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Table 3 Organizing overall working time

From: Psychosocial demands and resources for working time organization in GP practices. Results from a team-based ethnographic study in Germany

Topics

Quote number

Quote

Different roles and tasks

Quote 3

“I think probably it is the coordination of everything. You are not a physician […] from 3 to 4 p.m., but you are everything at the same time. And I think that is probably it. We are not made for multitasking after all, right? Then one of [the employees] comes and says […] the printer doesn’t work anymore and the other one says the telephone system [is faulty.] I think it is the expectation that something can happen at any time which makes the day slip out of line.” (Interview with GP, group practice 5)

Decision-making authority

Quote 4

“We will have another emergency staffing this afternoon. […] This morning the team did not communicate properly at the times when it was possible […][.] Instead I [GP] was asked, in the bustle, where I was just doctor, and I said: ‘I will decide later.’ And then they decided something without consulting me again. That is a no-go.” (Interview with GP, group practice 2)

Administrative tasks

Quote 5

“Many organizational things, dictating letters, medical reports, and inquiries. All this is not achievable in the daily routine; it all takes place at the weekend or in the evening.” (Interview with GP, group practice 1)

Extended working week

Quote 6

“Yes, we certainly do not have a five-day week, but rather a six-day week. I certainly have a seven-day week at the moment, because I’m doing a little bit more. The partner physician of the practice has at least a five and a half-day week. So, work is done on half of the Saturday or half of the Sunday.” (Interview with GP, group practice 1)

Predictability of working time

Quote 7

“Predictability. As you have seen, there are […] staff members here, […] who are now back from parental leave with one or two children. They must be able to plan [their working day]. They have to know: at a certain time I can pick up my son from the childcare center. [If] the practice is so disorganized and they don’t know when they are off work, then [they] could not work here, or they would feel pressure all the time.” (Interview with GP, group practice 3)

Scope for action of the PrAs

Quote 8

“At 6:00 p.m., we are definitely done. But it is also the staff who ensure that […]. They have a little bit of control themselves, and they know a lot of the patients. Usually they know [which patients] need a lot of time. […] [The PrAs] do not arrange appointments with [these patients] at 5:45 p.m. That is self-protection […]. I think that is reasonable and understandable. I think, it is important that [the PrAs] have their own tasks and that [the GPs] don’t constantly meddle with these.” (Interview with GP, group practice 3)

Insufficient breaks

Quote 9

“I think you could relieve a lot of stress and at least have lunch on time. That is what I find most exhausting, that sometimes you are not able to take a break on time and then you work through the whole day. You may have just taken a quarter of an hour’s [break] and the work [continues] until 6, 7, 8 p.m.” (Focus group discussion among practice staff, group practice 2)

Work-privacy-balance

Quote 10

“We as mothers are finishing work quite punctually, because we have to pick up the children. But for example, I am currently working in the afternoon, […], and the end [of the working day] is just open for us, too.” (Focus group discussion among practice staff, group practice 2)