The results of the study show how organizational attributes and socio-demographic characteristics are associated with the job satisfaction of practice assistants in German primary care settings. As there is limited published research in this field so far this study contributes important issues to a field with increasing importance.
Higher scores of the different aspects of job satisfaction compared to our data were found in studies which have also evaluated job satisfaction of practice assistants in general practices with the Warr-Cook-Wall questionnaire [17
]. A possible explanation for higher scores could be the different study populations. All of the respondents from these previous studies were members of general practices participating in a quality management program. In a study conducted by Vail et al. it was also shown that, despite a high overall satisfaction, practice assistants were dissatisfied with their income, status and career progression [19
]. Practice assistants in Australia indeed showed higher scores for overall job satisfaction than in our study, but were also less satisfied with their ‘income’ and ‘recognition for their work’ [20
One solution to the noticeable lack of recognition could be the reallocation of tasks giving practice assistants more responsibilities, which might not only strengthen the importance of their job but also reduce the workload of general practitioners. It was shown that task substitution could contribute to an improvement of quality of care as well as patient outcomes such as patient adherence to treatment, patient quality of life and patient satisfaction [21
]. Moreover, a study of Dini et al. showed that 48% of general practitioners in Germany inclined to delegate home visit tasks to their practice assistants. The main disadvantage here was the related costs for training of the practice assistants, while the ability to save time was named as the main advantage [23
]. To realise task substitution in Germany there are for example the so called ‘AGnES-model projects’ in different federal states, which transfer medical duties and house visits to qualified practice assistants. Results of these model projects showed that general practitioners feel exonerated and patient compliance is improved through AGnES-employees [24
As our data suggests colleagues make an important contribution to job satisfaction. These results are in accordance with other studies. Zangaro et al. for example showed that through a high satisfaction with colleagues stress could be reduced leading to a more positive work environment [25
]. Moreover, a review of Van Laar et al. emphasized that in most of the researched 17 countries medical staff was stressed and incriminated. It was assumed that the nature of work, numerous changes in organizational fields and the growing workload lead to worse physical and mental conditions which could deteriorate the quality of patient care [26
]. Moreover, job dissatisfaction implicated more stress and burnout amongst health care workers [27
]. This shows the importance of research evidence concerning organizational culture, job satisfaction and working conditions of practice assistants. Our study found that the level of ‘stress’ was moderate, with a lower mean indicating a lower stress level. Moreover, there was a significant association between this subscale and the age of the participants. A lower level of stress within the practices is associated with a younger age of the practice assistants, group practices and practices with a higher level of satisfaction with physical working condition. This emphasizes the importance of the general trend towards more group practices as a contribution to a reduction of the level of stress [28
In our study we found a strong and significant association between organizational attributes, job satisfaction and socio-demographic characteristics throughout the regression models. This means that job satisfaction affects changes in the organizational culture within a general practice concerning, for example, decision making, improving working conditions, teamwork, provided quality of care, reducing stress and exhaustion. In further intervention studies should be investigated to establish whether or not interventions could have an impact on both organizational culture and job satisfaction. Additionally, improved job satisfaction could lead to a better organized primary care team. This association, which was also shown in other studies [15
], is important as team-level job satisfaction is a telling predictor for the effectiveness of how primary care teams manage patient care [15
]. Kuokkanen et al. found that organizational commitment and job satisfaction are essential factors for empowerment. With empowerment they mean “the process of personal growth and development”, which is important in the context of the attractiveness of the profession as well as the development of care, education and management [30
]. Other factors instrumental for empowerment include a low-hierarchy organization, a teamwork oriented approach within a practice, sufficient capabilities and a management which creates opportunities [31
]. An important contribution to the job satisfaction of nurses could be set in a meta-analysis from 1993 performed by Blegen et al., which revealed that nurses’ job satisfaction was strongly associated with declined work stress, organizational commitment, communication and recognition for work [32
]. These findings are exposed and confirmed for practice assistants by our study. It should be noted that ‘history of change’ had only an explained variance of 4.2%. The reason for this might be due to the limited options of practice assistants to initiate changes as the general practitioner makes most of the final decisions. To confirm this assumption and to address the question regarding the distribution of decision-making in a team, further studies need to be conducted.
Strengths and limitations
A main strength of our study is that we used internationally validated measures for the evaluation of organizational attributes and job satisfaction of practice assistants [13
]. Furthermore, there is little research for organizational attributes of practice assistants, particularly for Germany. Therefore, our study provides an important addition to this field of research. However, without being able to collect data from a broader range of socio-demographic characteristics of practice assistants only limited conclusions regarding this area are possible. In addition, as this was an exploratory study; p values should be interpreted carefully. Significant results might be due to chance and will need to be confirmed in further targeted studies.