In Malawi’s healthcare system, a significant doctor shortage compels clinical officers who are mid-level health professionals, to shoulder responsibilities traditionally reserved for medical doctors. This study delves into the unintended consequences of functional reviews within Malawi’s health sector. The research, employing a qualitative case-study approach across five public hospitals, investigated how the functional reviews triggered an identity crisis among clinical officers. The findings revealed that the implemented changes caused an identity crisis among clinical officers. This identity crisis, demonstrably exacerbated occupational stress among clinical officers. To address this unforeseen consequence and safeguard the well-being of clinical officers in particular and healthcare workers in general, this paper proposes the incorporation of psychosocial risk assessments before implementing functional reviews in the health sector. This proactive approach can help identify potential threats to social identity and mitigate the risk of increased stress among healthcare workers. Ultimately, this research contributes to the growing body of knowledge that underscores the intricate link between social identity and the impact of large-scale workplace changes within the healthcare system.
AbramsD.HoggM. A. (2006). Social identifications: A social psychology of intergroup relations and group processes. Routledge.
2.
AbramsD.HoggM. A. (2010). Social identity and self-categorization. In DovidioJ. F.HewstoneM.GlickP.EssesV. M. (Eds.), The SAGE handbook of prejudice, stereotyping and discrimination (Vol. 1, pp. 179–193). SAGE.
3.
AldersonP. (1998). The importance of theories in health care. BMJ, 317(7164), 1007–1010.
4.
AshforthB. E.MaelF. (1989). Social identity theory and the organization. Academy of Management Review, 14(1), 20–39.
5.
AtkinsonS. (1995). Restructuring health care: Tracking the decentralization debate. Progress in Human Geography, 19(4), 486–503.
6.
BennellP. (1994). Improving the performance of the public sector in LDCs: New approaches to human resource planning and management. International Labour Office, Geneva.
7.
BourbonnaisR.BrissonC.MalenfantR.VézinaM. (2005). Health care restructuring, work environment, and health of nurses. American Journal of Industrial Medicine, 47(1), 54–64.
8.
BourbonnaisR.BrissonC.VézinaM.MasseB.BlanchetteC. (2005). Psychosocial work environment and certified sick leave among nurses during organizational changes and downsizing. Relations Industrielles/Industrial Relations, 60(3), 483–509.
9.
BradleyS.McAuliffeE. (2009). Mid-level providers in emergency obstetric and newborn health care: Factors affecting their performance and retention within the Malawian health system. Human Resources for Health, 7(1), 14.
10.
BroadheadR. L.MuulaA. S. (2002). Creating a medical school for Malawi: Problems and achievements. BMJ, 325(7360), 384–387.
11.
BrownR. (2000). Social identity theory: Past achievements, current problems and future challenges. European Journal of Social Psychology, 30(6), 745–778.
12.
BrunettoY.Farr-WhartonR. (2002). Using social identity theory to explain the job satisfaction of public sector employees. International Journal of Public Sector Management, 15(7), 534–551.
13.
BrymanA. (2012). Social research methods. Oxford University Press.
14.
Charles-JonesH.LatimerJ.MayC. (2003). Transforming general practice: The redistribution of medical work in primary care. Sociology of Health & Illness, 25(1), 71–92.
15.
ChatterjeeN. (2005). Theory for all and rehabilitation for the few (with money): Who does our theory serve?Disability and Rehabilitation, 27(24), 1503–1508.
16.
ChiloporaG.PereiraC.KamwendoF.ChimbiriA.MalungaE.BergströmS. (2007). Postoperative outcome of caesarean sections and other major emergency obstetric surgery by clinical officers and medical officers in Malawi. Human Resources for Health, 5(1), 17.
17.
ChinguwoP. (2024). Implications of task shifting on power relations in healthcare: The case of clinical officers at public hospitals in Malawi. Medical Humanities, medhum-2023-012867. https://doi.org/10.1136/medhum-2023-012867
18.
ChiwezaA. L. (2010). Public-sector reforms and decentralisation of public services: Lessons from Malawi (1994–2006). Reforming the Malawian Public Sector, 1–29.
19.
CockerhamW. C. (2013). The rise of theory in medical sociology. In CockerhamW. C. (Ed.), Medical sociology on the move: New directions in theory (pp. 1–10). Springer.
20.
CullatiS.BochatayN.MaîtreF.LarocheT.Muller-JugeV.BlondonK. S.PerronN. J.BajwaN. M.VuN. V.KimS. (2019). When team conflicts threaten quality of care: A study of health care professionals’ experiences and perceptions. Mayo Clinic Proceedings: Innovations, Quality & Outcomes, 3(1), 43–51.
21.
d’EttorreG.GrecoM. (2015). Healthcare work and organizational interventions to prevent work-related stress in Brindisi, Italy. Safety and Health at Work, 6(1), 35–38.
22.
DayA.CrownS. N.IvanyM. (2017). Organisational change and employee burnout: The moderating effects of support and job control. Safety Science, 100, 4–12.
23.
DurevallD. (2001). Reform of the Malawian public sector: Incentives, governance and accountability. Wider Discussion Paper.
24.
DuttonJ. E.DukerichJ. M.HarquailC. V. (1994). Organizational images and member identification. Administrative Science Quarterly, 239–263.
25.
FiolC. M.O’ConnorE. J. (2013). Stuff matters: Artifacts, social identity, and legitimacy in the US medical profession. In Rafaeli, A and Pratt, M. G (eds) Artifacts and organizations (pp. 241–258). Psychology Press.
26.
GajewskiJ.BorgsteinE.BijlmakersL.MwapasaG.AljohaniZ.PittalisC.McCauleyT.BrughaR. (2019). Evaluation of a surgical training programme for clinical officers in Malawi. British Journal of Surgery, 106(2), e156–e165.
27.
GansterD. C.RosenC. C. (2013). Work stress and employee health: A multidisciplinary review. Journal of Management, 39(5), 1085–1122.
28.
GestalJ. (1987). Occupational hazards in hospitals: Risk of infection. Occupational and Environmental Medicine, 44(7), 435–442.
29.
GittellJ. H.GodfreyM.ThistlethwaiteJ. (2013). Interprofessional collaborative practice and relational coordination: Improving healthcare through relationships. Journal of Interprofessional Care, 27(3), 210–213. https://doi.org/10.3109/13561820.2012.730564
30.
GoetzK.BergerS.GavartinaA.ZarotiS.SzecsenyiJ. (2015). How psychosocial factors affect well-being of practice assistants at work in general medical care. A questionnaire survey. BMC Family Practice, 16, 1–7.
31.
GosseriesO.DemertziA.LedouxD.BrunoM.-A.VanhaudenhuyseA.ThibautA.LaureysS.SchnakersC. (2012). Burnout in healthcare workers managing chronic patients with disorders of consciousness. Brain Injury, 26(12), 1493–1499.
32.
GreenB. N.JohnsonC. D. (2015). Interprofessional collaboration in research, education, and clinical practice: Working together for a better future. Journal of Chiropractic Education, 29(1), 1–10.
33.
GrimesC. E.MkandawireN. C.BillingsleyM. L.NgulubeC.CobeyJ. C. (2014). The cost-effectiveness of orthopaedic clinical officers in Malawi. Tropical Doctor, 44(3), 128–134.
34.
HarveyM. (2020). How do we explain the social, political, and economic determinants of health? A call for the inclusion of social theories of health inequality within US-based public health pedagogy. Pedagogy in Health Promotion, 6(4), 246–252.
35.
HerttingA.NilssonK.TheorellT.LarssonU. S. (2004). Downsizing and reorganization: Demands, challenges and ambiguity for registered nurses. Journal of Advanced Nursing, 45(2), 145–154.
36.
Industrial Health Research Group and South African Municipal Workers Union. (2005). Who cares for health care workers: The state of occupational safety and health in municipal health clinics in South Africa (Occasional Papers Series Issue).
37.
JenkinsR. (1996). Social identity. Routledge.
38.
JiskootP. (2008). On-the-job training of clinical officers in Malawi. Malawi Medical Journal, 20(3), 74–77.
39.
JonesL.AranaG. (1996). Is downsizing affecting incident reports?The Joint Commission Journal on Quality Improvement, 22(8), 592–594.
40.
KalimoR.TarisT. W.SchaufeliW. B. (2003). The effects of past and anticipated future downsizing on survivor well-being: An equity perspective. Journal of Occupational Health Psychology, 8(2), 91–109.
41.
KivimäkiM.VahteraJ.PenttiJ.FerrieJ. E. (2000). Factors underlying the effect of organisational downsizing on health of employees: Longitudinal cohort study. BMJ, 320(7240), 971–975.
42.
KrögerC. (2020). Shattered social identity and moral injuries: Work-related conditions in health care professionals during the COVID-19 pandemic. Psychological Trauma: Theory, Research, Practice, and Policy, 12(S1), S156.
43.
MaelF.AshforthB. E. (1992). Alumni and their alma mater: A partial test of the reformulated model of organizational identification. Journal of Organizational Behavior, 13(2), 103–123.
44.
MaguireM.DelahuntB. (2017). Doing a thematic analysis: A practical, step-by-step guide for learning and teaching scholars. All Ireland Journal of Higher Education, 9(3). https://doi.org/10.62707/aishej.v9i3.335
Malawi Government. (2017). Health sector strategic plan II (2017–2022) for Malawi.
47.
Malawi Government. (2018a). Functional review report on central hospitals autonomy.
48.
Malawi Government. (2018b). Human resources for health strategic plan (2018–2022) for Malawi.
49.
Malawi Government. (2020). Performance contract between the Government of the Republic of Malawi and Ministry of Health.
50.
MathisenG. E.BrønnickK.ArntzenK. J.BerghL. I. V. (2017). Identifying and managing psychosocial risks during organizational restructuring: It’s what you do and how you do it. Safety Science, 100, 20–29.
51.
McAuliffeE.BowieC.ManafaO.MasekoF.MacLachlanM.HeveyD.NormandC.ChirwaM. (2009). Measuring and managing the work environment of the mid-level provider–the neglected human resource. Human Resources for Health, 7(1), 13.
52.
McAuliffeE.ManafaO.MasekoF.BowieC.WhiteE. (2009). Understanding job satisfaction amongst mid-level cadres in Malawi: The contribution of organisational justice. Reproductive Health Matters, 17(33), 80–90.
53.
McDonaldR. (2004). Individual identity and organisational control: Empowerment and modernisation in a primary care trust. Sociology of Health & Illness, 26(7), 925–950.
54.
MkandawireN.NgulubeC.LavyC. (2008). Orthopaedic clinical officer program in Malawi: A model for providing orthopaedic care. Clinical Orthopaedics and Related Research, 466(10), 2385–2391.
55.
MuulaA. S. (2009). Case for clinical officers and medical assistants in Malawi. Croatian Medical Journal, 50(1), 77.
56.
MuulaA. S.MulwafuW.ChiwezaD.MatayaR. (2016). Reflections on the first twenty-five years of the University of Malawi College of Medicine. Malawi Medical Journal, 28(3), 75–78.
57.
National Institute for Occupational Safety and Health. (1999). Stress at work (NIOSH publication no. 99-101, issue). http://www.cdc.gov/niosh/docs/99-101/
PansiriJ. (2005). Pragmatism: A methodological approach to researching strategic alliances in tourism. Tourism and Hospitality Planning & Development, 2(3), 191–206.
60.
PaulS.PetersonC. Q. (2002). Interprofessional collaboration: Issues for practice and research. Occupational Therapy in Health Care, 15(3–4), 1–12. https://doi.org/10.1080/J003v15n03_01
61.
Physician Assistants Union of Malawi. (2020, September1). Open letter to the minister of health.
62.
QuinlanM.BohleP. (2009). Overstretched and unreciprocated commitment: Reviewing research on the occupational health and safety effects of downsizing and job insecurity. International Journal of Health Services, 39(1), 1–44.
63.
SalilihS. Z.AbajobirA. A. (2014). Work-related stress and associated factors among nurses working in public hospitals of Addis Ababa, Ethiopia: A cross-sectional study. Workplace Health & Safety, 62(8), 326–332.
64.
ScheepersD.EllemersN. (2019). Social identity theory. In SassenbergK.VliekM. L. W. (Eds.), Social psychology in action: Evidence-based interventions from theory to practice (pp. 129–143). Springer.
65.
SilvermanD. (2010). Qualitative research. SAGE.
66.
TajfelH. (1978). The achievement of inter-group differentiation. In TajfelH. (Ed.), Differentiation between social groups (pp. 77–100). Academic Press.
67.
TajfelH.TurnerJ. C. (1979). An integrative theory of inter-group conflict. In WorchelW. G. A. S. (Ed.), The social psychology of inter-group relations (pp. 33–47). Brooks/Cole.
68.
ThetardR.MachesoA. (2004). Clinical officers in Malawi. South African Family Practice, 46(2), 32–32.
69.
TunčikienėŽ.SkačkauskienėI.GrenčikováA. (2013). Sustainable development of public sector: The state and assumptions of improvement of functional review in public institutions. Journal of Security and Sustainability Issues, 3, 11–21.
WescottC. (1999). Guiding principles on civil service reform in Africa: An empirical review. International Journal of Public Sector Management, 12(2), 145–170.
72.
WhettenD. A.GodfreyP. C. (1998). Identity in organizations: Building theory through conversations. SAGE Publications.
