Adapting, coping, compromising research – exploring the tactics and decisions doctors are applying in a system under pressure.
Why did we commission this research?
This research was commissioned to help us understand how doctors are adapting, coping and compromising in their day-to-day practice, while working in systems under pressure. It explored the different ways doctors are working, how sustainable this is and if patient care and safety could be impacted.
What were the key findings?
- Doctors report high workload pressure – over half of their working days were high pressure or unsustainable pressure days.
- Doctors talked about two main types of pressure:
- External pressure – can I do my job with the limited time and resources available?
- Internal pressure – can I do my job well?
- Types of pressure included:
- a lack of resources – not many experienced doctors or beds etc
- more patients with more complicated illnesses
- the winter, or weekends, when more people are ill or the number of staff is low
- feelings of responsibility, which mean that some doctors take on more work than they can manage.
- Doctors use a range of different ways to deal with this pressure, which fall under three main areas:
- Compromising – looking for ways to reduce their workload such as prioritising individual workload, patient problems or what the service can offer; delegating tasks, making referrals and encouraging patients to take more responsibility for their own health.
- Adapting – trying to change the way they work such as effective team working, working longer and harder; spreading the workload with colleagues, using telephone or technology to save time; developing more effective triage systems and reducing admin.
- Coping – learning how to live with the pressure, such as getting breaks during the working day; keeping their role varied, looking after their emotional wellbeing, taking exercise; and spending time with family or friends etc.
- Doctors felt that many of these were not sustainable long term and over half (55%) felt that there were only a few things left they could try/they had already reached the limit of new strategies to reduce pressure.
- Most doctors felt they were often exhausted and emotionally drained and nervous of making mistakes. One in four doctors said they were currently not coping with their day to day workloads.
- Most doctors thought that patient care was reduced due to doctors being under pressure with patients waiting longer to be seen, having less time with doctors and less effective communication.
- Many doctors felt that despite their best efforts, patient safety was impacted - with one in four (25%) of the surveyed doctors saying they have witnessed situations where pressure of work has placed patient safety at risk on a weekly basis
What did the research involve?
The research was conducted in two phases.
Phase one was delivered by an independent research consultancy Community Research and involved 40 in-depth qualitative interviews with doctors across a wide range of locations, levels, specialisms and types of workplaces. Fifteen of the doctors who took part in an interview also completed an online follow up exercise, via a smartphone app, to understand individual practice ‘in the moment’.
Phase two was delivered by another independent research consultancy medeConnect and involved a survey of 700 doctors across a wide range of locations, levels, specialisms and types of workplaces.