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Burnout in Healthcare Workers: Prevalence, Impact and Preventative Strategies


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Approximately, one in three physicians is experiencing burnout at any given time. This may not only interfere with own wellbeing but also with the quality of delivered care. This narrative review discusses several aspects of the burnout syndrome: prevalence, symptoms, etiopathogenesis, diagnosis, impact, and strategies on how to deal with the problem.
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Burnout in Healthcare Workers: Prevalence,
Impact and Preventative Strategies
This article was published in the following Dove Press journal:
Local and Regional Anesthesia
Stefan De Hert
Department of Anesthesiology and
Perioperative Medicine, Ghent University
Hospital, Ghent University, Ghent,
Abstract: Approximately, one in three physicians is experiencing burnout at any given time.
This may not only interfere with own wellbeing but also with the quality of delivered care.
This narrative review discusses several aspects of the burnout syndrome: prevalence, symp-
toms, etiopathogenesis, diagnosis, impact, and strategies on how to deal with the problem.
Keywords: burnout, healthcare worker, prevalence, impact, symptoms, prevention
Never overestimate the strength of the torchbearer’s arm, for even the strongest arms
grow weary.
AJ Darkholme, Rise of the Morningstar
Burnout is a work-related stress syndrome resulting from chronic exposure to job
stress. The term was introduced in the early 1970s by psychoanalyst Freudenberger
and has subsequently been dened by Maslach et al as consisting of three qualita-
tive dimensions which are emotional exhaustion, cynicism and depersonalization,
reduced professional efcacy and personal accomplishment.
Burnout can occur
in any kind of profession.
Healthcare workers, and especially perioperative clinicians seem to be at parti-
cular risk for burnout.
This may have signicant negative personal (substance
abuse, broken relationships and even suicide),
but also important professional
consequences such as lower patient satisfaction,
impaired quality of care,
even up to medical errors,
potentially ending up in malpractice suits with
substantial costs for caregivers and hospitals.
Therefore, alertness for the phenomenon with prompt recognition together with
the development of adequate coping personal and organisational strategies is
essential in dealing with this important problem in contemporary healthcare. The
last 10 years have witnessed an increasing interest in the topic with an exponential
growth in the number of papers published on the topic (Figure 1).
Because of the absence of a generally accepted denition of the syndrome of
burnout, its multifactorial origin and the vagueness and subjectivity of the diag-
nostic criteria, it is difcult to get a clear and correct overview of the prevalence of
burnout in a general population. Estimations report values up to 20% of the
Correspondence: Stefan De Hert
Department of Anesthesiology and
Perioperative Medicine, Ghent University
Hospital, Ghent University, Corneel
Heymanslaan 10, Ghent B-9000, Belgium
Tel +32 9 332 32 81
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working population but the number is strongly dependent
on the cut-off values to dene severe burnout.
Interestingly, the results of a Finnish study, looking at
the relation between the level of burnout and socio-
demographic factors found only small differences between
the different population groups studied. There was
a slightly higher incidence with increased age and some
gender-specic features. For instance, in women burnout
was related to education and socio-economic status while
for men, a relation to marital status was observed.
The reported incidence of burnout varies worldwide.
For instance, in Europe, a difference is observed between
the European Union countries (10%) and the non-
European Union countries (17%). Within the European
Union countries, the incidence of burnout ranges from
4.3% in Finland to 20.6% in Slovenia and within the non-
European Union countries from 13% in Albania to 25% in
This study also indicated that burnout at the
country level seemed positively related to the workload.
Burnout in Physicians
Burnout has been shown to occur in all kinds of jobs.
However, the incidence seems to be higher in physicians.
In a study comparing incidences of burnout between US
physicians and a population control sample, Shanafelt et al
observed an incidence of symptoms of burnout of 37.9%
in physicians compared to 27.8% in the control population
(p < 0.001).
Physicians in specialties at the front line of
care access such as family medicine, general internal med-
icine, and emergency medicine seem to be at greatest risk.
The 2020 Medscape National Physician Burnout and
Suicide Report reported a burnout rate of about 43%,
which remains quite similar to the 46% reported in 2015
and 39.8% in 2013. While most studies agree on the fact
that there is no real gender effect in the incidence of
the data from the Medscape National
Physician Report indicate that women physicians reported
more commonly symptoms of burnout (in 2015, 51%
female vs 43% male and in 2020, 48% female vs 37%
Interestingly, there seem to be gender differences
in the presence of the different symptoms: exhaustion,
depersonalization, and lack of efcacy. A study in general
practitioners showed that exhaustion and fatigue occur
equally in both sexes. On the other hand, the feeling of
lack of efcacy seems more common in women. It seems
that male physicians are less likely to doubt the quality of
their work than women.
It is difcult to have an exact estimation of the inci-
dence of burnout in physicians. A recent systematic review
including 182 studies published between 1991 and 2018
and involving 109,628 individuals in 45 countries
observed a substantial variability in prevalence estimates
of burnout among physicians, ranging from 0% to 80.5%.
This appeared to be related to important differences in
denitions of the syndrome and of the assessment methods
applied. There were no relevant associations between
burnout and demographic factors.
1970 1980 1990 2000 2010 2015 2016 2017 2018 2019
1970 1980 1990 2000 2010 2015 2016 2017 2018 2019
027 145
Figure 1 Overview of the number of PubMed hits for the search term “burnout” between 1970 and 2019.
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Burnout in Anesthesiologists
The 2020 Medscape National Physician Burnout and
Suicide Report ranked the incidence of burnout on 29
medical specialities. The top three medical specialisms
for burnout are urology (54%), neurology (50%), and
nephrology (49%). The lowest incidence of burnout is
reported in general surgery (35%), psychiatry (35%), and
orthopedics (34%). Anesthesiology comes on the 16th
place with 41%, emergency medicine on place 14 with
43%, and critical care on place 10 with a reported inci-
dence of burnout of 44%.
During the last decade, several studies have been pub-
lished specically looking at burnout in the anesthesiology
community. A recent systematic review identied a total
of 167 papers on the topic, from which nally 17 were
included to assess the prevalence and initiating factors for
From this study, it appeared that the occurrence
of burnout varied substantially among the different reports,
ranging from 10% to 59%. It seems to occur in all career
stages and is related to a stressful work situation. No
specic relationship was observed between burnout and
gender, or marital status. However, the authors underscore
that the small number of studies included together with the
large differences in their methodology and reporting
approach make reliable conclusions difcult and warrant
further research.
Burnout has been dened as a syndrome of emotional
exhaustion, depersonalization, and a sense of low personal
accomplishment that leads to decreased effectiveness at
Burnout seems to occur mainly in professions
involving an interaction with people, such as physicians,
nurses, social workers, and teachers but meanwhile, the
syndrome has been described in other professions.
The symptomatology of burnout appears to be rather
complex as the syndrome seems to develop in several con-
secutive stages. Initially, Freudenberger described its devel-
opment in a 12-stage model
(Figure 2). Later on, this model
has been simplied, and currently, a 5-stage model is most
frequently used (Figure 3). This 5-stage model starts with the
honeymoon phase and is characterized by enthusiasm.
However, inevitably, after time this becomes associated
with experiencing the stresses of the job. If at this stage, no
positive coping strategies are implemented, the process of
burnout risks to become initiated. This is followed by a stage
of stagnation characterized by the onset of stress. This second
stage begins with an awareness of some days being more
difcult than others. Life becomes limited to work and taking
care of business, while family, social life and personal prio-
rities are neglected and suffer and common stress symptoms
appear, which affect the person emotionally, but also physi-
cally. Then a stage of chronic stress develops which leads to
own needs
of conflicts
of values
denial of
Figure 2 12-stage model for the development of burnout as described by Freudenberger.
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frustration. Individuals get the feeling of failure and a sense
of powerlessness. Efforts do not visibly pay off and the
impression or fact of not receiving enough acknowledgement
leads to one feeling incompetent and inadequate. This then
leads to the stage of apathy, where despair and disillusion-
ment occur. People do not see a way out of the situation and
become resigned and indifferent. The nal stage is habitual
burnout. Symptoms of burnout cause a signicant physical or
emotional problem and ultimately these may prompt one to
look for help and intervention.
The list of symptoms is long and most of them are not
very specic (Figure 4). Symptoms are related to the
different stages of the syndrome and have been divided
into different clusters.
These include warning symptoms
in the early phase (increased commitment to goals and
exhaustion), followed by a phase of reduced commitment
(towards patients and clients, towards others in general,
towards work, towards increased demands), emotional
reactions and blaming (depression, aggression), nally
leading to reduction in cognitive performance, motivation,
creativity, and judgement, attening of emotional, social,
and intellectual life, psychosomatic reactions and despair.
The etiopathogenesis of burnout is multifactorial.
Different etiological factors are summarized in Figure 5.
These factors have been taken into account in the devel-
opment of the different psychological explanatory models
for the etiopathogenesis of burnout. The job demand-
control model focuses on the job task prole (job demand
vs control),
the effort-reward imbalance model focuses
on the work contract (effort vs reward),
and the organi-
zational injustice model focuses on organizational justice
(unfair procedures and their interactions).
Job Demand-Control Model
The job demand-control model was introduced by Karasek
in 1979 and focuses on the balance between the magnitude
of the demands (height of strain) and the level of control
(decision latitude) in a person’s work situation.
height of strain represents the requirements that are set at
work which may cause for stress. This includes all aspects
of the workload of a particular job such as work rate,
availability, time pressure, travel time, difculty of the
tasks, etc. The decision latitude refers to the possibilities
and freedom of an employee to organise and manage the
workload. Based on these concepts a diagram has been
proposed representing four different job situations, where
both the stress imposed by the work situation and the
personal attitude and engagement of the employee are
incorporated. These are the low- and high strain jobs and
the passive and active jobs (Figure 6).
The low strain job rectangle represents the combination
of a job without important demanding tasks but with where
the employee has some job decision latitude for instance
some freedom to decide on own schedules and targets. This
section represents a majority of the routine jobs. Persons in
this category may progressively get bored in their work
Figure 3 Simplied 5-stage model for the development of burnout which is most frequently used.
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Figure 4 Symptoms in the different stages of burnout.
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situation. A high strain job, on the contrary, refers to very
demanding and/or complex jobs with little control about
working conditions and targets by the employee. As
a consequence, the risk of stress is very high.
Passive jobs are simple jobs but with very little
decision latitude, typically repetitive production jobs.
Such jobs present very little stress but also no substan-
tial challenge to the employees. Active jobs, on the
Figure 5 External (environmental) and internal (personality-related) etiological factors for burnout.
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other end, represent highly demanding jobs but where
the employees have a high level of decision
In fact this model focuses on the balance between the
requirements of a job and the level of control the employee
has in his/her professional situation.
job demands
low high
risk for
psychological and
physical stress
motivation to
develop new
behavioral patterns
Figure 6 The job demand-control model, introduced by Karasek in 1979 focuses on the balance between the magnitude of the demands (height of strain) and the level of
control (decision latitude) in a person’s work situation.
Figure 7 The effort-reward imbalance model, proposed by Siegrist in 1996 denes threatening job conditions as a mismatch between high demand (high workload) and low
control over long-term rewards.
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Effort-Reward Imbalance Model
Another theoretical explanatory model for the etiopatho-
genesis for burnout is the effort-reward imbalance model.
It was proposed by Siegrist in 1996 and denes threaten-
ing job conditions as a mismatch between high demand
(high workload) and low control over long-term rewards.
An additional point in the model is the concept of over-
commitment to the job, which may negatively impact the
balance between effort and reward (Figure 7).
Organizational Injustice Model
A third model is the organizational injustice model. In
1987 Greenberg introduced the concept of organizational
justice. This refers to how an employee judges the beha-
vior of the organization.
There are four components of
organizational justice: distributive, procedural, interperso-
nal, and informational justice. Several models have been
proposed to explain the structure of organizational justice
perception including a two factor, a three factor, and a four
factor model. It is beyond the scope of this review to
discuss these. The interested reader is referred to specic
articles on the topic.
Other Proposed Models
Additional proposed models include the person-
environment t model, the job characteristics model, the
diathesis stress model, and the job demands resource
The multitude of explanatory models proposed
indicates the complexity of the syndrome of burnout and
no single model is capable of incorporating all the aspects
of its etiopathogenesis. As a consequence, the different
potential causative factors need to be explored when deal-
ing with an individual case of burnout (Figure 5). An
integration model of personality-related and environment-
related etiological factors has been proposed by Fisher
and has been considered plausible and practicable.
this model, the precondition for the development of burn-
out is a complementary interplay of factors in the employ-
ee’s personality and environmental triggering factors.
A health technology assessment report from 2010 commis-
sioned by the German Institute for Medical Documentation
and Information concluded that to date there is no standar-
dized and generally valid procedure to diagnose the burnout
A number of screening tools are now available.
The most frequently used is the Maslach Burnout Inventory
Others include the Tedium Measure (later
renamed the Burnout Measure),
the Shirom Melamed
Burnout Questionnaire (SMBQ), the Oldenburg Burnout
Inventory (OLBI), the Copenhagen Burnout Inventory
(CBI), and the School Burnout Inventory (SBI).
different questionnaires are adapted for the specic popula-
tion studied, in terms of language and culture and of specic
occupations. They all share a similar approach of looking at
burnout as a multi-dimensional construct consisting of the
main three components, emotional exhaustion, depersona-
lization, and reduced personal accomplishment (or dissatis-
faction with personal accomplishment). The problem is that
all value for the diagnosis of burnout, and when such a value
is used, it is determined arbitrarily. In addition, while the
dimension emotional exhaustion appears to be a constant
feature of burnout, this seems to be less the case for the
dimensions depersonalization and personal accomplish-
ment, which appear heterogeneous, thereby reducing the
signicance of the latter two dimensions.
Following its publication in 1981,
several new adapted
versions of the MBI were progressively developed to t
different groups and different settings.
There are currently
ve versions: Human Services Survey (MBI-HSS), Human
Services Survey for Medical Personnel (MBI-HSS (MP)),
Educators Survey (MBI-ES), General Survey (MBI-GS),
and General Survey for Students (MBI-GS (S)). The ques-
tionnaires look at the different dimensions of burnout. The
9-item emotional exhaustion (EE) scale measures feelings
of emotional overextension and exhaustion. The scale is
used in the MBI-HSS, MBI-HSS (MP), and MBI-ES ver-
sions. The MBI-GS and MBI-GS (S) use a shorter 5-item
version. The 5-item depersonalization scale assesses the
degree of impersonal response towards the recipients of
one’s care, treatment or service. This scale is used in the
MBI-HSS, MBI-HSS (MP) and the MBI-ES versions. An
8-item personal accomplishment scale measures feelings of
competence and achievement in one’s work and is used in
the MBI-HSS, MBI-HSS (MP), and MBI-ES versions. The
MBI-GS and MBI-GS (S) additionally score cynicism
(indifference towards one’s work) on a 5-item scale and
professional efcacy (feelings of competence and achieve-
ment) on a 6-item scale. All items are scored on a 7-level
frequency scale: never (0), a few times a year or less (1),
once a month or less (2), a few times a month (3), once
a week (4), a few times a week (5), and every day (6).
Currently, none of the assessment tools for burnout
provides instruments for differential diagnosis. In particu-
lar, the association between burnout and the chronic
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fatigue syndrome and burnout and depression is relevant,
as all entities share quite some common symptoms and
burnout is a risk factor for the development of
Burnout seems to be associated with musculoskeletal
diseases among women and with cardiovascular diseases
among men. These associations are not explained by socio-
demographic factors, health behavior, or depression.
Other studies have suggested that chronic burnout might
be a risk factor for the onset of type 2 diabetes,
The underlying neurobiological mechan-
isms for the physical effects of burnout are still unknown.
Several studies have investigated the association between
burnout and functioning of the hypothalamic-pituitary-
adrenal axis, but the results are not consistent and the
clinical implications of these ndings remain to be
Currently, there is no hard evidence for the
clinical usefulness of any specic biomarker for burnout.
Consequences of burnout are decreased job satisfaction,
turnover in personnel,
and cynicism.
These effects at work frequently have repercussions on per-
sonal life such as feeling unhappy, anxiety, depression, iso-
lation, substance abuse, frictional and broken relationships
and divorce.
Burnout in physicians may have more
serious professional implications than in other professions.
Indeed, physician burnout has been linked to suboptimal
patient care [8] resulting in lower patient satisfaction,
impaired quality of care.
This may eventually lead up
to medical errors,
with potential malpractice suits and
subsequent litigation, with substantial costs for caregivers
and hospitals as a consequence.
How to Deal with Burnout?
The complexity of the interaction between all the pre-
viously discussed external and internal factors in the
development of burnout underscores the importance of
a multifactorial approach in the prevention and the treat-
ment of the syndrome. This means that both the work
environment and the person’s own personality and attitude
towards the work situation need to be addressed. This
implies not only the implementation of measures at the
level of the professional employers and work environment
but also developing and implementing individual coping
Approaches to treating burnout syndrome should be
guided by the severity of the symptoms. If these are
minor and slight, measures such as changing life habits
and optimizing work–life balance are recommended.
These measures concentrate on three important pillars:
relief from stressors, recuperation via relaxation and
sport, and “return to reality” in terms of abandoning the
ideas of perfection.
Various wellness strategies can be applied by physi-
cians in order to cope with the symptoms of
A rst strategy focuses on relationships.
It refers to an understanding of the importance of spending
quality time with family, friends and signicant others.
This strategy also includes actively developing connec-
tions with colleagues, to share and reect with them on
emotional and existential aspects of being a physician.
A second element that seems to promote well-being in
some people is religious belief and/or spiritual practice.
This refers to a personal attentiveness to nurturing own
spiritual aspects.
It has been reported that up to 34%
of persons mentioned this aspect to be important and even
A third element deals with work attitudes.
This has two components. The rst one refers to nding
meaning and fulllment in work, the second one to
actively choosing and limiting the type of medical practice
such as working part-time, being involved in education
and/or research, managing schedule and discontinuing
unfullling aspects of practice. A fourth strategy consists
of self-care practices, in which an individual actively
cultivates personal interests and self-awareness in addition
to professional and family responsibilities. This also
implies actively seeking professional help in case of per-
sonal physical and psychological problems or illness.
Examples of such practices are, among others, exercise,
self-expression activities, adequate nutrition and sleep,
regular medical care, professional counseling, etc.
Finally, the fth component is adapting a specic life
philosophy. This is developing a philosophical approach
to life that is based on a positive outlook where one
identies own values and acts accordingly with emphasis
on the balance between personal and professional life. It is
likely that such strategies are also the designated tools to
be implemented in the prevention of the development to
Although each individual is in the end responsible for
his/her own wellness, organizational and institutional
awareness, attention to and recognition of the problem can
play a crucial role in promoting physicians’ well-being.
Job characteristics and institutional factors that contribute
to wellbeing include promoting autonomy,
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adequate ofce resources and support staff,
and facil-
itating a collegial work environment.
Giving physicians
the ability to inuence their work environment, to partici-
pate in organizational decisions that affect medical practice,
and to have more control over their time schedules seem to
have a substantial positive effect regardless of practice
Efforts to minimize work-home interference by
providing exible scheduling, childcare adapted to irregular
work hours, etc., are also important for increasing the
employees’ well-being.
If the symptoms of burnout are severe, psychothera-
peutic interventions are recommended. There may also be
a place for antidepressants, preferably combined with
There are several therapies for the treat-
ment of burnout but all with unclear evidence. In 2012,
a health technology assessment analyzed the usage and
efcacy of different burnout therapies.
In this systematic
review, 17 papers were included. Thirteen of them (partly
in combination with other techniques) deal with the ef-
cacy of psychotherapy and psychosocial interventions for
the reduction of burnout. In the majority of the studies,
cognitive behaviour therapy seems to result in the
improvement of emotional exhaustion. However, evidence
is inconsistent for the efcacy of stress management and
music therapy. Two studies on the efcacy of Qigong
therapy do not deliver a distinct result and only one
study shows the efcacy of the roots of Rhodiola Rosea.
Physical therapy is examined separately in only one study
and does not show a better result than standard therapy.
Some authors report the effects of considerable natural
Burnout has become an important problem and a challenge
for public health. Unfortunately, the syndrome still is not
clearly dened and there is no consensus on the
There is an agreement that burnout in medicine is
harmful to the professional, the institution, and the patient.
Risk situations should be identied and preventive mea-
sures should be implemented early to avoid future harm.
Therefore, prospective, longitudinal studies are needed to
further explore the causes of burnout and identify the
specic instruments to measure physician’s well-being.
We are also in need of additional prospective studies to
identify individual and organizational interventions that
can promote wellness and evaluate its effect on productiv-
ity, patient care, and patient satisfaction. Of note, well-
being may depend on different variables and therefore
studies specically focusing on different subpopulations
are needed.
Staff working in critical care
settings may be particularly affected.
This situation
may aggravate when the ow of critically ill patients starts
to exceed available capacities, as is for instance the case
with the recent COVID-19 pandemic.
Also the efcacy of therapies for the treatment of
burnout syndrome is insufciently investigated. There is
evidence from meta-analyses that organisational issues
need to be addressed as well as individual ones,
the exact most effective strategies to apply in each indivi-
dual remain to be established. Further studies are needed
to evaluate the efcacy of the different therapeutic options.
The author reports no conicts of interest in this work.
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... environment suffers from the displayed lack of empathy and unexpected emotional eruptions, the quality of patient care reduces due to mental distance and threats to patient safety [1,[7][8][9]. The existing high levels of burnout, especially among residents have led to attempts to improve residents' personal and jobrelated resources [10,11]. ...
... There is increasing knowledge of the etiological factors of burn-out in residents [1,9,28]. The Job Demands resource Model is a valuable and often cited model in this regard. ...
Full-text available
Background The burn-out rates among residents urge for adequate interventions to improve resilience and prevent burnout. Peer reflection, also called group intervision sessions, is a potentially successful intervention to increase the resilience of young doctors. We aimed to gain insight into the perceived added value of intervision sessions and the prerequisite conditions to achieve this, according to residents and intervisors. Our insights might be of help to those who think of implementing intervision sessions in their institution. Methods An explorative, qualitative study was performed using focus groups and semi-structured interviews with both residents (n = 8) and intervisors (n = 6) who participated in intervision sessions in a university medical center in the Netherlands. The topic list included the perceived added value of intervision sessions and factors contributing to that. The interviews were transcribed verbatim and coded using NVivo. Thematic analysis was subsequently performed. Results According to residents and intervisors, intervision sessions contributed to personal and professional identity development; improving collegiality; and preventing burn-out. Whether these added values were experienced, depended on: (1) choices made during preparation (intervisor choice, organizational prerequisites, group composition, workload); (2) conditions of the intervision sessions (safety, depth, role of intervisor, group dynamics, pre-existent development); and (3) the hospital climate. Conclusions Intervision sessions are perceived to be of added value to the identity development of medical residents and to prevent becoming burned out. This article gives insight in conditions necessary to reach the added value of intervision sessions. Optimizing preparation, meeting prerequisite conditions, and establishing a stimulating hospital climate are regarded as key to achieve this.
... Lack of employee engagement may contribute to burnout; however, limited research exists examining this perceived relationship [1]. High levels of burnout affect engagement levels, particularly in health care [2]. This critical problem correlates to patient safety concerns, profitability, productivity, turnover, absenteeism, shrinkage, and medical errors [3]. ...
... Freudenberger originally outlined burnout as a 12-stage process, but recently a 5-stage burnout development model is accepted. These 5 stages are elation, stagnation, prolonged pressure, burnout and habitual burnout (Kaschka et al., 2011;De-Hert, 2020). ...
... For example, early-career psychiatrists have shown emotional exhaustion and a low sense of personal accomplishment, whilst non-medical mental health practitioners report higher depression and depersonalisation as a coping strategy (Alqarni et al., 2022;Volpe et al., 2014). Higher levels of therapist occupational burnout and disengagement have additionally been associated with poorer psychological treatment outcomes due to the therapist's reduced ability to build alliance and empathy (De Hert, 2020;Delgadillo et al., 2018). ...
Full-text available
Purpose Resilience can protect against workplace stress, benefit psychological wellbeing and promote effective clinical practice in mental health professionals. The purpose of this study was to consider the feasibility and acceptability of resilience training for trainee mental health professionals based on the skills-based model of personal resilience (Baker et al. , 2021). The study also aimed to explore the impact of the training on resilience, wellbeing and burnout. Design/methodology/approach In a within-subject 10-week follow-up study, mixed methods were used to evaluate the one-day resilience training for trainee mental health professionals working in services in the UK. Findings The intervention was found to be acceptable to attendees, with high levels of satisfaction reported. Resilience was evaluated through self-report measures at three-time points. Resilience scores at follow-up were significantly higher than pre- and post-intervention scores. The secondary outcomes of wellbeing and burnout did not significantly improve. Research limitations/implications Preliminary support was found for the feasibility and acceptability of resilience training for trainee mental health practitioners. Audience-specific adaptations and follow-up groups to aid skills practice and implementation may further enhance benefits to resilience. Resilience interventions may supplement practitioner training to improve resilience. Resilience is associated with higher wellbeing and lower burnout. The impact of resilience training on overall wellbeing and burnout remains uncertain; however, newly learned resilience skills may take time to benefit wellbeing. Originality/value A key contribution of this study is to provide evidence regarding the feasibility of implementing the skills-based model of personal resilience, outlined in Baker et al. (2021), in a learning environment.
... Quanto à atividade assistencial, conclui-se que, globalmente, os valores efetivamente melhoraram, mas não é possível distinguir se isto se deve apenas ao facto de o CHL agora ser composto por três hospitais ao invés de apenas um, como acontecia em 2005, ou se existe componente derivada do pensamento administrativo de lógica privada. Já os dados financeiros estudados, demonstram que o CHL tem vindo a produzir mais em termos monetários consistentemente, no entanto, os custos subiram de forma ainda mais substancial, sendo os resultados negativos, o que vai contra o mote de racionalidade económica defendido pela empresarialização.Dado que o efeito da empresarialização hospitalar na cultura organizacional é um tema que tem vindo a ser estudado, havendo evidências de que as técnicas de gestão privadas não são bem aceites pelos funcionários públicos(Pereira & Correia, 2020;Pereira et al., 2022), mas que ainda carece de dados, procurou-se investigar mais sobre esse tema, e compreender se existem opiniões divergentes entre os funcionários do CHL.Constatou-se, através de um questionário e análise de clusters, que existe um grupo de funcionários com perceções positivas quanto à CO e um grupo com perceções negativas quanto à CO, considerando-se que a administração beneficiaria em estudar este fenómeno e perceber qual a melhor forma de colmatar as opiniões negativas, possivelmente através de uma maior valorização das ideias fornecidas pelos trabalhadores, para que estes se sintam ouvidos e respeitados, diminuindo o risco de burnout e de churning dos recursos humanos, dado que ambos estes fenómenos resultam em perdas financeiras, produtividade, e na qualidade do serviço prestado ao utente(De Hert, 2020; Pirrolas & Correia, 2023).Desta forma, evidencia-se o facto de que a reforma administrativa é morosa e complexa, e que apesar das intenções da empresarialização serem de melhorar a produtividade, a racionalidade económica e de desenvolver uma CO em que os funcionários têm atitudes quase empreendedoras, semelhantes a uma empresa(Diefenbach, 2009), não foi isto que se verificou ao longo desta investigação. Este estudo, nomeadamente o questionário, foi limitado pela circunstância de se basear num número restrito de impressões, facto explicado pelo curto espaço de tempo em que se recolheram respostas, e por ter sido enviado para o e-mail institucional dos funcionários, sendo que muitos deles não o hábito de o consultar com frequência. ...
Full-text available
A reforma administrativa fomentada pelos ensinamentos da Nova Gestão Pública trouxe, entre várias inovações, a empresarialização dos hospitais públicos. O propósito desta medida foi aumentar a eficácia, a eficiência, e a racionalidade económica. Passadas duas décadas desde a implementação deste novo estatuto, o presente estudo tenciona compreender a forma como este impactou os hospitais na prática, de modo a sondar o seu sucesso. Para atingir este fim a abordagem utilizada foi indutiva, valendo-se de um estudo de caso, o Centro Hospitalar de Leiria (CHL). Os métodos de recolha de dados empregados foram a análise documental e o questionário. Os dados secundários recolhidos através da análise documental provieram dos Relatórios e Contas 2006-2022 do CHL. A informação sobre o desempenho assistencial e financeiro foi analisada de modo a averiguar qual a tendência ao longo dos anos estudados. Os dados primários resultantes do questionário respondido por 282 funcionários do CHL, foram sujeitos a uma análise de clusters com o objetivo de perceber se existem perfis distintos entre os trabalhadores do CHL no que a cultura organizacional diz respeito. Os resultados obtidos demonstram que o objetivo primordial da empresarialização hospitalar, nomeadamente no caso do CHL, ainda tem um longo caminho a percorrer. No que concerne o desempenho assistencial, os dados são otimistas, tendo havido melhorias ao longo dos anos, no entanto, os dados financeiros não são tão promissores, visto que os custos anuais ultrapassam os proveitos anuais consideravelmente. Relativamente à cultura organizacional e aos agrupamentos de perceções apurados, determinou-se que o grupo maior (63.1%) de trabalhadores tem perceções negativas quanto à cultura organizacional, sendo o cluster com perceções positivas a minoria (36,9%). The administrative reform fostered by the teachings of New Public Management brought, among several innovations, the entrepreneurialization of public hospitals. The end goal was to increase efficiency, effectiveness, and economic rationality. Two decades after the implementation of this new statute, the present study intends to understand how it impacted hospitals in practice, to probe its success. To achieve this end, the approach used was inductive, using as case study, Leiria’s Hospital Centre. The data collection methods employed were document analysis and a questionnaire. The secondary data collected through document analysis came from the Hospital Center’s Reports and Accounts 2006-2022. The information on medical assistance and financial performance was analyzed to understand the trend over the years studied. The primary data resulting from the questionnaire answered by 282 employees were submitted to a cluster analysis, with the aim of perceiving whether there are different profiles among workers in terms of their perceptions of the organizational culture. The results obtained showed that the primary objective of hospital entrepreneurialization, particularly in the case of Leiria’s Hospital Center, has a long way until its fully reached. Regarding medical care performance, the data is optimistic, with improvements having been made over the years, however, the financial data is not as promising, as annual costs exceeded annual income. Regarding the organizational culture and the groupings of perceptions, it was determined that the largest group (63.1%) has negative perceptions regarding organizational culture, with the cluster with positive perceptions being the minority (36.9%).
... Por su parte Ahmed et al. (2020), menciona que el burnout en los médicos se considera una epidemia y tiene efectos negativos en la atención médica y la seguridad del paciente. Se ha estimado que uno de cada tres médicos sufrirá burnout en algún momento dado (Hert, 2020). A lo largo de la década anterior, se han realizado muchos estudios sobre la prevalencia, así como, los factores de riesgo del síndrome de burnout entre el personal médico (Youssef et al., 2022). ...
Full-text available
El burnout de los médicos se considera una epidemia y tiene efectos negativos en la atención médica y la seguridad del paciente; por lo que, el presente estudio tiene como objetivo determinar Síndrome de Burnout y su impacto en el desempeño laboral de los internos de un Hospital de la ciudad de Latacunga; para lo cual se efectuó una investigación metodológica de tipo descriptiva, correlacional Los datos se recopilaron a través de dos cuestionarios que fueron aplicados a 45 internos rotativos que laboran actualmente, obteniendo como resultado que existe una prevalencia de burnout del 40%. Además, en general el desempeño laboral es promedio y finalmente, los resultados de los análisis correlacionales indican que existe una relación positiva entre todas las dimensiones del desempeño y el burnout; esto implica que a medida que se mejora los índices de burnout se obtendrá un mejor desempeño laboral en los trabajadores.
... Rather, the test was initially developed to determine whether medical students would be eligible for state licensure at a later stage in training [4]. Student well-being and long-term burnout from stress surrounding Step 1 preparation have also been referenced as reasons for change [5][6]. Other analyses indicated that socioeconomic factors may also play a factor in performance on the Step 1 exam, with the assumption that more affluent students or those with more resources may be able to access more study materials or attend medical schools that provide more instructional material and support than the less affluent students [4,7]. ...
Full-text available
Background: Burnout rate is a global concern that everyone can experience. Burnout rate has reached epidemic proportions among healthcare professionals, with more than half of physicians and one-third of nurses reporting symptoms. The burnout rate epidemic is harmful to patient care and may worsen the looming physician shortage specifically and organizational employees in general. Studies have been done facility-based and department-wise but not at the organizational level. This study provides a brief history of burnout rate as well as a summary of its major associated factors and prevalence among Ethiopian Ministry of Health employees. Objective: The main objective of the study is to assess staff burnout rate and associated factors in the Case of the Ministry of health-Ethiopia. Methodology: A mixed methodology, both qualitative and quantitative and a cross-sectional study design are used to analyze staff burnout rate among the ministry of health employees. Relying on the study’s target population, a sample of 309 MoH Staffs complied to partake in the survey. Data was obtained from the administration of a well‑structured electronic questionnaire containing the Maslach Burnout Inventory together with open-ended questionnaires correspondingly. The scales were then analyzed using the STATA version 14 software. Result: Prevalence of Burnout rate was 44.14% in MoH-Ethiopia staffs. The main quantitative findings associated with high burnout rate were depersonalization OR 0.271(95%CI, 0.189-0.387), level of participation in decision making OR 0.369 (OR=95% CI, 0.1634-0.8345), educational level OR 1.379 (95% CI, 1.056-1.8017), and work experience OR 0.364(95% CI, 0.1354-0.9793). From the qualitative findings, low salary scale, bureaucratic leadership style, absence of incentive mechanism, organizational restructuring, long commute from work, low educational level, and female sex were the factors associated with high burnout rate. Conclusion: The study concluded that, surge in teamwork .high level participation in decision making, near residency to workplace leads to reduced emotional exhaustion and reduced depersonalization while simultaneously increasing professional accomplishment. Therefore, this study presents a solid foundation for decreasing burnout syndrome in healthcare that can be implemented by successfully increasing levels of teamwork quality, sufficient salary, decision making involvement, full staff awareness on organizational restructuring and positive leadership roles. Key words: Burnout rate, Burnout Inventory Tool, Exhaustion, commute, Teamwork, and Organizational Restructuring.
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Despite the significant consequences for medical practice and public health, burnout in healthcare workers remains underestimated. Pandemic periods have increased the reactivity to stress by favoring some changes whose influence are still felt. Purpose: This study aims to identify opportune factors during pandemic periods that predispose medical personnel to burnout and the differences between medical staff which worked with COVID-19 patients and those who did not work with COVID-19 patients. Material and Methods: This is a prospective study on 199 subjects, medical staff and auxiliary staff from national health units, COVID-19 and non-COVID-19, who answered questions using the Google Forms platform about the level of stress related to the workplace and the changes produced there. All statistical analyses were conducted using IBM SPSS Statistics (Version 28). Results: The limited equipment and disinfectant solutions from the lack of medical resources category, the fear of contracting or transmitting the infection from the fears in relation to the COVID-19 pandemic category and the lack of personal and system-level experience in combating the infection due to the lack of information on and experience with COVID-19 were the most predisposing factors for burnout. No significant differences were recorded between those on the front line and the other healthcare representatives. Conclusions: The results of this study identify the stressors generated in the pandemic context with prognostic value in the development of burnout among medical personnel. At the same time, our data draw attention to the cynicism or false-optimism stage of burnout, which can mask a real decline.
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Background Burnout syndrome has reached epidemic levels among physicians (reported around 50%). Anesthesiology is among the most stressful medical disciplines but there is paucity of literature as compared with others. Analysis of burnout is essential because it is associated with safety and quality of care. We summarize evidence on burnout in anesthesiology. Methods We conducted a systematic review (MEDLINE up to 30.06.2017). We included studies reporting burnout in anesthesiology with no restriction on role or screening test used. Results Fifteen surveys/studies described burnout in anesthesiology, including different workers profiles (nurses, residents, consultants, and directors). All studies used the Maslach Burnout Inventory test but with significant differences for risk stratification. Burnout prevalence greatly varied across studies (10%–41% high risk, up to 59% at least moderate risk). Factors most consistently associated with burnout were strained working pattern, working as younger consultant, and having children. There was no consistent relationship between burnout and hospital characteristics, gender, or marital status. Conclusions Burnout prevalence among anesthesiologists is relatively high across career stages, and some risk factors are reported frequently. However, the small number of studies as well as the large differences in their methodology and in reporting approach warrants further research in this field.
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Even though burnout is one of the most widely discussed mental health problems in today’s society, it is still disputed and not officially recognized as a mental disorder in most countries. In the tradition of the social study of science, the objective of this article is to analyze how burnout has been investigated in the health sciences in the past four decades, and how this has influenced the ways burnout is understood today. We conducted an extensive quantitative and qualitative literature analysis on all publications on burnout listed in PubMed until 2011. We show that the number of publications on burnout increased considerably over the past 40 years, and identified six categories into which each study can be grouped. The studies are not equally distributed across the categories: Most focus on causes and associated factors. Only a very small number of articles deal with psychological and somatic symptoms of burnout and attempt to develop diagnostic criteria. We argue that just this distribution is the reason why burnout research reproduces the vagueness and ambiguity of the concept that it aims to clarify, and discuss our results in the light of the concept of medicalization.
Objectives: To summarize the results of expert discussions and recommendations from a National Summit and survey on the promoting wellness and preventing and managing burnout in the ICU. Data sources: Literature review; Critical Care Societies Collaborative (CCSC) Statement on Burnout Syndrome in Critical Care Healthcare Professionals: A Call for Action; CCSC's National Summit on Prevention and Management of Burnout in the ICU; and a descriptive survey on strategies for addressing burnout using Research Electronic Data Capture (REDCap) ( Data synthesis: Building on the CCSC call for action to address burnout among critical care professionals, the CCSC sponsored the National Summit on Prevention and Management of Burnout in the ICU with 55 invited experts in various fields including psychology, sociology, integrative medicine, psychiatry, suicide prevention, bereavement support, ethics, palliative care, meditation, mindfulness-based stress reduction, among others. Attendees joined breakout groups, to identify factors influencing burnout in ICU professionals and the value of organizational and individual interventions. As a follow-up to the Summit, a descriptive survey assessing strategies for addressing burnout was sent via email or newsletter blast with responses received from 680 CCSC members, including physicians, nurses, pharmacists, therapists, and others. Conclusions: The Summit attendees identified the importance of raising awareness among critical care clinicians and key stakeholders, advocating for workplace changes to promote healthy work environments, and promoting research to further explore practical strategies to address, mitigate, and prevent burnout. Critical care clinicians reported that a number of initiatives are being implemented both at their hospitals and at the unit level to build resilience and address burnout prevention. However, other respondents reported that no measures were being used within their organizations, and that colleagues were experiencing burnout. Dissemination and application of resiliency building measures and strategies to address burnout in critical care clinicians are needed.
Importance: Burnout is a self-reported job-related syndrome increasingly recognized as a critical factor affecting physicians and their patients. An accurate estimate of burnout prevalence among physicians would have important health policy implications, but the overall prevalence is unknown. Objective: To characterize the methods used to assess burnout and provide an estimate of the prevalence of physician burnout. Data sources and study selection: Systematic search of EMBASE, ERIC, MEDLINE/PubMed, psycARTICLES, and psycINFO for studies on the prevalence of burnout in practicing physicians (ie, excluding physicians in training) published before June 1, 2018. Data extraction and synthesis: Burnout prevalence and study characteristics were extracted independently by 3 investigators. Although meta-analytic pooling was planned, variation in study designs and burnout ascertainment methods, as well as statistical heterogeneity, made quantitative pooling inappropriate. Therefore, studies were summarized descriptively and assessed qualitatively. Main outcomes and measures: Point or period prevalence of burnout assessed by questionnaire. Results: Burnout prevalence data were extracted from 182 studies involving 109 628 individuals in 45 countries published between 1991 and 2018. In all, 85.7% (156/182) of studies used a version of the Maslach Burnout Inventory (MBI) to assess burnout. Studies variably reported prevalence estimates of overall burnout or burnout subcomponents: 67.0% (122/182) on overall burnout, 72.0% (131/182) on emotional exhaustion, 68.1% (124/182) on depersonalization, and 63.2% (115/182) on low personal accomplishment. Studies used at least 142 unique definitions for meeting overall burnout or burnout subscale criteria, indicating substantial disagreement in the literature on what constituted burnout. Studies variably defined burnout based on predefined cutoff scores or sample quantiles and used markedly different cutoff definitions. Among studies using instruments based on the MBI, there were at least 47 distinct definitions of overall burnout prevalence and 29, 26, and 26 definitions of emotional exhaustion, depersonalization, and low personal accomplishment prevalence, respectively. Overall burnout prevalence ranged from 0% to 80.5%. Emotional exhaustion, depersonalization, and low personal accomplishment prevalence ranged from 0% to 86.2%, 0% to 89.9%, and 0% to 87.1%, respectively. Because of inconsistencies in definitions of and assessment methods for burnout across studies, associations between burnout and sex, age, geography, time, specialty, and depressive symptoms could not be reliably determined. Conclusions and relevance: In this systematic review, there was substantial variability in prevalence estimates of burnout among practicing physicians and marked variation in burnout definitions, assessment methods, and study quality. These findings preclude definitive conclusions about the prevalence of burnout and highlight the importance of developing a consensus definition of burnout and of standardizing measurement tools to assess the effects of chronic occupational stress on physicians.
This study explores the dimensionality of organizational justice and provides evidence of construct validity for a new justice measure. Items for this measure were generated by strictly following the seminal works in the justice literature. The measure was then validated in 2 separate studies. Study 1 occurred in a university setting, and Study 2 occurred in a field setting using employees in an automobile parts manufacturing company. Confirmatory factor analyses supported a 4-factor structure to the measure, with distributive, procedural, interpersonal, and informational justice as distinct dimensions. This solution fit the data significantly better than a 2- or 3-factor solution using larger interactional or procedural dimensions. Structural equation modeling also demonstrated predictive validity for the justice dimensions on important outcomes, including leader evaluation, rule compliance, commitment, and helping behavior.
Background: Physician burnout has reached epidemic levels, as documented in national studies of both physicians in training and practising physicians. The consequences are negative effects on patient care, professionalism, physicians' own care and safety, and the viability of health-care systems. A more complete understanding than at present of the quality and outcomes of the literature on approaches to prevent and reduce burnout is necessary. Methods: In this systematic review and meta-analysis, we searched MEDLINE, Embase, PsycINFO, Scopus, Web of Science, and the Education Resources Information Center from inception to Jan 15, 2016, for studies of interventions to prevent and reduce physician burnout, including single-arm pre-post comparison studies. We required studies to provide physician-specific burnout data using burnout measures with validity support from commonly accepted sources of evidence. We excluded studies of medical students and non-physician health-care providers. We considered potential eligibility of the abstracts and extracted data from eligible studies using a standardised form. Outcomes were changes in overall burnout, emotional exhaustion score (and high emotional exhaustion), and depersonalisation score (and high depersonalisation). We used random-effects models to calculate pooled mean difference estimates for changes in each outcome. Findings: We identified 2617 articles, of which 15 randomised trials including 716 physicians and 37 cohort studies including 2914 physicians met inclusion criteria. Overall burnout decreased from 54% to 44% (difference 10% [95% CI 5-14]; p<0·0001; I(2)=15%; 14 studies), emotional exhaustion score decreased from 23·82 points to 21·17 points (2·65 points [1·67-3·64]; p<0·0001; I(2)=82%; 40 studies), and depersonalisation score decreased from 9·05 to 8·41 (0·64 points [0·15-1·14]; p=0·01; I(2)=58%; 36 studies). High emotional exhaustion decreased from 38% to 24% (14% [11-18]; p<0·0001; I(2)=0%; 21 studies) and high depersonalisation decreased from 38% to 34% (4% [0-8]; p=0·04; I(2)=0%; 16 studies). Interpretation: The literature indicates that both individual-focused and structural or organisational strategies can result in clinically meaningful reductions in burnout among physicians. Further research is needed to establish which interventions are most effective in specific populations, as well as how individual and organisational solutions might be combined to deliver even greater improvements in physician wellbeing than those achieved with individual solutions. Funding: Arnold P Gold Foundation Research Institute.