Mental well-being, job satisfaction and self-rated workability in general practitioners and hospitalisations for ambulatory care sensitive conditions among listed patients: a cohort study combining survey data on GPs and register data on patients

Family medicine and general practitioner supervisor wellbeing: a literature review

BACKGROUND

Research examining general practice supervisor wellbeing has often been conducted within the context of trainee wellbeing and educational outcomes.

AIM

To consolidate the current literature regarding the wellbeing of GP supervisors through a 'supervisor-wellbeing' lens.

DESIGN & SETTING

Literature review of original research studies on Embase, Ovid MEDLINE, and Ovid PsycINFO from inception to December 2022.

METHOD

The Embase, Ovid MEDLINE, and Ovid PsycINFO databases were systematically searched from inception to December 2022. Original research studies were eligible if they explored any aspect of wellbeing or burnout (that is, construct conceptualisations, risk and protective factors, implications, or interventions) among GPs involved in educating GP trainees. Reporting quality of included studies was assessed using the QualSyst tool. Results from included studies were narratively synthesised.

RESULTS

Data from 26 independent samples were reviewed. Burnout was generally conceptualised using the Leiter and Maslach model. Wellbeing was poorly defined in the literature, largely being conceptualised in personal psychological terms and, to a lesser extent, professional satisfaction. Risk and protective factors were identified and grouped as individual (for example, satisfaction with capacity to teach) and external (for example, autonomy, collegial relationships, resource availability) factors. GP supervisors' wellbeing appeared to affect their job performance and retention. This review identified only two studies evaluating interventions to support GP supervisors' wellbeing.

CONCLUSION

The present review highlights a lack of conceptual clarity and research examining interventions for GP supervisor wellbeing. It provides guidance for future research designed to maximise the wellbeing of GP supervisors and support the wellbeing of trainees.

Barriers for continuous medical education: a cross-sectional questionnaire study among Danish GPs

BACKGROUND

GPs' participation in continuous medical education (CME) is essential for patient care, GPs' wellbeing, and healthcare expenditure. However, one-quarter of Danish GPs did not use their reimbursement for CME in 2022. Knowledge of barriers for participating in CME is limited.

AIM

To analyse the barriers GPs face to participation in CME, and patterns in perceived barriers.

DESIGN & SETTING

A cross-sectional questionnaire study design was used. The study population comprised all 3257 GPs in Denmark who, in May 2023, were registered as entitled to reimbursement for CME.

METHOD

The response rate was n = 1303/3257 (40%). Based on a question about use of CME, the responders were divided into 'frequent', 'partial', and 'seldom' users. Partial and seldom users answered questions about barriers related to CME (n = 726). The presence of barriers was quantified, and a latent class analysis (LCA) was used to stratify GPs according to their barrier patterns.

RESULTS

The most frequent barriers were as follows: too busy (67%); fully booked courses (45%); and no substitute or locum doctor (39%). Based on the LCA, we found three distinctive patterns, clustering around the following: GPs from clinics with no tradition for CME (class 1, 17%); GPs who used time on professional work outside clinic (teaching, organisational work) (class 2, 43%); and GPs who were personally or professionally affected (class 3, 40%). Singled-handed and male GPs were slightly overrepresented among seldom users.

CONCLUSION

We have identified barriers for CME. We found three different profiles of GPs who perceived different patterns of barriers. Identified patterns in barriers should be considered in future CME initiatives.

Prioritising nurses' and doctors' health at work: a scoping review of monitoring instruments

OBJECTIVE

Nurses' and doctors' health at work is crucial for their overall performance and the quality of care they provide. The Jobs Demands Resources (JD-R) model offers a framework for health at work, encompassing 'job demands', 'job resources', 'personal resources', 'leadership', 'well-being' and 'outcomes'. While various instruments exist to measure health, an overview of instruments specifically designed for assessing nurses and doctors health is currently missing. This study provides a comprehensive overview of available health instruments specifically developed and validated for healthcare professionals in hospital care.

DESIGN

Scoping review.

DATA SOURCES

MEDLINE, Embase and CINAHL.

ELIGIBILITY CRITERIA

Studies assessing the health of nurses and/or doctors in hospitals using or evaluating instruments based on the JD-R model, published between January 2011 and January 2024, excluding student-exclusive samples.

DATA EXTRACTION AND SYNTHESIS

We extracted data on study and sample characteristics, as well as details of the measurement instruments, including main and subconstructs. Instruments were categorised based on the JD-R model domains. Descriptive analysis and data visualisation were performed using Excel and Python.

RESULTS

We included 1204 studies, reporting 986 unique instruments. We identified 32 comprehensive instruments suitable for broad health screening, measuring four or more of the JD-R model domains. Additionally, we identified instruments focusing on specific domains for targeted screening needs. Furthermore, we present frequently reported instruments assumed to be extensively evaluated, user-friendly, accessible and available in multiple languages.

CONCLUSIONS

Health at work cannot be determined by a single instrument alone, underscoring the multidimensional nature of workplace health. Alternatively, organisations should select instruments based on domains most relevant and applicable to their context. This approach ensures a more comprehensive assessment of health at work.

Workload and GP burnout: a survey and register-based study in Danish general practice

BACKGROUND

Burnout is common among GPs. Previous studies have indicated an association between high workload and burnout among doctors.

AIM

To assess the risk of burnout among single-handed GPs in Denmark in relation to self-reported and register-based workload.

DESIGN & SETTING

Questionnaire data from 312 Danish single-handed GPs and register data on their patients and provided services.

METHOD

Burnout was measured using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). A composite burnout score of quartile points was calculated. The questionnaire provided information on working hours. Register data included number of services and patient list size. Association between composite burnout score and workload was estimated with binomial regression analyses adjusting for the GP's age and sex, and social deprivation score of their patient lists.

RESULTS

Working >5 days a week in practice increased the risk of a high burnout score (adjusted risk ratio [RR] = 2.34, 95% confidence interval [CI] = 1.62 to 3.37). Spending >7.5 hours a day on patient-related tasks increased the risk of a high burnout score. The highest score was among GPs spending 8.5-9.5 hours a day on patient-related tasks (adjusted RR = 2.01, 95% CI = 0.90 to 4.51), although not statistically significant. There was no association between number of services and risk of burnout.

CONCLUSION

Working 5 days a week in practice significantly increased the risk of burnout in Danish single-handed GPs. Spending >7.5 hours a day on patient-related tasks tended to increase the risk. We found no association between a high number of services and increased risk of burnout.

Assessing the Well-Being at Work of Nurses and Doctors in Hospitals: Protocol for a Scoping Review of Monitoring Instruments

BACKGROUND

Well-being at work can be defined as "creating an environment to promote a state of contentment which allows an employee to flourish and achieve their full potential for the benefit of themselves and their organisation." In the health care context, well-being at work of nurses and doctors is important for good patient care. Moreover, it is strongly associated with individual- and organization-level consequences. Relevant literature presents models and concepts of physical, mental, and social well-being. This study uses the 6 elements of the job demands-resources (JD-R) model to interpret well-being at work (job demands, job resources, personal resources, leadership, well-being, and outcomes) as part of a Netherlands Federation of University Medical Hospitals program to find ways to improve and monitor health care professionals' well-being in Dutch hospitals. Many instruments exist to measure well-being at work in terms of population, setting, and other aspects. An overview of available and eligible instruments assessing and monitoring the well-being of nurses and doctors is currently missing.

OBJECTIVE

We will perform a scoping review aiming to provide an overview of validated instruments assessing and monitoring the well-being of nurses and doctors at work.

METHODS

We will perform a search of published literature in the following databases: Medline, Embase, and CINAHL. Studies will be eligible if they (1) assess well-being at work of nurses and doctors employed in hospitals; (2) describe an evaluation of an instrument or review an instrument; (3) measure well-being at work or aspects of well-being at work according to the elements of the JD-R model, and (4) were published in English from 2011 onwards. Title/abstract screening according to the eligibility criteria will be followed by full-text screening. Data extraction of included studies will be conducted by 3 reviewers independently. Reviewers will use standardized data extraction forms that include study characteristics, sample characteristics, measurement instrument details, and psychometric properties. The analysis will be descriptive. When synthesizing the data, a distinction will be made between comprehensive instruments and common instruments.

RESULTS

This scoping review identifies instruments that have been developed and validated for monitoring the well-being of nurses and doctors at work. Studies were searched between September and December 2021 and screened between December 2021 and May 2022. A total of 739 studies were included.

CONCLUSIONS

Timely screening of well-being at work may be beneficial for individual health care workers, the organization, and patients. There is often a substantial gap and mismatch between employer perceptions of well-being and well-being interventions. It is important to develop and implement suitable interventions adapted to the needs of nurses and doctors and their health or other problems. Well-being screening should be timely to gain insight into these needs and problems. Moreover, to determine the effectiveness of well-being interventions, measurement is mandatory. The results will be critical for organizations to select a monitoring instrument that best fits the needs of employees and organizations.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/43692.

Primary care provider's job satisfaction and organizational commitment after COVID-19 restrictions ended: A mixed-method study using a mediation model

Objectives

More and more countries have decided to cancel most or even all COVD-19 restrictions. However, it is unclear how ending of restrictions will affect primary care providers' job satisfaction and organizational commitment. Our objectives are to explore the current status and possible change in primary care providers' job satisfaction and organizational commitment after massive restriction policies ended in China.

Methods

This was a mixed-method study that utilized structured questionnaires and semi-structured qualitative individual interviews. The 20-item Minnesota Satisfaction Questionnaire (MSQ) and 25-item organizational commitment survey were adopted to assess job satisfaction and organization commitment. Descriptive statistics and mediation models, as well as inductive thematic analysis, were used to analyze quantitative and qualitative data.

Results

A total of 18 interviews and 435 valid survey responses were included in our analysis. The average scores for job satisfaction and organizational commitment were 80.6 and 90.8. The thematic analysis revealed one major theme: ethical and moral responsibility to provide care as primary care providers, on which we established a mediation model. The mediation analysis revealed that normative commitment could positively affect the other four dimensions of organizational commitment and job satisfaction. The direct effect of affective commitment on job satisfaction was significant (LLCI = 0.11, ULCI = 0.31), and the mediators were identified to have a partial mediating effect instead of a total mediating effect.

Conclusion

After COVID-19 restrictions end, the job satisfaction and organizational commitment of primary care providers will return to levels before the pandemic and during this estimated process, a brief rise in resignation is predictable. The normative commitment positively affects the other four dimensions of organizational commitment and job satisfaction for primary care providers, which suggests a possible way to motivate primary care providers when restrictions end.

Burnout, coping strategies and help-seeking in general practitioners: a two-wave survey study in Denmark

OBJECTIVE

Work pressure remains an issue among general practitioners (GPs). Nevertheless, GPs rarely seek help for symptoms of burnout. The aim of this study was to examine whether burnout level was associated with coping strategies and help-seeking behaviour during time pressure.

DESIGN

A two-wave nationwide survey (2016 and 2019) based on questionnaire data from 1059 GPs.

SETTING

Primary care in Denmark.

METHODS

Burnout was measured by the Maslach Burnout Inventory (MBI), whereas coping strategies and help-seeking behaviour were measured by questions developed for the study. A composite score of quartile points was calculated for the three subscales of the MBI subscales. A score ≥9 was categorised as high level of burnout, and the composite score of 2019 was used as outcome. Data were analysed with logistic regression adjusted for sex, age and composite burnout score in 2016.

RESULTS

High scores in 2016 on four key factors were associated with increased risk of high composite burnout score in 2019. These factors were compromising work (OR_adjusted=2.27, 95% CI=1.45 to 3.56), postponing decisions (OR_adjusted=1.53, 95% CI=1.04 to 2.24), delaying tasks (OR_adjusted=1.61, 95% CI=1.16 to 2.25) and reducing breaks (OR_adjusted=1.46, 95% CI=1.01 to 2.11) during time pressure. A lower risk of high composite burnout score was seen in 2019 in GPs who had sought help compared with GPs who did not seek help despite a perceived need (OR_adjusted=0.59, 95% CI=0.35 to 0.97).

CONCLUSION

Certain coping strategies used in 2016 were associated with increased risk of high burnout score in 2019, whereas lower risk of high burnout was seen in the GPs seeking help. These findings are relevant to reduce burnout rates among GPs.

Prevalence of Burnout among General Practitioners: A Systematic Review and Meta-Analysis

Background Burnout is a work-related syndrome documented to have negative consequences for general practitioners (GPs) and their patients. Our objective was to conduct a systematic review and meta-analysis of the literature to provide an estimate of how widespread this phenomenon is.

AIM

To review the existing literature concerning studies published up to December, 2020, on the prevalence of burnout amongst GPs in general practice, to determine GP burnout estimates worldwide.

DESIGN AND SETTING

Systematic literature search and meta-analysis.

METHOD

Searches of CINAHL Plus, Embase, MEDLINE, PsycINFO, and Scopus were conducted to identify published peer-reviewed quantitative empirical studies in English up to December, 2020, that have used the Maslach Burnout Inventory-Human Services Survey to establish the prevalence of burnout in practising GPs (i.e., excluding GPs in training). A random-effects model was employed.

RESULTS

Wide-ranging prevalence estimates (6% to 32%) for 22,177 GPs across 29 countries were reported for 60 studies included in this review. Mean burnout estimates were as follows: 16.43 (EE); 6.74 (DEP); and 29.28 (PA). Subgroup and meta-analyses documented that country-specific factors may be important determinants of the variation in GP burnout estimates. Moderate overall burnout cut-offs were found to be determinants of the variation in moderate overall burnout estimates.

CONCLUSION

Moderate to high GP burnout exist worldwide. However, substantial variations in how burnout is characterised and operationalised resulted in considerable heterogeneity in GP burnout prevalence estimates. This highlights the challenge of developing a uniform approach, and the importance of considering the GP's work context, to better characterise burnout.

The Science of Health Care Worker Burnout: Assessing and Improving Health Care Worker Well-Being

CONTEXT.—

Problems with health care worker (HCW) well-being have become a leading concern in medicine given their severity and robust links to outcomes like medical error, mortality, and turnover.

OBJECTIVE.—

To describe the state of the science regarding HCW well-being, including how it is measured, what outcomes it predicts, and what institutional and individual interventions appear to reduce it.

DATA SOURCES.—

Peer review articles as well as multiple large data sets collected within our own research team are used to describe the nature of burnout, associations with institutional resources, and individual tools to improve well-being.

CONCLUSIONS.—

Rates of HCW burnout are alarmingly high, placing the health and safety of patients and HCWs at risk. To help address the urgent need to help HCWs, we summarize some of the most promising early interventions, and point toward future research that uses standardized metrics to evaluate interventions (with a focus on low-cost institutional and personal interventions).

Effectiveness of a group intervention to reduce the psychological distress of healthcare staff: a pre-post quasi-experimental evaluation

Background

Work stress and compassion fatigue are prevalent among healthcare staff and their negative effects on staff well-being and patient care are well-known. This paper reports on the implementation and evaluation of Schwartz Rounds® (Rounds) in UK healthcare organizations, predominantly part of the National Health Service (NHS). Rounds are one-hour, typically monthly, multidisciplinary forums during which clinical and nonclinical healthcare staff discuss the emotional and social demands of delivering patient care. The purpose of this research was to evaluate the effectiveness of Rounds attendance on the psychological distress, work engagement, compassion and self-reflection of healthcare staff.

Methods

We used a pre-post control design to assess the effect of Rounds attendance across 10 UK healthcare organizations. This design was most appropriate given the voluntary nature of Rounds and ensured the study had ecological validity. Self-reported data were collected from attenders and non-attenders at baseline and at eight-months follow-up. The outcomes were psychological distress, work engagement, compassion and self-reflection.

Results

During the 8 months’ study duration, regular attenders (N = 51) attended Rounds on average 4 times (2–8). Attenders showed a significantly greater decrease in psychological distress (as measured with the General Health Questionnaire (GHQ)) than non-attenders (N = 233; odds ratio of 0.197; 95% confidence interval (0.047–0.823)). However, Rounds attendance had no significant effect on work engagement, compassion and self-reflection.

Conclusions

Rounds attendance was linked to a 19% reduction in psychological distress adjusting for covariates. As an organization-wide intervention, Rounds thus constitute an effective, relatively low-cost intervention to assist staff in dealing with the demands of their work and to improve their well-being.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06413-4.

Effect of burnout among physicians on observed adverse patient outcomes: a literature review

Background

Physician burnout has potentially harmful effects for both physicians and their patients. Despite relationships between physician burnout and lowered patient satisfaction and clinician-rated adverse patient outcomes, there is scarce literature regarding effects on objective patient outcomes. This study aimed to examine the relationship between physician burnout and observed adverse patient outcomes via a review of the literature.

Methods

A search was performed on the MEDLINE, EMBASE and PsychINFO databases, using keywords and Medical Subject Headings. The identified studies were in English, published from 2007 to 2019, measured burnout among physicians using the Maslach Burnout Inventory (MBI), and included observed adverse patient outcomes. In total, 360 eligible articles were identified, and 11 were included in the final review. All included studies measured patient outcomes by observed clinical measures (e.g. quality of care and medical errors).

Results

Four studies found a clear significant relationship between physician burnout and observed adverse patient outcomes, while 6 did not. One study found a significant relationship with one of the MBI subscales. Burnout was, in contrast to depression, only partly associated with observed patient outcomes.

Conclusions

This review illustrates the need for a validation of physician burnout measured by MBI with respect to observed patient outcomes. Further studies are required to investigate the effects of physician burnout on observed quality of their patient care.

Mental well-being and job satisfaction in general practitioners in Denmark and their patients' change of general practitioner: a cohort study combining survey data and register data

OBJECTIVES

Low job satisfaction and poor well-being (eg, stress and burnout) among physicians may have negative consequences for patient experienced healthcare quality. In primary care, this could manifest in patients choosing another general practitioner (GP). The objective of this study was to examine change of GP (COGP) (unrelated to change of address) among patients in relation to their GPs' job satisfaction, well-being and self-assessed work-ability.

DESIGN AND SETTING

Data from a nationwide questionnaire survey among Danish GPs in May 2016 was combined with register data on their listed patients. Associations between patients' COGP in the 6-month study period (from May 2016) and the job satisfaction/well-being of their GP were estimated as risk ratios (RRs) at the individual patient level using binomial regression analysis. Potential confounders were included for adjustment.

PARTICIPANTS

The study cohort included 569 776 patients aged ≥18 years listed with 409 GPs in single-handed practices.

RESULTS

COGP was significantly associated with occupational distress (burnout and low job satisfaction) in the GP. This association was seen in a dose-response like pattern. For burnout, associations were found for depersonalisation and reduced sense of personal accomplishment (but not for emotional exhaustion). The adjusted RR was 1.40 (1.10-1.72) for patients listed with a GP with the lowest level of job satisfaction and 1.24 (1.01-1.52) and 1.40 (1.14-1.72) for patients listed with a GP in the most unfavourable categories of depersonalisation and sense of personal accomplishment (the most favourable categories used as reference). COGP was not associated with self-assessed work-ability or domains of well-being related to life in general.

CONCLUSIONS

Patients' likelihood of changing GP increased with GP burnout and decreasing job satisfaction. These findings indicate that patients' evaluation of care as measured by COGP may be influenced by their GPs' work conditions and occupational well-being.