The following research proposal is presented with the objective of outlining a plan for a research on doctors of a Cardio Department of a hospital with an objective of understanding how these doctors manage emotions and respond to various emotions needs at work.
Overview of emotion labour
According to (Korczynski, M., 2005) the credit for ripping off the blinker of emotional labour goes to Hochschild. Her contribution through her study of emotional labour among flight attendants and debt collector created immense interest in this field for academic researchers of the 1980's and the 1990's (Hochschild, 1983). She has defined the term Emotional labour as ‘the management of feelings to create a publicly observable facial and bodily display' (Hochschild, 1983). She further argues that emotional labour in such a context is something which is sold for a wage and therefore has exchange value associated to it (Hochschild, 1983). Hochschild identifies two processes through which emotional labour is achieved; these include surface and deep acting. One of Hochschild's major contributions in the study of emotion labour is her recognition that management of emotions requires a degree of effort on part of the individual. Hence we see that in ‘Managed Heart' Hochschild introduces the term emotional labour to describe the term emotion management with a ‘profit motive slipped under it' (Hochschild 1983, p.119).
Despite the enduring popularity of Hochschild‘s work there has been considerable criticism of (Hochschild, 1983). By large the biggest of the criticism on Hochschild' work has been its limitation in transposing this understanding of emotional labour onto public sector professionals. (Bolton and Boyd, 2003) provide criticisms on Hochschild's work on basis of following clauses. Firstly according to (Bolton and Boyd 2003, p.295) Hochschild's concept of commercialization of feeling, neglects to identify ‘feelings rules' in workplace that are not commercially driven. This notion disqualifies the possibility that employees may play any role in self management of these emotions. In our current study we will be strongly drawing on to the works of Bolton which has been developed out of her studies within the health care sector (Bolton S. C., 2005). Bolton's term emotional management is used to identify the work associated with managing one's own feelings as well as others emotions at work..Adopting to the term emotion management is also reflective of the works of James's (1989, p15) which relates emotional labour to the ‘labour involved in dealing with other people's feelings, a core component of which is the regulation of emotions'.
Emotional labour in health care:
Over the last few decades Emotion work has attracted a lot of debate and empirical enquiries within the health care settings. A lot of work has been performed on studying emotion management by nurses. Examples of such studies include Emotion labour among general nurses (Henderson, 2001) (Smith and Gray, 2001) mental health nurses (Mann and Cowburn, 2005), gynaecology nurses (McCreight, 2004) (Bolton, 2000), hospice nurses (James, 1989) and midwives (Hunter, 2001). However there is limited empirical evidence which provide an understanding of role of emotion work in health care settings for other medical professionals(Sandi M, 2005).Studies within health care apart from nursing include work on medical students (Smith and Kleinman, 1989); (Lief and Fox, 1963)) and as well as clinical psychologists ( (Mann and Jones, 1996). Numerous reasons are associated to why emotion labour has been a topic of such interest within the medical profession and nursing in particular. Researchers like Phillips (1996) deem it as an important expectation of the patients, others like (Mitchell and Smith, 2003) relate it to the image of nursing itself. McQueen (2004) feels the need to manage these emotions through suppression; control and performance are an essential means of making the patient feel cared for. Another perspective is provided by (Smith and Gray, 2001 which state that the main reason for this popularity are uncertainty of medical treatments and difficult medical experiences, including trauma and young deaths which call for constant need to manage emotions.
An important contribution within this setting comes from the works of Bolton (2001), who uses the word ‘emotional jugglers' to describe nurses way of matching face in a given situation (Bolton 2001, p.86). In her study of 45 nurses she distinguishes 3 main kinds of faces nurses adopt to manage their emotion demands. These faces include ‘professional face', the ‘smiley face' and the ‘humorous face'. The changing context of business world in the West, has added a capitalist dimension to the work of nurses, (Bolton 2001; Charles et al., 1999), where patients are viewed as consumers (Sandi 2005).
Empirical studies examining the role of emotion labour in the health care setting other then nursing is limited in nature. This can be understood in the light of care being associated with roles of nurses and more specifically to the ‘female' gender (Sandi 2005).Some of the main reasons why doctors have been excluded from research on emotion labour include traditional technical/clinical roles of doctors which did not involve emotive aspects of care (McCreight, 2004). According to (Lupton, 1997) doctors and consultants make a conscious attempt to restrict emotional involvement with the patients. This can be noted as a precautionary or a protective strategy. For some this may be understood as something which limits their professional capabilities. Irrespective of the rationale behind this, if we look closely it still calls for a need to regulate emotions and mange them, and even suppress them in a lot of cases. It is this very understanding which takes its basis for studying emotion labour in doctors in the current study.
Before we talk in great length about the aims and objectives of the current research, it is essential to look at the previous studies which have been performed on doctors exclusively. One of the study which explored emotion labour amongst doctors was Smith and Kleinman's (1989) study on medical students .The research findings highlight the lack of training in emotion management provided to the medical students. It showed that even though there was a lack of emotion management in the curriculum, yet culture of medicine itself is such that it fosters certain unspoken mechanism to deal with emotions. In another study done on clinical psychologists by Mann and Jones (1996), it was found that 80% of patient doctor interactions involved performance of emotion labour (Mann and Jones, 1996) as cited in (Sandi M, 2005).
Looking at the literature we can identify the emotion role played by doctors and its significance for managing patients who experience pain, anxieties and even fear (Phillips, 1996).Within this caring profession, management of one's own emotions and that of the patients become detrimental for delivering efficient care. Hence emotion management signifies a more extensive understanding of how emotions form a part of work life, it also provides a better understanding on the role of organization in management of emotions of employees.
In this paper, we will be drawing on to Bolton and Boyd (2003) term emotional management, which refers to managing one's own emotions as well as others as this is largely the very requirement of our profession under study. The proposed research will provide an understanding of how doctors in a Cardiac Department manage emotions. Further on this research aims at providing a holistic demonstration of Bolton's model of emotional management by identifying the dominant role of presentational and philanthropic emotion management amongst doctors along with emotion management driven by professional and organizational norms. The research would be conducted within the time scale of 4 months. One month for data collection. One month for transcription and theme identification. And two months for analysis of data, given all ethical approvals and formalities are completed before hand.
Today's literature constitutes to a wide range of publications on emotional labour including work such as that of psychiatrists, teachers, nurses, police officers, professional care, academic professions and paralegals (Pierce 1999; Brown 1997; Leander 1999; Ashforth and Humphy 1995 as cited in Fineman 2000). However emotional labour among professional groupings and public service workers have been ignored within the existing literature Harris (2002); Jenkins and Conley ( 2007)
Identifying this particular gap within existing literature, this study is aimed at providing sufficient empirical research within the professional group of Doctors - an original status profession. Emotion management amoung doctors is under researched. The research would focus on Bolton's framework of emotion management to understand the range and complexity of emotion management in doctors.
RQ1) How do doctors manage emotions?
RQ2) What are the consequences of emotional management?
To investigate our current subject this research will be using an iterative approach as it will be a combination of both deductive as well inductive approaches. It is deductive as our research utilizes the existing framework of emotion management developed by Bolton 2005.The researcher considered the research approach inductive because there is no empirical evidence of any research on the particular occupational group under study i.e. doctors.
According to Robson (2002) research enquiries may be classified in terms of their purpose as well as the research strategy adopted. The research questions (discussed above) developed after carefully reviewing the literature reflect the exploratory and descriptive nature of the present study. Two research questions would be used to arrive at the required data and conclusions for this research. The first question is exploratory in nature where doctor's need to manage emotions will be studied and its management. This study focuses on the different forms of management of emotions which doctors perform namely presentational, philanthropic and prescriptive. The unit of analysis will be the Cardio Department of the organization with focus on doctors in particular.
Research design is a very important element within research. The research design links the research questions to the relevant empirical research (Ghauri and Gronhaug 2002). The research design for this research is a case study of a social group, which in our scenario is a professional group of cardiovascular doctors. Case studies are the chosen research design for numerous reasons/benefits. Firstly case study as a design of research shall provide us with flexibility as noted by (Hakim, 1987). It shall also provide us with a detailed, in-depth understanding of our subject (Stake, 1998) and a contextual understanding of the research setting (Yin 2003). Examples of some case studies adapted previously to study social groups are by Jenkins and Conley on Teachers and Emotional Management (Jenkins and Conley 2007) and by Harris on Barristers and Emotional Management (Harris, 2002) .
The research shall be conducted at Cardio Department at National Institute of Health – A university Hospital in York. It is a philanthropic, not-for-profit, private teaching institution committed to providing the best possible options for diagnosis of disease and team management of patient care. This department provides immediate, high quality cardiac care to patients. There were many reasons for choosing this research site. A very important consideration on choice of research site was access and the nature of work .
The primary method for data collection proposed is qualitative interviews. This method is chosen in order to gather reliable and valid data that is related to the research questions (Saunders et al., 2007). Qualitative interviews are preferred, as they provide a rich source of data suited to uncovering complex social processes (Bryman, A.,Bell, E., 2003) . Interviews are ideal for this research, based on emotional management by doctors which is a complex phenomena and every doctor's view and personal experience needs to be discussed to get a true picture of their emotions/feelings while dealing with different patients.
As this research aims to research on a complex phenomenon, therefore it will not be appropriate to follow a specific set of questions as the interviewer will require to change the order of questions depending on the flow of conversation. As May (2001) argues that probing is allowed in semi-structured interviews as long as they are not detrimental to the aims of standardization and comparability. In addition as this is an exploratory research, therefore semi-structured interviews are the most appropriate choice (Cassell and Symon 1994). In this research, interviews are given preference over observations as observation is not practical or ethical in the given research setting based on the criticality and sensitive nature of work within the this department.
Fifteen interviews would be conducted. These include 14 interviews with doctors including the faculty plus one interview with the training and development manager. Our population consists of homogeneous occupational subgroups based on ranks. The department staffs include senior medical officers, medical officers and residents. These are supervised by various faculty members .There are altogether 26 senior medical officer these are mostly part time employee who work under flexi hours, there are around 7 Medical officers in the department along with 8 residents. Convenience sampling will be adopted to sample the population. Convenience sampling is incorporated in a research to keep the cost to minimal and as the name suggests its also convenient to access the participants without any issue of probability sampling. Marshall (1996) agrees that it is the least costly method in terms of money, time and effort. Convenience sampling is the proposed means because not all Doctors are available for research; some of them are busy with preparations for some professional examination. And the nature of work within the cardiovascular department is such that most of the doctors on call are unable to take out time for interviews and some doctors generally are not interested in the research and have reservations in giving out information.
The sample will consist of equal numbers of males and females in order to enable us to get perspectives from both gender and see how emotion work related to gender within our context. All participants will be send an e mail informing them about the research .The objectives an purpose of the research would be effectively communicated. Each interview shall be between 40- 60 minutes long on an average and conducted in the on call residence rooms, faculty offices or conference rooms. Each interview will be recorded to ensure data is not lost .This was done with participant consent.
After transcribing the interviews, the transcripts would be given an in-depth and thorough study to highlight different themes and divide them into various sections. This technique helps to allocate the data under its respective theme that emerge through a skeptical procedure of data reduction (Robson, 2002).
A true understanding of this subject would require a lot of time. As per schedule the primary research collection had to be completed within one month's time in order to provide sufficient time to incorporate collection, collation and interpretation of the data. Moreover, since there were human participants in the study, the ethical implications had to be identified to avoid unnecessary complications. First and far most important element is ethical approvals required from the NHS, keeping into consideration the NHS's new claim for patients as customers; it is sought that this research would be supported by them. A ethical approval request form from the NHS would be filled along with a supervisor's letter to provide a contact and clarity of subject. A detail copy of proposal will be send to them to clear any ethical issues they may have. Prospective interview questions will also be taken approval off, given an understanding of marginal alteration on a case base. Ethical guideline provided by the university as well as those by the Hospital will also be kept in consideration. In order to obtain consent of the participants they will be made fully aware of the aims and objectives of the research. Pseudonyms will be used in order to ensure the confidentiality of data. Inefficiency in gathering required data by the researcher may also act as one of the constraints. Probing and digging the right information out of the participant would be a challenge given the researcher's interpersonal skills.
Methodological Considerations and Constraints
The authenticity of the data obtained during a research has always been an issue that has to be taken into account while conducting research. In order to reach the right conclusion one needs to take such measures to ensure that the research is free from any kind of subjectivity and the information acquired is valid and reliable. Saunders et al., (2007) argues that there are four threats to reliability. The first is participant error. This is likely to occur if the respondent is not provided the right environment or time to give out significant information. The second is participant bias. This is likely to occur if the respondents know that there are being monitored and this influences their answer in a manner that is suitable to the higher management. Such evidence is found in organizations having authoritarian management style and where there is employment insecurity. The third and fourth ones are likely to occur by the researcher himself. The third one is observer error which occurs due to unstructured interviews where the data gathered does not match the research questions. Fourth, is the observer subjectivity which occurs on how each interviewer perceives a response. All these four issues would be taken into consideration while conducting the research. Participant error shall be removed by taking interviews when the doctors had either finish their shifts or when they have their department well covered .Secondly participant bias shall be handled by taking interviews in a close room that cannot be monitored and interviewees can speak openly about the research .A conscious effort will be made to remind and recollect the conversation in the best possible manner, in order to prevent any loss of information. Immediately after interviews notes will be taken on the essential points including, ease of participants and his body language .Third, conducting semi-structured interviews will allow gathering data to match with the research questions. It will provide an ability to return interview focus back to the subject in cases where interviewees digressed from the topic under discussion. The issue of personal bias shall be removed by audio taping the interviews. In the stage of transcription interviews, audio recordings will be listened repeatedly and transcripts shall be counter checked to avoid any errors. Second major issue of a qualitative research is the validity of the acquired data. In order to increase validity we will incorporate semi-structured interviews as these types of interviews are meant for qualitative research and are known as qualitative research interviews (Cassell and Symon 1994).All interviews will be audio taped and help the researcher in ensuring the validity and reliability of the data and helped in yielding deep insight into the subject.
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