This study investigates psychosocial demands related to work organization depicted by managers and employees in the health and service sector. During an in-depth analysis, we focused on the main category “Organization of work”. A complete overview of the subcategories and themes of this category is presented in Supplementary Material 3.
Within this category, the following four themes prevailed and were frequently reported by managers and employees: “Possibilities and time for recovery after work”, “Communication and cooperation with customers”, “Work intensity”, and “Interruptions and prioritization”. While these themes primarily address aspects of work organization, they also reflect and are closely interrelated to other themes of the GDA framework such as work content and tasks, and social relations. Thus, these four themes illustrate the various psychosocial demands faced by managers and employees in the health and service sector.
Subsequently, we describe the four themes in detail presenting the results assigned to the perspectives of managers and employees to highlight differences in the way work-related psychosocial demands related to work organization are perceived.
Possibilities and time for recovery after work
Perspective of managers
As a result of work organization, managers from all companies reported various examples for a lack of possibilities and time for recovery after work due to limited division between work and private life. Managers had to organize many duties during and beyond the working hours of the company (e.g., work at the weekend, meetings with other managers, certain urgent administrative tasks, availability for urgent matters outside working hours).
Manager, orthopaedic company: “For employees, if they call me,…if they write me something via WhatsApp or something like that, or at home on the private phone or on the mobile phone…that's fine for me. Or when we go on holiday, it's the same, then it's clear that if there's an emergency or something, you have to do something special, then they send me a picture and I write back in the evening.”
These aspects of work organization (WhatsApp group, availability during holidays, …) are in turn closely related to aspects of work content and task. For example, the manager from the optician and hearing aid company reported that they often carried home perceived mental stress from work and reflected on work issues and possible solutions, since there is no time during work to think about such things. In the cosmetic company, managers often worked without breaks or with only few breaks between customers. In contrast, one manager of the optician and hearing aid company stated having regular breaks. Managers from two companies (dental technology company, cosmetic studio) also reported that they worked for very long hours. Working days were long in the cosmetic company in order to meet customer requirements (as customers in this setting mainly come to an appointment in the afternoon or evening).
Manager, cosmetic studio: “We are not an industrial company. Many applicants for a job just say: Yes, I'll come from 7 a.m. to 4 p.m.. Then I say: Yes, OK. Nice fantasy. If I work at Mercedes, BMW and so on, that's possible. But that's not possible in a small company. So, we have to adapt to the customer. (…)”.
During the interviews, there was hardly any discussion about the consequences of a lack of possibilities and time for recovery after work. One manager (orthopaedic shoemaker) reported paying attention to an appropriate level of recovery after work. This was related to a recent serious illness that resulted in a significant lifestyle change, which included a reduction of work-related duties through delegation of responsibilities. In another interview, permanent availability for work-related issues was not seen as a major problem (orthopaedic company). Nevertheless, managers seemed to be aware of the lack of possibilities and time for recovery after work and different coping strategies were therefore used to deal with this issue. One coping strategy aimed at maintaining stable working and business hours, and, if possible, to avoid working on weekends (pharmacy, orthopaedic shoemaker). Another manager stated that they tried to get things accomplished at the workplace, desire to limit the own availability to the opening hours, and during the regular working hours to keep a balanced workload with sufficient rest (orthopaedic shoemaker). In one family business (orthopaedic company), the possibilities and time for recovery was supported by the feedback of the children of the managers encouraging their parents to try to switch off from work at home. Another coping strategy was the hiring of additional staff in order, for example, to be able to further reduce the work as a spontaneous replacement for sickness absence of employees.
Manager, pharmacy: “And then I'm often the person who jumps in when someone is sick or on holiday. And now I have reduced it again, because I have just hired a pharmacist and I am no longer so much at the front of the hand-selling.”
Perspectives of employees
Compared with managers, employees reported fewer problems regarding the division between work and private life. Some examples for a lack of possibilities and time for recovery after work were courses for further education in leisure time (pharmacy), and the use of WhatsApp groups for work-related issues (pharmacy, optician and hearing aid company). The use of the work-related WhatsApp group was, however, not perceived as a burden (pharmacy).
Contrary to the managers, employees rarely worked overtime (orthopaedic shoemaker), and usually fulfilled their working time within their contractually agreed hours. Also, in most companies, breaks for employees were scheduled. Often, for example, the shop was closed for a certain period of time during lunch breaks, and during this time it was possible for employees to take a break.
Employee, pharmacy: “We close from 12:30 to 14:00. And that is fine, too. The manager agrees and that's also good, just to come down for a while.”
In certain companies (orthopaedic company, cosmetic studio), employees decided when they take a break, depending on their work schedule. In the optician and hearing aid company the shop did not close at lunchtime. Here, the employees agreed among themselves who will take a break and when. All employees stated that it rarely happens that employees cannot take their break and have to continue working. Since many companies were located in the middle of the city, breaks were used to get some fresh air.
Employee, orthopaedic shoemaker: “Yes, that's actually … you get something, you go to a restaurant, you occasionally bring something with you. Whatever you want, whatever you feel like.”
One employee from the orthopaedic shoemaker company (orthopaedic shoemaker) addressed furthermore some strategies for receiving a good level of recovery after work. He did not take work home, tried to resist stress and reduce overtime in agreement with his manager.
Communication and cooperation with customers
Perspective of managers
According to the managers, several requirements were necessary for good communication and cooperation with customers. Here, as well, the link between aspects of work organization, work task and content as well as social relations emerges. With regards to work organization, disruptions of customers’ conversations or treatments should be avoided (optician and hearing aid company, cosmetic studio). For the managers, it was essential that customers are in the centre of attention (orthopaedic company) and that a good customer service is ensured (optician and hearing aid company, orthopaedic company). Other requirements were the consideration of good social relations in form of communication at the same level with the customer (dental technology company). Managers from two companies (orthopaedic company, cosmetic studio) mentioned in particular a close customer relationship and personal contacts. Furthermore, they stated that good communication has a strong impact on customer loyalty.
Manager, cosmetic studio: “Rather, it's all about that, because customer loyalty is often present, i.e. very strong customer loyalty here. We have noticed that in the extreme (…).”
This theme also revealed differences between the companies. While five companies (pharmacy, optician and hearing aid company, orthopaedic company, orthopaedic shoemaker, cosmetic studio) had a “classic customer base” with customers or patients entering the store, the dental technology company represented a unique case. For the dental technology company, the dentists were the customers, and the company received the work assignments from them. Thus, the customers of the dental technology company were also experts in the same field. Due to the special situation of the dental technology company, honesty, openness and willingness to criticize were considered by the manager as important requirements for good communication and cooperation with the dentists. They also emphasized several challenges regarding the communication and cooperation with them.
Manager, dental technology company: “We are of course greatly dependent on the dentists. And this is always a big issue, because the dentists can of course send the work to another laboratory from now on. And this is a dependency that I don't like that much (…). I want to be part of the team, and actually we are, dentists and dental technicians, because both sides have to work together, and some dentists don't see that. They always think they are at the top because they are the client.”
This dependency is often related to a high degree of economic pressure. Therefore, the manager of the dental company described his customers differentiated in terms of cooperation with them. Clients with whom the cooperation is perceived difficult, often do not adhere prior agreements. The communication and cooperation with dentists affect the whole work situation, and the motivation of the employees:
Manager, dental technology company: “(…) Motivation of the dental technicians is enormously important, because if you only have customers who treat you from above, you don't like to work for them. And at some point, the quality you deliver is necessarily the same. And if you are subconsciously influenced by customers you like, with whom you can really exchange ideas, even in critical moments, it works much better (…).”
Perspective of employees
Employees of the companies shared a similar way of looking at the theme communication and cooperation as the managers. Employees from the orthopaedic company regarded the following requirements as important: friendliness, competence, empathy, tolerance, taking time for the customer, and taking them seriously. Other requirements to facilitate communication and cooperation were to ensure good customer care (optician and hearing aid company, orthopaedic company), mutual respect (optician and hearing aid company), and the ability to learn how to deal with customers (orthopaedic shoemaker).
Employee, orthopaedic shoemaker: “And that's where I learned most of it. How to deal with people. And also, when people come in that you can see from the beginning, like, what kind of guy, what's coming at you. It took a long time before it sat like that, but that's what I thought. But it works out quite well.”
Employees of the dental technology company also cited challenges regarding the cooperation and communication with dentists as customers. Frequent challenges were an insufficient flow of information and the difficult availability, for example to make enquiries:
Employee, dental technology company: “Yes, also from the information about the desired work, that's exactly the same, not everything is written on it, then you have to ask, you don't catch anybody. But the appointment is made ... and then the practice is closed again in the evening or at noon.”
Perspective of managers
Managers from different companies reported being confronted with high work intensity. Reasons for high work intensity for managers were an additional high bureaucratic workload, and the changing and not predictable number of customers (orthopaedic company), that the companies were confronted with. The orthopaedic company is also responsible for providing acute therapy for customers:
Manager, orthopaedic company: “Of course. It is always a challenge for us when there are 20 people in the clinic and then ten come to us and need urgent care immediately, then we sometimes pile up the people. And we also need our time if a shoe needs to be changed immediately. This is a big challenge, which we have to face with our personnel, because these are all things that have to be changed immediately.”
Managers tried to find solutions to deal with high work intensity. They try to improve the work organization by for example extending the processing time, or in some cases, the working time was also extended (orthopaedic shoemaker).
Manager, orthopaedic shoemaker: “Or, what we do when things get really tough, which happens two or three times a year at most, we say: OK. We're usually closed on Wednesday, and the shop is closed and the repair shop is closed, but then we just work for a few hours (…).”
Other solutions from the perspective of managers were to perform their administrative tasks only when there were a few customers in the shop (orthopaedic company). High work intensity resulted in perceived stress for managers as well as stress due to deadline pressure (orthopaedic shoemaker), and to waiting customers (orthopaedic company).
Perspective of employees
Employees provided additional insights into the theme work intensity. Reasons for high work intensity were bureaucratic factors and occurring delivery shortages (pharmacy), the changing and not predictable number of customers (optician and hearing aid company), an increase in incoming orders (orthopaedic shoemaker, cosmetic studio) or phone calls (optician and hearing aid company). Employees from two companies reported an increase in work intensityat certain times of the year, for example during the Christmas season for the dental technology company and in spring for orthopaedic mechanics:
Employee, orthopaedic shoemaker: “When it's springtime now, people think, oh yes, now I should prepare myself for my spring shoes. The loafers, sandals, everything they have. And of course, they'll bring all that stuff. And then it can happen that you have quite a pile of work.”
Other reasons for high work intensity were due to required corrections of job tasks, and repeated work steps and delays (dental technology company). Employees of the same company also indicated that work orders and the periods of time allowed for their processing were often unpredictable, external determined and short-term in nature.
Employees, dental technology company: “Right. Yes, and it's generally the same with the deadlines, so I think that no matter who does what, it's somehow the same with everyone, because it's really a bit … You can't predict it. For example, we got two dental crowns today, so it's always … You can never tell, there can be something new in the morning, at noon, in the evening, so it's always. Exactly.”
As a consequence of high work intensity, the most frequently mentioned factor for employees is also perceived work-related stress including stress due to completing increasing tasks (e.g., during springtime) (orthopaedic shoemaker), as well as due to the correction and repetition of job tasks (dental technology company). Another consequence for employees of the orthopaedic shoemaker and the dental technology company was that their own ability to plan their work suffers due to externally determined processing periods or specific customer demands.
Employees, dental technology company: “And that's just the difficulty with us, the planning, a certain amount of planning is already possible, that's fine. But as I said, if something goes wrong in between, or if something goes wrong at the dentist, for example, and we have to repeat it again or have to repair it, or whatever, that's the difficulty for us. That is the stress, so to speak (…).”
Employees of two companies (orthopaedic shoemaker, dental technology company) specified suggestions to avoid high work intensity. Suggestions included reasonable processing time, and better coordination of work steps so that they run more smoothly. Employees of the dental technology company also suggested more influence on time scheduling and good working documents with complete instructions to guarantee good work for the customer (in this case the dentist). They emphasized that the dentists as customers should prepare the required measurements to the dental laboratory (e.g., for dentures) as specifically as possible. According to the employees, this avoids and reduces subsequent corrections and repetition of job tasks, for which the dental technology company is not compensated.
Interruptions and prioritization
Perspective of managers
Managers reported many interruptions during their working day. They indicated that the processing of administrative tasks and customer conversations were frequently interrupted (orthopaedic company). In the cosmetic studio, interruptions of ongoing tasks were reported when new customers entered the store while other customers were being treated and no additional staff members were available. In such cases, the treatment would be interrupted to serve the new customer. Yet, these interruptions interfere with the manager's instructions that the treatment and contact with customers should not be interrupted (cosmetic studio). However, incoming customers have a higher priority than incoming phone calls. In the cosmetic studio, customers were encouraged to leave their requests on the answering machine and make online reservations themselves because serving current customers in the store was understood as the priority task:
Managers, cosmetic studio: “And that's why we said, all right, phone's ringing, let it ring. (…) Yes, but the customer who is in the shop has the priority, that's the highest priority.”
Managers try to deal with interruptions including strategies such as the prioritization of specific work tasks (orthopaedic company, cosmetic studio) and the scheduling of certain work activities before opening hours:
Managers, orthopaedic company: “I am a person who can do that, but you often don't get into focused work activities in such a way that you can really think your way into something that you can stay at it for a long time. That's actually already … Well, my life is here … really characterized by interruptions every day. The fact that I can stay at something for a quarter of an hour is rather the exception. That's why I love the early morning hours.”
The most frequently perceived negative consequences of interruptions reported by managers were increased perceived stress, and a lack of concentration (orthopaedic company).
Perspectives of employees
Employees also listed many examples for interrupted work tasks, e.g. administrative tasks (optician and hearing aid company, orthopaedic company), tasks in the repair shop (optician and hearing aid company) and customer conversations (orthopaedic company). Employees explained why some of their work tasks were interrupted and other tasks were prioritized. The main reason for interruptions was due to additional customers who could not be served by additional personnel (optician and hearing aid company, orthopaedic company, orthopaedic shoemaker). Other reasons for interruptions in the different companies included incoming phone calls (optician and hearing aid company, orthopaedic company), equipment failure (orthopaedic shoemaker), queries from the manager (orthopaedic company), and the parallel running of store and repair shop (orthopaedic shoemaker).
Employee, orthopaedic shoemaker: “(…) And now you are interrupted during this work. Yes, it's nothing new for me, because … I've been doing this job for about 30 years now and I've also worked with customers before. I have also been interrupted at times. So, it's nothing new and doesn't bother me more or less. Sometimes it's stressful, … sometimes you have more repairs and then there are more customers and then it all gets a bit annoying, a bit stressful.”
In the pharmacy, some work tasks were very urgent and needed to be prioritized. In particular, acute care and preparation of refrigerated products were specific work tasks that were given a high priority. Employees of the dental technology company often had to interrupt their work process due to sudden arising deadlines for incoming new orders:
Employees, dental technology company: “And every customer has different deadlines. One gives us two weeks to do a job, another gives us three weeks, and the third has to be done in a very short time, so you can only plan to a limited extent.”
Employees used under supervision and in agreement with their managers different strategies to deal with interruptions of work tasks. Strategies included the prioritization of specific work tasks (optician and hearing aid company, orthopaedic company), creating reminder notes (pharmacy), attempting to rapidly complete most of a task (pharmacy, orthopaedic company), not answering incoming phone calls (orthopaedic company, cosmetic studio), or spontaneous coordination of work tasks with colleagues (optician and hearing aid company). In the optician and hearing aid company, work begins before the opening of the store in order to avoid interruptions during the dealing with repairs:
Employees, optician and hearing aid company: “And I think that my colleague is now one hour earlier because of the repair shop, because there are many orders where only lenses are ordered (…) The daily business is still in the repair shop. And there are also many things that are perhaps a bit more extensive. And that you can perhaps … that you can perhaps do a bit of preparatory work in peace.”
Many consequences were mentioned which are caused by interruptions at work. The most frequently mentioned consequences by employees were long processing times (optician and hearing aid company, orthopaedic company), a perceived disruption of the work routine (orthopaedic company), tension (pharmacy), perceived psychological stress (optician and hearing aid company, orthopaedic shoemaker), being annoyed (optician and hearing aid company), and mistakes.
Employee, pharmacy: “Of course I try to keep everything organized, but if the product is not back where I put it, then I get a bit tense and then I think to myself: Where did I put it after all? Then, yes, then you have to do one thing at a time. I try to learn how to do it, because otherwise mistakes are made and then you are in a stressful situation.”