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Effect of burnout on quality of care may be exaggerated
Although physician burnout is associated with poor quality of care, the effects of burnout on patient care may have been exaggerated in some studies, according to findings published in the Annals of Internal Medicine.
“Although we did find that the published literature may contain more significant results than should be expected, the relationship between burnout and poor quality of care still appears to be moderately strong,” Daniel S. Tawfik, MD, MS, instructor in pediatric critical care medicine at Stanford University School of Medicine, told Healio Primary Care.
Researchers conducted a systematic literature review and meta-analysis of 123 studies that evaluated the relationship between physician burnout and quality of patient care. The studies included more than 240,000 health care providers. Metrics of quality of care were divided into five categories — best practices, communication, medical errors, patient outcomes, and quality and safety.
The effect of physician burnout on quality of care was varied among the studies(I2 = 93.4% to 98.8%).
Out of 114 unique combinations of physician burnout and quality of care outcomes, 58 demonstrated a statistically significant relationship between burnout and poor-quality care, 50 showed no significant effect between the two, and six found significant associations between burnout and high-quality care.
Tawfik and colleagues used the effect size from the most precise study with a low risk for bias to calculate the predicted prevalence of statistically significant associations between burnout and poor-quality care. They compared this to the actual prevalence of statistically significant associations found in the studies. Their analysis showed that the predicted prevalence of 62% was lower than the observed prevalence of 73% (P = .011), demonstrating an “excessive significance” of the associations between burnout and poor-quality care. This excess significance was most common in studies that assessed quality of care based on best practice guidelines and quality and safety metrics.
Tawfik told Healio Primary Care that more longitudinal studies are needed to determine the degree physician burnout reduces quality of care in a variety of medical setting to help inform effective approaches to reduce burnout and improve care.
“Primary care physicians are among the most severely affected by burnout and were strongly represented in the publications analyzed in this study,” Tawfik told Healio Primary Care. “Professional burnout is a systemic problem, and its strength of association with poor quality of care as described in this study should empower physicians to seek change if they are experiencing burnout, for their own benefit and that of their patients.” – by Erin Michael
Disclosures: Tawk reports receiving grants from Stanford Maternal and Child Health Research Institute during the conduct of the study. Please see study for all other authors’ relevant financial disclosures.