Associations between job demands, work-related strain and perceived quality of care: a longitudinal study among hospital physicians.

Objective: Drawing on a sample of hospital physicians, we attempted to determine prospective associations between three job demands, work-related strain and perceived quality of care.

Design: Longitudinal follow-up study with with a 1-year time lag.

Setting: Physicians of two acute-care hospitals in Germany (one general urban and one children's hospital).

Study participants: Ninety-five physicians filled out a standardized questionnaire.

Main outcomes measures: Physicians' evaluations of quality of care at both waves.

Results: Our results support the hypothesis that job demands directly influence quality of care irrespective of strain. Specifically, high social stressors (β = -0.15, P = 0.036) and time pressure (β = -0.19, P = 0.031) were associated with decreased quality of care over time. We additionally observed reversed effects from quality of care at baseline to time pressure at follow-up (β = -0.35, P = 0.006). Contrary to expectations, physicians' work-related strain did not mediate the job demands-quality of care-relationship, nor were strain-to-stressor effects observed.

Conclusions: Our results corroborate that hospital work environments with high demands have a direct impact on physician-perceived quality of care. In turn, poor care practices contribute to increased job demands. Our findings also emphasize that further understanding is required of how physicians' workplace conditions affect job demands, well-being, and quality of care, respectively.