title: Linkages between workplace stressors and quality of care from health professionals' perspective - Macedonian experience.
abstract: OBJECTIVE
  During last two decades, within the process of transition, the socio-economic reforms in Republic of Macedonia reflected on the national health care system. The objective of this article was to identify workplace stressors and factors that influence quality of care, from the perspective of health professionals (HPs), and to understand how they were linked in the context of such social circumstances.
  
  
  METHODS
  A qualitative research based on focus group (FG) methodology was conducted in a general teaching hospital. Two main topics were the subjects of discussion in FGs: workplace stressors and factors that influence quality of care, from the HPs perspective. Six FGs were conducted with a total of 56 HPs (doctors, nurses, interns, and residents) divided into two sets of three FGs for each topic separately. Two sets of data were processed with thematic analysis, and the obtained results were compared with each other.
  
  
  RESULTS
  By processing the data, we identified themes relating to factors that generate stress among HPs and factors that influence quality of care, from HPs' perspective. By comparing the two sets of themes, we found that many of them were identical, which means factors that increase workplace stress at the same time reduce quality of care.
  
  
  CONCLUSIONS
  Implementation of specific organizational interventions in the hospital setting can lead to the prevention of work-related stress and improvement in quality of care. Our research suggests that the prevention of work-related stress will impact positively on the quality of care, which may contribute to establish criteria and recommendations for the improvement in organizational culture and climate in hospitals.
  What is already known on this subject? Psychosocial stress at work among health professionals is often present and well studied, but relations between job stress and quality of care were rarely examined. Job demands-resources model by Demerouti, Bakker, Nachreiner and Schaufeli (2001), for assessment of job stress includes job demands (working environment, work overload, time pressures, recipient contact, shift work) and job resources (feedback, rewards, job control, participation, job security, supervisor support) was applied in different studies. There is scientific evidence that burned-out physicians have shown depersonalization from their patients, they have withdrawn from patients, demonstrated sub-optimal care, and sometimes burnout has been related to serious mistakes and patient death. Different research has shown that some workplace factors contributed to the development of work-related stress and burnout among HPs whereas others contributed protectively. What does this study add? Similar and overlapping workplace factors in hospital setting produce stress in health professionals and influence quality of care. Impact of specific socioeconomic environment in Macedonia as a country in transition and EU candidate country on job stress among health professionals and quality of care. Development of criteria and recommendations for the job stress prevention and improvement of the organizational culture and climate in hospital settings.
authors.affiliation: Institute of Occupational Health of RM, WHO Collaborating Center, Skopje, Republic of Macedonia.
authors.forename: Jovanka
authors.initials: J
authors.lastname: Karadzinska-Bislimovska
authors.forename: Vera
authors.initials: V
authors.lastname: Basarovska
authors.forename: Dragan
authors.initials: D
authors.lastname: Mijakoski
authors.forename: Jordan
authors.initials: J
authors.lastname: Minov
authors.forename: Sasho
authors.initials: S
authors.lastname: Stoleski
authors.forename: Nada
authors.initials: N
authors.lastname: Angeleska
authors.forename: Aneta
authors.initials: A
authors.lastname: Atanasovska
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D005260:Female; D017144:Focus Groups; D006115:Greece; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital / Q000523:psychology*; D008875:Middle Aged; D036301:Qualitative Research; D011787:Quality of Health Care; D013315:Stress, Psychological; D017132:Workplace / Q000523:psychology*; D055815:Young Adult