Burnout
a bigger factor than unsafe facilities
By TRACIE WHITE
Physician burnout is
at least equally responsible for medical errors as unsafe medical workplace
conditions, if not more so, according to a study led by researchers at
the Stanford
University School of Medicine.
“If we are trying to
maximize the safety and quality of medical care, we must address the factors in
the work environment that lead to burnout among our health care providers,”
said Tait Shanafelt, MD, director of the Stanford WellMD
Center and associate dean of the School of Medicine.
“Many system-level changes have been implemented to improve safety for patients in our medical workplaces. What we find in this study is that physician burnout levels appear to be equally, if not more, important than the work unit safety score to the risk of medical errors occurring.”
“Many system-level changes have been implemented to improve safety for patients in our medical workplaces. What we find in this study is that physician burnout levels appear to be equally, if not more, important than the work unit safety score to the risk of medical errors occurring.”
The study was published online July 9 in the Mayo Clinic Proceedings. Shanafelt, who is also a professor of hematology and the Jeanie and Stew Ritchie Professor, is the senior author. Daniel Tawfik, MD, an instructor in pediatric critical care medicine at Stanford, is the lead author.
A national epidemic
Medical errors are
common in the United States. Previous studies estimate these errors are
responsible for 100,000 to 200,000 deaths each year. Limited research, though,
has focused on how physician burnout contributes to these errors, according to
the new study.
The researchers sent
surveys to physicians in active practice across the United States. Of the 6,695
who responded, 3,574 — 55 percent — reported symptoms of burnout.
Ten percent also reported that they had made at least one major medical error during the prior three months, a figure consistent with previous published research, the study said.
The physicians were also asked to rank safety levels in the hospitals or clinics where they worked using a standardized questionnaire to assess work unit safety.
Ten percent also reported that they had made at least one major medical error during the prior three months, a figure consistent with previous published research, the study said.
The physicians were also asked to rank safety levels in the hospitals or clinics where they worked using a standardized questionnaire to assess work unit safety.
“We found that
physicians with burnout had more than twice the odds of self-reported medical
error, after adjusting for specialty, work hours, fatigue and work unit safety
rating,” Tawfik said. “We also found that low safety grades in work units were
associated with three to four times the odds of medical error.”
Shanafelt said, “This
indicates both the burnout level as well as work unit safety characteristics
are independently related to the risk of errors.”
Physician burnout has
become a national epidemic, with multiple studies indicating that about half of
all doctors experience symptoms of exhaustion, cynicism and feelings of reduced
effectiveness.
The new study notes that physician burnout also influences quality of care, patient safety, turnover rates and patient satisfaction.
The new study notes that physician burnout also influences quality of care, patient safety, turnover rates and patient satisfaction.
“Today, most
organizations invest substantial resources and have a system-level approach to
improve safety on every work unit. Very few devote equal attention to address
the system-level factors that drive burnout in the physicians and nurses
working in that unit,” Shanafelt said.
“We need a holistic and systems-based approach to address the epidemic of burnout among health care providers if we are truly going to create the high-quality health care system we aspire to.”
“We need a holistic and systems-based approach to address the epidemic of burnout among health care providers if we are truly going to create the high-quality health care system we aspire to.”
The study also showed
that rates of medical errors actually tripled in medical work units, even those
ranked as extremely safe, if physicians working on that unit had high levels of
burnout.
This indicates that burnout may be an even a bigger cause of medical error than a poor safety environment, Tawfik said.
This indicates that burnout may be an even a bigger cause of medical error than a poor safety environment, Tawfik said.
“Up until just
recently, the prevailing thought was that if medical errors are occurring, you
need to fix the workplace safety with things like checklists and better
teamwork,” Tawfik said.
“This study shows that that is probably insufficient. We need a two-pronged approach to reduce medical errors that also addresses physician burnout.”
“This study shows that that is probably insufficient. We need a two-pronged approach to reduce medical errors that also addresses physician burnout.”
Impact on physicians
In addition to their
effect on patients, both errors and burnout can also have serious personal
consequences for physicians. “We also know from our previous work that both
burnout and medical errors independently double the risk of suicidal thoughts
among physicians,” Shanafelt said.
“This contributes to the higher risk of death by suicide among physicians relative to other professionals.”
“This contributes to the higher risk of death by suicide among physicians relative to other professionals.”
Jochen
Profit, MD, associate professor of pediatrics at Stanford, and
researchers at the Mayo Clinic also contributed to the study.
The work was supported
by the National
Institutes of Health (grants R01HD084679 and K24HD053771), the
Jackson Vaughan Critical Care Research Fund, the Mayo Clinic Program on
Physician Well-Being and the American Medical Association and the Mayo Clinic
Program on Physician Well-Being.
Stanford’s Department of
Medicine also supported the work.