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Table 5 Organizing predictable and unpredictable absence of staff

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

Delegation

Quote 16

“The PrAs coordinate vacations among themselves. The doctor does not want to [get involved]. All [the GP] cares about is that somebody is there and the place is up and running.” (Observation protocol, group practice 5)

Adjusted patient volume

Quote 17

“We have a week of Pentecost holidays this [year]. And we don’t work during this time, because I [the GP] am not here either. The practice is closed. And afterwards [one PrA] goes on vacation for another two weeks in June because she has so much planned […]. In this case we will make fewer appointments or postpone [some]. We will manage that.” (Interview with GP, single practice 1)

Mutual social support

Quote 18

“I1: We ask each other: Can I go on vacation during this time, can we somehow organize that someone comes additionally or anything else? Sure, we...

I2: And it always works out.

I1: Well, I don’t think anyone would ever say no.

I2: That is how it works.

I1: Sure, because we respect each other’s vacation requests.

I2: Anyone’s.” (Focus group discussion among practice staff, single practice 1)

Sickness absence of GPs

Quote 19

“I think my colleague and I have the same work spirit. It must happen a lot not to show up for work. This happened to me once, three years ago. I got so dizzy, I could not get up. I definitely could not work. I think in the last 27 years I have missed this one week. Apart from that, I was always here.” (Interview with GP, group practice 5)

Leadership tasks

Quote 20

“And if someone is ill, it is discussed in the morning whether to change the areas. I think it works quite well. […] But because [the doctor] is the one who is usually called if a PrA does not come. Thus, [the doctor] is the first to know when there is an absence […]. [The doctor] knows exactly which PrA is on vacation and which one is here […]. […] So when I [one PrA] arrive at 8:00 a.m., it is all arranged.” (Focus group discussion among practice staff, group practice 3)

PrAs organize sickness absence

Quote 21

“I [GP] organize absences due to illness almost never. The girls do it themselves. [They organize] who comes instead or who stays longer, […] or we cancel appointments. […] Sometimes that is just the way it is. But it must be said that they are rarely sick.” (Interview with GP, single practice 1)

PrAs have the required knowledge

Quote 22

“I1: I [PrA] think we have become pretty good at reorganizing in case of sickness absence. […] What is the boss supposed to say?

I2: Exactly.

I3: We have to share the work in the front. […]

I2: [The doctors] have a lot of work to do. And it is actually the job of the PrAs to make house calls. I think it is pretty important that we can assess how many patients are still waiting, what other tasks need to be done and then divide that up.” (Focus group discussion among practice staff, group practice 2)

Planning of staffing ratio

Quote 23

“And since I am the personnel manager of this company, we have simply changed the number of staff, so that we do not get into shortages too easily.” (Interview with GP, group practice 2)

On-call roster

Quote 24

“I1: Due to the fact that stress has come up so often, we or [name of a certain employee] have made an on-call roster […] for the whole year.

I2: Yes. That means that every week there is someone else who should theoretically have to fill in when someone else is absent.

I3: So that you know right from the start: It is my turn a certain week of the year. […] This enables mothers […] to ensure childcare in order to be able to fill in flexibly.” (Focus group discussion among practice staff, group practice 1)

  1. I1, I2: interview partner 1, interview partner 2