Physician Burnout Poses Patient Safety Risk

By John Palmer

A new study suggests that physician burnout is associated with a higher risk of patient safety incidents, poor care, and lower patient satisfaction.

The meta-analysis of 47 studies, published in the Journal of American Medical Association (JAMA) Internal Medicine, included more than 40,000 physicians. Looking at data compiled from the studies, the researchers found that physician burnout doubled the odds of them being involved in patient safety incidents.

“Physician burnout has taken the form of an epidemic that may affect core domains of healthcare delivery, including patient safety, quality of care, and patient satisfaction,” the report said.

An increased risk for safety incidents occurred when physicians were emotionally exhausted. The most risk for incidents occurred when physicians exhibited symptoms of depression and emotional distress—these symptoms more than doubled the risk for safety incidents, the report found.

The risks of burnout and depression from long hours in a high-stress and emotional job aren’t surprising. In another recent survey of American doctors conducted by Medscape, 42% of respondents said they felt burned out, and another 15% said they were depressed. Of those who identified as depressed, 3% said they suffered from clinical depression.

The highest rates of burnout occurred among critical care physicians (48%), neurologists (48%), and family physicians (47%), the survey found. Filtered by gender, women more often felt burned out than their male counterparts (48% versus 38%). By age, doctors in the 45–54 range most often experienced burnout, at just over 50%.

As far as patient care was concerned, 29% of the depressed survey respondents admitted to being less friendly with patients, 24% were less motivated to be careful when taking patient notes, and 14% expressed their frustration in front of patients. And when it came to safety implications, 14% of the depressed respondents said they made errors they wouldn’t normally make, putting patients and other healthcare workers at risk.

The effects of burnout on patient safety did not significantly vary by how established physicians were in their careers, the researchers found in the JAMA report. But residents and physicians who were just starting their careers showed a bigger association between burnout and lack of professionalism than physicians who had been practicing longer; presumably the latter group had greater maturity along with longer exposure to the stresses of the industry.

Reporting systems for care quality and patient safety outcomes need better standardization across healthcare organizations, enabling larger and more rigorous studies to examine the association between burnout and patient care, the researchers said.

“This meta-analysis provides evidence that physician burnout may jeopardize patient care; reversal of this risk has to be viewed as a fundamental healthcare policy goal across the globe,” the report said. “Healthcare organizations are encouraged to invest in efforts to improve physician wellness, particularly for early-career physicians. The methods of recording patient care quality and safety outcomes require improvements to concisely capture the outcome of burnout on the performance of healthcare organizations.”

Tips to help healthcare workers relax

Part of your responsibility as a healthcare safety professional is to make sure that your workers are healthy, and helping them reduce stress will help protect patients as well. It’s never a bad time to encourage your workers to take better care of their own health. The best thing to do is to make it part of your overall workplace culture, and to introduce safety and well-being into your training sessions. Here are some tips to help staff relax:

Lend them an ear. Some of the biggest complaints from healthcare workers are that they feel like no one is listening to them, that there is no process to report patient violence or safety problems, or that they simply need an avenue to talk about their feelings—after all, they are working in a very stressful career path, and the rigors of caregiving can and do take their toll.

Some healthcare facilities have counselors on call—or even on staff—to help their staff members deal with life’s issues. Others create peer groups consisting of fellow co-workers that can lend a listening ear when needed.

Put them in control. Train employees to be in control of stressful situations. This could be as simple as training them to de-escalate potentially violent incidents or putting them in control of decisions around the office—for example, letting one of the nurses pick the training topic for the upcoming monthly in-service. Allowing employees a little control over things shows they are valued and gives them more ownership over their jobs and careers—which ultimately leads to happiness and better job satisfaction.

It also might make your facility a safer place to work. Many healthcare security experts agree that violence stems from anxiety and fear, and they recommend de-escalation tactics that focus on calm talking and nonverbal language, sending a message of sympathy to the agitated person. These tactics can help your employees defuse a situation and give them the upper hand. Call your local police department or consult the internet to find a program that works for you.

Promote exercise and good nutrition. There is a cliché that people under a lot of stress feed their emotions, and that holds true in the healthcare environment, where long hours and high-intensity work conditions don’t always make for the best opportunities to eat right and get exercise.

Some workplaces organize groups of employees who walk together at lunch or after work, or offer an annual wellness benefit or a discount at a local fitness club. Some facilities even organize Zumba classes or other group exercise programs in their conference rooms.

To make sure your employees are eating at least one healthy meal a day, why not set up a “lunch bunch” or a weekly potluck breakfast or lunch where everyone brings in a healthy dish to share? It’s fun, it shows off employees’ culinary skills, and it gives your staff a chance to take a break and socialize (which, coincidentally, is a great way to relieve stress).

Put an end to bad ergonomics. Not all stress is born from moment-to-moment emergency response. Workers who sit at an office desk or a laboratory microscope all day are also prone to the stress and fatigue that comes from the repetitive motions of typing and sample handling, and from staring at a computer screen or into a lens for hours on end.

These things may not sound very stressful, but they have real health effects, and there is a growing field of study devoted to the prevention of injuries caused by poor ergonomics over a long period of time. You may want to employ the services of an occupational therapist to help improve the ergonomics at your employees’ workstations. For example, an occupational therapist will teach your office workers about proper posture, appropriate keyboard position, and correct monitor height to reduce neck strain.

At the very least, workers should be encouraged to take frequent breaks (once every 20 minutes at minimum) to stretch their legs and take their eyes off the computer screen. Many safety experts subscribe to the “20-20-20 rule,” which states that for every 20 minutes at a computer screen, workers should look up for 20 seconds at something 20 feet away to give the eyes a chance to refocus and relax.

Give them some help in their personal lives. Financial troubles, family issues, and childcare struggles can also affect a person’s work performance. Give your employees a hand by offering childcare services or invite an accountant to come in and give them a primer on personal finance. Also, a little stress relief can go a long way. Why not offer chair massages, a lunch out, bagels in the morning, or even a half-hour nap to help them recharge and relax?

John Palmer is a freelance writer who has covered healthcare safety for numerous publications. Palmer can be reached at