Higher patient waiting times are associated with higher chronic stress of general practice personnel: Results of the cluster-randomized IMPROVEjob study

Julian Göbel, Karen Linden, Matthias Grot, Brigitte Werners, Lukas Degen, Tanja Seifried-Dübon, Esther Rind, Anna-Lisa Eilerts, Claudia Pieper, Verena Schröder, Monika A. Rieger, Birgitta Weltermann

Keywords: waiting times, stress, general practitioners, practice personell

Background:
Studies showed that higher waiting times in general practices lower patients’ satisfaction with care. Yet, there are little data on associations between patients’ waiting times and chronic stress of practice personnel. We used baseline data of the cluster-randomized IMPROVEjob study with 60 German general practices to address this question.

Research questions:
We aimed to assess associations between chronic stress of practice personnel and personnel-reported waiting times.

Method:
The IMPROVEjob study included 366 professionals from 60 practices in the German North-Rhine region: 84 practice leaders, 28 employed physicians and 254 practice assistants. Perceived chronic stress was measured with the validated TICS-SSCS questionnaire (scale 0=low to 48=high). The waiting time was surveyed with a self-developed item (“On average, how long do patients wait in your practice?”) offering 6 answer options: “5-15 minutes”, “16-30 minutes”, “31-45 minutes”, “46-60 minutes”, “over 1 hour”, “over 2 hours”. A multilevel regression model analyzed for associations between personnel’s perceived chronic stress and the reported waiting time while respecting the clustered data.

Results:
The reported waiting times were: 5-15 minutes: 11.0%, 16-30 minutes: 35.8%, 31-45 minutes: 30.3%, 46-60 minutes: 12.1%, over 1 hour: 7.5%, over 2 hours: 3.2%. The average TICS-SSCS sum score across all 3 occupational groups was 19 out of 48 (SD = 8.78). Higher waiting times correlated with higher chronic stress of personnel on individual level (r all staff = 0.25; r practice leader = 0.24; r employed physician = 0.40; r practice assistants = 0.22). In the regression model, each waiting time shift from a shorter to a longer waiting time was associated with a significant increase in chronic stress (+1.72 points on the TICS SSCS scale).

Conclusions:
Higher patient waiting times are associated with a negative effect on practice staff’s wellbeing. Optimized work processes are needed to reduce waiting times and personnel’s chronic stress.

Points for discussion:
What is your experience from your practice? Do you feel stressed when patients wait for a long time?

Do you have experience with trainings improving workflows to avoid or reduce waiting times?