Physician burnout undermines safe healthcare, says study

Healthcare systems which push staff to the brink of burnout will result in less patient satisfaction, according to a a study published in the BMJ. 

A systematic review of 170 observational studies has found that burnout among healthcare professionals is associated with a doubling of the chances of patient safety incidents, low levels of professionalism, and significant decreases in patient satisfaction.

The review also found that burnout was associated with a threefold to almost fourfold increase in the odds of job dissatisfaction and regrets about career choice, that physicians with burnout were three times more likely to consider quitting than staying in their jobs, and that burnout was associated with significantly lower productivity.

These relationships vary with respect to specialty, age, career stage, clinical setting, and level of national income and resources. The findings suggest that the consequences of burnout are exacerbated by acute healthcare environments, such as emergency departments and intensive care units.

The challenges for patients, practitioners, researchers and leaders in healthcare management and policy fall into three broad themes.

First, burnout undermines professional engagement and results in loss of commitment and high turnover and absenteeism. Physician’s wellbeing must be prioritised in all efforts to resolve these problems.

Second, burnout is fundamentally rooted in the work environment. Although manifesting in individuals, burnout is an indicator of a dysfunctional workplace. A broad evidence base in occupational health research has detailed various related adverse characteristics in work clinical environments. Excessive workloads, and work intensity in particular, have been shown to increase physician fatigue and deplete both motivation and engagement.

Burnout is the inevitable result of physicians coping with exceedingly high workload caused by understaffing, inadequate support, and poor leadership, combined with imbalances between effort and reward, and moral injury stemming from the inability to provide adequate standards of care.

Third, healthcare provider burnout is a risk to patient safety and must be treated like any other patient safety risk. Effective, evidence based interventions to reduce burnout are available at individual, workplace, and organisational levels. Work design and organisation level interventions are often neglected but are the key to meaningful progress on burnout.

Reducing any preventable harm requires understanding the underlying causes of that harm, changing practices and culture, promoting staff engagement through peer learning, and aligning policy efforts around common goals and measures. Systems engineering approaches are needed to successfully design and secure these improvements, in full partnership with healthcare professions. Advocacy and policy changes that address burnout on a societal level are also pivotal.

Better research methods are needed to explore and quantify the specific contribution of physician burnout. Research is needed that goes beyond observational studies and self-reported safety outcomes to establish effects of burnout and disengagement on patient outcomes. Qualitative studies are also required to explore the complex relationships between physicians and their working environments.

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