Business Management and Consumer Studies: An International Journal

Vol. 1, No. 1, (2016), pp. 12-23

The influence of occupational stress on job performance–An

empirical study of Pakistan
Syed Muzzammil Wasima, Shumaila Naz Akhterb
a
Department of Business Administration, University of Sindh, Pakistan
b
School of Management and Economics, University of Electronic Science and
Technology of China

ARTICLE INFO ABSTRACT

Article History: The aim of the researchers in this endeavor is to investigate the
impact and direction of occupational stress on medical doctors’ job
Received:
November 01, 2015 performance where a hospital is taken as a case study. This study
Accepted: also explores practical implications and what adaptation can be
November 25, 2015 utilized in order to avoid negative stress for high performance
Available Online: among medical doctors. Researchers have applied quantitative
Jan 10, 2016 methodology where Chi-Square testing is used to accept/reject
hypotheses in this descriptive research. Structured questionnaires
Keywords: were distributed among 150 doctors of the case study hospital in
Performance, job stress, order to identify various reasons of stress and their outcomes.
occupation, Pakistan Research results indicated that by providing the quality work
environment, work/life balance, avoiding conflicts at workplace,
and promoting sense of responsibility could bring the high
performance among medical doctors while avoiding occupational
stress. Current research may be use by hospital to identify and
resolve the doctors’ stress related problems in order to get high
performance. It also provides the literature for future
researches.

1. Introduction
Public health sector is one of the most crucial sectors of Pakistan, the objectives and
goals defined by every public health care sector is same, irrespective of their size and
nature, the purpose of public health care setting is to provide patients and doctors with
enough facilities to live up a healthy life. Some of the goals and motives of each hospital
includes saving lives and reducing the effects of growing disease, disability, and injury.
There are a number of reasons that can influence a person’s level of performance in a
public health care sector. Some of these factors affecting performance in heath care unit
include stress involved in a job arising from personal issues, monetary reward,
acceptability of work done, the eminence of the working situations and social
associations. The more contented people are with their current or future job, the more
satisfied they are said to be and the more up to the mark their performance would be.
Stress results in high portion of absence and loss of interest in ones work. The ratio of
stress affected in health care sectors is escalating on shocking rate which is affecting the
health of its employee, which results in poor performance and is not able to reach its final
goal (Treven, 2005).
Stress is the body’s reaction that changes the physical, psychological or emotional
adjustment or response as defined in Wikipedia. After the human being observation or
research stress early or later they are born. Specific amount of stress is normal and
necessary for continued existence (Middlebrooks, J. S. & Audage, N. C., 2008). Stress

ISSN: 2414-2808
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which has major affects on individual‘s attitudes, behaviour and interpersonal

relationship, is a case formed by the mixture of several factors. Due to the creation of
stress people need to be affected by the surrounding they live in. (Torun, 1997 and Rice,
1999). People’s mental and emotional status, their way of life, financial status determines
the level of being affected by these changes. Now in society stress related diseases
increase day by day, so the people and institution are confronted with significant problem
has been faced (Torun, 1997 and Rice, 1999). Stress is the multidimensional phenomenon
which determines the dynamic relationship between the individual and the environment
(Beddoe &Murphy, 2004).
1.1 Research background
Bahawal Victoria Hospital (BVH) started its operation as a civil hospital in 1876, but
later expanded its functioning according to the increase in numbers of patients. Bahawal
Victoria Hospital is located in Bahawalpur, Pakistan. At the beginning it only consisted of
operating department, a dispensary and an outdoor ward that used to facilitate patients.
Another additional effort made by Bahawal Victoria Hospital was formation of medical
college, which was named as Quaid-e-Azam Medical Collage (QAMC), and now it has
become as one of the biggest facilities providing institute in southern Punjab.
Previously some of the research has been conducted addressing on the same issue and
results obtained were quite similar to this present study, the previous result shows that
39.5% of doctors undergo stress and which have greater impact on their performance.
1.2 Significance
The aim to conduct this study is to evaluate the level of stress and its effects on job
performance of doctors. This descriptive study is conducted by keeping in mind the
importance of public health care settings, which is supporting Pakistan economy and is
contributing about 19% in GDP results in health sector. The objectives of study were to
classify and empirically test the factors, which highly affect the doctor’s performance due
to presence of inevitable stress, that cannot be minimized until and unless they are
managed by some sought of strategies. It also identified some of the variables, that are in
some way connected to stress, and reduces the performance, the variables are as follows;
work and social life balance and conflicts at working place.
2. Literature Review
The function of this literature review is to delineate the theoretical framework for this
study and to present current research on different factors responsible for causing
occupational stress, emphasizing the control of stress on the performance of doctors
rendering their services in public health care units. Globalization and liberalization has
made many of us exposed to stressful conditions. Stress has made our lives far more
difficult than it was before. Capturing our minds and not being able to think in sensible
way, for me stress is a feeling of not being in control. According to Rosenstein (2010)
medical has always been the most wanted profession from the very start, and dream of
being a doctor of worthy respect has increased since then. This profession holds a lot of
challenging task which puts stress more specifically occupational stress and strain in
doctors, if they are not performing like they are meant to.
Jones and George (2000) explained that occupational stress may exist in all those
situations where interest, wants and requirements of people are not compatible and / or
have been blocked by certain circumstance that does not permit them to work freely.
According to (Anderson, 2003) occupational stress resides in each and every single
firms regardless of its size or nature, the emerging concepts of decentralization has made
the organizational working more complex than it was before. Work related stress has
really significant impact on work performance of doctors, doctors are considered as one

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of the most precious resource, so it needs to be calculated and evaluated so that doctors
can manage their working styles without getting tangled up in the stressful issues.
According to (Simpson & Grant, 1991) stress arises from some sources and those
factors giving birth to stress are called “Stressors”.
It is approximation that about hundred million workdays are being lost due to stress
and nearly 40% -85% of diseases and problems are related to stress and strain, and the
individuals that are mostly affected from stressful conditions are doctor themselves, as
they are considered to be responsible for one’s death. The impact of stress on employees
specifically doctors working in a public health care centres in spite of any prejudice of
male and female is of intense nature, and they all go through the stressful phase (Bashir &
Asad 2007).
Hussein at el (2012) pointed out that job stressors present when health staff encounters
uneasiness or disappointment from aspects of their work that they cannot control. Major
health difficulties due to the occupational stress for both the individual worker and
organizational worker, and also produce the burnout, illness, absenteeism, labour
turnover, poor morale and reduce competencies and performance.

Fig: Preliminary model of the causes of occupational stress and its

consequences for job performance.

2.1Work/life balance
Work/Life balance is a terminology used to define the conditions faced by employees
and employer to maintain equilibrium between workplace requirements and personal
responsibilities at the same time and not losing the balance in any one of them. Whenever
there is imbalance between the two it would generate work and social life conflict, which
starts when there, is increasing demands of work at home and at office as well. These
types of conflict cases are most common with female members who have to balance their
married, social life along with their responsibilities towards work. According to
(Sirajunisa & Panchanatham) the interference of work with family is more than family
interference with work. The conflict between these multiple roles has been studied and
theories on the impact are covered under role theory. Role theory predicts the multiple
roles played by an individual are at conflict because of limited amount of time and energy
they have to spend on each of the roles. The conflict between these roles exacts a cost;

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normally poor health decreased marital or job satisfaction, reduced job performance, and
/or intent to leave one’s profession. This type of imbalance is usually seen in the doctors
where parents are on call, have night duties and are not able to give their children the
proper time they need.
(Arya & Baroda, 2012) presented the same concept and agreed that stress encountered
by doctors due to imbalance in their work/life environment must be valued as their
performance is really dependent on their healthy mind. The gap between work life
balance leads to greater pressure and stress affecting their moods and performance.
According to (Wong, 2008) it is well-known that being a doctor is stressful and they are
bound to go through stress originated work/life imbalance.
2.2 Conflict at work
Presence of conlict at work is a common problem that is seen almost everywhere.
Conflict arises when two mind are not able to draw the same conclusion and endup
enforcing the other individual to accept the argument. Conflict can seriously be dangerous
when individuals are at same designation. Conflict in doctors have found to be most
dangerous of all, as many lives are dependent for their survival on healthy performance of
doctors. If there lies any kind of conflict at work, that would surely upset their mental
peace and would decline their performance (Kendall, Murphy, O’Neill, & Bursnall,
2000).
Conflict at workplace settings has been recognized as a most important source of stress
for almost all of the doctors, as concluded by the author that stressful events are linked
with generally lager number of reasons as unprofessional conduct by other mates at work,
conflict at work, unconstructive interpersonal communications with co-workers, and
negative reactions to organization decisions (Cotton & Fisher, 1995).
According to (Toohey, 1994) conflict is a state of serious matter that needs a right
away solution or else it can get worse with every passing minute, an on-going incident of
conflict between employees and their employers, or between the employee an d
employee, between employer and employer, and those in managerial positions. Conflict is
consider to be one of the most irritating factor that leads to stress and provides enough
space for stress to penetrates in the mind of individuals, allowing them not to pay
attention to their work which is a cause for poor performance by the doctors, which
ultimately affects their intellect and cause blunders during working hours.
3. Research methodology
3.1 Hypothesis
Following null hypotheses have been developed:
H1: There is no relationship between the occupational stress and work place
environment affecting doctor’s performance
H2: There is no relationship between occupational stress and work/life balance
affecting doctor’s performance.
H3: There is no relationship between Occupational stresses by conflict at workplace
affecting doctor’s performance.
3.2 Instrument and Date Collection
Data is collected through primary source using structured questionnaire; the questions
about occupational stress and performance were recorded by respondent in the presence
of author. The questionnaire was adopted from the study of (Teasdale, Drew, Taylor, &
Ramirez, 2008). However, certain amendments were made to the questionnaire regarding
ehavior of doctors under stress.

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The variables tested have been integrated using a Likert scale. Before collecting the
data certain steps were exercised for short-listing the concerned variables. The whole
process begins with literature review to recognize significant factors for success. The
questionnaire was distributed among house jobians, assistant professor and associate
professors and demonstrators. Following departments were focused; Pulmonology
department, pediatric ward, surgical department, radiologist and medicine ward. Before
giving it a final touch the questionnaire was tested and piloted. Testing for reliability and
validity checks were conducted. At last, a list of 2 variables was developed taking inputs
from senior doctors. The instrument chosen contained 19 questions in total with sub
questions under the main head, related to stress and performance being affected if one of
them is not evaluated properly. Respondents of the study were asked to rate their opinion
on a five point likert scale 1 being strongly disagree and 5 being strongly agree.
Data was collected through questionnaire from doctors of Bahawal Victoria Hospital
(BVH), Bahawalpur, Pakistan, in age group 28 to 55 years. Respondents were asked to
record information regarding the impact of occupational stress faced by them in hospital
in a structured questionnaire.
3.3 Sample Size
150 questionnaires were floated in total, but actually received were (98) (it’s 65%). The
numbers of male and female who filled the questionnaire among the target population
were 48 and 46 respectively, whereas some of the questionnaire was left unanswered. In
this study, convenience sampling technique has been used. This method was adopted to
speed up the research procedure, by obtaining a large number of questionnaires efficiently
and effectively.
4. Data analysis
This section of the study deals with the analysis of the research data collected through
questionnaire. Keeping in view, the nature of the variables Chi-Square technique has been
applied and the hypothesis are tested. The statistical results along with the testing of
hypothesis individually and cumulatively are presented here under:
4.1. Chi-Square test
4.1.1 Quality of work environment
H 1: There is no relationship between the occupational stress and work place
environment affecting doctor’s performance
Since the computed value of Chi-Square to measure the relationship between the
occupational stress and workplace conditions provided to the medical doctors of BVH is
42.094 at 16 degree of freedom with 5% level of significance is greater than the tabulated
value which is 26.296. Hence, we reject to accept to null hypothesis and accept alternate
hypothesis and conclude that there is strong significant relationship between the
occupational stress and quality workplace environment given to the medical doctors
discharging their health care services at Bahawal Victoria Hospital (BVH), Bahawalpur,
and Pakistan.
4.1.2 Work/life balance
H2: There is no relationship between occupational stress and work/life balance
affecting doctor’s performance
Since the computed value of Chi-Square to measure the relationship between the
occupational stress and work/life balance maintained by medical doctors of BVH is
37.593 at 24 degree of freedom with 5% level of significance is greater than the tabulated
value which is 36.415. Hence, we reject to accept to null hypothesis and accept alternate
hypothesis and conclude that there is significant relationship between the occupational
stress and work/life balance of medical doctors discharging their health care services at
Bahawal Victoria Hospital (BVH), Bahawalpur, and Pakistan.

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4.1.3 Conflict at work

H3: There is no relationship between Occupational stresses by conflict at workplace
affecting doctor’s performance
Since the computed value of Chi-Square to measure the relationship between the
occupational stress and conflicting situation they have to encounter during their job by
medical doctors of BVH is 33.632 at 22 degree of freedom with 5% level of significance
is greater than the tabulated value which is 32.964. Hence, we reject to accept to null
hypothesis and accept alternate hypothesis and conclude that there is significant
relationship between the occupational stress and conflict at work place of medical doctors
discharging their health care services at Bahawal Victoria Hospital (BVH), Bahawalpur,
Pakistan.

Variables Pearson Chi-Square Df

Quality of work environment 42.094a 16

Work/life balance 37.593a 24

Conflict at work 33.632a 22

4.1.4 Interpretation
The statistical results shown in the table shows that computed value of Chi-Square at
5% level of significance is 42.094 greater than the tabulated value of Chi-Square at the
same level of significance, therefore, there is a very strong significant relationship
between the quality of work environment and confirmation of stress factors among the
medical doctors of BVH, hence, we reject to accept null hypothesis and therefore accepts
the alternate hypothesis. The computed value of Chi-Square at 5% level of significance
for work life balance is 37.593 greater than the tabulated value of Chi-Square at the same
level of significance, therefore, there is significantly strong relationship between the work
life balance and confirmation of stress factors, hence, we reject to accept null hypothesis.
The computed value of Chi-Square obtained is 33.632 at 5% level of significance which is
greater than the tabulated value of Chi-Square at the same level of significance, therefore,
there is strongly significant relationship between the conflict faced during work settings
and stress factors focused in research, hence, we reject to accept null hypothesis.
4.2 Pie Charts
4.2.1 Gender
A total of 98 target respondents were asked to fill the questionnaire of which 50% were
male and 50% were females. Therefore, there is an equal participation of gender for the
collection of data.

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4.2.2 Age
The questionnaire filled by
respondent’s lies within the pre-defined set of age groups, data shows that there is
reasonable distribution among population which covered almost every individual from
age groups. Therefore, form the graphical data obtained, shows that majority of the
respondent’s lies between the age group of 28-34 of years.

4.2.3 Conflict at Work

Similar results were found for the variable “Conflict at work place”, doctors found it
problematic when they have conflicting working situations, they were agreeing to the fact
that if there is conflict free environment, they’ll be able to generate more productive
work.

4.2.4 Work Life Balance

The data collected form respondents were in favor of this variable. Majority of
respondents (Doctors) agreed that they undergo continues stress when they are not being
able to manage a balance between their domestic and work life, the graph here is to assist
the findings.

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4.2.5 Major Stress Sources

Majority of our target population agreed that the stress oriented variables defined in the
questionnaire have a negative impact on the job performance.

4.3. Frequencies, Mean, Std.dv and Variance Analysis

The statistical results as shown in the table are indicating that of the total of 98
Variable Frequency Mean S.D Variance

Strongly Disagree Indifferent Agree Strongly

Disagree Agree
Gender - - - - - 1.4894 .50257 .253

Age - - - - - 2.5484 1.19343 1.424

work life 2 2 9 5 20 3.7163 1.04868 1.100

balance

Work life 6 15 11 38 28 - - -
balance (wlb1)

Work life 6 19 7 36 30 - - -
balance (wlb2)

Work life 8 6 9 43 32 - - -
balance (wlb3)

Conflict at 4 4 14 15 21 3.7500 1.09179 1.192

work
Conflict at 9 11 12 35 31 - - -
work (conflict
1)
Conflict at 5 13 8 42 30 - - -
work (conflict
2)

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respondents 49% were males, 46.9% were females and 4.1% did not respond to the
questionnaire. The deviation from the mean value of Gender response is .50257, and
variance is measured with the value obtained of .253. The target respondent were widely
scattered among different age groups, the majority of the respondent lie within the age
range form 28-34 of years, which means that 41.8% were of age between 28-34 years,
15.3% were among those respondents whose age were between 21-27, 18.4% were
between age of 35-41 of years, only 8.2% and 10.2 % of respondents were between the
age group of 42-48 and 49-55years respectively. The deviation from the mean value of
Age response is 1.19343, and variance is measured with the value generated 1.424 .From
the data retrieved through questionnaire, The statistical data for Quality of work
environment shows that 22.4% of total population agreed that if they were given with
quality working conditions they could have control over their stress level and have greater
job performance, 11.2% of population were indifferent to the situation, and only 3.1% of
population disagreed with the statement. The statistical figure obtained for Work life
balance is more inclined towards the strongly agreeing which is 20.4%, respondents are of
the view that imbalance in work life pattern surely adds stress to their lives and which
further affects the performance at job, 9.2% of target population were of neutral view
regarding work life balance, and only 2% said that they have no problems regarding
balancing the too. The deviation from the mean value of work life balance response is
1.04868, and variance is measured as 1.100. The statists obtained for Conflict at work is
21.4%, which shows that majority of our targeted population strongly agrees with the fact
that conflict at work place hinders their performance and is the source of adding stress as
well, 14.3% of population were indifferent towards conflict at work place, 4.1% totally
disagreed with the statement. The deviation from the mean value of conflict at work place
response is 1.09179, and variance is measured as 1.192. 22.4% of target population gave
the positive response indicating that long work hours not just affect their physical health
but also their mental state not allowing them to give full performance required by job,
15.3% were neutral and 5.1% totally denied the fact. The deviation from the mean value
of long working hour’s response is 1.07734, and variance is measured as 1.161.
4.4. Limitations
Following are some of the limitations of the study:
First, the subject study’s finding could not be generalized on broader aspects with just
two stress causing factors alone. However, by increasing the numbers of stress causing
factors would be a positive step for generalizability. Secondly, sample size chosen was
limited in number, with large sample size adopted; interesting results could have been
achieved. Thirdly, our data was based on the responses of respondents living in one
District (Bahawalpur) only. Therefore, this fact allows fewer generalizations across
different cultures prevailing within Pakistan. Fourthly, the findings are limited to BVH
public health care sector only but by extending this research to other private hospitals in
Bahawalpur may produce informative insights. Lastly, the scope could have been
enhanced and improved by including samples from other cities.
4.5. Recommendations
Following are some of the recommendations that might help doctors in preventing
form stress full conditions and manage it way more easily without affecting their job
performance:
 Allowing doctors to share their personal issues and helping them in weighing the
value of alternative strategies, would help reduce stress and increase their
performance level and satisfaction, in both home and workplace settings.
 Physical exercise can be helpful measurement in reducing stress.

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 Another beneficial act for reducing stress is attending to wellness conference,

which often takes place at different location providing the doctors with
opportunity to learn more and spend a quality time with family as well, it can
surly be helpful in changing their tiresome routine.
 To balance social and work life, doctors should avoid taking work at home and
avoid multiple tasks at a time.
 Developing a supportive social network can make doctors easily handle their
stress by sharing their feelings with the most trusted person.
 Conflict usually arises where there is communication gap, so doctors should try to
communicate well with others and sought out the problems instead of waiting
for it to over.
 Proper tools and resources should be made available to doctors so that they can
perform well without facing any problems.
 Build up a good interpersonal environment within the hospitals, in order to create
good working conditions free of stress arousing factors.
 Public health care units should improve the overall salary packages of house
jobians, medical staff and doctors.
 Flexible working time schedule must be determined for doctors, so that they can
lower their stress and can concentrate more effectively on their job
performance.
5. Conclusions
The importance of public health care settings cannot be denied, as it is supporting
Pakistan’s economy and is contributing about 19% in GDP. Nearly about 1 lakh of
students graduate as medical professionals, who put great effort to become renowned
doctors and spend their lives as doctors, their utmost desires to become doctors makes
them achieve their career in the health sector, which is why in Pakistan; doctors are
valued more than any other profession. Stress has different dimensions and different
effects depending upon the individual facing it. We are already familiar with the fact that
excess of everything is bad; same is the case with stress. Stress can be good sometimes
but more often it affects are devastating, as it not only affects physically but mentally too.
Jones and George (2000) explained that occupational stress may exist in all those
situations where interest, wants and requirements of people are not compatible and / or
have been blocked by certain circumstance that does not permit them to work freely. It is
approximation that 40% -85% of diseases and problems are related to stress and strain,
and the individuals that are mostly affected from stressful conditions are doctor
themselves, as they are considered to be responsible for one’s death.The present study
empirically examined the significance of the relationships between occupational stress
and job performance which includes variables such as conflict at work place and work/life
balance. From the analysis, it has been concluded that stress indirectly plays an important
role in the affecting the job performance of doctors. Noted from the results obtained from
previous studies, it shows that 41.2% of doctors face severe issues related to stress and
only about 3.2% of doctors are able to manage stress by using stress managing strategies
Stress is more commonly seen arising in situation where there are conflicts, as presence of
conlict at work is obvious. Conflict arises when two mind are not able to draw the same
conclusion and endup enforcing the other individual to accept the argument. Conflict can
seriously be dangerous when individuals are at same designation. Conflict in doctors have
found to be most dangerous of all, as many lives are dependent for their survival on
healthy performance of doctors. If there lies any kind of conflict at work, that would
surely upset their mental peace and would decline their performance (Kendall, Murphy,

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O’Neill, & Bursnall, 2000). Secondly, inadequate facilities as providing the doctors with
the best of workplace environment are as essential as any other necessity of the doctors.
Public health sectors have failed to give the doctors the best working environment
(Agdelen, Ersöz, & Sarp, 2010). Finally stress causing agent is imbalance between social
and work life. According to (Wong, 2008) it is well-known that being a doctor is stressful
and they are bound to go through stress originated work/life imbalance. On the other hand
monetary compensations benefits provided to doctors are not of much importance; their
stress level remains the main as it was before.I have verified it all through extensive tools
applied on the research, data was collected from primary source by the use of structured
questionnaire and doctors of BVH were my target population. The tool applied in the
study includes frequencies, cross-tab analysis, mean, standard deviation, variance and
charts. The data obtained is reliable. The stress can be reduced to certain level as it cannot
be totally terminated, few strategies can be helpful in this regard, which includes sharing
problems with most trusted person, believing in oneself, exercising on regular basis, being
helpful to other mates and controlling anger.
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