctor perspectives on their working conditions British Journal of Health Psychology DOI: 10.1111/bjhp.12037

Further reading:
Kay, M., Mitchell, G., Clavarino, A., & Doust, J. (2008). Doctors as patients: a systematic review of doctors’ health access and the barriers they experience. British Journal of General Practice, 58 (552), 501–508. doi:10.3399/bjgp08X319486
 

Employees don't feel obliged to pay back managers who support them emotionally

The offering of emotional support from a manager at times of need is perceived very differently by managers and the recipients of that support. According to a new paper, while managers see such efforts as over-and-above their expected responsibilities, employees see it as just part of the manager's job. This clash of expectations can lead to problems.

Researchers Ginka Toegel, Martin Kilduff and N Anand drew their data through interviews and network analysis of staff at a recruitment agency. The network analysis asked the 67 employees to detail who they relied on when experiencing negative emotions. Those lower in the company hierarchy tended to turn to more senior colleagues for emotional support when stressed, angry or fatigued. There was little traffic in the other direction, as senior staff typically sought support from peers rather than subordinates. (We've covered leadership responses to challenges here.)

Interview data suggested that as well as responding to direct requests for support, managers often actively scanned their environment for brewing issues, and engaged with subordinates to offer venues to discuss emotional issues. And the ways in which managers helped ranged from simple listen-and-advice to more involved interventions, such as reframing and transforming the employees perspective.

What are the managerial motivations that lie behind such patterns of helping behaviour? Some managers expressed a fairly-hard nosed attitude: 'I don’t want that people leave, or I don’t want them to be really low or down at work, because this will have negative impact on me.' These individuals expected their efforts to pay back in terms of renewed commitment to the team. Other managers were more pro-social, acting because they are interested in people and concerned for their feelings. Still, they also expected reciprocity in terms of warmth and appreciation for their efforts. As one manager expressed, 'what I am doing [by way of emotion help] is over and above my responsibilities as a manager', and this view emerged as a consistent theme across the 14 managers interviewed: emotional support is an extra-role activity.

But employees saw things differently. 'If it is a work-related emotional problem, then it is my manager’s job to support me.' From their perspective, emotional support is simply a feature of the managers job, and saw little or no obligation to reciprocate. Employees did sometimes perceive that a manager was doing an excellent job in emotional support and consequently saw them as exceptional leaders, attributing them experience, wisdom and even referring to them as father- and mother-figures. The authors speculate whether putting the manager into such roles is a way to remove the need to actively reciprocate, just as children are rarely expected to match the efforts of their parents. While this can be flattering to a manager, the lack of a quid pro quo led to some managers feeling 'let down and disappointed', such as when an employee supported through a difficult episode went on to abruptly quit the company for a better position.

Neither the employee nor manager is wrong, but this study suggests that they can commonly be on different pages with regard to the role of emotional support. Being a 'toxin handler' of other people's negative emotions can be challenging and have knock-on effects for those who intervene. The authors conclude that 'our model suggests the paradox that helping behavior designed to ameliorate negative emotions may itself generate negative emotions on the part of managers waiting in vain for employees to repay their kindness with personal loyalty.'

Toegel, G., Kilduff, M., & Anand, N. (2012). Emotion Helping by Managers: An Emergent Understanding of Discrepant Role Expectations and Outcomes Academy of Management Journal, 56 (2), 334-357 DOI: 10.5465/amj.2010.0512

Further reading:
Elfenbein, H. A. 2007. Emotion in organizations. In J. P. Walsh & A. P. Brief (Eds.), Academy of Management annals, vol. 1: 315–386. New York: Erlbaum.
 

Starting negative may help you be creative

Positive emotion has long been recognised as facilitating creativity, through broadening thinking and allowing exploratory mental wandering. Conversely, high negative emotion tends to lead to narrow focus on salient, possibly threatening environmental features (such as an impending deadline or difficult conversation), which has lead many to discount it as an impediment to creativity. But recent research suggests that prior states of negative emotion can improve subsequent creative activity.

The paper, by Ronald Bledow, Kathrin Rosing and Michael Frese, does not contest the idea that positive emotions crucially support creativity: what they propose is that positivity rising over time while negativity descends over time may offer better conditions than high positivity coupled with an absence of negative affect. They provide two reasons for this.

Firstly, the narrow, alert focus on issues can be useful by focusing on things that are in need of a solution and spurring motivation to act on these; previous research does suggest that negative emotion can lead to more persistence in problem solving. Once this focus has been set, allowing the negative emotions to slide away and positive emotions to explore the possibility space is a good recipe for getting to innovative solutions. The first study investigated this by asking 102 participants in creative roles to document their affect at the start and end of each day for a week, independently rating positive (excited, alert, inspired) and negative (distressed, hostile, guilty) emotional terms. Positive affect at the end of the day predicted how much creativity the participant reported in that day, but that relationship was significantly stronger when start-of-day negative affect was higher.

In a second, experimental study, Bledow's team focused solely on another advantage of starting in a negative mood, that it is specifically a decrease in negative mood that opens up associative networks of memory, allowing wider associations. The 80 participants in this study completed a brainstorming task after writing an autobiographical essay about a positive event. Before either, all participants wrote an initial autobiographical essay, and those who were tasked with articulating an unpleasant instead of a neutral experience ultimately performed better the brainstorming task, producing more varied and unique ideas. This happened even though the negative state had no function in focusing their attention on anything related to the creative task, which suggests the better performance was due to entering a more suitable cognitive mode.

Further research is needed on these dynamic relationships between different types of affect, in particular to examine more closely how fluctuations on a shorter timescale may impact work goals. But this paper suggests that treating positive affect as the wellspring of creativity may perversely be itself an example of overly narrow focus. Individuals who routinely dismiss negative thoughts to stay in their happy place may wish to dwell a little longer, as a station on the way to their creative destinations.

Bledow, R., Rosing, K., & Frese, M. (2012). A Dynamic Perspective on Affect and Creativity Academy of Management Journal, 56 (2), 432-450 DOI: 10.5465/amj.2010.0894

Further reading:
Baas, M., De Dreu, C. K. W., & Nijstad, B. A. 2008. A meta-analysis of 25 years of mood-creativity research: Hedonic tone, activation, or regulatory focus? Psychological Bulletin, 134: 779 – 806.
 

Do we make too much of workplace conflict between women?

This month, the Women's Business Council released a report revealing that underuse of women's workplace potential costs the economy £160 billion.

As well as structural issues, such as inadequate workplace childcare, psychological factors can also provide obstacles to an unrestricted workplace.  A recent paper by Leah Sheppard and Karl Aquino suggests one may be the tendency to overstate the consequences of female-female workplace conflict.

 There is a pedigree of research into female-female conflict, sometimes framed in terms of the 'Queen Bee', and the data is explained through plausible psychological mechanisms. For instance, social identity theory predicts that when a group has a low status in its social environment its members will partly inherit that status, unless they distance themselves from the group and define themselves by other means.

Men tend to hold higher status roles in organisations, so women are incentivised to minimise identification with their gender, focusing on their non-feminine attributes and distancing themselves from other women. When in a position of power, these attributes are often described in the literature as hallmarks of a 'Queen Bee', and there is interesting research (reported by our Research Digest) on how such an attitude can be the consequence of workplace conditions.

However, Sheppard and Aquino highlight that there is very little data showing behavioural consequences - that women in power are more likely to actually deny positions to other women, for instance. In fact, data from a related field points the opposite way: female mentors with female proteges tend to put in more mentoring effort than men with male ones. And this points to a second critique: the lack of attention to whether male same-sex conflict has a similar incidence or severity. On an evolutionary account,  same-sex competition is likely to be more commonplace for either sex. But it is specifically tensions between women that get communicated as a phenomena, possibly because it is in violation of gender norms – women are supposed to be nurturers – and hence both more salient and judged as more negative.

Sheppard and Aquino looked at this systematically through an online experiment, where an even mix of male and female participants were presented with a single account of a fictional conflict between either two men, two women, or one party of each gender. In their feedback, the 152 participants in the various conditions saw the conflict as comparably bad for the organisation, long-term. However, those in the female-female condition believed it was less likely that the parties would reconcile, and that the personal consequences for each - in terms of satisfaction, emotional identification with the organisation and willingness to stay in role - were also worse. Both effects were statistically significant.

Such perceptions have implications: as the authors note, 'a manager might decide against assigning two female subordinates to a task that requires them to work together if he or she suspects that they cannot set their interpersonal difficulties aside'.  The message to take away is that scientific findings matter, but baselines do too. Research in a vacuum can be counterproductive to understanding the true nature of things, and as things stand it's not clear whether workplace conflict between women deserves a special status in public perception. Most of all, we need research that goes beyond attitudes to what actually happens in the workplace, in all-male relationships as well as all-female.

Sheppard, L., & Aquino, K. (2012). Much Ado About Nothing? Observers' Problematization of Women's Same-Sex Conflict at Work Academy of Management Perspectives, 27 (1), 52-62 DOI: 10.5465/amp.2012.0005

Further reading:
Epstein, C. F. (1980). Women’s attitudes toward other women: Myths and their consequences. American Journal of Psychotherapy, 34(3), 322–333.
 

What happens to an organisation when people leave?

Today, one of your colleagues is packing the contents of his desk into a cardboard box. A few weeks back you were at a leaving do for someone in another department. On the personal scale, these can be sad events. But what does turnover augur for the organisation? Different studies show different things, for example that sales suffers, benefits or is unaffected by turnover rates. Contrasting hypotheses exist, but a meta-analysis by Tae-Youn Park and Jason D. Shaw takes us from the theories into the data. Let's start with the competing ideas.

The first position is that turnover disrupts how well an organisation does. More experienced workers perform better, an idea stemming from human capital theories. And people in an organisation for a while get to know each other, reducing transaction costs between them, an insight from social capital theory. Replacing people undermines these benefits and is costly.

Another view is that in a company with low turnover - people don't leave often - human capital is indeed accumulating. This means when people leave the organisation loses a resource, as per idea one. However, when turnover stands at a high rate, the company isn't accumulating appreciable human/social capital: it simply isn't a big part of how the organisation succeeds. Hence losses are fairly painless, and to boot the company is likely to be efficient at replacing staff, given it's such a routine issue. So low levels of turnover hurt, but the impact tails off at higher levels.

The third perspective turns this on its head: at low levels, turnover is actually useful, as it revitalises the workforce by eliminating misfits who harm performance. It's only when turnover gets too high, meaning fewer misfitting people are exiting, that costs exceed this benefit.

To decide between these possibilities and explore other factors described below, Park and Shaw identified 255 studies on the relationship between organisational performance and turnover using standard searches of databases. Through use of exclusion criteria, they arrived at 110 sources containing 371 correlations. Before performing analysis, correlations were coded according to a number of factors, from industry of organisation to methodological approach. We'll see these in a moment.

Across the studies, a significant negative effect was found of -.15, suggesting that a 1SD increase in turnover produces a .15 decrease in performance. And when turnover was higher, the negative relationship became if anything stronger. This aligns most strongly with the simple human/social capital predictions: turnover hurts at all levels.  But the relationships varied widely across the included studies, and it's important to understand what's behind this.  Here's the overview.

Turnover affects certain performance measures more than others

• Customer Satisfaction and Quality showed large effects
• Weaker effects found for employee attitudes, productivity and financial performance
• Generally the effects were greater when measuring performance soon after the turnover, rather than moderately far or far into future

Organisational Type and structure matters

More effects were found in

• smaller companies
• executive level samples
• industries such as healthcare and hospitality, coded as 'human-capital-centric'
• those with so-called 'primary employment systems' that focus around delivery through committed employees (instead of a transactional, control-system)

These all paint a consistent picture that when organisations rely more on human capital, turnover hurts more. A large company which differentiates itself through use of equipment/other resources, eg mining, is less hurt by departures, especially so if it isn't investing in people practices (such as training, development, or engagement strategies) that secure commitment.

Turnover type matters

Reduction in force (downsizing) and voluntary turnovers both showed a significant negative relationship to performance. Involuntary turnover (getting fired) showed a relationship not different from zero. As some theories suggest all turnover should hurt, and others suggest that involuntary turnover should help organisations by losing weak performers, it's important to take this away. Possibly the benefits of losing misfits are cancelled by the costs of rehire.

The author conclude that 'organizations must recognize that when turnover rates rise, their workforce and financial performance are at risk. They should
 search for strategies to mitigate and eliminate turnover, recognizing
 that lower turnover is always better.'

Park, T., & Shaw, J. (2013). Turnover rates and organizational performance: A meta-analysis. Journal of Applied Psychology, 98 (2), 268-309 DOI: 10.1037/a0030723

Status shifts in groups as extraverts disappoint and neurotics overdeliver

New research suggests that the higher status bestowed on extraverts in new groups may drop as their contributions become better understood. In the meantime, neurotic people may see their lower status improve.

Corrine Bendersky and Neha Parikh Shah investigated this in two studies. The first examined how 44 student teams working on MBA assignments over 10 weeks attributed status and competence to individual members. One week after forming, each member was asked to rate the other 3 to 5 members' group status - e.g., 'To what extent does each individual influence the group’s decisions?' - and expected level of contribution to the group. Ten weeks after meeting, the members again rated each other on status and (now actual) contributions.

Personality measures taken at the start of the course showed that more neurotic individuals received lower status ratings at the first measurement stage, but made gains at the second stage. Extraverts, meanwhile, received marginally higher initial ratings but these decreased by time two. The effects were small, possibly because researchers controlled for a wide range of measures including other personality factors, gender, cognitive ability and individual assignment grades, which may soak up what might otherwise be observed. Further analysis confirmed effects were not due to regression to the mean, as variability in ratings was similar across the two time points. Instead, it appeared that the status changes were due to neurotics being seen to contribute more than had been expected, and extroverts less than expected.

In a computer-based experimental follow-up, 340 participants rated a hypothetical colleague before and after seeing their response to a request to assist the participant on a task. Beforehand, the colleague received higher status ratings when described using extraverted keywords, and was considered more likely to assist than when they were described as neurotic. However, when the colleague responded with a generous offer of help, neurotics were rewarded with greater increases in ratings than extraverts. And when the colleague was tight with their time, they were punished more heavily when portrayed as an extravert.

Extraverts find it easier to make a rapid, positive impact, being assertive, dominant and talkative. But for ongoing contributions to a team, their demeanour may introduce problems. They can be poorer listeners, and less able to cope with others being proactive, leading to group competition. This means that initially high expectations can lead to disappointment. Meanwhile, the low self-belief and and sense of powerlessness associated with neuroticism can make it easy to dismiss their group value. But neurotics are keen to avoid social disapproval and not be seen as incompetent, making them motivated to prepare for activities and put effort in, over-delivering on their original promise.

Bendersky and Shah argue that we should recognise that status is responsive to these factors, updating dynamically as a group gets to know each other or experiences different conditions. And in terms of practical implications, they offer a warning:  'Managers may rely too heavily on extraverted employees, which could be problematic if these individuals become less appreciated group members over time. In contrast, introverted and neurotic employees may be underutilized because managers inaccurately assume they will be less effective team members. With experience working together, however, both types of people may be important and valued contributors to their teams.'

Bendersky, C., & Shah, N. (2012). The Downfall of Extraverts and Rise of Neurotics: The Dynamic Process of Status Allocation in Task Groups Academy of Management Journal, 56 (2), 387-406 DOI: 10.5465/amj.2011.0316

Further reading:
Judge, T. A., & Bono, J. E. 2001. Relationship of core self-evaluations traits—Self-esteem, generalized self-efficacy, locus of control, and emotional stability — With job satisfaction and job performance: A meta-analysis. Journal of Applied Psychology, 86: 80 –92.

Does it take two to tango to get win-win negotiation outcomes?

Negotiation training has been shown to lead to positive outcomes for parties on both sides of the table, identifying 'win-win' solutions and helping the wheels of the world turn more amicably. But many studies focus on consequences when both negotiators are trained using the same methodology, when the reality is that a counterpart from another organisation may be trained differently or not at all. What happens then? A study by Alfred Zerres and colleagues finds out.

The study recruited 360 business administration students as either a 'buyer' or 'seller' and gave each some information on the context to study. Participants then conducted an initial negotiation over computer chat with a counterpart (a buyer to their seller), each trying to achieve their assigned objectives. Pair performance was measured by combining the success of buyer and seller: the negotiation was designed to be non-zero-sum as some factors were framed as more valuable to the buyer than seller, and vice versa, making some settlements more 'efficient' or mutually attractive than others. For this first negotiation, pair performance was fairly inefficient, on average reaching just 61% of the best outcome for both parties.

After this, some participants were kept busy with a filler task, whilst others received negotiation training. The training introduced the idea of 'logrolling', trading factors that mean more to the person receiving than the one giving, epitomised by two children fighting over an orange when one is most interested in the juice and the other the peel. Trainees then had opportunities to work through an example and then try and extend the concept to some other cases.

After this session, all pairs reconvened for a second negotiation on a separate issue. In some cases both parties had received training, and their pair performance was significantly better. What about when just one party had been trained? They did just as well – but only if it was the seller who had gotten training. Seeking a causal mechanism behind this, the researchers had recorded the computer-chat negotiation interactions, and looked at the amount of active information exchange in each pair, specifically sharing their own priorities or asking the counterpart about theirs. This kind of information sharing is crucial for logrolling, and analysis confirmed that this was behind the better performance by pairs with a trained seller. In a third negotiation one month later, groups with a trained seller both were better at spotting logrolling opportunities but also at recognising entirely compatible factors such as a buyer wanting quick delivery and a seller wanting to clear their warehouse rapidly.

The buyer role in a negotiation is about loss-aversion (not being suckered into a bad purchase)  which encourages a vigilant but passive stance - 'convince me!' - putting the onus on the seller to push and shape the conversation. If the seller is focused on log-rolling, then that conversation will be more transparent and lead to better outcomes. In some cases, a purchasing organisation might benefit more by identifying vendors  that are trained in (virtuous, win-win) negotiation techniques than to invest in training their own buyers. Alternatively, organisations who do train buyers might want to go beyond providing new concepts and investigate whether changing motivational mindset could lead to better outcomes in negotiations that matter.

Zerres, A., Hüffmeier, J., Freund, P., Backhaus, K., & Hertel, G. (2013). Does it take two to tango? Longitudinal effects of unilateral and bilateral integrative negotiation training. Journal of Applied Psychology, 98 (3), 478-491 DOI: 10.1037/a0032255
 
Further reading:
Nadler, J., Thompson, L., & Van Boven, L. (2003). Learning negotiation
skills: Four models of knowledge creation and transfer. Management
Science, 49, 529 –540. doi:10.1287/mnsc.49.4.529.14431