General practitioners and specialists in Germany: The valve function of employee surveys

What it’s all about

When GPs or specialists carry out a practice management comparison that includes an employee survey, a remarkable phenomenon is repeatedly revealed: if the practice owners are sceptical before the survey begins that there will be any responses at all and assume that staff participation will be low, exactly the opposite occurs: The workforce always participates fully and, what’s more, individual employees submit an average of five pages of suggestions for change. This behaviour reflects deep psychological mechanisms associated with frustration, anger and the feeling of not being heard. The following article explores the deep psychological underpinnings of this behaviour and the psychological profile of practice owners that foster such dynamics.

The feeling of not being heard

Psychological foundations of frustration

Frustration occurs when a need is not met. In the workplace, frustration often arises when employees have no opportunity to express their opinions or influence their working conditions. In medical practices with rigid hierarchical structures, the voice of employees is ignored, leading to a deep sense of frustration. It is exacerbated when employees see no opportunity to change the situation or communicate their needs.

The need for recognition

A fundamental human need is the need for recognition and appreciation. If employees feel that their opinions and contributions do not count, this inevitably leads to considerable psychological stress. The lack of recognition and the feeling of being overlooked affect self-esteem and always lead to resignation.

The mechanism of learned helplessness

In an environment where employees continually experience their efforts and opinions being ignored, a state of learned helplessness quickly develops. It describes the feeling of having no control over one’s own situation and generates passivity and reduced commitment. However, if the opportunity arises to express oneself, this has an outlet function in the sense of a sudden and intense discharge of pent-up thoughts and feelings, as can be seen in the extensive suggestions made by employees.

The expression of anger and resignation

Psychodynamics of anger

Anger is often the result of frustration and is experienced as a reaction to perceived injustice or disregard. In medical practices where employees have no platform to express their opinions, this anger builds up over long periods of time. When suddenly offered the opportunity to give feedback, this pent-up anger manifests itself in extensive and detailed suggestions that not only reflect ideas for improvement, but also long-suppressed emotions.

Resignation as a protective mechanism

In many cases, employees also develop resignation as a protective mechanism to deal with their powerlessness. Resignation is the emotional disconnection from the working conditions in order to protect one’s own psyche from the constant feeling of not being heard. However, if a change occurs in the structure or the opportunity to express oneself, this resignation can be lifted and employees begin to express their pent-up thoughts.

The dynamics of hierarchy and power structures

Suppressed voices in hierarchical structures

In hierarchical systems, such as those still found in the majority of German medical practices today, decisions are made from the top down, without taking into account the opinions of those who are affected by these decisions. In medical practices, this manifests itself in a clear separation between the practice owners and the rest of the staff. This power dynamic leads to staff holding back their thoughts because they fear that their opinions will not count or could even have negative consequences.

The influence of power on communication

Power differentials influence the way information is shared. In a practice where owners have absolute control, they unconsciously or consciously control the flow of information, whereby employees’ opinions are considered less valuable. This attitude creates a culture of silence where employees do not feel safe to speak openly.

The psychological profile of practice owners

The role of the authoritarian management style

The majority of German practice owners tend to have an authoritarian management style. They see themselves as the main decision-makers and expect their employees to implement their work instructions and decisions. The opinions of staff are ignored and doctors rely on their own judgements without recognising the benefits of a wider range of perspectives.

Lack of awareness of interpersonal dynamics

Another characteristic of these practice owners is often a lack of awareness of interpersonal dynamics and the psychological needs of their staff. They fail to recognise the importance of listening to and valuing the opinions of their staff, or lack the emotional intelligence to respond empathetically to staff needs.

Resistance to change and self-reflection

Practice owners who work within rigid structures are unwilling to change and show no willingness to self-reflect. They are afraid of losing control or authority if they include the opinions of their staff. This results in a defensive attitude that blocks any attempt to improve the organisation through collective input.

Conclusion

The extensive feedback from staff in medical practices that previously offered little opportunity to express their opinions is a clear expression of deep psychological mechanisms resulting from frustration and anger at not being listened to. The outdated hierarchical structures in such practices foster a culture of silence that alienates staff on the one hand and leaves practice owners in an isolated and authoritarian position on the other. This dynamic leads to potential innovations and improvements being nipped in the bud and the full potential of employees remaining unrealised. A deep understanding of the psychological mechanisms behind these behaviours can help to identify the underlying problems inherent in the practice environment.