Work stress, burnout, and perceived quality of care: a cross-sectional study among hospital pediatricians

Psychosocial working conditions and mental health among medical assistants in Germany: a scoping review

BACKGROUND

Medical assistants (MA) constitute one of the largest professions in outpatient health care in Germany. The psychosocial working conditions of health care staff are generally believed to be challenging and to thereby increase the risk of poor mental health. A review of MA's psychosocial working conditions and mental health is lacking, however. We aimed to systematically identify and summarize existing research on psychosocial working conditions and mental health of MA by addressing (1) Which methods, concepts, and instruments have been used to capture the psychosocial working conditions and mental health among MA in Germany? (2) What findings are available? and (3) What are the research gaps?

METHODS

We systematically searched Medline, Scopus, CCMed and Google Scholar. Using the Population Concept Context (PCC)-framework, we applied the following eligibility criteria: (a) Language: English or German, (b) publication between 2002-2022, (c) original study, (d) study population: mainly MA (i.e., ≥ 50% of the study population), (e) concept: psychosocial working conditions and/or mental health, and (f) context: Germany. Two reviewers extracted data independently, results were compared for accuracy and completeness.

RESULTS

Eight hundred twenty-seven sources were identified. We included 30 publications (19 quantitative, 10 qualitative, and one mixed methods study). Quantitative studies consistently reported high job satisfaction among MA. Quantitative and mixed methods studies frequently reported aspects related to job control as favorable working conditions, and aspects related to job rewards as moderate to unfavorable. Qualitative studies reported low job control in specific work areas, high demands in terms of workload, time pressure and job intensity, and a desire for greater recognition. Social interactions seemed to be important resources for MA. Few studies (n = 8) captured mental health, these reported inconspicuous mean values but high prevalences of anxiety, burnout, depression, and stress among MA. Studies suggested poorer psychosocial working conditions and mental health among MA during the COVID-19 pandemic.

CONCLUSIONS

Quantitative studies tend to suggest more favorable psychosocial working conditions among MA than qualitative studies. We suggest mixed methods to reconcile this alleged inconsistency. Future research should examine discrepancies between job satisfaction and unfavorable working conditions and if psychosocial working conditions and mental health remain changed after the COVID-19 pandemic.

A model of hope as a protective measure to lower burnout and secondary traumatic stress among employees working in developmental and intellectual disabilities services

BACKGROUND

Burnout and secondary traumatic stress (STS) are problems for the workforce supporting people with developmental disabilities. This study investigated hope as a potential protective resource for burnout and STS among the developmental disability services workforce.

METHOD

One hundred and fifty-two non-supervisor caseworkers from a state agency, developmental disabilities division were recruited to participate in an anonymous web-based survey.

RESULTS

The analyses showed that hope was negatively associated with the three dimensions of STS (intrusion, avoidance, and arousal) and burnout. Controlling for tenure in the workforce and STS, the results of the hierarchical regression analyses showed that hope accounted for a significant incremental variance to burnout.

CONCLUSION

These findings provide support for emerging literature showing hope as a protective resource to workforce burnout.

A Cross-Sectional Study on Physical Activity and Burnout among Family Physicians in Slovenia during the First Year of the COVID-19 Pandemic: Are the Results Alarming Enough to Convince Decision-Makers to Support Family Medicine?

Physical activity has a positive effect on general health, but its influence on burnout remains unclear. The aim of this study was to determine the association between physical activity and the incidence of burnout in Slovenian family physicians (FPs) and family medicine trainees (FMTs) during the COVID-19 pandemic, which exacerbated the already-existing problem of burnout. We conducted a cross-sectional observational study among Slovenian family physicians and FMTs in which sociodemographic variables, the type and duration of physical activity, and an assessment of burnout were collected using the Maslach Burnout Inventory. Comparisons between groups were made using the independent-samples t-test, Fisher's exact test, and the Wilcoxon sign-rank test. A value of p < 0.05 determined the limit of statistical significance. Of 1230 FPs and FMTs invited to participate, 282 completed the survey (22.9% response rate); there were 243 (86.2%) FPs and 39 (13.8%) FMTs. The overall rating for burnout during the pandemic was high, at 48.6% of FPs and FMTs; 62.8% of respondents reported a high rating for emotional exhaustion and 40.1% for depersonalization. Compared to FMTs, emotional exhaustion and total burnout scores were higher for FPs (p < 0.001 and p = 0.010, respectively), but work status was not related to personal acomplishment, which 53.5% of all participants rated as low. Physical activity did not appear to be a statistically significant factor in the occurrence of burnout during the pandemic. Therefore, work status or occupational role (FP vs. FMT) should be thoroughly investigated in the future along with some other factors and a better response rate.

Screening for psychosocial risks among physicians in a pediatric hospital

Over the past decades, productivity practices at hospital resulted in staff overload and burnout. Prompted by physicians' complaints, this study assessed the level of psychosocial risk among senior pediatricians in a university hospital. The survey used the checklist of Quebec's National Institute of Public Health that comprises two six-indicator parts: "Context" and "Key Components" of the Organization. The psychosocial risk level was evaluated by a physician-psychologist duo during interviews of homogeneous groups of workers. The indicators were scored, tabulated, and discussed. The survey led to a substantial qualitative and quantitative clarification of physicians' working conditions, claims, and needs. Regarding Context, the staff reported mainly: (a) cumbersome organization and norms vs. limited human resources (lack of stability, incentives, and promotions); (b) absenteeism and presenteeism; (c) reluctance to seek care or advice for fear of discredit; (d) presence of verbal violence; (e) self-imposed harsh returns-to-work; (f) work-life conflicts and difficult mental disconnection from work. Regarding the Key Components, the staff reported mainly: (a) work overload (physical, mental, psychological, and relational/social), continuous stress, and perceived exhaustion; (b) low job satisfaction and insufficient recognition; (c) inconstant support by their superiors; (d) poor job relationships and colleagues' support; (e) occasional participation and lack of real autonomy and/or strategy sharing. The survey succeeded in underlining concerning issues that required the immediate attention of occupational physicians and managers. It proved the method feasible and valuable in the medical context despite a high diversity of staff functions and degrees.

What helps hospital staff in times of crisis: qualitative results of a survey on psychosocial resources and stressors in German hospitals during the COVID-19 pandemic

Background

Even before the COVID-19 pandemic, hospital workers faced a tremendous workload. The pandemic led to different and additional strain that negatively affected the well-being of employees. This study aims to explore psychosocial resources and strategies that were used by hospital staff.

Methods

In the context of an intervention study, employees of three German hospitals were questioned in writing in summer and fall 2020. Five open-ended questions about the pandemic were asked to capture corresponding effects on daily work routine. Answers of 303 participants were evaluated using structuring qualitative content analysis.

Results

Significant stressors and resources were identified in the areas of work content and task, social relations at work, organization of work, work environment and individual aspects. Stressors included, for example, emotional demands, conflicts, an increased workload, time and performance pressure. Important resources mentioned were, among others, the exchange with colleagues and mutual support. Sound information exchange, clear processes and guidelines and a positive work atmosphere were also important. In addition, the private environment and a positive mindset were perceived as helpful.

Conclusion

This study contributes to a differentiated understanding of existing psychosocial resources of hospital staff in times of crisis. Identifying and strengthening these resources could reduce stress and improve well-being, making hospital staff better prepared for both normal operations and further crisis situations.

Second Victims among Austrian Pediatricians (SeViD-A1 Study)

(1) Background: The second victim phenomenon (SVP) plays a critical role in workplace and patient safety. So far, there are limited epidemiological data on the SVP in German-speaking countries. Some studies have been carried out in Germany, but so far, no quantitative studies have been carried out in Austria examining the prevalence, symptom load and preferred support measures for second victims (SVs). This study therefore examines the SVP among Austrian pediatricians. (2) Methods: A nationwide, cross-sectional and anonymous online study was conducted using the SeViD questionnaire (Second Victims in Deutschland) including the Big Five Inventory-10 (BFI-10). Statistical analysis included binary-logistic and multiple linear regression with the bootstrapping, bias-corrected and accelerated (BCa) method based on 1000 bootstrap samples. (3) Results: Of 414 Austrian pediatricians, 89% self-identified as SVs. The main cause of becoming an SV was the unexpected death or suicide of a patient. High neuroticism and extraversion values as well as working in outpatient care positively correlated with having experienced the SVP. A preferred support strategy was access to legal counseling. (4) Conclusions: Austrian pediatricians have the highest SVP prevalence measured with the SeViD questionnaire. Further research should focus on prevention strategies and intervention programs.

Critical care staff wellbeing: A new paradigm for understanding burnout

BACKGROUND

The wellbeing of paediatric intensive care unit (PICU) staff members influences their engagement with work and the quality of care they provide to patients. Baseline burnout measures in research provide inconclusive evidence of the determinants of burnout and how to target interventions to promote staff wellbeing.

OBJECTIVES

The objectives of this study were to determine the prevalence of burnout using the Maslach Burnout Inventory (MBI) burnout-engagement workplace profiles in a sample of Australian PICU staff and investigate associations between demographic characteristics, meaningful work, satisfaction with life, and psychological distress on burnout.

METHODS

A cross-sectional survey was administered to a multidisciplinary sample of PICU staff (target n = 464) from three tertiary paediatric hospitals in Australia. The survey tool was comprised of the MBI, Work and Meaning Inventory, Satisfaction with Life Scale, Kessler Psychological Distress Scale, and demographic questions. Hierarchical multiple regressions examined the relationships between burnout and these variables of interest.

RESULTS

A sample of 258 participants (56%) completed the survey. For most respondents, burnout was scored as a low to moderate risk, with over half the participants scoring low risk for emotional exhaustion (EE) (56%) and depersonalisation (DP) (54%). Personal accomplishment (PA) was more evenly distributed (range of burnout risk: low, 32%; moderate, 32%; high, 36%). MBI scores were classified using the burnout-engaged workplace profile system, identifying low levels of burnout (8% burnout, 3% disengaged, 21% overextended, 29% ineffective, and 39% engaged). Psychological distress significantly increased burnout risk across all three dimensions EE (β = 0.253, p < 0.001), DP (β = 0.145, p < 0.05), and PA (β = -0.13, p < 0.05), and being aged between 41 and 55 years was protective of depersonalisation (β = -0.214, p < 0.05).

CONCLUSION

Utilising MBI workplace profiles, this study has built upon the demand for a more comprehensive assessment of burnout. Research that helps improve our understanding of contributory factors to burnout and wellbeing will inform the development of effective interventions that promote wellbeing of staff.

Workplace policies and quality of working life (QoWL) during the COVID-19 pandemic in Jordanian hospitals

BACKGROUND

Many healthcare organizations place a high value on quality of work-life (QoWL). The healthcare system's long-term sustainability and capability to offer high-quality services to patients depend on improving QoWL for their healthcare workers.

OBJECTIVE

The study aimed to explore the impact of Jordanian hospitals' workplace policies and measures in three main domains: (I) Infection prevention and control (IPC) measures, (II) Supply of personal protective equipment (PPE), and (III) COVID-19 precautionary measures on the QoWL among healthcare workers during the COVID-19 pandemic.

METHODS

A cross-sectional survey was conducted from May to June 2021 through an online self-reported questionnaire (Google Form) targeting hospital healthcare professionals working at Jordanian hospitals (public, private, military, and university). The study used a valid work-related quality of life (WRQoL) scale to study the QoWL.

RESULTS

A total of 484 HCWs in Jordanian hospitals participated in the study with a mean age of (34.8 ± 8.28 years). 57.6% of the respondents were females. 66.1% were married, with 61.6% having children at home. An average QoWL among healthcare workers in Jordanian hospitals during the pandemic was observed. The study results also showed a significant positive correlation between workplace policies (IPC measures, supply of PPE, and COVID-19 preventive measures) and the WRQoL among healthcare workers.

CONCLUSION

Our findings highlighted the vital need for QoWL and psychological well-being support services for healthcare staff during pandemics. Improved IPC systems and other precautionary measures at the national and hospital management levels are required to help minimize the stress and fear that healthcare workers experience and lower the risk of COVID-19 and future pandemics.

[Mobbing Among Hospital Physicians]

OBJECTIVES

Bullying in the workplace is considered an interpersonal stress factor. Occupational stress and mental health among physicians is increasingly becoming the focus of public attention. The extent to which mobbing plays a role in this has hardly been investigated yet. The aim of this study is to provide data on the prevalence of bullying among hospital physicians in Germany and possible correlations with occupational stress and mental health.

METHODS

Within the framework of two cross-sectional studies, 692 hospital physicians in the field of psychiatry/psychotherapy (P/PT) and 667 hospital physicians in intensive care (IM) were interviewed at conferences. Standardized questionnaires on mobbing experience, occupational stress and mental health (single item from COPSOQ, BDI-II, ERI, MBI) were used.

RESULTS

Bullying was experienced by 4.6% (n=61) of the respondents. IM and women physicians were more often affected (not significant) and correlations with occupational stress (ERI), overcommitment (OC), emotional exhaustion (MBI) and depression (BDI-II) were found.

CONCLUSION

Our data on a large cohort of physicians in specialties with different exposure profiles show that a relevant proportion is affected by bullying and that bullying is related to the experience of occupational stress as well as mental health impairments. From this, implications for institutional and individual prevention and support services can be derived.

Physician Health and Wellness

Physician health and wellness is a complex topic relevant to all pediatricians. Survey studies have established that pediatricians experience burnout at comparable rates to colleagues across medical specialties. Prevalence of burnout increased for all pediatric disciplines from 2011 to 2014. During that time, general pediatricians experienced a more than 10% increase in burnout, from 35.3% to 46.3%. Pediatric medical subspecialists and pediatric surgical specialists experienced slightly higher baseline rates of burnout in 2011 and similarly increased to just under 50%. Women currently constitute a majority of pediatricians, and surveys report a 20% to 60% higher prevalence of burnout in women physicians compared with their male counterparts. The purpose of this report is to update the reader and explore approaches to pediatrician well-being and reduction of occupational burnout risk throughout the stages of training and practice. Topics covered include burnout prevalence and diagnosis; overview of national progress in physician wellness; update on physician wellness initiatives at the American Academy of Pediatrics; an update on pediatric-specific burnout and well-being; recognized drivers of burnout (organizational and individual); a review of the intersection of race, ethnicity, gender, and burnout; protective factors; and components of wellness (organizational and individual). The development of this clinical report has inevitably been shaped by the social, cultural, public health, and economic factors currently affecting our communities. The coronavirus disease 2019 (COVID-19) pandemic has layered new and significant stressors onto medical practice with physical, mental, and logistical challenges and effects that cannot be ignored.

Work stress, burnout, occupational commitment, and social support among Chinese pediatric nurses: A moderated mediation model

PURPOSE

Pediatric nurses are at high risk for burnout, resulting in unsatisfactory care quality. Although job resources like social support can prevent the development of burnout under work stress, the mediating role of personal resources like occupational commitment is not well studied. This study was to examine the mediating role of occupational commitment in the relationship between work stress and burnout, and test if the effect of work stress on occupational commitment varies at different levels of social support among pediatric nurses.

METHODS

A cross-sectional survey was conducted to collect data of pediatric nurses from 6 hospitals in Chengdu, China. Multiple linear regressions and bias-corrected bootstrap confidence intervals were used to test the proposed model.

RESULTS

In this sample of 488 pediatric nurses, work stress was significantly associated with emotional exhaustion (β = 0.278, p < 0.001), depersonalization (β = 0.112, p < 0.001), and personal accomplishment (β = -0.047, p < 0.05). Occupational commitment partly mediated the links of work stress and emotional exhaustion (β = 0.056, 95%CI: 0.034-0.082), and depersonalization (β = 0.026, 95%CI: 0.014-0.041), and fully mediated the relationship between work stress and personal accomplishment (β = -0.059, 95%CI: -0.080 ∼ -0.039). Social support significantly moderated the relationship between work stress and occupational commitment (β = 0.007, p < 0.01).

CONCLUSION

Among pediatric nurses, work stress has an indirect influence on burnout through occupational commitment, and such an effect is weakened when social support is high.

PRACTICE IMPLICATIONS

Nurse managers could consider developing interventions by promoting both occupational commitment and social support to prevent burnout of employees.

[egePan-VOICE study on the psychosocial burden of the Covid-19 pandemic among - medical technical assistants]

egePan-VOICE study on the psychosocial burden of the Covid-19 pandemic among - medical technical assistants Objectives: The Covid-19 pandemic is associated with increased demands on healthcare workers. A previously neglected occupational group is medical technical assistants (MTA). The aim is therefore to identify stress factors among MTA in Germany during the pandemic. Methods: A cross-sectional online survey of medical staff was conducted in spring 2020 (N = 8088). Results: N = 1483 records of MTA were analyzed. Retrospectively, the stress increased under the pandemic, and 60.1 % of MTA suffered from work stress (ERI). Staff shortages and extra work were associated with an increase in work stress. Problems of work-life balance and contact with contaminated material/infected persons favored stressful experiences. Conclusions: Some working conditions in the pandemic pose a potential health risk to MTA. It seems necessary to create improvements in the general conditions that enable healthily and effective work.

Physical and psychological workloads and their association with occupational fatigue among hospital service personnel

BACKGROUND

Physical and psychological workloads are a vital issue in the workplace. This study aimed to investigate the association between physical and psychological workloads and occupational fatigue among Iranian hospital service personnel. In Iran, hospital service personnel refers to a group of healthcare workers who undertake a range of duties, such as moving and carrying the hospital waste, transporting patients by wheelchair or gurney to the operating room, x-ray department, other wards, or other locations around the facility, performing cleaning tasks such as changing linens, mopping floors, and sterilizing equipment, and following infection control procedures to reduce the risk of spreading germs within the hospital setting.

METHODS

This cross-sectional study was conducted on 198 Iranian hospital service personnel. The response rate was 86%. The data were gathered using 1) The Persian version of the Job Content Questionnaire (P-JCQ) for assessing physical and psychosocial workloads and 2) The Persian version of the Swedish Occupational Fatigue Inventory (P-SOFI-20) for assessing fatigue dimensions.

RESULTS

According to the P-JCQ, the physical and psychological workload intensities were high in 72.7% and 47% of the participants, respectively. Based on the P-SOFI, the participants' mean scores of "physical fatigue" (21.73 ± 6.2), "psychological fatigue" (13.61 ± 5.76), and "fatigue due to shift work" (18.17 ± 5.6) were moderate, while the mean score of "general fatigue" was high (27.3 ± 6.98). The findings revealed that various types of fatigue are associated with age, gender, marital status, daily working hours, and psychological workload.

CONCLUSIONS

Psychological workload was a determinant of occupational fatigue among Iranian hospital service personnel. Hence, an interventional program, including job enrichment, job rotation, and work-rest cycle, is recommended.

Brief Mindfulness Intervention for Emotional Distress, Resilience, and Compassion in Family Physicians During COVID-19: A Pilot Study

Background and Objective

There are high rates of professional burnout among family physicians and trainees. We undertook this study to investigate whether a brief mindfulness intervention could help manage burnout and improve well-being among family physicians in a residency program.

Methods

A total of 21 family physicians participated in a brief, 8-week mindfulness program. We used a single-sample, pre/post design at a Midwestern family medicine residency program. At two points in time (baseline and postintervention), participants completed an online survey measuring burnout, depression, anxiety, stress, perceived resilience, and compassion. We used linear mixed models to estimate the effect of the intervention on the outcome measures.

Results

Participants had improvements after the 8-week intervention. At postintervention, they had significantly better scores on anxiety (P<.004), stress (P<.001), perceived resilience (P<.001), and compassion (P<.001). There were no significant changes on the personal accomplishment, emotional exhaustion, and depersonalization subscales of either the abbreviated Maslach Burnout Inventory or the depression subscale of the Depression Anxiety Stress Scales-21.

Conclusion

This brief mindfulness program was associated with significant reduction in the scores of anxiety and stress as well as significant improvement in perceived resilience and compassion scores. Brief mindfulness interventions may be a convenient and effective approach to support and improve health and well-being among family physicians.

Factors That Influence NICU Health Care Professionals' Decision Making to Implement Family-Centered Care

BACKGROUND

Neonatal intensive care unit (NICU) is a multifaceted, technology-driven high stress environment for professionals, infants and families.

PURPOSE

Examine healthcare professionals' beliefs and perceptions regarding providing FCC within the context of NICU.

METHODS

This exploratory descriptive study used an online-survey format. The survey comprised several instruments including the Perceived Stress Scale, symptoms of burnout subscale from the Professional Quality of Life scale, and the Family Nurse Caring Belief Scale (FNCBS). Demographic and open-ended items were also included.

RESULTS

Sample consisted of 115 multidisciplinary participants working in a level IV neonatal intensive care unit. Participants report strong levels of FCC beliefs. Participants strongly agreed (82%) or agreed (18%) that no matter how sick the infant is, he or she needs to be treated as an individual. A significant correlation (r=-0.343, P < .001) exists between participant's stress composite score and FNCBS composite score. There were significant relationships between participant's years of experience (F = 5.35, P < .002) and education levels (F = 2.60, P < .05) and higher FNCBS composite scores. There were also significant relationships between participant's years of experience (F = 4.77, P < .004) and education (F = 2.89, P < .039) with higher Perceived Stress Scale composite scores.

IMPLICATIONS FOR PRACTICE

Results suggest that while participants agreed that FCC is important, they also believed that inadequate staffing and inappropriate assignments may lead to rationing of care.

IMPLICATIONS FOR RESEARCH

Further research is needed to explore factors that lead to rationing of FCC.

Mental Health Promotion and Intervention in Occupational Settings: Protocol for a Pilot Study of the MENTUPP Intervention

Depression and anxiety are the most prevalent mental health difficulties in the EU, causing immense suffering and costing the global economy EUR 1 trillion each year in lost productivity. Employees in construction, health and information and communications technology have an elevated risk of mental health difficulties. Most mental health interventions for the workplace have been targeted at larger companies and small and medium-sized enterprises (SMEs) are often overlooked despite most people being employed in SMEs. The MENTUPP intervention aims to improve mental health and wellbeing and reduce depression, anxiety, and suicidal behaviour. The MENTUPP project involves the development, implementation, and evaluation of a multilevel intervention targeting both clinical and non-clinical mental health issues and combating the stigma of mental (ill-)health, with a specific focus on SMEs. The intervention is underpinned by a framework of how to create a mentally healthy workplace by employing an integrated approach and has been informed by several systematic reviews designed to understand organisational mental health interventions and a consultation survey with key experts in the area. The intervention is facilitated through the MENTUPP Hub, an online platform that presents interactive psychoeducational materials, toolkits, and links to additional resources in an accessible and user-friendly manner. This paper presents the pilot study protocol for delivering the MENTUPP intervention in eight European countries and Australia. Each intervention country will aim to recruit at least 23 participants in 1-3 SMEs in one of the three high-risk sectors. The central aim of the pilot study will be to examine the feasibility, acceptability, and uptake of the MENTUPP intervention across the target SMEs. The findings will contribute to devising the protocol for a cluster randomised controlled trial (cRCT) of the MENTUPP intervention. Findings from this study will also be used to inform the optimisation phase of the MENTUPP intervention which will aim to improve the materials and the implementation of the intervention as well as enhancing the evaluation strategy which will be employed for the cRCT.

What is the prevalence and risk factors of burnout among pediatric intensive care staff (PICU)? A review

Staff in the paediatric intensive care unit work with children and their families in an area of high acuity, mortality, and morbidity. There is complexity due to technological advancements and confronting psychosocial situations. With increasing reports of the threat of burnout to healthcare professionals it is imperative to understand the prevalence of burnout and the determinants of risk factors for staff to work in the paediatric intensive care unit (PICU) in order to inform interventions that reduce risk and support growth and wellbeing of this specialised workforce. We conducted electronic searches of PUBMED, Medline, CINAHL and PsychINFO. Studies meeting eligibility inclusion criteria comprised English text, publication dates 1995 to 2019, use of standardized measures to assess prevalence and risk factors for burnout where the PICU staff data was reported separately and contained sample sizes ≥10 PICU staff. Two reviewers independently identified and extracted citations and assessed the quality of papers using two standardised reporting tools. Twenty studies were included in the final review. Due to the heterogeneity of the included studies a descriptive account of the studies was developed. Outcomes reported included prevalence and levels of burnout reported across professional disciplines, reported scoring criteria for burnout, risk and protective factors for burnout, comparative populations, systems and social context associated with burnout and study strengths and limitations. Most studies were cross-sectional, used a single measure of burnout and focussed on either physicians or nurses. Of the 20 studies reported 62% reported high burnout, 19% moderate burnout, and 19% reported low levels of burnout. Inconsistency was identified in adherence to recommended cut-off scores or reporting for the categorisation of burnout, which contributed to a lack of clarity in the interpretation of prevalence and severity. Reports of factors associated with increased risk and likely protective factors for burnout were often contradictory suggesting that burnout may be situational; dependent upon personal, environmental, leadership, cultural and patient factors within the PICU. This review revealed that determining levels and risk of burnout in PICU staff remains problematic. Further research which examines the experiences of all members of the multidisciplinary team and identification of factors that affect the development of burnout, including those which are protective, is required.

Correlates and Predictors of PTSD Symptoms Among Healthcare Workers During the COVID-19 Pandemic: Results of the egePan-VOICE Study

Background: The COVID-19 pandemic has led to ongoing challenges for healthcare systems across the world. Previous research has provided evidence for an increased prevalence of depression and anxiety as well as post-traumatic stress disorder (PTSD). In Germany, however, only scarce data on correlates and predictors for PTSD symptomatology in the context of the COVID-19 pandemic among healthcare workers (HCW) are available. Methods: This research is part of a large prospective web-based survey (egePan-VOICE study) among HCW in Germany. The current sample (N = 4,724) consisted of physicians (n = 1,575), nurses (n = 1,277), medical technical assistants (MTA, n = 1,662), and psychologists (n = 210). PTSD symptomatology was measured using the abbreviated version of the Impact of Event Scale (IES-6). In addition, sociodemographic, occupational, COVID-19-related, psychological (e.g., depressive symptoms and generalized anxiety), as well as work-related variables were assessed. Results: Our findings revealed significant higher PTSD symptoms with medium effect sizes among HCW reporting an increased self-report burden during the pandemic, increased fear of becoming infected or infecting relatives with the virus, sleep problems, feeling physically or mentally exhausted, as well as increased levels of depressiveness and generalized anxiety. According to multiple linear regression analysis, the most relevant predictors for higher IES-6 scores were increased level of generalized anxiety and depressiveness, increased fear of infecting relatives, as well as medical profession (MTA compared to physicians). Conclusion: Despite the cross-sectional design of our study, the here identified associations with PTSD symptomatology may provide a basis for future preventive interventions.

Impact of a Mindfulness-Based, Workplace Group Yoga Intervention on Burnout, Self-Care, and Compassion in Health Care Professionals: A Pilot Study

OBJECTIVE

To investigate whether a workplace, group mindfulness-based yoga intervention could help manage burnout and improve wellbeing among health care professionals.

METHODS

A total of 43 health care professionals participated in 8-week supervised workplace, group mindfulness-based yoga activities. The authors used a single-sample, pre-post design. At two points in time (baseline and postintervention), participants completed a set of online measures assessing burnout, depression, anxiety, stress, resilience, and compassion. The authors used linear mixed model analysis to assess changes in outcome measures.

RESULTS

Participants had improvements after the 8-week intervention. At postintervention, they had significantly better scores on personal accomplishment, depression, anxiety, stress, perceived resilience, and compassion. Participants had a positive perception of the yoga intervention.

CONCLUSION

Group mindfulness-based yoga program may be convenient and low-cost approach to support health and wellbeing among health care professionals.

Burnout and Work Engagement Among US Dentists

BACKGROUND

Burnout is a threat to patient safety. It relates to emotional exhaustion, depersonalization, and lack of personal accomplishment. Work engagement conversely composed of levels of vigor, dedication, and absorption in one's profession. The aim of this study was to examine burnout and work engagement among US dentists.

METHODS

This study used the extensively validated Maslach Burnout Inventory-Human Services Survey and Utrecht Work Engagement Scale to measure burnout in a self-administered survey of 167 US dentists who attended continuing education courses held in Boston, Pittsburg, Iowa City, and Las Vegas. The mean scores on the 3 subscales of Maslach Burnout Inventory-Human Services Survey and Utrecht Work Engagement Scale were computed. The interscale correlations between the components of burnout and work engagement were assessed using Pearson correlations. We used 1-way analysis of variance and independent 2 sample t tests to examine the relationship between burnout and work engagement across sex and various age categories. Prevalence of burnout in our study population was also computed.

RESULTS

We observed that 13.2% of our study population experienced burnout and 16.2% of our study population was highly work engaged. There was a statistically significant, unadjusted association between burnout risk and work engagement (χ2 = 22.51, P < 0.0001). Furthermore, the scores in the subscales of burnout were significantly correlated with scores in the subscales of work engagement.

CONCLUSIONS

In this preliminary study, we observed some evidence of burnout among practicing US dentists. It is imperative that the dental profession understands this and works to promote professional practices that increase work engagement and decrease burnout.

The effect of work-related psychosocial stressors on musculoskeletal disorder symptoms in hospital attendants

BACKGROUND

Psychosocial stress at work is an important issue among hospital attendants.

OBJECTIVE

This study aimed to examine psychosocial stressors in the work environment and assess their impacts on WMSD symptoms among hospital attendants in Shiraz, southern Iran.

METHODS

This cross-sectional study was conducted on 198 hospital attendants from Shiraz. The study data were collected using a basic demographic questionnaire, Nordic Musculoskeletal Questionnaire (NMQ), the Persian version of Effort-Reward Imbalance Questionnaire (F-ERIQ), and an individual risk assessment (Evaluación del Riesgo Individual [ERIN]). The data were entered into SPSS version 16 and analyzed using Mann-Whitney U, Chi-square, and Spearman's correlation tests.

RESULTS

The prevalence of WMSD symptoms was 29.8% in the lower back, 25.3% in knees, and 20.7% in ankles/feet. Posture analysis by the ERIN technique demonstrated that 95.5% of the postures were high risk for WMSDs. F-ERIQ identified that 83.4% of the hospital attendants belonged to the "1 < ER-ratio" category. Besides, the "effort" subscale of the F-ERIQ was significantly associated with reporting of MSD symptoms in the neck, shoulders, wrists/hands, and lower back. In addition, a significant correlation was observed between effort (r = 0.367, p = 0.028), esteem (r = -0.273, p = 0.041), security (r = -0.253, p = 0.045), and over-commitment (r = 0.301, p = 0.019) and the total score of the ERIN technique.

CONCLUSION

Intervention programs and coping strategies for reduction of work-related stress and, subsequently, prevention of WMSD symptoms are recommended among hospital attendants.

The Relationships between Health Professionals' Perceived Quality of Care, Family Involvement and Sense of Coherence in Community Mental Health Services

Mental health professionals have a responsibility to ensure the best possible quality of care. Family is strongly involved in the patient's everyday life. The aim of this study was to investigate the relationship between health care professionals' perception of the quality of care, attitudes of family involvement and their own sense of coherence. A descriptive quantitative study with fifty-six health professionals, completed "Quality in Psychiatric Care-Community Outpatient Psychiatric Staff", "Families' Importance in Nursing Care-health professionals' attitudes", "The Sense of Coherence Scale-13". The health professionals perceived quality as high and did not perceive the families as a burden.

Effect of Online Psychological Intervention on Burnout in Medical Residents From Different Majors: An Exploratory Study

Background: Work-related stress among healthcare professionals poses a serious economic and healthcare burden. This study aimed to investigate the prevalence of burnout as well as anxiety, depression, and stress in medical residents from different majors, and assess the effects of an online psychological intervention on the mental health status of medical residents with a high degree of burnout. Methods: We conducted an online survey that collected information on the demographics, mental health, and burnout conditions of medical residents from Shengjing Hospital. The mental health condition was assessed by the Depression, Anxiety, and Stress Scale (DASS)-21. Further, burnout was assessed by the Maslach Burnout Inventory (MBI). Medical residents with a total MBI score between 50 and 75 were selected to receive online psychological intervention for 3 months. Results: Two-hundred and ten medical residents completed the questionnaire, of whom, 63 residents with an MBI score between 50 and 75 received the 3-month online psychological intervention. Anesthesia residents showed the highest level of depression, anxiety, and stress, and presented with a lower sense of personal accomplishment, higher emotional exhaustion, and higher depersonalization. Furthermore, pediatric residents had the second highest DASS and MBI scores following anesthesia residents. Following the online psychological intervention, negative emotional states and burnout levels were significantly lower among anesthesia and pediatric residents. There were no differences in the level of stress and sense of personal accomplishment pre- and post-online psychological intervention among the different majors. Conclusion: Our findings revealed high levels of burnout, as well as depression, anxiety, and stress symptoms in medical residents, with marked differences among different majors. The online psychological intervention effectively improved emotional exhaustion, and depersonalization, and relieved the psychological problems such as anxiety and depression in medical residents.

Effort-Reward-Imbalance, Burnout, and Depression Among Psychiatrists 2006 and 2016-Changes After a Legislative Intervention

Background: Physicians, especially psychiatrists, have a high risk of job-related stress, and mental impairment. In our study we examined changes in private and occupational stress factors and mental health within a decade. The legislative reduction of physicians' working hours in Germany during this period made it possible to investigate the impact of working hours in particular. Methods: Questionnaires were administered at two psychiatrist meetings (2006 and 2016) about job and family situation, depressiveness, burnout and effort-reward imbalance. A total of N = 1,797 datasets were analyzed. Results: Working hours and free weekends were associated with mental health indices. Correlation analyses showed that a reduction in weekly working hours and working days at weekends was related to reduced scores for effort-reward-imbalance, burnout and depression. Conclusions: Our data show changes in workplace stress and mental health in psychiatrists in a decade in which a reduction in working hours has been required by law. These results can provide indications of effective prevention strategies in the professional context of physicians working in psychiatry.

The mediating role of COVID-19-related burden in the association between adverse childhood experiences and emotional exhaustion: results of the egePan - VOICE study

BACKGROUND

Adverse childhood experiences (ACEs) increase the risk for mental health problems. However, there is a lack of data targeting the role of ACEs for one of the most prevalent mental health problems in health-care professionals: burnout.

OBJECTIVE

We aimed to assess the relationship between ACEs and the core burnout dimension 'emotional exhaustion' (EE). As health-care professionals have been facing particular challenges during the COVID-19 pandemic, we furthermore aimed to assess the role of COVID-19 associated burden in the interplay between ACEs and EE.

METHODS

During the first lockdown in Germany, a total of 2500 medical healthcare professionals were questioned in a cross-sectional online survey. Questions targeted, among others, sociodemographics, ACEs, COVID-19-associated problems (e.g. increase of workload, worries about relatives and patients) and emotional exhaustion, measured by the respective dimension of the Maslach Burnout Inventory (MBI).

RESULTS

In German health-care professionals, ACEs were associated with a higher EE score. The number of experienced ACEs was associated with the majority of assessed COVID-19-associated problems. An increasing number of ACEs predicted higher EE scores, controlling for gender. The association between ACEs and EE was mediated significantly by COVID-19-associated problems. These included maladaptive coping strategies such as increased smoking, drinking and use of antidepressants/tranquilizers, feeling less protected by measures of the employee or the state, a greater feeling of being burdened by COVID-19-associated problems and greater exhaustion and sleep problems.

CONCLUSION

Our findings suggest ACEs as significant risk factor for EE in German health-care professionals. The current pandemic means a significant burden that further pronounces this risk.

Cognitive job crafting as mediator between behavioral job crafting and quality of care in residential homes for the elderly

Extending previous studies on job crafting, the aim of the present study is to analyze the effect of job crafting on quality of care in residential homes for elderly people in two European countries (Spain and Sweden). We hypothesize that cognitive crafting could be a consequence of behavioral crafting and that it will mediate the relationship between behavioral crafting and the perception of quality of care. A correlational design was used, with two-waves approximately 12 months apart (n = 226). Our results indicate that behavioral job crafting at T1 had an effect on cognitive job crafting at T2, relational job crafting at T1 increases quality of care at T2, and the mediation effect of cognitive job crafting. These results indicate that we must differentiate between the two forms of crafting (behavioral and cognitive), not as indicators of the same latent construct, but as aggregates. Additionally, we point out two main implications for managerial practice. First, as relational job crafting has a direct effect on quality of care, it is important to assure an organizational culture oriented towards employees. Secondly, due to the mediation effect of cognitive job crafting, managers should facilitate meaningful work environments. To do so, jobs should be re-designed, increasing skills variety, identity and significance.

Job demands and job control among occupational therapists in public sector in Finland

BACKGROUND

Although health care professionals' increased job demands and strain have generated much public debate in recent years, the way in which occupational therapists' job strain has developed remains unknown.

OBJECTIVE

To examine how Finnish occupational therapists working in municipalities experienced job demands and control in 2014-2018 compared with physiotherapists and registered nurses.

MATERIAL AND METHODS

Occupational therapists (OT, n = 107), physiotherapists (PT, n = 331) and registered nurses (RN, n = 1389) responded to repeated surveys in the Finnish Public Sector Study in 2014-2018. We used the Job Content Questionnaire and analyzed the data using repeated measures analysis of variance and multiple linear regression with generalized estimating equations to identify the trends and differences.

RESULTS

More OTs had lower job demands and higher job control than PTs and RNs in each year of study. These differences were statistically significant. Most OTs had low job strain. The changes in job control and job demands of participants in different years were not statistically significant.

CONCLUSIONS

The OTs consistently experienced low job strain as compared to the PTs and RNs. Developing good practices in OT's work may be beneficial for improving employee health and well-being and high-quality client care.

Low-Cost, Open-Source Mechanical Ventilator with Pulmonary Monitoring for COVID-19 Patients

This paper shows the construction of a low-cost, open-source mechanical ventilator. The motivation for constructing this kind of ventilator comes from the worldwide shortage of mechanical ventilators for treating COVID-19 patients—the COVID-19 pandemic has been striking hard in some regions, especially the deprived ones. Constructing a low-cost, open-source mechanical ventilator aims to mitigate the effects of this shortage on those regions. The equipment documented here employs commercial spare parts only. This paper also shows a numerical method for monitoring the patients’ pulmonary condition. The method considers pressure measurements from the inspiratory limb and alerts clinicians in real-time whether the patient is under a healthy or unhealthy situation. Experiments carried out in the laboratory that had emulated healthy and unhealthy patients illustrate the potential benefits of the derived mechanical ventilator.

The Association Between Burnout and Pediatrician Management of Adolescent Depression

Objective: Given the increased demand for pediatric primary care providers to manage adolescent depression, the current study examines the association between burnout and provider comfort and perception of feasibility managing adolescent depression. Method: Data were collected from 52 pediatricians at a Midwest academic health center. Results: Higher scores on depersonalization were associated with lower provider-reported comfort managing adolescent depression. Emotional exhaustion and personal accomplishment were not associated with provider-reported comfort managing adolescent depression. None of the burnout domains were associated with the provider-reported perception of the feasibility managing adolescent depression in this setting. Limitations and recommendations for future research regarding the impact of behavioral health training on burnout are discussed. Conclusions: The interpersonal stress dimension of burnout is associated with less comfort managing depression. Adding positive systematic interventions, such as behavioral health trainings that support pediatricians in the management of behavioral health may have impact on burnout.

Health Care Professionals' Experiences of Providing Care to Hospitalized Medically Fragile Infants and Their Parents

PURPOSE

To understand contemporary experiences of pediatric health care professionals' (HCPs) caring for hospitalized Medically Fragile Infants (MFI) and their parents.

DESIGN AND METHODS

Convenience sampling was adopted to recruit 26 HCPs who provided care to MFI and their parents on inpatient units at a large tertiary pediatric hospital in Western Canada. Participants participated in either a focus group or individual face-to-face interview. Themes and concepts emerged during open and focused coding.

FINDINGS

HCPs encountered barriers to establishing relationships with parents, including: (a) intricate nature of MFI, (b) lack of social supports, (c) inconsistency, (d) moral distress, (e) burnout, and (f) struggle to gain control. HCPs utilized strategies to establish relationships with parents, including: (a) normalizing and building parental confidence, (b) tailoring care and being flexible, (c) providing parent care, and (d) optimizing communication.

CONCLUSION

HCPs aimed to establish relationships built on trust with parents of MFI to empower and enable parents to care for their infants. The relationship was the vehicle to enhance the care provided and well-being of MFI. HCPs encountered barriers to establishing trusting relationships and utilized strategies to establish such relationships.

PRACTICE IMPLICATIONS

It is valuable to understand the importance that the parent-HCPs relationship plays in the care provided to hospitalized MFI and how lack thereof can lead to moral distress and burnout among HCPs. Increasing HCPs' awareness of barriers and strategies to the establishment of a trusting relationship with parents could help improve the collaborative relationship between parents and HCPs.

Provider burnout: Implications for our perinatal patients

OBJECTIVE

To describe the syndrome of physician burnout within neonatology, its relation to neonatal quality of care, and outline potential solutions.

FINDINGS

Burnout affects up to half of physicians, including up to one-third of neonatologists, at any given time. It is linked to suicidality, substance abuse, and intent to leave practice, and it is strongly associated with reduced quality of care in the published literature. Resilience and mindfulness interventions rooted in positive psychology may reduce burnout among individual providers. Because burnout is largely driven by organizational factors, system-level attention to leadership, teamwork, and practice efficiency can reduce burnout at the level of the organization.

CONCLUSIONS

Burnout is common among neonatologists and consistently relates to decreased quality of patient care in a variety of dimensions. Personal resilience training and system-wide organizational interventions are needed to reverse burnout and promote high-quality neonatal care.

Changes in Working Conditions and Mental Health Among Intensive Care Physicians Across a Decade

Background: International studies have shown that among physicians working in intensive care, a relatively high level of work load, an elevated risk of developing burnout and reduced mental health are frequent. The implementation of a legislative intervention in Germany with the goal to reduce the working hours of physicians, offered an opportunity to investigate the potential influence of occupational conditions on stress and mental health. The present study investigates working conditions, occupational stress and burnout risk in two samples of German Intensive Care Physicians in 2006 and 2016. The aim was to assess how occupational and private stress factors influenced burnout and Effort-Reward-Imbalance indices over this time-period. Methods: Intensive care physicians were surveyed during the annual conference of their profession in two cross-sectional studies (10-year gap). Data on demographic (occupational, family), medical history, and mental health (burnout and Effort-Reward-Imbalance) were assessed by paper pencil questionnaires. Results: In total, N = 2,085 physicians participated (2006: N = 1,403, 2016: N = 695), with N = 1,840 (2006 = 1,248; 2016 = 592) eligible for propensity score matching comparison. In general, more working hours per week and working days on weekends were associated with an increased effort/reward imbalance and higher burnout scores. From 2006 to 2016, reductions in working hours per week and days worked on weekends were accompanied by improvements in occupational stress (Effort-Reward-Imbalance) and by trend in mental health indices (burnout) after matching for differences in working conditions. Conclusions: The study presents the changes concerning occupational stress factors and mental wellbeing in physicians working in intensive care in 2016 as compared to 2006. These findings may promote the implementation of preventive strategies in the vocational context to protect health and productivity of physicians, especially intensive care physicians.

Burnout and Other Types of Emotional Distress Among Medical Students

BACKGROUND

The medical literature reports that many medical trainees experience burnout. The primary goal of this study was to determine how the prevalence of burnout and other forms of emotional distress among the University of Kansas School of Medicine (KUSM) medical students compared to the previously published data.

METHODS

We conducted a cross-sectional survey of 379 medical students. Between July and September 2018, we surveyed 872 KUSM medical students on the three campuses (Kansas City, Salina, and Wichita) of KUSM. The survey included items on demographic information, burnout, symptoms of depression, fatigue, quality of life, and self-reported general health. The authors used standard descriptive summary statistics, Kruskal-Wallis test/one-way analysis of variance, chi-square test, correlation, and multivariate logistic regression model to analyze the data.

RESULTS

The overall response rate was 43.5% with 48% of the students reporting manifestations of burnout. Burnout, depression, and fatigue were lowest during the first year of training and increased as year in training progressed. In multivariate models, only year in training was associated with increased odds of burnout, symptoms of depression, and fatigue. Nearly 46% of the students screened positive for depression, and 44.6% reported high levels of fatigue in the past week.

CONCLUSION

Even though KUSM students have a lower prevalence of burnout than the national rate (48% vs. 55.9%), this prevalence is high enough to warrant new interventions. Because burnout and other emotional distress increase over the course of medical school no matter what campus the students attend, interventions should be both longitudinal and global across all campuses.

Evidence Relating Health Care Provider Burnout and Quality of Care: A Systematic Review and Meta-analysis

BACKGROUND

Whether health care provider burnout contributes to lower quality of patient care is unclear.

PURPOSE

To estimate the overall relationship between burnout and quality of care and to evaluate whether published studies provide exaggerated estimates of this relationship.

DATA SOURCES

MEDLINE, PsycINFO, Health and Psychosocial Instruments (EBSCO), Mental Measurements Yearbook (EBSCO), EMBASE (Elsevier), and Web of Science (Clarivate Analytics), with no language restrictions, from inception through 28 May 2019.

STUDY SELECTION

Peer-reviewed publications, in any language, quantifying health care provider burnout in relation to quality of patient care.

DATA EXTRACTION

2 reviewers independently selected studies, extracted measures of association of burnout and quality of care, and assessed potential bias by using the Ioannidis (excess significance) and Egger (small-study effect) tests.

DATA SYNTHESIS

A total of 11 703 citations were identified, from which 123 publications with 142 study populations encompassing 241 553 health care providers were selected. Quality-of-care outcomes were grouped into 5 categories: best practices (n = 14), communication (n = 5), medical errors (n = 32), patient outcomes (n = 17), and quality and safety (n = 74). Relations between burnout and quality of care were highly heterogeneous (I2 = 93.4% to 98.8%). Of 114 unique burnout-quality combinations, 58 indicated burnout related to poor-quality care, 6 indicated burnout related to high-quality care, and 50 showed no significant effect. Excess significance was apparent (73% of studies observed vs. 62% predicted to have statistically significant results; P = 0.011). This indicator of potential bias was most prominent for the least-rigorous quality measures of best practices and quality and safety.

LIMITATION

Studies were primarily observational; neither causality nor directionality could be determined.

CONCLUSION

Burnout in health care professionals frequently is associated with poor-quality care in the published literature. The true effect size may be smaller than reported. Future studies should prespecify outcomes to reduce the risk for exaggerated effect size estimates.

PRIMARY FUNDING SOURCE

Stanford Maternal and Child Health Research Institute.

Physicians' Perceptions of Stakeholder Influence on Discharge Timing in a Children's Hospital

Attending physicians (N = 53) at a nonprofit, university-affiliated academic children's hospital completed a survey about how key stakeholders affect timing of patient discharge beyond attending assessment of medical stability. Physicians perceived families and hospital administration as more often having an impact on discharge timing than they should and perceived members of the care team and peer physicians/consultants as less frequently having an impact than they should. All but one physician reported discharging a patient either earlier or later than they felt was appropriate due to pressure from at least one stakeholder group; almost all physicians had done so in response to pressure from families. When physicians changed discharge timing based on stakeholder pressure, they tended to extend hospital stay except in the case of administrative pressure. These findings highlight the need for improvements in communication regarding discharge goals and for future research on how navigating competing interests affect physician stress.

Effects of Flow Disruptions on Mental Workload and Surgical Performance in Robotic-Assisted Surgery

BACKGROUND

Robotic systems introduced new surgical and technical demands. Surgical flow disruptions are critical for maintaining operating room (OR) teamwork and patient safety. Specifically for robotic surgery, effects of intra-operative disruptive events for OR professionals' workload, stress, and performance have not been investigated yet. This study aimed to identify flow disruptions and assess their association with mental workload and performance during robotic-assisted surgery.

METHODS

Structured expert-observations to identify different disruption types during 40 robotic-assisted radical prostatectomies were conducted. Additionally, 216 postoperative reports on mental workload (mental demands, situational stress, and distractions) and performance of all OR professionals were collected.

RESULTS

On average 15.8 flow disruptions per hour were observed with the highest rate after abdominal insufflation and before console time. People entering the OR caused most flow disruptions. Disruptions due to equipment showed the highest severity of interruption. Workload significantly correlated with severity of disruptions due to coordination and communication.

CONCLUSIONS

Flow disruptions occur frequently and are associated with increased workload. Therefore, strategies are needed to manage disruptions to maintain OR teamwork and safety during robotic-assisted surgery.

Association Between Physician Burnout and Patient Safety, Professionalism, and Patient Satisfaction: A Systematic Review and Meta-analysis

IMPORTANCE

Physician burnout has taken the form of an epidemic that may affect core domains of health care delivery, including patient safety, quality of care, and patient satisfaction. However, this evidence has not been systematically quantified.

OBJECTIVE

To examine whether physician burnout is associated with an increased risk of patient safety incidents, suboptimal care outcomes due to low professionalism, and lower patient satisfaction.

DATA SOURCES

MEDLINE, EMBASE, PsycInfo, and CINAHL databases were searched until October 22, 2017, using combinations of the key terms physicians, burnout, and patient care. Detailed standardized searches with no language restriction were undertaken. The reference lists of eligible studies and other relevant systematic reviews were hand-searched.

STUDY SELECTION

Quantitative observational studies.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers were involved. The main meta-analysis was followed by subgroup and sensitivity analyses. All analyses were performed using random-effects models. Formal tests for heterogeneity (I2) and publication bias were performed.

MAIN OUTCOMES AND MEASURES

The core outcomes were the quantitative associations between burnout and patient safety, professionalism, and patient satisfaction reported as odds ratios (ORs) with their 95% CIs.

RESULTS

Of the 5234 records identified, 47 studies on 42 473 physicians (25 059 [59.0%] men; median age, 38 years [range, 27-53 years]) were included in the meta-analysis. Physician burnout was associated with an increased risk of patient safety incidents (OR, 1.96; 95% CI, 1.59-2.40), poorer quality of care due to low professionalism (OR, 2.31; 95% CI, 1.87-2.85), and reduced patient satisfaction (OR, 2.28; 95% CI, 1.42-3.68). The heterogeneity was high and the study quality was low to moderate. The links between burnout and low professionalism were larger in residents and early-career (≤5 years post residency) physicians compared with middle- and late-career physicians (Cohen Q = 7.27; P = .003). The reporting method of patient safety incidents and professionalism (physician-reported vs system-recorded) significantly influenced the main results (Cohen Q = 8.14; P = .007).

CONCLUSIONS AND RELEVANCE

This meta-analysis provides evidence that physician burnout may jeopardize patient care; reversal of this risk has to be viewed as a fundamental health care policy goal across the globe. Health care organizations are encouraged to invest in efforts to improve physician wellness, particularly for early-career physicians. The methods of recording patient care quality and safety outcomes require improvements to concisely capture the outcome of burnout on the performance of health care organizations.

Correlates of burnout among professionals working with people with intellectual and developmental disabilities

BACKGROUND

Although burnout has been recognised as an important stress-related problem among staff working with people with intellectual and developmental disabilities (IDD), literature on the subject is limited yet emerging. The aim of this study is twofold: (1) to evaluate the level of burnout within different professions working with IDD; (2) to examine the association between socio-demographic, professional and organisational characteristics and burnout.

METHOD

One hundred ninety-nine professionals working with people with IDD were enrolled in the study (66% response rate). Participants were recruited from several facilities that provide care for people with IDD of all ages, in the Jerusalem area and in other cities in central Israel. The anonymous questionnaires included valid and reliable measures of burnout, socio-demographic variables, professional variables and organisational variables.

RESULTS

Participants' mean age was 38.3 years, and most were women. There were no significant differences in burnout levels among the different professionals. Role ambiguity, perceived overload, care-recipient group and job involvement were significant predictors of burnout. The model explained a high percentage (46.8%) of the observed variance.

CONCLUSIONS

Most of these predictors are organisational measures. These findings demonstrate that organisational variables are more significantly associated with burnout of staff working with people with IDD than the socio-demographic factors or professional characteristics. Identifying and better understanding the specific factors associated with burnout among professionals working with IDD could facilitate unique intervention programs to reduce burnout levels in staff.

The Correlation of Stress in Residency With Future Stress and Burnout: A 10-Year Prospective Cohort Study

BACKGROUND

Residents and practicing physicians displaying signs of stress is common. It is unclear whether stress during residency persists into professional practice or is associated with future burnout.

OBJECTIVE

We assessed the persistence of stress after residency and its correlation with burnout in professional practice. We hypothesized that stress would linger and be correlated with future burnout.

METHODS

A prospective cohort study was conducted over 10 years using survey instruments with existing validity evidence. Residents over 3 academic years (2003-2005) were surveyed to measure stress in residency. Ten years later, these residents were sought out for a second survey measuring current stress and burnout in professional practice.

RESULTS

From 2003 to 2005, 143 of 155 residents participated in the initial assessment (92% response rate). Of those, 21 were excluded in 2015 due to lack of contact information; follow-up surveys were distributed to 122 participants, and 81 responses were received (66% response rate and 57% of original participants). Emotional distress in residency correlated with emotional distress in professional practice (correlation coefficient = 0.45, P < .0001), emotional exhaustion (correlation coefficient = 0.30, P = .007), and depersonalization (correlation coefficient = 0.25, P = .029). Multivariate linear regression showed that emotional distress in residency was associated with future emotional distress (β estimate = 0.57, P = .005) and depersonalization (β estimate = 2.29, P = .028).

CONCLUSIONS

We showed emotional distress as a resident persists into individuals' professional practice 10 years later and has an association with burnout in practice.

Associations between job demands, work-related strain and perceived quality of care: a longitudinal study among hospital physicians

Objective

Drawing on a sample of hospital physicians, we attempted to determine prospective associations between three job demands, work-related strain and perceived quality of care.

Design

Longitudinal follow-up study with with a 1-year time lag.

Setting

Physicians of two acute-care hospitals in Germany (one general urban and one children's hospital).

Study participants

Ninety-five physicians filled out a standardized questionnaire.

Main outcomes measures

Physicians' evaluations of quality of care at both waves.

Results

Our results support the hypothesis that job demands directly influence quality of care irrespective of strain. Specifically, high social stressors (β = -0.15, P = 0.036) and time pressure (β = -0.19, P = 0.031) were associated with decreased quality of care over time. We additionally observed reversed effects from quality of care at baseline to time pressure at follow-up (β = -0.35, P = 0.006). Contrary to expectations, physicians' work-related strain did not mediate the job demands-quality of care-relationship, nor were strain-to-stressor effects observed.

Conclusions

Our results corroborate that hospital work environments with high demands have a direct impact on physician-perceived quality of care. In turn, poor care practices contribute to increased job demands. Our findings also emphasize that further understanding is required of how physicians' workplace conditions affect job demands, well-being, and quality of care, respectively.

The relationship between physician burnout and quality of healthcare in terms of safety and acceptability: a systematic review

OBJECTIVES

This study reviews the current state of the published peer-reviewed literature related to physician burnout and two quality of care dimensions. The purpose of this systematic literature review is to address the question, 'How does physician burnout affect the quality of healthcare related to the dimensions of acceptability and safety?'

DESIGN

Using a multiphase screening process, this systematic literature review is based on publically available peer-reviewed studies published between 2002 and 2017. Six electronic databases were searched: (1) MEDLINE Current, (2) MEDLINE In-process, (3) MEDLINE Epub Ahead of Print, (4) PsycINFO, (5) Embase and (6) Web of Science.

SETTING

Physicians practicing in civilian settings.

PARTICIPANTS

Practicing physicians who have completed training.

PRIMARY AND SECONDARY OUTCOME MEASURES

Quality of healthcare related to acceptability (ie, patient satisfaction, physician communication and physician attitudes) and safety (ie, minimising risks or harm to patients).

RESULTS

4114 unique citations were identified. Of these, 12 articles were included in the review. Two studies were rated as having high risk of bias and 10 as having moderate risk. Four studies were conducted in North America, four in Europe, one in the Middle East and three in East Asia. Results of this systematic literature review suggest there is moderate evidence that burnout is associated with safety-related quality of care. Because of the variability in the way patient acceptability-related quality of care was measured and the inconsistency in study findings, the evidence supporting the relationship between burnout and patient acceptability-related quality of care is less strong.

CONCLUSIONS

The focus on direct care-related quality highlights additional ways that physician burnout affects the healthcare system. These studies can help to inform decisions about how to improve patient care by addressing physician burnout. Continued work looking at the relationship between dimensions of acceptability-related quality of care measures and burnout is needed to advance the field.