European Journal of Social Sciences Volume 9, Number 3 (2009)

Role Stress Among Doctors Working in a Government Hospital in Shimla (India)

Hirak Dasgupta Assistant Professor Balaji Institute of Modern Management Tathwade, Opp.Wakad Police Station Pune-411033, Maharashtra (India) E-mail: hirak20@yahoo.com Suresh Kumar Professor, Institute of Management Studies Himachal Pradesh University Shimla-171005, Himachal Pradesh (India) E-mail: ims_suresh@yahoo.co.in Abstract Objectives: To determine sources of role stress among doctors in Indira Gandhi Medical College & Hospital, a Government Medical Hospital located in Shimla (India) and to examine the stress levels among Male and Female doctors working in the hospital. Methodology: Two hundred and fifty three (253) questionnaires were distributed to the doctors and one hundred and fifty (150) duly completed questionnaires were received. Non probability (Judgment) sampling method was used to select the sampled units within the hospital for study. Statistical treatment included Factor analysis and t-test. Results: The factors causing role stress among doctors is: (1) Role Overload (2) Self-role distance (3) Role Isolation (4) Inter-role distance (5) Role Stagnation (6) Role expectation conflict (7) Role ambiguity and (8) Role Inadequacy. Roles overload shows 40 percent variance which was found to be a significant factor causing stress among the doctors. t-test indicated that there was no significant difference between the stress levels among male and female doctors except in cases of Inter-role distance and Role Inadequacy. Conclusions: The study showed that Role Overload is most significant source or factor causing role stress among the doctors working in the hospital. Male doctors are more stressed than the female doctors in cases of Inter-role Distance and Role Inadequacy. Keywords: Role Stress, Hospital, Shimla.

1. Introduction
Stress is an inevitable part of our life. Academicians, practitioners, administrators and researchers have always been interested in studying this problem as it directly affects the efficiency of the employee. An optimum amount of stress is required for an optimum performance. The present study was undertaken in Indira Gandhi Medical College & Hospital (IGMC), located in Shimla (Himachal Pradesh) India which was established in the year 1966 and is one of the prominent hospitals in northern India. The hospital has bed strength of 872 and there are 100 faculty members and 170 senior residents/demonstrators. 356

European Journal of Social Sciences Volume 9, Number 3 (2009) Job stress has been defined as the non-specific response of the body to any demands made upon it (Selye, 1976). Robbins (2001) defines stress as a dynamic condition in which the individual is confronted with an opportunity, constraint, or demand related to what he or she desires and for which the outcome is perceived to be both uncertain and important. Organizational based factors have been known to induce job stress for employees at the workplace (Greenhaus and Beutell, 1985). These factors are termed as organizational stressors since they serve as agents that trigger various stress reactions (Van Onciul, 1996). Factors making General Practitioners (GPs) more vulnerable to stress can be analyzed from individual and organizational perspective. In the past studies, at the individual level sources of psychosocial stress were mentioned age, gender and marital status. At organizational level work place location, type of practice, job demands and decision latitude were considered as sources of psychosocial stress. Work related stress has been implicated as a major contributing factor to growing job dissatisfaction among doctors. It has been found that work stress impacts not only on doctors health but also their abilities to cope with job demands. This will seriously impair the provision of quality health care and the efficacy of health service delivery. 1.1. Conceptual Framework of Role Role is the position one occupies in the system, and is defined by the functions one performs in response to the expectations of the significant members of a social system, and ones own expectations from that position or office. A role is not defined without the expectations of the role senders, including the role occupant. The position of a Human Resource Manager may be created in an organization, but his role will be defined by the expectations (stated or unstated) that different persons have from the Human resource manager, and the expectations that he, in turn, has from the role. In this sense, the role gets defined in each system by the role senders, including the role occupant. The concept of role and the two role systems (Role Space and Role set) have built-in potential for conflict and stress (Pareek, 2002). 1.1.1. Role Space Conflicts Role space is the dynamic relationship between the various roles and individual occupies and his self. It has three main variables; self, the role under question and the other roles he occupies. Any conflict among these is referred to as role space conflict or stress. These conflicts may take several forms. Self Role distance: This stress arises out of the conflict between the self concept and the expectations from the role, as perceived by the role occupant. If a person occupies a role that he may subsequently find to be conflicting with the self concept, he feels stressed. Intra-role Conflict: Since an individual learns to develop expectations as a result of his socializing and identification with significant others, it is quite likely that he sees a certain incompatibility between the different expectations (functions) of his role. For example, a professor may see incompatibility between the expectations of teaching students and of doing research. These may not be inherently conflicting, but the individual may perceive these as incompatible. Role Stagnation: As an individual grows older, he also grows in the role that he occupies in an organization. With the individuals advancement, the role changes; and with his change in role, the need for taking on a new role becomes crucial. This problem of role growth becomes acute especially when an individual who has occupied a role for a long time enters another role in which he feel less secure. The new role demands that an individual outgrows the previous one and takes charge of new the role effectively. This is bound to produce some stress. In organizations that are fast expanding, and which do not have any systematic strategy of human resource development, managers are likely to experience this stress of role stagnation when they are promoted. Inter-role distance: When an individual occupies more than one role there are bound to be conflicts between them. For example, a lady executive often faces a conflict between her 357

European Journal of Social Sciences Volume 9, Number 3 (2009) organizational role as an executive and her familial role as a wife and mother. The demands on her time by husband and children may be incompatible with organizational demands. Such inter-role conflicts are quite frequent in a modern society, where an individual is increasingly occupying multiple roles in various organizations and groups. 1.1.2. Role Set Conflicts The role set consists of important persons who have varying expectations from the role that an individual occupies. The conflicts which arise as a result of incompatibility among these expectations by the significant others (and by the individual himself) are referred to as role sets. Role Ambiguity: When an individual is not clear about the various expectations that people have from his role he faces role ambiguity. Role ambiguity may be due to lack of information available to a role occupant, or his lack of understanding of the cues available to him. Role ambiguity may be in relation to activities, responsibilities, priorities, norms or general expectations. Generally, role ambiguity is experienced by persons occupying roles that are newly created in organizations, roles that are undergoing change, or process roles (with less clear and less concrete activities). Role expectation Conflict: When there are conflicting expectations or demands by different roles senders (persons having expectations from the role), the role occupant experiences this type of stress. The conflicting expectations may be from the boss, subordinates, peers or clients. Role Overload: When a role occupant feels that there are too many expectations from the significant others in his role set, he experiences role overload. Role overload has been measured by asking questions about peoples feelings on whether they can finish work given to them during a modified work day and whether the amount of work they do interfere with how well it is done. Most executive role occupants experience role overload. Role overload is more likely to occur where role occupants lack power, where there are large variations in the expected output, and when delegation or assistance cannot procure more time. Role Erosion: A role occupant may feel that the functions he would like to perform are being done by some other role. Role erosion is the individuals subjective feeling that some important expectations that he has from a role are shared by other roles within the role set. Role erosion is likely to be experienced in an organization that is redefining its role and creating new roles. Studies indicate that in several such organizations the stress of role erosion was inevitably felt. In one organization, a particular role was abolished and in its place two were created to cater to executive and planning needs. This led to great erosion, and a feeling that the new roles were less important than the previous role. Resource Inadequacy: Resource inadequacy stress is experienced when the resources required by a role occupant for performing his role is effectively are not available. Resources may include information, people, material, finance or facilities. Personal Inadequacy: When a role occupant feels that he does not have enough knowledge, skills or training to undertake a role effectively, or that he has not had time to prepare for the assigned role he may experience stress. Persons who are assigned new roles without adequate preparation or orientation are likely to experience feelings of personal inadequacy. 7. Role Isolation: In a role set, the role occupant may feel that certain roles are psychologically closer to him, while others are at a much greater distance. The main criterion of distance is the frequency and ease of interaction. When linkages are strong, the isolation will be low and vice versa. Role isolation can therefore be measured in terms of existing and the desired linkages. The gap between them indicates the amount of role isolation. The present study aims to investigate the factors causing stress among doctors in IGMC; a prominent government hospital in northern region located in Shimla (Himachal Pradesh) India and also examines the stress levels among male and female doctors working in the hospital. To the best of our knowledge, there is a paucity of Indian work in this field which is another major reason to undertake this study.

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2. Review of Literature
Work stress is increasingly recognized as one of the most serious occupational health hazards reducing workers satisfaction and productivity, and increasing absenteeism and turnover (Gianakos, 2001). Hospital staff in particular is subject to work related stress simply because they are severely challenged by their rapidly changing environment. (Al-Aameri, 2005). Previous studies have revealed positive association between work stress and the number of errors. (Perry et al, 2000). In UK more GPs experienced poorer mental health, more dissatisfaction and higher stress level in 1993 than 1987 (Kirwan and Armstrong 1995; Rout and Rout, 1994). 25 percent to 50 percent of the British National Health Services staff reported distress suffering (Weinberg and Creek, 2000). Therefore, many reports suggested that stress among physicians, nurses and other health professionals is high (Caplan, 1994; Graham et al, 1996; Al-Aameri and Al-Fawzan, 1998). The quality of health care can be extremely influenced by the stressed health staff (FirthCozens, 1998). In fact there is an ongoing concern in the UK, about the mental health of the practitioners (Ramirez et al, 1996). Such mental problems make health staff in general and doctors in particular susceptible to more physical and emotional morbidity (Gautam, 2001) which in turn needs careful consideration. The World Health Organization (WHO) called work stress as a world wide epidemic. Such important facts about stress show that excessive stress has costs to both the organization and the employees. In fact stress and burnout are sometimes conceived among the organizational behavior concerns (DuBrin, 1984). Previous research revealed that there were many causes correlated to work stress found within worker personality and within the work environment (Newman and Beehr, 1979) . A study conducted on 1133 consultants working in the UK, reported that work overload and influenced home life; poor administration and resources; administrative responsibilities assumed; and dealing with patients pain were perceived as sources of stress. In addition, lack of clear direction concerning the organizational goals was found to be among the significant causes of work stress (Murphy, 1987). Role ambiguity, role conflict and clarity of organizational roles were also found to be of significant relationship with work stress among 433 employees of seven Kuwaiti governmental sectors (Al-Fadli, 1999). Role ambiguity and role conflict were also correlated with work stress among 50 emergency doctors working in nine hospitals of the northern areas of Jordan (Nusair and Deibageh, 1997). A study conducted on 333 doctors in Scotland indicated that higher clinical workloads were related to higher stress (Deary et al 1996) Responsibility for others and career development were found to be of significant relationship with work stress among doctors (Nusair and Deibageh, 1997). It is known that work can be an exciting source of challenge, where potentials and capabilities of the self are discovered and utilized. This positive stress perspective has been termed as Eustress (Mesler, 1994). Yet work is more commonly indicated as one of the most universal and intense kinds of Distress. Distress is viewed as a malady, needing treatment. The nature of hospital job was also found to be a source of stress; the fact that the employee may deal with communicable disease patients causes a threat to the employee health. On the basis of the review of literature we are of the opinion that stress always affects the efficiency and performance of the doctors working in hospitals. Academicians, researchers, administrators and consultants have identified a number of factors responsible for role stress among doctors. In addition, we believe that providing attractive working conditions may be used for minimizing the stress level among the doctors so that their efficiency may be increased. This investigation aims to study the factors causing stress among doctors in IGMC, a prominent government hospital located in Shimla (Himachal Pradesh) India and also determine the stress levels among male and female doctors working in the hospital. To the best of our knowledge, there is a paucity of Indian work in this field which is another major reason to undertake this study. 359

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3. Methodology
The methodology includes research design, population and sample, data collection and data analysis process are outlined. Methodology is the total strategy for the study and it starts from the identification of the problem to the final plans of for the data collection. 3.1. Need of the Study In the context of the present study, little research has been conducted to investigate the role stress experienced by doctors in a developing country like India. India comprises of about 35% population who are below poverty line and it is this part of the population who approach government hospitals for their medical treatment because they cannot afford to get the expensive treatment done in a private hospital. Our study involves one of the prominent government hospitals in northern India i.e. Indira Gandhi Medical College & Hospital, Shimla (Himachal Pradesh) India. A typical day of a doctor in this hospital starts with attending patients in the OPD (in case of physicians) or performing surgery in the operation theatre (in case of a surgeon), then visiting the wards, taking lectures, guidance to doctoral students and research , attending emergency cases and working for long hours. Besides these activities, he/she has administrative duties and family responsibilities to perform as well. Moreover, this govt. job prohibits private practice which may also be a cause of dissatisfaction among the doctors. This proliferation of roles that the doctors have to undertake during their everyday educational and clinical practice lead to stress which has become an inherent feature of the work life of the doctors and growing evidence suggest that it may increase in severity. Medical knowledge is increasing exponentially, the disease patterns are changing, the approach to health care delivery and medical education is shifting and also professional roles and boundaries are being modified. Work-related stress has been implicated as a major contributing factor to growing job dissatisfaction among doctors. It has been found that job stress impacts not only on doctors health but also their abilities to cope with job demands. This will seriously impair the provision of quality care and the efficacy of the health service delivery. To the best of our knowledge there is a paucity of Indian work in this field which is another reason to undertake this study. 3.2. Objectives of the study (i) To determine the factors causing role stress among doctors working in Indira Gandhi Medical College & Hospital, Shimla (Himachal Pradesh). (ii) To examine the stress levels among male and female doctors working in the hospital. In the present study the population consisted of doctors in all of the units/wards/departments at Indira Gandhi Medical College &Hospital. The respondents were scattered in all units/wards/departments already stated at Indira Gandhi Medical College & hospital. Because the nature of work of the doctors it made difficult to conduct face interviews and a questionnaire was ideal as the respondents used their own time and pace to complete the questionnaire. Judgment sampling was used for the selection of the doctors which was found to be a convenient and economical method. Two hundred and fifty three (253) questionnaires were distributed to the respondents and one hundred and fifty (150) questionnaires (duly completed) were received back from the respondents. This means that about 59% of the questionnaires (duly completed) were returned. The academic rank of the faculty members and their experience is shown in Table 1.

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Table 1: Showing the Academic ranks and experience of faculty members.
Number 32 28 35 55 Percentage 12.8% 18.8% 23.3% 33.3% Years of experience Between 15-25 Years Between 10-15Years Between 5-10 Years Less than 5 Years

Academic Rank Professors Associate Professors Assistant Professors Registrars/Demonstrators

The respondents comprised of 92 (61.3%) male doctors and 58 (38.7%) female doctors. We have made an attempt to form a representative sample which included all ranks of doctors working in the hospital. Due care has been taken in giving representation to female doctors as well. The Organizational Role Stress scale - ORS (Pareek,2002) was used as a tool to measure 10 role stresses, i.e. self-role distance, inter-role distance, role stagnation, role isolation, role ambiguity, role expectation conflict, role overload, role erosion, resource inadequacy and personal inadequacy. ORS is a 5-point scale (0 to 4), containing five items for each role stress and a total of 50 statements.

4. Results & Discussion

4.1. Results It may be mentioned that the data collected has been analyzed by using the software package SPSS (Statistical package for Social sciences) with the help of Factor Analysis. A useful statistic is the Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy. This index compares the magnitudes of the observed correlation coefficients to the magnitudes of the partial correlation coefficients. Generally, a value greater than 0.5 is desirable. In this case, the KMO measure is 0.847 (as shown in table 2) which indicates that the correlations between pairs of variables can be explained by other variables and that factor analysis is an appropriate test for the present study.
Table 2: showing KMO and Barletts Test
Test Statistic 0.847 7305.608 Degrees of Freedom 1225 Significance .000

Test Kaiser-Meyer-Olkin Measure of Sampling Adequacy Bartletts Test of Sphericity

Once it was determined that factor analysis is an appropriate technique for analyzing the data, the method of - Principal Component Analysis was applied. Principal Component Approach considers the total variance in the data and the factors are called principal components/Components in this case 4.2. Scale Reliability The reliability statistics, as shown in table 3 gives the value of the Cronbachs alpha coefficient and the number of items selected for the scale.
Table 3: showing the reliability statistics
Cronbachs Alpha 0.9668 N of Items 150

The present study shows a Cronbachs alpha of 0.9668 which indicates satisfactory internal consistency of the set of items forming the ORS scale. SPSS next shows the table titled Factor matrix/ Component matrix which gives the factor loadings before rotation is carried out. Factor loadings indicate the strength of relationship between a particular variable and a particular factor, in a way similar to a correlation. For each of the variables, 361

European Journal of Social Sciences Volume 9, Number 3 (2009) we get a loading in each of the columns representing factors. The factor loadings in the component matrix are not easily interpretable. Because there are many variables with high loadings on more than one factor in the component matrix. Rotation of the matrix solves this problem as shown in the table 4 below.
Table 4: Showing the Rotated Component Matrix
1 0.598 0.163 0.419 0.235 0.595 0.247 0.189 0.273 0.114 0.058 0.790 0.574 0.255 0.101 0.723 0.161 0.115 0.095 0.183 0.270 0.780 0.630 0.299 -.379 0.625 0.105 0.212 0.189 0.413 0.750 0.652 0.352 0.299 0.092 0.618 0.557 0.064 0.379 0.166 0.425 0.757 0.266 0.398 0.091 0.799 0.420 0.317 0.465 0.101 0.516 2 0.389 0.199 0.174 0.311 -.481 0.112 0.307 0.563 0.756 0.310 0.072 0.205 0.480 0.554 0.160 0.140 -.012 0.171 0.404 0.103 0.135 0.262 0.726 0.241 0.417 0.254 0.650 0.587 0.511 0.096 0.347 0.350 0.358 0.123 0.509 0.363 0.754 0.036 0.539 -.020 -.045 0.295 0.270 0.083 0.286 0.164 0.429 0.472 0.738 -.104 3 0.122 0.279 0.348 0.658 0.045 0.737 0.616 0.480 0.326 0.683 0.122 0.172 0.214 0.545 0.379 0.447 0.222 0.568 0.394 0.456 0.223 0.019 0.219 0.291 0.273 0.087 0.289 0.546 0.385 0.041 0.104 0.224 0.224 0.008 0.017 0.162 -.044 0.212 0.040 -.094 0.073 0.147 0.241 0.235 0.007 0.380 0.145 0.192 0.228 0.018 4 0.008 -.038 0.072 0.076 0.377 0.311 0.029 0.137 0.051 0.064 0.118 0.241 0.046 0.200 -.093 0.140 0.252 0.131 0.090 0.149 0.070 0.028 0.079 0.549 0.162 0.193 0.080 0.057 -.012 0.052 0.153 0.227 0.131 0.818 0.086 0.133 0.449 0.639 0.238 0.407 0.189 0.061 0.204 0.753 0.042 0.195 0.523 -.036 -.058 0.487 5 0.062 0.070 0.185 -.032 -.010 0.002 0.243 0.003 0.088 0.123 -.090 0.063 0.183 0.067 0.142 0.394 0.085 0.209 0.414 0.168 0.090 0.428 0.262 0.210 0.023 0.798 0.429 0.126 0.130 0.236 0.007 0.293 0.494 -.010 0.052 0.188 0.083 0.114 0.559 0.145 0.293 0.132 0.302 0.256 0.125 0.450 0.079 0.201 0.235 0.065 6 0.165 0.682 0.507 0.186 0.125 0.022 0.203 0.79 0.217 0.297 0.158 0.413 0.365 0.085 -.011 0.388 -.040 0.248 0.324 0.239 0.059 0.223 0.262 0.078 0.010 0.057 -.266 -.082 -.205 -.029 0.252 0.101 0.132 -.033 0.155 0.261 0.151 0.088 0.138 -.236 -.086 -.042 0.409 0.012 0.007 0.097 0.093 0.186 0.137 0.128 7 0.084 0.025 -.175 0.333 0.011 -.101 -.014 0.154 0.179 -.062 0.087 -.094 0.092 0.279 0.041 0.207 -.042 0.180 -.160 0.263 -.036 0.206 -.082 -.054 0.135 0.064 0.122 0.334 0.144 0.196 0.111 0.471 0.393 0.120 0.070 0.274 -.058 -.040 0.153 0.305 -.025 0.726 0.313 0.105 0.163 0.051 -.380 0.123 0.164 0.259 8 -.306 -.137 0.199 -.105 0.103 0.140 0.102 0.031 0.045 0.058 0.054 0.078 0.439 0.210 -.001 0.055 0.731 0.375 0.191 -.399 -.116 0.036 -.110 -.176 -.123 0.107 -.004 0.040 0.099 0.037 0.125 -.181 -.026 0.188 0.046 0.241 -.031 -.072 0.019 0.255 0.078 -.004 0.023 0.128 0.128 -.034 0.094 0.056 -.039 0.095 9 -.011 -.004 0.203 0.028 0.088 0.100 -.417 0.053 -.082 0.181 -.235 -.335 -.012 -.049 0.054 -.244 0.004 -.063 0.137 -.033 0.008 0.000 0.015 -.102 0.293 -.024 0.00 -.180 0.026 -.037 -.070 0.152 0.004 0.005 0.366 0.084 -.183 0.176 0.142 0.321 0.056 0.029 0.015 -.118 0.256 0.391 -.006 0.422 0.162 0.272

Component Variables Item 1 Item 2 Item 3 Item 4 Item 5 Item 6 Item 7 Item 8 Item 9 Item 10 Item 11 Item 12 Item 13 Item 14 Item 15 Item 16 Item 17 Item 18 Item 19 Item 20 Item 21 Item 22 Item 23 Item 24 Item 25 Item 26 Item 27 Item 28 Item 29 Item 30 Item 31 Item 32 Item 33 Item 34 Item 35 Item 36 Item 37 Item 38 Item 39 Item 40 Item 41 Item 42 Item 43 Item 44 Item 45 Item 46 Item 47 Item 48 Item 49 Item 50

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Eigen value % of Variance Cumulative percentage 19.947 39.89 39.89 4.318 8.636 48.53 2.836 5.67 54.2 2.412 4.82 59.02 1.738 3.47 62.5 1.53 3.06 65.56 1.48 2.97 68.54 1.27 2.54 71.08 1.054 2.54 73.19

Table 4 shows the Rotated Factor/Component Matrix which has rotated loadings, the eigenvalues, % of variance and the cumulative percentages. For a good factor solution, a particular variable should load high on one factor and low on all other factors in the rotated component matrix. A cut off of 0.40 or 4+ to identify high loadings has been used in the present study. 4.3. Frequency of Factor Loadings The following table (table 5) gives the summary of the loadings, mentioning the frequency of loadings of 8+, 7+, 6+, 5+, 4+, 3+ and 2+.
Table 5: showing the summary of Loadings of Factors of Role Stress
2+ 9 7 14 5 9 12 (-3) 6 3 5(-2) 3+ 4 (-1) 8 6 --2 3 5(-1) 3(-2) 3 4+ 3 4 3 3 5 2 1 1 2(-1) 5+ 4 6 3 2 1 1 ------6+ 4 1 3 1 --1 ------7+ 7 4 1 1 1 --1 1 --8+ ------1 ----------%of variance 40 9 6 5 3 3 3 3 2

Factor- loadings Factors 1 2 3 4 5 6 7 8 9

The table 5 shows that factor 9 has a loading of 4+ only on one item and contributes only 2% to the total variance. In view of this consideration, this factor can be dropped. Factor 1 has high loadings on 3 items of role overload, one each on inter-role distance, role inadequacy and role stagnation. Since Inter-role distance and Role overload contributes to a conflict between organizational and the family role, therefore, this factor can be called as Role overload factor. On the basis of this information, it can be concluded that Role Overload factor is an important stressor for the doctors in the hospital. Factor 2 has high loading of 7+ each on self-role distance, role overload and role erosion. Since Self-role distance (value-role performance conflict), role erosion (attention given to other roles) indicate a conflict between self image and the role contents, therefore, this factor can be called as Selfrole Distance factor. On the basis of the information given in the table 5 it can be concluded that Selfrole distance is another important cause for stress for the doctors in the hospital. Factor 3 has high loadings of 7+ on Role isolation item and one each of 6+ on inter-role distance, role erosion and role ambiguity. It has 3 factor loadings of 5+ on inter-role distance, role isolation and role ambiguity. Most of the items can be grouped under the factor called - role isolation. Therefore, on the basis of this information it can be concluded that Role Isolation is an important stressor for the doctors in the hospital. Factor 4 has one high loading of 8+ on Inter-role distance and one 7+ loading on role ambiguity. It has two loadings of 5+ on item 24(Role inadequacy) and item 47(i.e. Personal inadequacy) and most of these factors can be clubbed under the factor Inter-role Distance. On the basis of this we can conclude that Inter-role distance is an important stressor for the doctors in the hospital. Factor 5 has a one high loading of 7+ on Role erosion, one 5+ loading on role ambiguity and five loadings each of 4+ on item 33 (Self-role distance), item46 (resource inadequacy), item27 (Role stagnation), item 22 (role isolation) and item 19(role stagnation)therefore we can call this factor as role 363

European Journal of Social Sciences Volume 9, Number 3 (2009) stagnation. Therefore, on the basis of this information it can be concluded that Role stagnation is a vital stressor for the doctors in the hospital. Factor 6 comprises of one high loading each of 6+ and 5+ on role stagnation and role expectation conflict. It contains two loadings of 4+ on item 12(role ambiguity) and item 43 (role expectation conflict). Since there are two items of role expectation conflict, therefore this factor can be called role expectation conflict. On the basis of the information provided in the table 5 it can be concluded that Role Expectation Conflict is an important cause of stress for the doctors in the hospital. Factor 7 has one loading of 7+on item 42(role stagnation) and one loading of 4+ on item 32(Resource Inadequacy). This factor can be called Role ambiguity. On the basis we can conclude that Role Ambiguity is an important stressor for the doctors in the hospital. Factor 8 has a loading of 7+ on item 17 i.e. self-role distance (interest-responsibility conflict) and one loading of 4+ on item 13 i.e. role overload (too many people expect too much). This factor can be called Role Inadequacy. Role adequacy can be of two types personal inadequacy (lack of resources to meet the role demands) and resource inadequacy (lack of external resources to meet role demands). Role inadequacy or in this case can also be termed as Personal inadequacy is an important cause of stress for the doctors in the hospital. We thus got the following factors for ORS scale: Factor 1: Role Overload (RO) 40% variance Factor 2: Self Role Distance (SRD) 9% variance Factor 3: Role Isolation (RI) 6% variance Factor 4: Inter-role Distance (IRD) 5% variance Factor5: Role Stagnation (RS) 3%variance Factor 6: Role Expectation Conflict (REC) 3% variance Factor 7: Role Ambiguity (RA) 3% variance Factor 8: Role Inadequacy (RI) 3% variance The following factors were identified as factors causing role stress among doctors working in IGMC :(1) Role Overload (2) Self-role distance (3) Role Isolation (4) Inter-role distance (5) Role stagnation (6) Role expectation conflict (7) Role ambiguity (8) Role Inadequacy. 4.4. Comparison between Stress levels among Male and Female Doctors The following table (table 6) below shows the means in stress levels among the male and female doctors working in the hospital.

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Table 6: Showing the means between the stress levels among male and female doctors t-test was performed to study the differences in the stress levels among male and female doctors.
Number 92 58 92 58 92 58 92 58 92 58 92 58 92 58 92 58 Mean 8.30 8.50 6.46 5.79 5.83 5.17 6.48 4.86 7.11 6.84 5.69 4.87 5.50 4.79 5.51 4.12 Standard deviation 5.63 5.78 4.96 4.38 6.09 3.84 4.62 4.04 5.92 5.27 4.89 4.07 4.48 3.62 4.13 3.59

Gender RO Male Female SRD Male Female RI Male Female IRD Male Female RS Male Female REC Male Female RA Male Female RIn Male Female

Hypothesis: H0: H1
Table 7:

there is no significant difference between the stress levels among male and female doctors working in the hospital. there is a significant difference between the stress levels among male and female doctors working in the hospital.

t-test
t -2.05 .847 0.742 2.202** 0.288 1.059 1.010 2.106** Sig.(2tailed) .838 0.398 0.459 0.029 0.744 0.291 0.314 0.037

Variables Role Overload (RO) Self-role Distance (SRD) Role Isolation (RI) Inter-role Distance (IRD) Role Stagnation (RS) Role expectation Conflict (REC) Role Ambiguity (RA) Role Inadequacy (RIn)

It is evident from table 7 that there is no significant difference between the stress levels among the male and the female doctors except in cases of Inter-role distance and Role Inadequacy. 4.5. Discussion The focus of the present study was to investigate the factors causing stress among doctors in a govt. hospital and comparison of the stress levels among the male and female doctors working in the hospital. Occupational stress is caused by workplace, individual and social factors, and it is recognized as one of the most pervasive and potent health hazards in the work environment. This is true in many workplaces, particularly the health care industry. An occupational stressor may be defined as any demand, physical or psychological, encountered in the course of working. Work stressors are influenced by such personal characteristics as personality, value system, health, educational background, goal orientation and perception of job situation. Work organization and job stress are topics of growing concern in the occupational safety and health field. The expressions "work organization" or "organization of work" refer to the nature of the 365

European Journal of Social Sciences Volume 9, Number 3 (2009) work process (the way jobs are designed and performed) and to the organizational practices (e.g., management and production methods and accompanying human resource policies) that influence the design of jobs The following factors were identified as factors causing role stress among doctors:(1) Role Overload (2) Self-role distance (3) Role Isolation (4) Inter-role distance (5) Role stagnation (6) Role expectation conflict (7) Role ambiguity (8) Role Inadequacy. Role Overload was found to be the most significant factor causing role stress among the doctors working in the hospital. Role overload describes situations in which employees feel that there are too many responsibilities or activities expected of them in respect to their available time and abilities (Pareek, 2002; Fisher, 1994). This was the case in this study, where high level of role overload was found among the doctors. The results of some of the past studies are similar to the present one on the factors causing stress among employees/doctors .Soleiman Ahmady et al (2007) investigated role stress experienced by medical school faculty members in Iran and concluded that the most role related stressors and forms of conflict among medical school faculty members include too many tasks and everyday workload; conflicting demands from colleagues and superiors; incompatible demands from their different personal and organizational roles; inadequate resources for inappropriate performance; insufficient competency to meet the demands of their role; inadequate autonomy to make decision on different tasks; and a feeling of underutilization. A study conducted on 1133 consultants working in the UK, reported that work overload and influenced home life; poor administration and resources; administrative responsibilities assumed ; and dealing with patients pain were perceived as sources of stress. In the same study, radiologists reported the highest level of burnout in terms of low personal accomplishment (Ramirez et al, 1996). A study conducted on 333 doctors in Scotland indicated that higher clinical workloads were related to higher stress (Deary et al, 1996). The nature of hospital job was also found to be a source of stress; the fact that the employee may deal with communicable-disease patients causes a threat to the employee health. Work overload both quantitatively and qualitatively has been empirically linked to a variety of physiological, psychological and behavioral strain symptoms (Roberts et al, 1997; Miller and Ellis, 1990). According to Greenhaus et al (1987) heavy work loads lowers ones psychological well being resulting in job stress. From the above studies it is clear that the most frequent causes of stress can be listed under role conflict and role ambiguity, work load, responsibility for others, poor relationships with others, job conditions, career planning and development. Role ambiguity arises out of being given inadequate information to perform a job properly. On the other hand, when roles and responsibilities contradict with each other, role conflict emerges. Quantitative work load arises when there is too much tasks to perform in a specific period of time. Yet, qualitative work overload occurs when the work requirements exceed workers intellectual competence and skills. Responsibility for others can be too much to the extent that it may contribute in causing work stress. Poor relationships with others lead to less trust and support between peers, subordinates, and superiors. Career planning and development include job security, promotions, work transfers and progress opportunities. A British Medical Association (BMA) report (2000) suggests that many senior doctors suffer high levels of stress as a result of their work and that this impairs their health and compromises their ability to provide high quality care to patients. The main sources of work related stress for consultants and GPs are excessive workloads, organizational changes, poor management and insufficient resources, dealing with patient suffering and mistakes, complaints, and litigation (Ramirez1996; McKevitt, Morgan&Simpson, 1995). Pressures of work also impact on the health of junior doctors. Our study involves one of the prominent government hospitals in northern India i.e. Indira Gandhi Medical College & Hospital, Shimla (Himachal Pradesh). The proliferation of roles that the doctors have to undertake during their everyday educational and clinical practice lead to stress which 366

European Journal of Social Sciences Volume 9, Number 3 (2009) has become an inherent feature of the work life of the doctors and growing evidence suggest that it may increase in severity. Medical knowledge is increasing exponentially, the disease patterns are changing, the approach to health care delivery and medical education is shifting and also professional roles and boundaries are being modified. Work-related stress has been implicated as a major contributing factor to growing job dissatisfaction among doctors. It has been found that job stress impacts not only on doctors health but also their abilities to cope with job demands. This will seriously impair the provision of quality care and the efficacy of the health service delivery. Dramatic changes in the health sector have altered doctors jobs, limiting autonomy and reducing morale. Comparison between Stress levels among Male and Female Doctors The table 6 shows the means among the male and female doctors working in the hospital. From the table 7 it can be inferred that Inter-role distance and Role Inadequacy are the two factors in which there is a significant difference in the stress levels among the male and female doctors. The doctors experience the stress of Inter-role distance because they may not be able to give enough time to their family. There exists a conflict in their organizational role and family role. The role stress of Role Inadequacy is another factor where the doctor the doctor feels lack of internal resources to meet his/her role demands and also faces various types of demands from the organization, peers/subordinates, and patients as well as from the family. Therefore, this factor of role inadequacy can be termed as personal inadequacy. Furthermore since the mean for male doctors is more than the mean for female doctors in case of Inter-role distance and Role Inadequacy, we can conclude that the stress levels for these factors are more in case of male doctors than the female doctors.

5. Conclusions
1. On the basis of the data analyzed, we have mainly selected the eight factors which cause stress among doctors. These factors are: (1) Role Overload (2) Self-role Distance (3) Role Isolation (4) Inter-role distance (5) Role stagnation (6) Role expectation conflict (7) Role Ambiguity (8) Role Inadequacy. There is no difference between the stress levels among male and female doctors except in case of the factors- Inter-role distance and Role inadequacy. Since the doctors feel the conflict between the organizational role and the family role, therefore the stress level is significant for the factor of Inter-role distance. Male and female doctors may feel the where the doctor the doctor feels lack of internal resources to meet his/her role demands conflicting demands from the organization and from the family; therefore, they may feel this stress which can also be termed as Personal inadequacy This study may help to explore doctors perceptions towards their roles. Organizational interventions at reducing the impact of stressors such as role overload can benefit the doctors. The findings of the study can assist administrators and policymakers to provide an attractive working climate in order to decrease the side effects and consequences of role stress and increase the productivity of the doctors.

2. 3. 4.

5. 6. 7.

6. Recommendations/Suggestions
On the basis of the data analysis we can provide the following suggestions for reducing and coping stress among the doctors working in IGMC, Shimla. 367

European Journal of Social Sciences Volume 9, Number 3 (2009) 1. It may not be possible to decrease the demands of the job some issues could be addressed in the first instance by providing support and improving working conditions and counseling services after stressful events and stress management training are amongst the approaches that may be beneficial in reducing the stress levels among the doctors working in the hospital. Adequate resources i.e. material, technical and human should be extended to perform the job effectively. Availability of resources is an important component of working conditions provided to a doctor. Therefore, adequate working conditions can help reduce stress among doctors. Clarifying the role and performance expectations Promoting prompt, constructive resolution of conflicts Psychological counseling and therapy that can recognize stress should be easily accessible and available for troubled staff members. Extent the counseling practices at the family level including dependents and relatives.

2.

3. 4. 5.

Conclusion
The productivity of the doctors is the most decisive factor as far as the success of the organization is concerned. The productivity in turn is dependant on the psychosocial well being of the doctors. In the age of highly dynamic and competitive world, man is exposed to all kinds of stressors that can affect on all realms of life. The growing importance of interventional strategies is felt more at the hospital level. Although certain limitations were met with the study, every effort has been made to make it much comprehensive. The researcher expects to draw attention of the administrators, policy makers, researchers and academicians in related fields to resume further research.

Acknowledgement
We would like to record our gratitude to the Principal, Indira Gandhi Medical College & Hospital, Shimla for granting his permission to undertake this study and to all the doctors who participated in the study and make this work a success.

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