Exploring the Impact of Primary Care Physician Burnout and Well-Being on Patient Care: A Focus Group Study

Improving joy at work and reducing burnout in health care workers in Victoria, Australia using the Institute for Healthcare Improvement joy in work framework: A mixed-methods study

BACKGROUND

Burnout in health care workers (HCWs) has serious ramifications for individual well-being, patients, organizations, and health systems. Global evidence demonstrates the COVID-19 pandemic has amplified the risk of burnout. Scalable interventions to address burnout are critical to protect HCW well-being.

PURPOSE

Underpinned by the Conservation of Resources theory, this study examines the impacts of a statewide improvement initiative (the Initiative), using the Institute for Healthcare Improvement Joy in Work (JiW) Framework, to reduce burnout and increase joy at work across participating health care organizations in Victoria, Australia.

METHODOLOGY/APPROACH

An impact evaluation was undertaken utilizing a mixed-methods design. Quantitative outcomes included burnout and joy at work measured using an adapted Mini Z tool. In-depth interviews with implementation teams sought insights into the effectiveness of interventions.

RESULTS

Overall, 20 teams from 17 organizations across diverse health care settings and geographical locations participated. At a statewide level, outcomes in burnout and joy at work were inconclusive due to limited data. However, five out of eight teams reporting sufficient data achieved measurable improvements in one or more outcomes. Qualitative data revealed the Initiative increased workplace resources and supports such as providing "permission" for HCWs to prioritize well-being at work, improved communications between management and HCWs, and increased HCWs' teamwork and camaraderie, resulting in safer and more positive workplaces.

CONCLUSION AND PRACTICE IMPLICATIONS

The JiW Framework, implemented across diverse settings, provided organizations with a structured process to develop multifaceted improvements that resulted in enhanced resources that appeared to improve HCW well-being. Compared to individual well-being support, this approach offers organization-level change and scalability potential.

Prevalence of burnout among healthcare professionals: a survey at fort portal regional referral hospital

The work environment in most hospitals is characterised by activities that are strenuous both physically and mentally. These can result in physical and mental exhaustion, which can lead to burnout if not adequately addressed. Burnout among healthcare professionals can negatively affect their clinical decision-making, quality of communication with patients and colleagues as well as their ability to cope with work-related pressure, and ultimately affect the quality of care and patient outcomes. The inclusion of burnout in the 11th revision of the International Classification of Diseases (ICD-11) as an occupational phenomenon indicates that it is an issue of concern in the workplace for which people may need professional attention. This descriptive cross-sectional survey aimed to determine the point prevalence of burnout among healthcare professionals at Fort Portal Regional Referral Hospital and the factors contributing to burnout. The study also evaluated the linear relationship between the age of workers, their work duration at the hospital, and their burnout score, in addition to the possible impact on patient care. Participants were selected from the hospital WhatsApp group and invitations to participate were sent to their individual accounts. Burnout was assessed using the Copenhagen Burnout Inventory. Generally, burnout scores ranged from 16% to 86%, with an overall mean burnout score of 57.4%. The notable factors contributing to burnout included imbalances in duty allocation, physically strenuous work, and resource constraints. Burnout of varying levels was found to be prevalent across all carders in the hospital, although the results indicate that most healthcare professionals experience moderate burnout. Most of the factors contributing to burnout are within the scope of hospital leadership to address. The possible impact on staff performance and patients' clinical outcomes is speculative, and additional studies are required.

Prevalence and factors associated with burnout among healthcare providers in Malaysia: a web-based cross-sectional study

BACKGROUND

This study aimed to assess the determinants of burnout among healthcare providers in the primary care setting.

METHODS

A web-based cross-sectional study was conducted among 1280 healthcare providers aged 18 years and older from 30 primary care clinics in Selangor, Malaysia. In this study, the Copenhagen Burnout Inventory was used to assess burnout. The results were analyzed using multiple logistic regression.

RESULTS

The prevalence of personal burnout was 41.7%, followed by work-related burnout (32.2%) and client-related burnout (14.5%). The determinants for personal burnout in this study were younger age, being a doctor, higher COVID-19 exposure risk, do not know where to seek help, inability to handle stress, poorer sleep quality score, higher total COVID-19 fear score, higher total stress score, and lower total BRS score. The determinants of work-related burnout were younger age, being a doctor, longer years of working, higher COVID-19 exposure risk, do not know where to seek help, lower altruistic score, poorer sleep quality score, higher total stress score, and lower total brief resilience score (BRS) score. The determinants of client-related burnout were doctor, single/divorced, more than one attachment site, and higher satisfaction toward the infection control, inability to handle stress, higher total depression score, and lower total BRS score.

CONCLUSION

Every fourth out of ten suffered from personal burnout, one-third from work-related burnout, and one-seventh from client-related burnout among healthcare providers during the COVID-19 pandemic. Healthcare systems must take care of healthcare workers' physical and emotional depletion, reducing the risk of burnout.

Assessment of Adverse Childhood Experiences, Adverse Professional Experiences, Depression, and Burnout in US Physicians

OBJECTIVE

To assess associations of adverse childhood experiences (ACEs) and adverse occupational experiences (AOEs) with depression and burnout in US physicians.

PARTICIPANTS AND METHODS

We performed a secondary analysis of data from a representative sample survey of US physicians conducted between November 20, 2020, and March 23, 2021, and from a probability-based sample of other US workers. The ACEs, AOEs, burnout, and depression were assessed using previously published measures.

RESULTS

Analyses included data from 1125 of the 3671 physicians (30.6%) who received a mailed survey and 6235 of 90,000 physicians (6.9%) who received an electronic survey. The proportion of physicians age 29-65 who had lived with a family member with substance misuse during childhood (673 of 5039[13.4%]) was marginally lower (P <.001) than that of workers in other professions (448 of 2505 [17.9%]). The proportion of physicians age 29-65 who experienced childhood emotional abuse (823 of 5038 [16.3%]) was similar to that of workers in other professions (406 of 2508 [16.2%]). The average physician depression T-score was 49.60 (raw score ± SD, 6.48±3.15), similar to the normed US average. The AOEs were associated with mild to severe depression, including making a recent significant medical error (odds ratio [OR], 1.64; 95% CI, 1.33 to 2.02, P<.001), being named in a malpractice suit (OR, 1.30; 95% CI, 1.07 to 1.59, P=.008), and experiencing one or more coronavirus disease 2019-related AOEs (OR, 1.76; 95% CI, 1.56 to 1.99, P<.001). Having one or more ACEs was associated with mild to severe depression (OR, 1.58; 95% CI, 1.38 to 1.79, P<.001). The ACEs, coronavirus disease 2019-related AOEs, and medical errors were also associated with burnout.

CONCLUSION

Assessing ACEs and AOEs and implementing selective primary prevention interventions may improve population health efforts to mitigate depression and burnout in physicians.

Barriers and Enablers Experienced by General Practitioners in Delivering Safe and Equitable Care during COVID-19: A Qualitative Investigation in Two Countries

Addressing equity in healthcare is fundamental for delivering safe care to vulnerable patients, especially during COVID-19. This paper aims to identify barriers and enabling factors for general practitioners (GPs) in delivering safe and equitable care during the COVID-19 pandemic. Semi-structured interviews took place during May-July 2020 among 18 Flemish and 16 Dutch GPs. Thematic analysis of the interviews demonstrated that while GPs acknowledged a smooth information flow by governments and professional organizations on care guidelines, the fast-changing information challenged them to stay up to date. Media communication facilitated information dissemination but also fueled misinformation and miscommunication, creating unrealistic patient expectations. Certain guidelines and patient reluctance delayed necessary care. A shortage of personal protective equipment made GPs concerned about patient safety during face-to-face contacts. Teleconsultations became a popular alternative, but posed increased patient safety risks. GPs struggled to identify and reach vulnerable patients. Equitable care was hindered by time constraints; thus, having the appropriate materials facilitated such care. An interprofessional collaboration involving paramedical, social, and city services benefited patient safety and equity in healthcare. However, limitations in this collaboration pressured GPs. The unprecedented and resource-constrained environment challenged GPs' capacity to provide the healthcare quality they aspired to deliver. A well-structured collaborative network involving all stakeholders could benefit safe and equitable care in future pandemics.

Burnout, wellbeing and how they relate: A qualitative study in general practice trainees

PURPOSE

Although research has explored burnout risk factors among medical trainees, there has been little exploration of the personal experiences and perceptions of this phenomenon. Similarly, there has been little theoretical consideration of trainee wellbeing and how this relates to burnout. Our study aimed to conceptualise both constructs.

METHOD

We situated this study within a post-positivist epistemology using grounded theory to guide the research process. Participants were recruited from one Australian General Practice training organisation. Fourteen trainees completed interviews, while a further five focus groups explored the views of 33 supervisors, educators and training coordinators. Data collection and analysis occurred concurrently, drawing upon constant comparison and triangulation. Template analysis, using an iterative process of coding, was employed to generate conceptual models of the phenomena of interest.

RESULTS

Participants described burnout as an insidious syndrome lying on a spectrum, with descriptions coalescing under seven themes: altered emotion, compromised performance, disengagement, dissatisfaction, exhaustion, overexertion and feeling overwhelmed. Wellbeing was perceived to comprise personal and professional domains that interacted and were fuelled by an underlying 'reservoir'. Both constructs were linked by the degree of a trainee's value fulfilment, with burnout occurring when a trainee's wellbeing reservoir was depleted.

CONCLUSIONS

Participants in this study characterised burnout and wellbeing as multifaceted, connected constructs. Given the complexity of these constructs, preventive interventions should target both person and workplace-focused factors, with value fulfilment proposed as the basic change mechanism. A novel model that synthesises and advances previous research is offered based on these findings.

"Going through the motions": A qualitative exploration of the impact of emergency medicine resident burnout on patient care

Objectives

Burnout occurs frequently in emergency medicine (EM) residents and has been shown to have a negative impact on patient care. The specific effects of burnout on patient care are less well understood. This study qualitatively explores how burnout may change the way EM residents provide patient care.

Methods

Qualitative data were obtained from a sample of 29 EM residents in four semistructured focus groups across four institutions in the United States in early 2019. Transcripts were coded and organized into major patient care themes.

Results

Residents described many ways in which feelings of burnout negatively impacted patient care. These detrimental effects most often fit into one of four main themes: reduced motivation to care for patients, poor communication with patients, difficult interactions with health care colleagues, and impaired decision making.

Conclusions

According to EM residents, burnout negatively impacts several important aspects of patient care. Resident engagement with clinical care, communication with patients and colleagues, and clinical care may suffer as a result of burnout.

How UK surgeons experience burnout and the link between burnout and patient care: A qualitative investigation

Background and Aims

Poor well-being affects the performance of all kinds of workers, including surgeons. This study aimed to answer two questions: (1) how does burnout affect surgeons personally, and what is their burnout experience like? (2) How does burnout affect the care that surgeons provide in the United Kingdom (UK)?

Method

This study conducted thematic analysis of semi-structured interviews with 14 surgeons recruited from the UK National Health Service (NHS).

Result

The study found three themes in surgeons’ experiences of burnout: first, burnout is common but frequently not recognised nor understood; second, burnout is a personal crisis; and third, burnout creates vulnerability at work. The study also revealed four themes related to burnout's effect on patient care: first, burnout reduces the quality of surgeon-patient relationships; second, burnout affects patient safety; third, burnout impairs staff relationships; and fourth, burnout makes surgeons less motivated to improve.

Conclusion

Burnout is common but not well recognised in surgeons. Improving understanding and treatment of burnout could have benefits for both surgeons themselves and the care they provide to patients.

The Effects of Safety Climate on Psychosocial Factors: An Empirical Study in Healthcare Workplaces

ABSTRACT

How to develop a better patient safety culture has been an important goal for healthcare organizations, but the effects of safety culture on psychosocial factors, such as emotional exhaustion and stress, have not been fully addressed. This study aimed to reconfigure important dimensions affecting safety culture and examine the associations between safety culture and psychosocial factors (emotional exhaustion and work-life balance). The partial least squaring technique was used to analyze the data, showing that job satisfaction (β = 0.320, P < 0.001), working conditions (β = 0.307, P < 0.001), and perception of management (β = 0.282, P < 0.001) positively affected the safety climate. The safety climate and work-life balance could reduce the occurrence of emotional exhaustion, whereas a high-stress environment would cause a higher level of emotional exhaustion. Given these findings, hospitals should endeavor to help employees feel safe and not threatened, reduce stress, and advise them to maintain a good work-life balance.

Exploring the role of social capital, self-efficacy and social contagion in shaping lifestyle and mental health among students representing the future healthcare workforce in Palestine: social cohort study protocol

INTRODUCTION

Non-communicable diseases (NCDs) and depression form an unhealthy mix. The project focuses on potentially effective psychosocial factors shaping health-related habits and mental health. The study is conducted among health domain students. Understanding what shapes their health will determine their quality of care. The study is implemented at An-Najah National University in Palestine. This zone of continuous conflict psychological stress is high and mental health problems are stigmatised.

METHODS AND ANALYSIS

Students who are enrolled in second and third year will be invited to fill in a baseline and two follow-up online questionnaires. The questionnaires will assess: health behaviours and outcomes (health-related habits, obesity and mental health), main predictors (social capital, social network, self-efficacy), confounders (general and sociodemographic characteristics) and effect modifiers (sense of coherence (SOC) and family SOC). Friendships within participating students will be identified by allowing students to name their friends from a pull-down menu of all students. Descriptive statistics and scores will describe participant's characteristics. The relationship between health behaviour, outcomes and main predictors will be examined by regression and structural equation models. Clustering of health behaviours and outcomes will be assessed by permutation tests. Their spread within the network of friends will be investigated by longitudinal generalised estimating equations.

DISCUSSION

The study will identify the prevalence of NCD-related health habits and mental health aspects in the future healthcare workforce in Palestine. It will be the first study to address the role of psychosocial factors for the targeted students. It has the potential to identify targets for promoting physical and mental health among these future professionals.

ETHICS AND DISSEMINATION

Ethical approval was obtained from Ethikkommission Nordwest- und Zentralschweiz (EKNZ) in Switzerland and the Institutional Review Board Committee (IRBC) in Palestine. Participation in the study is voluntary and requires informed consent. The data management methodology ensures the confidentiality of the data. The outcomes of the study will be published as scientific papers. In addition, it will be presented in stakeholder conferences and to students at An-Najah National University.

Designing the careful and kind clinic: an evidence-based approach

Background

There is evidence that creating a ‘healthy workplace’ can be of profound importance for clinicians, team members and patients. Yet there have been few papers that have proposed mechanisms to take decades of research and translate this into a practical list of options for leaders and managers to take into account when structuring a clinic based on care and kindness to achieve optimal health.

Evidence

We bring together 20 years of scholarship linking care of the caregivers with outcomes for caregivers and patients. The data are used to support both structures and cultures that will result in satisfied and thriving healthcare team members, as well as satisfied and healthy patients.

Results

The clinic based on care of the caregivers will be structured to address key aspects of worklife that are known to cause either satisfaction or burnout. Aspects of care, such as time pressure, chaotic environments and worker control of their workplace, will be taken into account in clinical design; organisational culture will be supportive and cohesive, emphasising quality, values and communication. Experiences based on gender and race will be measured and continuously improved; and performance will be evaluated in a new, human-centred manner.

Outcomes

The careful and kind clinic will be a remarkable place to work; in contrast to industrialised healthcare, this will be an environment where health can indeed be optimised, for both workers and patients.

Job Satisfaction and Evidence of Burnout Comparing Arab and Non-Arab Urologists with a Migration Background Working in German Hospitals

Background  In German hospitals, severe shortage of physicians can currently be partially compensated by hiring foreign physicians. Results on job satisfaction (JS) and physician burnout (PBO) in this important occupational group are currently not available.

Methods  The cross-sectional “Assessment of their urological work environment by foreign clinicians in Germany (EUTAKD)” study was conducted in 2020 using a 101-item questionnaire among physicians working in German urological departments who were born in a country outside Germany and having non-German citizenship. This study compared JS and the occurrence of PBO between Arab (group A, n = 57) and non-Arab (group B, n = 39) participants.

Results  Significant group differences with advantages for group B were analyzed in overall JS and also in other JS items. High scores in the PBO dimensions, that is, “emotional exhaustion” and “depersonalization,” were shown by 27.9 and 51.5% of the study participants, respectively, although there were no group differences found ( p = 0.972 and 0.237, respectively).

Conclusion  Prospective longitudinal studies of appropriate intervention measures aimed at increasing JS and decreasing PBO are needed.

Health and social care professionals' experiences of providing end of life care during the COVID-19 pandemic: A qualitative study

BACKGROUND

Health and social care professionals' ability to address the needs of patients and their relatives at end of life is likely to have been impacted by the COVID-19 pandemic.

AIM

To explore health and social care professionals' experiences of providing end of life care during the COVID-19 pandemic to help inform current/future clinical practice and policy.

DESIGN

A qualitative interview study. Data were analysed using thematic analysis.

SETTING/PARTICIPANTS

Sixteen health and social care professionals working across a range of clinical settings in supporting dying patients during the first wave (March-June 2020) of the COVID-19 pandemic in the United Kingdom.

RESULTS

Participants reported emotional and practical challenges to providing end of life care during the pandemic, including increases in patient numbers, reduced staffing levels and relying on virtual platforms for sensitive, emotive conversations with relatives. Participants were central to promoting connections between patients and their families at end of life and creating opportunities for a final contact before the death. However, the provision of support varied as a consequence of the pressures of the pandemic. Results are discussed under two themes: (1) challenges and facilitators to providing end of life care, and (2) support needs of relatives when a family member was dying during the COVID-19 pandemic.

CONCLUSION

There is a need for flexible visiting arrangements at end of life during a pandemic. A systems-level approach is necessary to promote the wellbeing of health and social care professionals providing end of life care during and after a pandemic.

Where There’s Smoke: Validating a Nonproprietary Single-Item Burnout-Impacting-Safety Scale

This study aimed to assess the utility of a single survey item to predict the impact of burnout on safety and quality of healthcare providers as perceived by their colleagues. The primary objective is to determine if the item predicts the frequency of patient safety event reports within certain clinical departments. The secondary objective will be to determine if there is an acceptable cutoff score for the item which predicts low versus high numbers of safety events reported by healthcare providers in each clinical department. Participants were 424 healthcare providers in an academic medical center in the mid-Atlantic region of the United States. The item was designed to assess for the perception of the impact of burnout on work in terms of quality or safety using a 5-point Likert scale. Data from a patient safety event reporting system was accessed for the year of survey completion (2017). A negative binomial regression was used to assess the ability of the item to predict reported patient safety event reports. The item was found to significantly predict objective safety event data. Sensitivity and specificity, as well as receiver operating characteristic (ROC) curve analyses, were conducted to determine appropriateness of cutoff scores to identify low- and high-risk clinical departments. The item was found to demonstrate adequate sensitivity (82%) using a cutoff score of 4 on the survey item. However, the area under the curves (AUCs) which assess diagnostic accuracy fell in the poor range. These results suggest that healthcare administrators could deploy this single item as a brief pulse or screener of teams of individuals who are within a work unit and use a cutoff score of 4 as a means to assess for hot spots where healthcare provider burnout may be putting patients at high risk in terms of safety.

Prevalence of burnout syndrome and its related risk factors among physicians working in primary health care centers of the Ministry of Health, Al Ahsa region, Saudi Arabia, 2018-2019

Burnout syndrome (BS) is a relatively common occupational problem. It is a psychological and behavioral syndrome described by three dimensions: emotional exhaustion (EE); depersonalization (DP); and low personal accomplishment (PA).

OBJECTIVES

This study aims to calculate the prevalence of BS and its related risk factors among physicians of primary health care centers (PHCCs) of the Ministry of Health (MOH, Al Ahsa, Saudi Arabia.

MATERIALS AND METHOD

A cross-sectional study was conducted in which 280 physicians working in PHCCs were selected as a comprehensive sample, the response rate was 80.7%. We excluded the trainee of residency programs, interns, and hospital physicians providing partial service in PHCCs. The data was collected by using two-part self-administered questionnaire including sociodemographic data, working conditions, and Maslach Burnout Inventory™-Human Services Survey for Medical Personnel-MBI-HSS (MP). This data was analyzed using Statistical Package for Social Sciences (SPSS) program.

RESULTS

The mean score for EE was 24.99 ± 11.54 SD. The mean score for DP was 9.19 ± 6.13 SD. For PA, it was 29.41 ± 9.9 SD. The percentage of participants who scored high in EE was 47.3%. About one-half of the participants scored high DP and 59.7% had diminished PA. About one-quarter of the participants (24.3%) scored high burnout in all three dimensions. High EE was present in ages from 35 to 45 years, Saudi participants, rotating or covering physicians, and participants who were satisfied with their job. High DP was seen in Saudi physicians, family physicians, rotating or covering physicians, those who were not satisfied with their job, and physicians who work in rural areas. Low PA was seen in physicians who were not satisfied with their job, rotating or covering physicians, participants who do not have tasks other than clinical work, and physicians who work in Omran sector.

CONCLUSION

There is a significant level of burnout among physicians working in PHCCs in Al Ahsa. High burnout was associated with some risk factors. Further research is needed to study this problem in depth.

Frontline Perspectives on Physician Burnout and Strategies to Improve Well-Being: Interviews with Physicians and Health System Leaders

BACKGROUND

Nationally over 50% of physicians report symptoms of burnout.

OBJECTIVE

To understand the perspectives of health system leaders and frontline physicians on contributors to physician burnout and strategies to improve well-being.

DESIGN

We conducted in-depth interviews with health system leaders and frontline physicians at a large, predominantly fee-for-service, multispecialty group practice with approximately 1300 physicians.

PARTICIPANTS

The 17 participants included 15 physicians, (12 Internal Medicine and Family Medicine physicians and 3 from other specialties), 11 individuals in leadership roles, and 11 women.

APPROACH

Interviews included a review of factors associated with burnout at the organization, asking participants which factors they believed contributed to burnout, questions about experiences of burnout, and what specific changes would improve well-being.

KEY RESULTS

All 17 participants agreed that organizational factors were key contributors to burnout, while only 9 mentioned the salience of individual factors: "It does not matter how resilient or positive you are, the work environment, especially in primary care will eventually be a problem." An increasing workload associated with the electronic health record (EHR) and a culture focused on productivity were cited as contributing to burnout, especially among physicians in Internal Medicine and Family Medicine (primary care) departments. Physicians in primary care, women, and leaders described multiple barriers to well-being. Participants described responding to increased workloads by reducing clinical work hours. Participants suggested reducing and compensating EHR work, expanding care teams/support staff, reducing use of metrics, providing more support to leaders, changing the business model, and increasing positivity and collegiality, as essential to improving well-being.

CONCLUSION

Interviews reveal a variety of interacting factors contributing to physician burnout. Reducing clinical work hours has become a coping strategy. Changes recommended to improve physician well-being include increasing support staff, reducing EHR workload, changing revenue generation and compensation approaches, and shifting organizational culture to place more value on physician wellness.

An investigation into the relationships between bullying, discrimination, burnout and patient safety in nurses and midwives: is burnout a mediator?

Background

Bullying and discrimination may be indirectly associated with patient safety via their contribution to burnout, but research has yet to establish this.

Aims

The aims of this study were to investigate the relationships between workplace bullying, perceived discrimination, levels of burnout and patient safety perceptions in nurses and midwives and to assess whether bullying and discrimination were more frequently experienced by Black, Asian and minority ethnic than White nurses and midwives.

Methods

In total, 528 nurses and midwives were recruited from four hospitals in the United Kingdom to complete a cross-sectional survey between February and March 2017. The survey included items on bullying, discrimination, burnout and individual level and ward level patient safety perceptions. Data were analysed using path analysis.

Results

The results were reported according to the STROBE checklist. Bullying and discrimination were significantly associated with higher burnout. Higher burnout was in turn associated with poorer individual- and ward-level patient safety perceptions. Experiences of discrimination were three times more common among Black, Asian and minority ethnic than White nurses and midwives, but there was no significant difference in experiences of bullying.

Conclusions

Bullying and discrimination are indirectly associated with patient safety perceptions via their influence on burnout. Healthcare organisations seeking to improve patient care should implement strategies to reduce workplace bullying and discrimination.

Effectiveness of a multimodal training programme to improve general practitioners' burnout, job satisfaction and psychological well-being

BACKGROUND

The changes in the models of care for mental disorders towards a community focus and deinstitutionalisation might have risen General practitioners' (GPs) workload, increasing their mental health concerns and the need for solutions. Pragmatic research into improving GPs' work-related health and psychological well-being is limited by focusing mainly on stressors and through not providing systematic attention to the development of positive mental health via interventions that develop psychological resources and capacities. The aim of this study was twofold: a) to determine the effectiveness of an intensive multimodal training programme for GPs designed to improve their management of mental-health patients; and b) to ascertain if the program could be also useful to improve the GPs management of their own burnout, job satisfaction and psychological well-being.

METHOD

Eighteen GPs constituted a control group that underwent the routine clinical Mental health support programme for primary care. An experimental group (N = 20) additionally received a Multimodal training programme (MTP) with an Integrated Brief Systemic Therapy (IBST) approach. Through questionnaires and a clinical interview, level of burnout, professional satisfaction, psychopathological state and various indicators of the quality of administrative and healthcare management were analysed at baseline and 10 months after the programme.

RESULTS

In relation to government of mental-health patients indicators, on the one hand MTP group showed statistically significant improvements in certain administrative health parameters, but on the other it did not improve opinions and attitudes towards mental illness. Regarding GPs management of their own burnout, job satisfaction and psychological well-being assessments, the MTP presented better scores on global psychopathological state and better evolution of satisfaction at work; psychopharmacology use dropped in both groups; in contrast, the MTP did not improve burnout levels.

CONCLUSIONS

Findings of this preliminary study are promising for the MTP (with an IBST approach) practice in primary care. More research evidence is required from larger samples and randomized controlled trials to support both the hypothetical adoption of MTP (with an IBST approach) as a part of a continuing professional-training programme for GPs' management of mental-health patients and its positive effects on work-related health factors.

Association of GP wellbeing and burnout with patient safety in UK primary care: a cross-sectional survey

BACKGROUND

GPs have particularly high levels of burnout and poor wellbeing. Although both are associated with poorer safety outcomes within secondary care, there have been no quantitative studies investigating this within primary care. Furthermore, little is known about how occupational demands, burnout and wellbeing, and patient safety are all associated.

AIM

To investigate whether occupational variables (demands and support) are associated with patient safety outcomes in general practice through their influence on GP burnout and wellbeing.

DESIGN AND SETTING

Cross-sectional survey in the UK between March 2016 and August 2017.

METHOD

A total of 232 practising GPs completed an online or paper survey measuring burnout, wellbeing, occupational demands and support, and patient safety.

RESULTS

In all, 93.8% of GPs were classed as likely to be suffering from a minor psychiatric disorder, 94.7% as suffering from mild (22.0%) or severe (72.7%) exhaustion, and 86.8% as having mild (37.9%) or severe (48.9%) disengagement. Structural equation modelling (SEM) analyses showed that spending a higher number of hours on administrative tasks and on call, and feeling less supported in their practice, was associated with lower wellbeing, which in turn was associated with a higher likelihood of having reported a near miss in the previous 3 months. A higher number of hours spent on administrative tasks, a higher number of patients seen per day, and feeling less supported were associated with higher burnout levels, which in turn was associated with worse perceptions of safety.

CONCLUSION

To improve patient safety within general practice changes could be made at both practice and individual levels to promote a healthier work environment for staff and patients.

Mindfulness intervention for foundation year doctors: a feasibility study

BACKGROUND

Mindfulness has been shown to reduce stress and burnout in medical students and healthcare professionals. This is a quality improvement study which assessed the feasibility of conducting a full-scale evaluation of a mindfulness intervention among UK foundation doctors to reduce stress and burnout.

METHODS

This is an uncontrolled before and after study taking place in a single university teaching hospital. The RE-AIM framework which comprises of five dimensions including Reach, Adoption, Effectiveness, Implementation, and Maintenance was used to guide this assessment. The intervention was a 6-week 'Mindfulness in the Workplace' course. The primary measure was change in self-reported levels of stress immediately before and after the course. Additional measures explored the subjective experiences of participating doctors through the use of questionnaires handed out before and after the course.

RESULTS

All 20 places on the course were filled from the population of 108 foundation doctors at the trust with an equal number of foundation year 1 (n = 10) and foundation year 2 (n = 10) doctors. Sixteen participants (80%) attended one or more sessions. The median baseline stress score of the participants was 6.5 (range = 2 to 9). The median post-course stress score was 5.0 (range = 2 to 8). The Mann-Witney test indicated that the stress levels of participants were significantly lower at the end of the course compared to baseline, U = 74.50, p = .04. Additional measures suggested that the intervention may be associated with some other potential promising benefits for doctors including greater wellbeing, improved working life, and more satisfactory relationships with patients. Implementation of this intervention requires further work at the institutional level because only 35% of participants completed the full intervention, the main barrier being work commitments.

CONCLUSION

This is the first programme of research to evaluate the feasibility of trialling and implementing a modified 'Mindfulness in the Workplace' intervention for foundation junior doctors in the UK. Based on the findings from this study, we conclude that this intervention is promising but further modifications are required such as the use of validated outcome measures and improving delivery aspects before this intervention programme is trialled among foundation doctors in the UK.

Effects of mindfulness training on perceived stress, self-compassion, and self-reflection of primary care physicians: a mixed-methods study

BACKGROUND

Primary care physicians are subjected to a high workload, which can lead to stress and a high incidence of burnout. A mindfulness training course was developed and implemented for primary care physicians to better cope with stress and improve job functioning.

AIM

To gain insight into the effects of the mindfulness training on perceived stress, self-compassion, and self-reflection of primary care physicians.

DESIGN & SETTING

A pragmatic mixed-methods pre-post design in which physicians received 8 weeks of mindfulness training.

METHOD

Participants completed validated questionnaires on perceived stress (Perceived Stress Scale [PSS]), self-compassion (Self-Compassion Scale [SCS]), and self-reflection (Groningen Reflection Ability Scale [GRAS]) before the training, directly after, and 6 months later. Semi-structured interviews were conducted with six participants after the training and a content analysis was performed to gain in depth understanding of experiences.

RESULTS

A total of 54 physicians participated in the study. PSS was reduced (mean difference [MD] -4.5, P<0.001), SCS improved (MD = 0.5, P<0.001), and GRAS improved (MD = 3.3, P<0.001), directly after the 8-week training compared with before training. Six months later, PSS was still reduced (MD = -2.9, P = 0.025) and SCS improved (MD = 0.7, P<0.001). GRAS did not remain significant (MD = 2.5, P = 0.120). Qualitative analysis revealed four themes: being more aware of their own feelings and thoughts; being better able to accept situations; experiencing more peacefulness; and having more openness to the self and others.

CONCLUSION

Mindfulness training might be an effective approach for improving stress resilience, self-compassion, and self-reflection in primary care physicians.

Mental healthcare staff well-being and burnout: A narrative review of trends, causes, implications, and recommendations for future interventions

Rising levels of burnout and poor well-being in healthcare staff are an international concern for health systems. The need to improve well-being and reduce burnout has long been acknowledged, but few interventions target mental healthcare staff, and minimal improvements have been seen in services. This review aimed to examine the problem of burnout and well-being in mental healthcare staff and to present recommendations for future research and interventions. A discursive review was undertaken examining trends, causes, implications, and interventions in burnout and well-being in healthcare staff working in mental health services. Data were drawn from national surveys, reports, and peer-reviewed journal articles. These show that staff in mental healthcare report poorer well-being than staff in other healthcare sectors. Poorer well-being and higher burnout are associated with poorer quality and safety of patient care, higher absenteeism, and higher turnover rates. Interventions are effective, but effect sizes are small. The review concludes that grounding interventions in the research literature, emphasizing the positive aspects of interventions to staff, building stronger links between healthcare organizations and universities, and designing interventions targeting burnout and improved patient care together may improve the effectiveness and uptake of interventions by staff.