Emotional labor in public health care organizations in Russia: How to improve the current situation

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GOVERMENT OF THE RUSSIAN FEDERATION

FEDERAL STATE AUTONOMOUS EDUCATIONAL INSTITUTION

OF HIGHER EDUCATION

«NATIONAL RESEARCH UNIVERSITY

“HIGHER SCHOOL OF ECONOMICS”»

DEPARTMENT OF SOCIAL SCIENCES

Emotional labor in public health care organizations in Russia: How to improve the current situation (based on the example

of a public hospital in Moscow)

Final qualifying paper - BACHELOR PAPER

Preparation direction 38.03.04 «Public Administration»

Educational program «Public Administration»

Gorshkova Natalia

Moscow 2016



ПРАВИТЕЛЬСТВО РОССИЙСКОЙ ФЕДЕРАЦИИ

ФЕДЕРАЛЬНОЕ ГОСУДАРСТВЕННОЕ АВТОНОМНОЕ ОБРАЗОВАТЕЛЬНОЕ УЧРЕЖДЕНИЕ

ВЫСШЕГО ОБРАЗОВАНИЯ

«НАЦИОНАЛЬНЫЙ ИССЛЕДОВАТЕЛЬСКИЙ УНИВЕРСИТЕТ

“ВЫСШАЯ ШКОЛА ЭКОНОМИКИ”»

ФАКУЛЬТЕТ СОЦИАЛЬНЫХ НАУК

Эмоциональная нагрузка в государственных учреждениях здравоохранения в России: как улучшить современную ситуацию (на примере государственной больницы в г. Москве).

Выпускная квалификационная работа - БАКАЛАВРСКАЯ РАБОТА

по направлению подготовки 38.03.04 «Государственное и муниципальное управление»

образовательная программа «Государственное и муниципальное управление»

Горшкова Наталья Алексеевна

Москва 2016



Content

INTRODUCTION

1. LITERATURE REVIEW

1.1 Definition of emotional labor

1.2 Grandey

1.3 Ashforth and Humphrey

1.4 Morris and Feldman

1.5 Consequences of emotional labor: Job satisfaction

1.6 Consequences of emotional labor: Burnout

1.7 Coping as a way of dealing with emotional labor

1.8 Sympathy and empathy

1.9 Emotional support and emotional labor

2. METHODOLOGY

2.1 Planning and preparing the interviews

2.2 Conducting the interviews

2.3 Analyzing the data

3. DATA

4. FINDINGS

5. DISCUSSION

CONCLUSIONS

REFERENCES

APPENDIX №1. INTERVIEWERґS GUIDE

APPENDIX №2. A SAMPLE INTERVIEW



Emotional labor in public sector is a concept that is used in social sciences to refer to the emotions that arise from the relationship between civil servants and citizens or civil servants and civil servants. This paper studies the issue of emotional labor in public health care organizations for children in Russia. The research aims at defining and examining the main features of emotional labor in public health care institutions in this country, to clarify their impact on current situation in the sector and to propose some possible improvements. This study is of great importance since the topic has been rather poorly developed by the domestic scholars so far and a more thorough research should be conducted. First, the theoretical research was conducted in order to analyze and systemize the existent literature on the topic. Second, the practical research in form of personal qualitative interviews took place. As a result, some suggestions were developed of how to improve the issues of emotional labor in public children health care organizations in Russia as well as some more general proposals concerning any field of public administration were given. In conclusion, this paper provides a complex analysis of the peculiarities of emotional labor of the medical personnel of public health care organizations for children and comes up with certain suggestions to improve the existing situation.

Keywords: emotional labor, coping strategies, empathy, social support.

emotional labor public health

Эмоциональная нагрузка в сфере государственного управления означает эмоции, которые возникают в отношениях государственных служащих и граждан или государственных служащих между собой. Данная работа исследует проблему эмоциональной нагрузки в государственных детских медицинских учреждениях здравоохранения в России. Целью исследования является выявить основные характеристики эмоциональной нагрузки в секторе государственных учреждений здравоохранения в России, уточнить их влияние на настоящее положение вопроса, а также предложить ряд инструментов по улучшению настоящей ситуации. На данный момент вопрос слабо изучен отечественными исследователями, а потому проведение практического исследования, как и продолжение литературы по данной теме в рамках государственных учреждений здравоохранения России представляется актуальным. В первую очередь был проведен обзор существующей литературы по исследуемому вопросу с целью проанализировать и систематизировать ее. Вторым этапом работы явилось проведение практического исследования в форме личных качественных интервью. На основе полученных данных после их анализа были разработаны рекомендации по улучшению сложившейся ситуации, которые могут быть применены как непосредственно к государственным детским учреждениями здравоохранения, так и к государственным организациям всего государственного сектора в России. Итак, данная работа представляет собой комплексный анализ особенностей эмоциональной нагрузки медицинского персонала российских государственных детских учреждений здравоохранения, а ее результатом является ряд предложений по улучшению современного состояния вопроса.

Ключевые слова: эмоциональная нагрузка, стратегии работы с эмоциональной нагрузки, эмпатия, общественная поддержка.



Introduction

Emotional labor in the public sector refers to the effort that a civil servant makes so that to perform organizationally appropriate emotions when interacting with a citizen. In the field of public health care services medical personnel of the public health care institutions act as providers of such services. The receiver of public medical services (a patient or its representative) has an expectation of how the services should be provided. The extent to which the actions of the medical personnel when providing services correspond to the citizens' expectations defines its satisfaction with the provided service.

The quality of the public services provided by the organizations of public administration system has recently become an extremely important in this country. The Decree No. 601 of the President of the Russian Federation dated May 7, 2012 On the Main Directions of Improving Governance Ukaz Prezidenta Rossiiskoy Fedetatsii ot 7 maya 2012 goda “Ob osnovnykh napravleniyakh sovershenstvovaniya sistemy gosudarstvennogo upravlenia” [Decree No. 601 of the President of the Russian Federation dated May 7, 2012 On the Main Directions of Improving Governance], satisfaction of the citizens of the Russian Federation with the public services provided must not be less than 90% by the year 2018.

That is why the topic of the emotional labor of the medical staff in public health care organizations in Russia seems to be relevant.

The concept of emotional labor in public health care organizations for children has been very poorly studied so far. That is why the development of the theoretical research in the field is considered the novelty of research.

The practical significance of the research consists in the suggestions given in the discussion part of the paper which could be applied to the field of public heal care as well as to any other field of public administration in Russia.

The object of the research is emotional labor of medical personnel of public health care institutions for children in Russia.

The subject is coping with emotional labor of medical personnel of public health care institutions for children in Russia.

The research question is as follows: How do administrators, doctors, and nurses deal with a emotionally charged context of service delivery on a daily basis?

The goal of the research is to overview the existing situation in the field of emotional labor in public health care organizations and to suggest some improvements of it. This, in its turn, can be divided into several tasks such as:

To define the term “Emotional labor” in the context of public health care institutions in modern Russia.

To define the main features of emotional labor of public health care institutions in Russia.

To clarify their impact on the performance of the studied organizations.

To propose possible suggestions to improve the current situation in the field.

The paper is organized as follows: in the first chapter the concept of emotional labor and its peculiarities are discussed. The second chapter is devoted to the empirical research conducted where its methods are explained as well as the results are given analyzed. In the third chapter the suggestions are made that could be considered useful in order to reduce the emotional labor of the Russian civil servants in any field of public administration and enhance their performance. The conclusions of the study are made.

The main terms used in the paper are as follows.

Emotional labor (in public sector) is a concept that is used in social sciences to refer to the emotions that arise from the relationship between civil servants and citizens or civil servants and civil servants Newman M. A., Guy M. E., Mastracci S. H. Beyond cognition: Affective leadership and emotional labor //Public Administration Review. - 2009. - Т. 69. - №. 1. - p. 6-20..

Emotional burnout was defined by Maslach et al. Maslach C., Schaufeli W. B., Leiter M. P. Job burnout //Annual review of psychology. - 2001. - Т. 52. - №. 1. - p. 397-422. as “a prolonged response to chronic emotional and interpersonal stressors on the job”.

Coping is defined as cognitive effort and actions that a person uses to deal with stress Shankar B., Kumar S. Emotional labour and burnout relationship: Role of social support and coping //Indian Journal Of Community Psychology. - 2014. - Т. 10. - №. 2. - p. 263-277..

Social support refers to a support that employees receive from their colleagues and chiefs Shankar B., Kumar S. Emotional labour and burnout relationship: Role of social support and coping //Indian Journal Of Community Psychology. - 2014. - Т. 10. - №. 2. - p. 263-277. .



1. Literature Review

1.1 Definition of emotional labor

Hochschild Hochschild A. R. The managed heart. Berkeley. - 1983. was the first to define the concept of emotional labor. The scholar stated it as “management of feeling to create a publicly observable facial and bodily display” Hochschild A. R. The managed heart. Berkeley. - 1983.. Her followers Morris and Feldman Morris J. A., Feldman D. C. The dimensions, antecedents, and consequences of emotional labor //Academy of management review. - 1996. - Т. 21. - №. 4. - P. 986-1010. explained emotional labor as follows: “the effort, planning, and control needed to express organizationally desired emotion during interpersonal transaction”. According to A. Grandey Grandey A. A. Emotional regulation in the workplace: A new way to conceptualize emotional labor //Journal of occupational health psychology. - 2000. - Т. 5. - №. 1. - P. 95., emotion labor is defined as demonstration of oneґs emotions that is considered a part of a professional role. Grandey summarized the Hochschil's Hochschild A. R. The managed heart. Berkeley. - 1983 and Ashfort and Humphrey's Ashforth B. E., Humphrey R. H. Emotional labor in service roles: The influence of identity //Academy of management review. - 1993. - Т. 18. - №. 1. - P. 88-115. theories and stated that there is a set of emotions that an employee of every organization has to perform. In both Ashforth and Humphrey's Ashforth B. E., Humphrey R. H. Emotional labor in service roles: The influence of identity //Academy of management review. - 1993. - Т. 18. - №. 1. - P. 88-115. and Grandey's Grandey A. A. Emotional regulation in the workplace: A new way to conceptualize emotional labor //Journal of occupational health psychology. - 2000. - Т. 5. - №. 1. - P. 95. works it is emphasized that there is a set of working rules that divide an emoployee's emotions into appropriate and inappropriate. To sum up, emotional labor is a conscious volunteer effort of workers in order to perform emotions that match organizational or professional display rules.

There are three ways in which workers display needed emotions. Firstly, it is suppressing negative emotions; secondly, expressing positive ones and finally, showing neutral emotions. Bulutlar F., Baєkaya Z. THE ROLE OF SUPERVISOR SUPPORT IN RELATIONSHIP BETWEEN EMOTIONAL LABOUR AND JOB SATISFACTION AND BURNOUT //Is, Guc: The Journal of Industrial Relations & Human Resources. - 2015. - Т. 17. - №. 4. Whereas most scholars devoted their works to analyzing first two types of emotions mentioned above, some studied this last phenomenon which was called emotional masking. Wharton A. S., Erickson R. I. Managing emotions on the job and at home: Understanding the consequences of multiple emotional roles //Academy of Management Review. - 1993. - Т. 18. - №. 3. - P. 457-486. Indeed, most jobs require demonstrating integrated emotions, which can be any possible combination of those in question. Cropanzano R., Weiss H. M., Elias S. M. The impact of display rules and emotional labor on psychological well-being at work //Emotional and physiological processes and positive intervention strategies. - 2003. - P. 45-89. In the field of health care, this is an even more relevant topic. With doctors and other medical personnel restraining negative emotions as well as expressing neutral ones is extremely common.

In accordance with Hochschild's theory Hochschild A. R. The managed heart. Berkeley. - 1983., there are two forms of performing emotions: deep acting and surface acting. By surface acting is meant demonstrating emotions a person do not feel, in other words, simply faking it. Grandey , A.A. (2003). When “The Show Must Go On”: Surface Acting and Deep Acting as Determinants of Emotional Exhaustion and Peer-Rated Service Delivery. Academy of Management Journal, 46 , 86-96. On the contrary, deep acting comprises acting of an emotion by a change in how a person percepts a certain situation Hochschild A. R. The managed heart. Berkeley. - 1983.. In their work Ashfort and Humphrey amplify the Hochshild's Hochschild A. R. The managed heart. Berkeley. - 1983. theory of surface and deep acting as the two components of emotional labor introducing a new component that is called “expression of genuine emotion” Ashforth B. E., Humphrey R. H. Emotional labor in service roles: The influence of identity //Academy of management review. - 1993. - Т. 18. - №. 1. - P. 88-115.. According to the scholars, the two-category system is not relevant since it does not include the fact that some workers provide a genuine performance of needed emotions. Ashforth B. E., Humphrey R. H. Emotional labor in service roles: The influence of identity //Academy of management review. - 1993. - Т. 18. - №. 1. - P. 88-115.

In case of simulation of an emotion one is likely to face emotional dissonance. This means the internal discord that is felt when a faked emotion is acted. Bulutlar F., Baєkaya Z. THE ROLE OF SUPERVISOR SUPPORT IN RELATIONSHIP BETWEEN EMOTIONAL LABOUR AND JOB SATISFACTION AND BURNOUT //Is, Guc: The Journal of Industrial Relations & Human Resources. - 2015. - Т. 17. - №. 4. As a result, emotional work can become stressful for an employee Lovelock C., Wirtz J., Chatterjee J. Services Marketing People, Technology Strategy A South Asian Perspective //Peason Education Inc, Delhi. - 2004.. Hochschild argues that emotional dissonance causes more harm if it is to self-detriment whereas it is does less harm when it comes at work role detriment. Hochschild A. R. The managed heart. Berkeley. - 1983.

Scholars do not totally agree on the situations in which emotional labor arises. Early emotional labor scientists, such as Hochschild Hochschild A. R. The managed heart. Berkeley. - 1983., claimed that emotional labor only occured in social-oriented professions, in which, firstly, there is personal contact with customers or, secondly, the aim of the interaction is to produce an emotional state in the customer or, finally, employers have control over emotional condition of employees Hochschild A. R. The managed heart. Berkeley. - 1983.. Other scholars, however, disagree arguing that emotional labor exists in all types of occupations. Fьsun Bulutlar, Nil Baєkaya The Role of Supervisor Support in Relationship between Emotional Labour and Job Satisfaction and Burnout, 2015 There are a number of different views.

1.2 Grandey

Grandey claims that it is advantageous if emotional labor is considered in terms of surface acting and deep acting for a few reasons. Grandey A. A. When “the show must go on”: Surface acting and deep acting as determinants of emotional exhaustion and peer-rated service delivery //Academy of management Journal. - 2003. - Т. 46. - №. 1. - С. 86-96. Firstly, while previous scholars claimed that emotional labor only had negative results Hochschild A. R. The managed heart. Berkeley. - 1983., Grandeyґs approach allows to see both positive and negative outcomes of emotional labor. Kruml and Geddes Kruml S. M., Geddes D. Exploring the dimensions of emotional labor The heart of Hochschild's work //Management communication quarterly. - 2000. - Т. 14. - №. 1. - P. 8-49. agree with the researcher's opinion. Positive one relates to the fact that deep acting may enhance job satisfaction. In contrast, surface acting results in job dissatisfaction due to emotional exhaustion and dissonance while deep acting have always been said to relate negatively to emotional exhaustion. Secondly, emotional labor being viewed in terms of surface and deep acting means that it is the internal regulation of oneґs emotions. This, in its turn, suggests that considering emotional labor skills learning is possible that gives a possibility to train workers to manage their emotions and to perform the appropriate ones. Bulutlar F., Baєkaya Z. THE ROLE OF SUPERVISOR SUPPORT IN RELATIONSHIP BETWEEN EMOTIONAL LABOUR AND JOB SATISFACTION AND BURNOUT //Is, Guc: The Journal of Industrial Relations & Human Resources. - 2015. - Т. 17. - №. 4.

1.3 Ashforth and Humphrey

Ashforth and Humphrey explored in their work the aspect of effortless emotional labor. Ashforth B. E., Humphrey R. H. Emotional labor in service roles: The influence of identity //Academy of management review. - 1993. - Т. 18. - №. 1. - P. 88-115. According to the scholars, it is commonly thought but is not always true that emotional labor is an effort-requiring work. They claim that under some circumstances it is possible to make emotional labor effortless, emphasizing that this considers both surface and deep action. Ashforth B. E., Humphrey R. H. Emotional labor in service roles: The influence of identity //Academy of management review. - 1993. - Т. 18. - №. 1. - P. 88-115

Moreover, Ashforth and Humphrey Ashforth B. E., Humphrey R. H. Emotional labor in service roles: The influence of identity //Academy of management review. - 1993. - Т. 18. - №. 1. - P. 88-115 examine the outcomes of emotional labor. The researchers state that there is a positive correlation between emotional labor and work effectiveness in case of customers believing in the sincerity of those providing services. Ashforth B. E., Humphrey R. H. Emotional labor in service roles: The influence of identity //Academy of management review. - 1993. - Т. 18. - №. 1. - P. 88-115

1.4 Morris and Feldman

Morris and Feldman Morris J. A., Feldman D. C. The dimensions, antecedents, and consequences of emotional labor //Academy of management review. - 1996. - Т. 21. - №. 4. - P. 986-1010. claim just the opposite of Ashforth and Humphrey Ashforth B. E., Humphrey R. H. Emotional labor in service roles: The influence of identity //Academy of management review. - 1993. - Т. 18. - №. 1. - P. 88-115: emotional labor is explained in terms of controlling emotions that arise in an individual. For this reason, according to Morris and Feldman, emotions can be changed and adapted to the situation in order to perform a needed emotion. Morris J. A., Feldman D. C. The dimensions, antecedents, and consequences of emotional labor //Academy of management review. - 1996. - Т. 21. - №. 4. - P. 986-1010.

Another aspect of Morris and Feldman's Morris J. A., Feldman D. C. The dimensions, antecedents, and consequences of emotional labor //Academy of management review. - 1996. - Т. 21. - №. 4. - P. 986-1010. work is that it is social surroundings that dictate the emotions that have to be expressed. In this, Morris and Feldman Morris J. A., Feldman D. C. The dimensions, antecedents, and consequences of emotional labor //Academy of management review. - 1996. - Т. 21. - №. 4. - P. 986-1010. acknowledge the ideas of Hochschild Hochschild A. R. The managed heart. Berkeley. - 1983 and Ashforth and Humphrey. Ashforth B. E., Humphrey R. H. Emotional labor in service roles: The influence of identity //Academy of management review. - 1993. - Т. 18. - №. 1. - P. 88-115

The scholars center at the frequency aspect of emotional labor. Like Hochschild Hochschild A. R. The managed heart. Berkeley. - 1983 put emotional labor down into the two categories of surface action and deep action and later it was amplified by Ashforth and Humphrey's Ashforth B. E., Humphrey R. H. Emotional labor in service roles: The influence of identity //Academy of management review. - 1993. - Т. 18. - №. 1. - P. 88-115 category of expressing genuine emotion, Morris and Feldman Morris J. A., Feldman D. C. The dimensions, antecedents, and consequences of emotional labor //Academy of management review. - 1996. - Т. 21. - №. 4. - P. 986-1010. examine emotional labor from the four different angles which are as follows:

1.Frequency of interactions. By frequency of interaction is meant how often a person comes in contact with another person.

2. Attentiveness (intensity of emotions, duration of interaction)

3. Variety of emotions required

4. Emotional dissonance. The concept of emotional dissonance was already explained and studies by scholars like Hochschild Hochschild A. R. The managed heart. Berkeley. - 1983, Ashforth and Humphrey Ashforth B. E., Humphrey R. H. Emotional labor in service roles: The influence of identity //Academy of management review. - 1993. - Т. 18. - №. 1. - P. 88-115 [, Grandey Grandey A. A. Emotional regulation in the workplace: A new way to conceptualize emotional labor //Journal of occupational health psychology. - 2000. - Т. 5. - №. 1. - P. 95.. Emotional dissonance is defined as an innerly felt opposition between the real emotion and the one that has to be performed. In terms of Hochschild's Hochschild A. R. The managed heart. Berkeley. - 1983 theory emotional dissonance is considered a negative outcome of displaying surface action. In their work, Morris and Feldman Morris J. A., Feldman D. C. The dimensions, antecedents, and consequences of emotional labor //Academy of management review. - 1996. - Т. 21. - №. 4. - P. 986-1010. also bring up the question whether emotional dissonance influences emotional exhaustion and/ or job satisfaction. As a result, it is claimed that emotional exhaustion is a negative outcome of emotional dissonance, and find out the positive correlation between these two phenomenon. Considering the influence of emotional dissonance on job satisfaction, it was stated that these are correlated, and job satisfaction reduces when emotional dissonance increases.

Morris and Feldman Morris J. A., Feldman D. C. The dimensions, antecedents, and consequences of emotional labor //Academy of management review. - 1996. - Т. 21. - №. 4. - P. 986-1010. also explore the gender aspect of emotional labor. According to the researchers, women feel more emotional labor than men.



1.5 Consequences of emotional labor: Job satisfaction

Many scholars studied the influence that has emotional labor on job satisfaction. Most of them claim that emotional labor is positively related to job satisfaction. Ashforth B. E., Humphrey R. H. Emotional labor in service roles: The influence of identity //Academy of management review. - 1993. - Т. 18. - №. 1. - P. 88-115.

If emotional labor in terms of Hochschild's theory is considered, relation between the two of the components of emotional labor and job satisfaction has to be studied. To begin with, Hochschild himself claimed that any organizational emotional management resulted in decrease of job satisfaction. Scholars' opinions differ on the subject of surface acting and deep acting. On the one hand, surface acting has a negative influence on job satisfaction, in accordance with Grandey, Fisk, & Steiner Grandey A. A., Fisk G. M., Steiner D. D. Must" service with a smile" be stressful? The moderating role of personal control for American and French employees //Journal of Applied Psychology. - 2005. - Т. 90. - №. 5. - P. 893.. On the other hand, deep acting is said to have a negative correlation with satisfaction in a job. Grandey A. A. Emotional regulation in the workplace: A new way to conceptualize emotional labor //Journal of occupational health psychology. - 2000. - Т. 5. - №. 1. - P. 95. Nevertheless, Kruml and Geddes Kruml S. M., Geddes D. Catching fire without burning out: Is there an ideal way to perform emotional labor //Emotions in the workplace: Research, theory, and practice. - 2000. - P. 177-188. argued that deep acting resulted in personal accomplishment and was not related to emotional dissonance. For this reason they assumed that deep acting was positively correlated with job satisfaction. Bulutlar F., Baєkaya Z. THE ROLE OF SUPERVISOR SUPPORT IN RELATIONSHIP BETWEEN EMOTIONAL LABOUR AND JOB SATISFACTION AND BURNOUT //Is, Guc: The Journal of Industrial Relations & Human Resources. - 2015. - Т. 17. - №. 4.



1.6 Consequences of emotional labor: Burnout

Freudenberger Freudenberger H. J. The staff burn-out syndrome in alternative institutions //Psychotherapy: Theory, Research & Practice. - 1975. - Т. 12. - №. 1. - P. 73., one of the earliest scholars to study emotional burnout claimed that not only does it affect all emotional exhaustion, it also causes mental and physical fatigue. Maslach defined emotional burnout as “psychological syndrome” that arises as a result of a stressful job Maslach C. Burnout: The cost of caring. - ISHK, 1982. that consists of three components: “emotional exhaustion, depersonalization, and reduced personal accomplishment” Maslch C., Jackson S. E. Maslach Burnout Inventory. Manual Research Edition. University of California. Palo Alto. - 1981. The scholars claimed that deep acting did not influence all the three aspects of burnout whereas only surface acting did. Emotional dissonance as a negative outcome of surface acting causes a great extent of burnout. Hochschild A. R. The managed heart. Berkeley. - 1983 Lee & Ashforth Lee R. T., Ashforth B. E. A longitudinal study of burnout among supervisors and managers: Comparisons between the Leiter and Maslach (1988) and Golembiewski et al.(1986) models //Organizational behavior and human decision processes. - 1993. - Т. 54. - №. 3. - P. 369-398. showed in their research that emotional dissonance leads to role conflicts of workers and their incomprehension of common goals of an organization. As explained below, wrong perception of organizational basics can cause emotional burnout.

It was found of that deep acting, as opposed to surface acting, accounted for more efficiency of employees' work Brotheridge C. M., Lee R. T. On the dimensionality of emotional labor: Development of an emotional labor scale //First Conference on Emotions in Organizational Life, San Diego, CA. - 1998.. Shankar and Kumar state that surface acting to relate to exhaustion as well as cynicism.

Emotional burnout was firstly studied exclusively in workers who had a client-oriented job, i.e. who worked constantly with people.

Whereas some researchers studied the causes of emotional burnout, others wondered what consequences it may have on employees. The possible matters of burnout were systemized by in the work of Scott Scott B. A., Judge T. A. Insomnia, emotions, and job satisfaction: A multilevel study //Journal of Management. - 2006. - Т. 32. - №. 5. - P. 622-645.. They were classified in three categories. The first one refers to job-related factors such as unprofessional leader(s), no clear goals, big amount of responsibility etc. The second one in said to be caused by lifestyle issues, like little time to recover from lots of stress, no support (first of all, emotional) and others. The last one refers to psychological factors pessimistic feelings, perfectionist kind of personality, not matching the job, etc.

Considering what emotional burnout can lead to in a person, Maslach and Leiter Leiter M. P. The truth about burnout //How Organizations Cause Personal Stress. - 1997. in their work showed the consequences. Among them are, first of all, emotional exhaustion and lack of energy; secondly, increased possibility of getting a disease; moreover, pessimistic feelings and a fall in job satisfaction; last but not least, increase in job ineffectiveness.

1.7 Coping as a way of dealing with emotional labor

Coping is defined as cognitive effort and actions that a person uses to deal with stress Shankar B., Kumar S. Emotional labour and burnout relationship: Role of social support and coping //Indian Journal Of Community Psychology. - 2014. - Т. 10. - №. 2. - p. 263-277.. This, by all means, can be applied to managing emotionally stressful situations.

Maslach and Leiterґs Maslach C., Leiter M. P. Early predictors of job burnout and engagement //Journal of applied psychology. - 2008. - Т. 93. - №. 3. - P. 498.demonstrated that coping was useful for an individual to prevent burnout. The concept of coping has changed with recent researches that now argue that coping is a conscious mechanism that a person chooses as his or her strategy to fight a stressful situation.

Lazarus and his colleagues Coyne J. C., Aldwin C., Lazarus R. S. Depression and coping in stressful episodes //Journal of Abnormal Psychology. - 1981. - Т. 90. - №. 5. - P. 439. indicated two forms of managing a stressful occasion and named them task-oriented and emotion-oriented. In the first type a worker focuses on eliminating the source of stress, for example, improving his or her working skills in order to perform better. If the second type is considered, an employee concentrates on the unpleasant emotion that causes the emotional stress. For instance, self-control, looking for help, distancing, venting, `tune oneself on' in the beginning of the day.

1.8 Sympathy and empathy

According to some scholars, there is one more coping strategy that is called empathy and refers to an individual ability to imagine what others feel based on oneґs life experience which does not mean involving oneself emotionally in the experience of others. Barrett-Lennard G. T. The empathy cycle: Refinement of a nuclear concept //Journal of counseling psychology. - 1981. - Т. 28. - №. 2. - P. 91.

Barrett-Lennard G. T. The empathy cycle: Refinement of a nuclear concept //Journal of counseling psychology. - 1981. - Т. 28. - №. 2. - P. 91 This is a coping strategy that is used to mentally ґdefendґ oneself from feeling the same as other people in an emotionally challenging situation by refusing to exactly feel it. Empathy is opposed to sympathy which means ґsharing the experience'.

It is very common that medical personnel in their practice take the problems to their patients to heart which provokes uncontrolled thought of it when at work as well as in the free time. From this point of view, empathy is a skill that every representative of the medical staff should learn in order to perform effectively and prevent emotional burnout.



1.9 Emotional support and emotional labor

Social support refers to a support that employees receive from their colleagues and chiefs. The idea of social support was first introduced in 1970s by such a researcher as Cassel Langford C. P. H. et al. Social support: a conceptual analysis //Journal of advanced nursing. - 1997. - Т. 25. - №. 1. - P. 95-100.. The concept was developed and introduced into organizational theory.

The concept of perceived organizational support was defined by Eisenberger. Eisenberger R. et al. Perceived organizational support //The employment relationship: Examining psychological and contextual perspectives. - 2004. - P. 206-225. By this is meant the extent to which workers thinks that an organization that he works for values their work and pays attention to their welfare Eisenberger R. et al. Perceived organizational support //The employment relationship: Examining psychological and contextual perspectives. - 2004. - P. 206-225. The benefits of perceived organizational support were pointed out by Rhoades and Eisenberger. Rhoades L., Eisenberger R. Perceived organizational support: a review of the literature //Journal of applied psychology. - 2002. - Т. 87. - №. 4. - P. 698. They showed that there were three main ideas why perceived organizational support was beneficial for an employee as well as for the organization. First and foremost, these beliefs of a worker should produce in them a feeling that they are to care about the organization's well-being which, in its turn, favors achieve its goals. Secondly, the feelings that perceived organizational support provokes in an employee make them satisfy their social and emotional needs. Last but not least, it is insuring an employee that the company encourages them to increase intensity of work.



2. Methodology

2.1 Planning and preparing the interviews

To begin with, the main goal of the investigation was defined. Next, the goal was divided into several tasks that altogether would serve to reach the goal of the investigation.

Conducting interviews for gathering qualitative data was chosen as the research method of the paper. First, a guide of topics to discuss with interviewees was developed. It was based on the tasks of the investigation as well as on the main aspects of emotional labor that were found in the existing literature on the topic. The main topics of the interviews were as follows: rewarding/ challenging parts of the work of the interviewees; situations in which emotional labor arose including the situations in which surface and deep acting appeared; coping strategies; social support; measures to deal with emotional labor; reduction of emotional labor and its consequences; burnout.

Second, questions to ask the respondents were written out, covering the chosen themes of interviews. The initial list of questions was generated, with the order of questions following the order in which the tasks appeared. Next, some test interviews were conducted in order to evaluate the appropriateness, value and number of the questions and make changes where necessary. As a result, certain questions were changed or deleted; some new were added to the list. The procedure was repeated several times until no more alterations were found needed. There were ten basic questions to star the conversation. The final list of questions is available in Appendix №1.

The estimated time of each interview was twenty-five minutes. Nevertheless, sometimes it took up to 40 minutes depending on the respondents' activeness, openness, desire to share their ideas and opinions and the amount of time they had for the conversation.

The interviews were of semi-structured type. By this is meant that there was a list of questions to star the conversation or one of its parts prepared beforehand which was then expanded with follow-up questions on the subject during the interviews depending on the actual answers of the respondents so as to collect more detailed information. The characteristics of a semi-structured interviews were defined by Cohen, Crabtree Cohen D., Crabtree B. Qualitative research guidelines project. - 2006. . Those were applied to the interviews conducted during my research. Firstly, the interviews were conducted in a formal environment. Secondly, as mentioned above, a guide of interviews was elaborated consisting of the topics and detailed questions to cover in the conversations. Furthermore, I followed the questions of the guide as well as I asked questions that were not a part of it when I found it appropriate.

Semi-structured interview as a method of conducting the research was used for several reasons. According to Bernard Bernard H. R. Research methods in cultural anthropology. - Newbury Park, CA : Sage, 1988. - P. 117., semi-structured interviews are the best when an interviewer did not have an opportunity to meet with respondents more than once, which corresponded to my conditions.

Face-to-face interviews were chosen for the research as opposed to telephone interviews for a few reasons. First, face-to-face interviews provide one with additional non-verbal information, for example, because of body language. Secondly, it is more likely that a personal interview takes place when and where it had been agreed. On the other hand, there are some challenges that were faced by me when conducting face-to-face interviews. One of them is that not every interviewee would permit that the dialogue is recorded. It takes time and effort to explain its importance and to persuade a person to give their permission. Another one is that it can be hard to arrange personal interviews, especially with busy workers.

A paper-based interviewer's guide was used during the interviews. The answers were recorded when permitted by the respondents and when not so, the main ideas were put down on the paper. When conducting the interviews I did not aim at following the order mentioned above but instead I followed the logic of the answers of the respondents in order to lead a natural conversation that would allow and encourage the interviewees to speak up their minds as much as possible. Sometimes I did follow the order in which the questions in the initial list appear while others I did not. When necessary I asked the respondents to clarify, precise or amplify their answers. After each interview, some time was spent to note down the overall impression of the conversation and the ideas that I could not write down as the interviewee was talking.

Before each interview permission to record the interview was obtained. Although recording of each interview was attempted, some interviewees did not allow me to record their answers. In cases when permission to record the conversation was not given I did not insist and asked if I could take notes in a block. All of those who did not agreed to be recorded did give such allowance. Whatever the case, paper notes were taken during the interviews on the important ideas, cites, facts, opinions relevant to the subject.

2.2 Conducting the interviews

Each interview was started by greeting the respondent followed by presenting myself, giving the overall goal of the research and asking permission to record the conversation.

In the beginning of the interview a simple and positive question was asked so that to ease the conversation and gain the interviewee's attention and emotional involvement.

As Britten Britten N. Qualitative research: qualitative interviews in medical research //Bmj. - 1995. - Т. 311. - №. 6999. - P. 251-253. advises, interviewees were given chance ask the interviewer whichever questions they wished all throughout the conversation.

Patton Patton M. Q. How to use qualitative methods in evaluation. - Sage, 1987. - №. 4. set certain requirements to qualitative interviews. The questions of the interview matched the demands which are as follows.

Open-ended questions. Open-ended questions are those that have no answer provided by the interviewer. This benefits collecting rich conversational data as it gives the respondents an opportunity to answers the questions as fully and in detail as they wish. Turner III D. W. Qualitative interview design: A practical guide for novice investigators //The qualitative report. - 2010. - Т. 15. - №. 3. - P. 756. The interviewer, in its turn, is free to ask as many follow-up questions as are needed. Open-ended questions were asked in the interviews.

Clear to the respondents questions. Questions were formulated as simple as possible so that every respondent could understand what he or she was asked. There were no technical terms (like emotional labor or burnout etc) used in the questions.

Sensitive questions. Questions that provoked emotional activity in the respondents were used in order for the interviewees to be “touched” by the question and want to speak on the topic.

Leading questions were not used in order not to provoke biased answers.

Three of the six types of questions for qualitative research Britten Britten N. Qualitative research: qualitative interviews in medical research //Bmj. - 1995. - Т. 311. - №. 6999. - P. 251-253. were used in the interviews. These are questions on behavior or experience; opinion or belief; feelings; sensory.

During the conversation, I gave the interviewees signs of understanding (yes, all right, I understand etc).

Different probe techniques were used in the interviews, which are as follows.

Repeating the question in a different way when interviewees derivate from the subject.

Silent probe technique which consists in reminding silent and giving the respondent an opportunity to think and talk without any rush. Following the advice of Bernard Bernard H. R. Research methods in anthropology: Qualitative and quantitative approaches. - Rowman Altamira, 2011. a nod was also added here as well as saying uh-huh in order to show the respondents that I was listening to them and to confirm that they were moving in the needed direction. Streib Streib, G. F. 1952. Use of survey methods among the Navaho. American Anthropologist 54:30-40 stated that cultural environment should be taken into account when choosing types of probes for an interview. In my research silent probe was chosen that corresponds to the Russian cultural norms of not interrupting of those who are talking but to listen instead.

Explanatory probe technique meaning asking questions such as “What do you mean by …?”, “”

Echo probe Bernard H. R. Research methods in anthropology: Qualitative and quantitative approaches. - Rowman Altamira, 2011. which consists in repeating respondents' last words with a question intonation when they did not finish a sentence or an idea in order to draw out the ending or understanding of their reasons of not finishing.

“Gentle inattention” Converse, J. M., and H. Schuman. 1974. Conversations at random. Survey research as the interviewers see it. New York: Wiley was used to avoid too much information not relevant to the study. By this is meant showing an interviewee that what they are saying is not especially important to the research by making them notice you focusing on something else rather than at the interviewee and slowly coming back to repeating the question with other words.

Introducing a new theme. Whyte W. F. Interviewing in field research //Field research: A sourcebook and field manual. - 1982. - С. 111-122.

When using probing questions, they were formulated as similar as possible to the interviewee's words and style of speech.

Moreover, laddering technique was used that consists of understanding the reasons by asking why.

In the end of an interview the respondents were asked to give feedback on the interview conducted. Collected ideas were used to improve every next interview.

Around 25-30% of the interview time was devoted to asking questions whereas over 70% was dedicated to listening to the respondents' answers.

Possible problems of conducting the interviews were anticipated and measures were taken to avoid them that are shown in the Table 1.

Table 1. Anticipated problems and measures taken to avoid them

№ of problem	Problem anticipated	Measures to avoid
1	Respondents not opening up to me, not being sincere enough, especially when the sensitive topic of their emotions is considered.	Preparing appropriate questions, rather general in the beginning, open the conversation with a positive question (“What is the most rewarding part of your work?”).
2	Distrust towards me.	Present myself and explained thoroughly the aims of the investigation.
3	Respondents refusing to be recorded.	Assured the anonymity of the conversation.
4	Interviewees not having enough time to answer all the questions in detail.	Arranging the interviews when it was more convenient for the respondents, being punctual on the day of the interviews.

When the needed data was gathered and I had it recorded or the answers were written down when the permission to record was not obtained, transcription the recordings and notes was performed. Since the interviews did not last very long and the number of interviewees was not extremely big, full transcriptions of the recorded interviews was performed whereas only the most relevant data of the non-recorded interviews was transcribed. Considering the fact that all the interviewees were Russian, the interviews were held in Russian. Therefore, once transcribed into Russian they were translated into English. To read a sample interview, transcribed and translated into English, see Appendix №2.



2.3 Analyzing the data

To begin with, preliminary analysis was conducted. By this is meant that all of the collected data was read several times in order to get an overall picture of the data gathered through the interviews conducted. The number of the interviews held, the scope of each of them, the basic questions and the range of follow-ups; professional range and demographical peculiarities of the respondents, general conclusions based on the given conversations. Moreover, at this stage possible improvements to the future interviews were found based on the feedback of the interviewees at the end of the conversation.

Then, the “tiding up” Romagnano L. S. Managing the Dilemmas of Change: A Case Study of Two Ninth-Grade General Mathematics Teachers. - 1991. was done. This refers to organizing and structuring the data on different basis so that to find out all the possible dimensions of the research and its results. The data was divided into several groups on the following criteria:

The public health care organization in which the research was conducted;

The date and the time of day when the interviews were held;

Professional positions of the medical personnel in their place of employment;

Gender aspects;

Age;

Duration of employment in the current position and/or in the hospital;

Permission to record;

The collected data was viewed once more and compared to the questions of the interviews so that to find the themes/areas/questions that were not completely covered. Nevertheless, as this research could only be done once, the completion of the uncovered topics was not possible. It was found out that the extent to which certain answers did not get full informative answers was extremely little, and so little information was lost during the interviews. One possible reason for this is that conducting interviews refers to dealing with people when a small proportion of information loss is a usual practice.

After that the gathered data was coded based on the criteria above. The two possible challenges of data coding were overcome. Gorden R. L. Basic interview skills. - 1992. The coding categories were neither too wide nor too narrow, which is why each piece of the collected data was managed to be coded.

Next, coding symbols were assigned to each group of data to be coded. To do this, abbreviations were used as the mechanism of assigning symbols. The table below illustrates the symbols of each category.

Table 2. Symbols of coding

Coding category	Symbol for coding
The public health care organization in which the research was conducted	H1 for the first hospital where the interviews were conducted H2 for the second hospital where the interviews were conducted.
The date and the time of day when the interviews were held	Day1 for the first day of conducting the interviews. Day2 for the second day of conducting the interviews.
Professional positions of the medical personnel in their place of employment	HD for head of department Doc for doctor N for nurse.
Gender aspects	F for female interviewees M for male respondents.
Age	MA for middle-aged employees (30-50 years old) A for aged workers (more than 51 years old).
Duration of employment in the current position and/or in the hospital	RE for recently employed workers (less than 5 years in the hospital) LE for long employed workers (more than 5 years)
Permission to record	R for recorded interviews WR for written interviews

The assessment of data was performed. The data assessment process was organized as follows.

First of all, it was assessed if the data was representative. The representativeness of the gathered information was gained by choosing different professional positions of the interviewees: heads of department, doctors, nurses. This way all types of medical occupations were presented in the interview data.

Secondly, the relevance of the data was checked. Since during the interviews the questions of the interviewer's guide were followed as well as the follow-up questions were asked depending on the actual answers of the respondents, the majority of the gathered data is relevant to the topic of the research. Nevertheless, there is some small extent to which some of the data in not relevant. This data was not included in the posterior analysis.

Next, “extreme cases” were found that differ much from the rest of the interviews.

Later, the codes used to code the information were checked. All of the codes were intelligible and clear.

After that, seeking for contradictions was performed. Some contradictions were found in the answers of the interviewees; however, they were all neutralized during the interview by asking to explain the answers or repeating the question looking for a new answer.

Next, the data was interpreted in order to provide the meaning of the results.

As the final stage of the research, the findings were formulated. According to Williams and Irurita Williams A. M., Irurita V. F. Therapeutically conducive relationships between nurses and patients: an important component of quality nursing care //The Australian journal of advanced nursing: a quarterly publication of the Royal Australian Nursing Federation. - 1997. - Т. 16. - №. 2. - С. 36-44., an effective way of reporting the findings includes this points:

* the label of the category,

* meaning of the category described by the author

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