A Study On Medical Staff Emotional Labor And Its Related Factors In Primary Health Care Institutions

Emotional labor refers to the emotional efforts of employees which in order to express emotions that meet the organization’s requirements at work, and the third mental labor except manual labor and mental work, widespread in the service industry. With the deepening of economic reform, China’s economic structure has undergone tremendous changes. The proportion of service industry has gradually increased, and emotional labor has received more attention. Studies have shown that, as organization, employees use emotional labor at work, such as sales staff smile at customers in accordance with the requirements of the organization, to make customers happy and do more shopping. It can also increase sales and improve general performance. For individual employees, that the emotional labor makes work effective is the basis for their own career development. Effective emotional labor can increase self-efficacy of employees, and improve the efficiency of handling employee-customer relations. However, on one hand the emotional labor brings many benefits, on the other hand there are also some inevitable undesirable effects which affect their physical and mental health, such as leading to work pressure, burnout, and lower job-satisfaction and so on. Thereby more attention should be paid to emotional labor research for the effects to organize and staff of both positive and negative brought by emotional labor.Primary health care services are an important and integral part of our health care system. But the shortages of human resource and quality have been a bottleneck in the long-term development of primary health institutions. Following the require of establishing and improving primary health care sendees system according to the new medical reform in 2009, the State Council promulgated a new policy of getting the primary into operation in 2013, which required a further enhancement of ability in the primary health care services. Although, by carrying out a series of measures such as free directional medical students and talent attraction and encouragement, there turned out an increase in the quantity of grassroots medical staff, so did their work and pressure cause of the rising in demand of seeing a doctor. When serving the patients and their families, doctors and nurses should not only pay the manual and intellectual labor, but also the emotional effort known as emotional labor. Emotional labor will not only affect the overall performance of primary health care institutions, but also their own physical and mental health. Moreover current researches on emotional labor of medical staff in primary health care institutions have not been reported, so it is particularly important and urgent to work on the study.ObjectiveThe purpose of this study was to investigate the status and characteristics of medical staff emotional labor in primary health care institutions, and the affect on job burnout, service damage, and doctor-patient relationship of emotional labor, as well as the impact on emotional labor of emotional intelligence, workload, and leadership behavior. Analyze the current problems of medical staff emotional labor, and find ways to reduce job burnout, workload and service damage and ease the doctor-patient relationship.MethodFirstly, use method of literature analysis to collect and summarize the literature about medical staff in primary health care institutions, emotional labor and relevant factors both at home and abroad. Provide a reference for the development of research program and follow-up studies based on deep analysis of the literature. Secondly, use method of interview. Deeply interview 28 doctors, nurses, managers and patients in primary health care institutions, to understand the experience and status of emotional labor. And determine to explore relationship about emotional labor with other six variables including burnout, service damage, doctor-patient relationship, emotional intelligence, workload, and leadership behavior combined with early literature analysis and summary. Then use method of questionnaire. Select 1170 medical staff of 55 town and township central hospitals and 21 community health service centers in Sichuan province for questionnaire survey to investigate their emotional labor, burnout, service damage, doctor-patient relationship, emotional intelligence workload, and leadership behavior. Finally, use method of mathematical statistical analysis. In order to get better explains of the findings, draw conclusions and make recommendations, using SPSS21.0 software for statistical analysis, including descriptive statistics, independent samples T-test, ANOVA, correlation analysis, and regression analysis.Result1. Status of medical staff emotional labor in primary medical care institutions showed:The deep acting strategy was the most commonly used which followed by the natural acting strategy, and finally was the surface acting strategy. Doctors preferred natural acting strategy than nurses (P<0.05); medical staff with secondary and college education were more likely both deep acting and natural acting strategy than those with university degree (p<0.001, p<0.05> p<0.01, p<0.01); medical staff with10～20 years of work experience preferred surface acting strategy than those with less than 10 or over 20 years (p<0.05, p<0.05); medical staff withl0-20 years and over 20 years of work experience were more likely deep acting strategy than those with less than 10 years (p<0.01, p<0.05).2. The effect on job burnout, service damage, and the doctor-patient relationship of emotional labor showed:Emotional labor had a significant effect on job burnout. The specifics: Surface acting strategy positively predicted emotional exhaustion, and depersonalization (P<0.001); deep acting strategy negatively predicted exhaustion, depersonalization, and reduced personal accomplishment (P<0.001); natural acting strategy negatively predicted reduced personal accomplishment (P<0.001).Emotional labor had a significant impact on service damage. The specifics: Surface acting strategy positively predicted service damage (P<0.001); deep acting strategy negatively predicted service damage (P<0.001).Emotional labor had a significant impact on doctor-patient relationship. The specifics:Surface acting strategy negatively predicted doctors’subjective experience, objective behavior of patients, and the combination of objective and subjective symptoms (P<0.001); deep acting strategy positively predicted doctor’s subjective experience, the combination of objective and subjective symptoms (P <0.001); natural acting strategy positively predicted doctor’s subjective experience (P<0.001).3. The impact on emotional labor of emotional intelligence, workload, and leadership behavior showed:Emotional intelligence had a significant influence on emotional labor. The specifics:Self-assessment of emotion negatively predicted surface acting strategy (P<0.001), and positively predicted deep and natural acting strategy (P<0.001); assessment of others mood positively predicted surface and natural acting strategy (P<0.001); the use of emotion positively predicted natural acting strategy (P <0.001); emotional regulation positively predicted deep and natural acting strategy (P<0.001).Workload had a significant impact on emotional labor. The specifics: workload positively predicted surface acting strategy (P<0.001), and negatively predicted deep acting strategy (P<0.05).Leadership behavior had a significant impact on emotional labor. The specifics:PM-type leadership behavior negatively predicted surface acting strategy (P<0.05), and positively predicted deep and natural acting strategy (P <0.001); pm-type leadership behavior positively predicted natural acting strategy (P<0.05). But the influence on natural acting strategy of P-type leadership behavior was not significant, so did the influence on deep acting strategy of M-type leadership behavior (P> 0.05).Conclusions and recommendationsThe results suggest that emotional labor has a significant impact on job burnout, service damage, and doctor-patient relationship. The more using of surface acting strategy, the higher of job burnout, the greater of the damage to service, the worse of the doctor-patient relationship; and more using of deep and natural acting strategy, the lower of job burnout and service damage, but the better of doctor-patient relationship. Therefore, it is necessary to train the hospital administrators and medical staff with emotional labor knowledge and skills in order to improve their understanding of the emotional labor.In addition, the results show that there is a significant impact of emotional intelligence, work load, the leadership behavior on emotional labor of medical staff. The higher of emotional intelligence, the less of using surface acting strategy, but the more of using deep or natural acting strategy; the greater of the workload, the more using of surface acting strategy, but the less using of deep or natural acting strategy; under PM-type leadership behavior, fewer of using of surface acting strategy, more of deep and natural acting strategy. Therefore, it is important to organize learning to improve the emotional intelligence of medical staff; increase the number of medical staff in order to reduce their workload; enhance hospital managers’capabilities of maintaining a team and job performance to improve their type of leadership behavior.