Organizational strategies to reduce physician burnout: a systematic review and meta-analysis

Physician burnout, associated factors, and their effects on work performance throughout first-year internships during the COVID-19 pandemic in Thailand: a cross-sectional study

BACKGROUND

Burnout has become a significant occupational concern for physicians who have recently graduated, attributed to their prolonged exposure to workplace stressors, poor work-life balance, and limited patient care experience. These challenges posed during the COVID-19 pandemic, placed unprecedented stress on healthcare systems and first-year interns navigating their careers. This study aimed to assess the prevalence of burnout among first-year intern physicians (1st IPs), investigate the factors contributing to burnout, and explore potential correlations between burnout and work performance.

METHODS

This cross-sectional study was carried out between June and July 2022, enrolling 412 1st IPs in Thailand. These participants completed a questionnaire through an online web-based platform. The questionnaire included the Maslach Burnout Inventory-Human Services Survey for Medical Personnel to assess burnout, as well as items addressing factors related to working conditions. These factors included colleague support, academic counselling, professional satisfaction, income and workload balance, medical errors, work performance, resignation thoughts, and suicidal ideation. Data were analysed using multivariable logistic regression.

RESULTS

Among the participants, 58.5% were female, with an average age of 25.59 years (SD 2.18). A significant proportion (81.2%) worked more than 80 h per week. Nearly half, 48.1% experienced burnout, characterized by high levels of emotional exhaustion (83.5%), depersonalization (74.8%), and low personal accomplishment (66.5%). In the adjusted model, physicians lacking support from their colleagues had higher levels of burnout (adjusted odds ratio [aOR] 2.56, 95% CI 1.18 to 5.58). Those dissatisfied with their professional life were more likely to experience burnout compared to those who were satisfied (aOR 4.52, 95% CI 2.31 to 8.84). Burnout was also significantly associated with poor work performance (aOR 2.14, 95% CI 1.08 to 4.21), while no association was found between burnout and suicidal ideation.

CONCLUSIONS

Our findings revealed a significantly high prevalence of burnout among 1st IPs in Thailand. This burnout was associated with inadequate colleague support and professional dissatisfaction, ultimately resulting in poor work performance. To address these issues, mentorship programs and buddy support systems, along with adherence to recommended work-hour guidelines, are crucial to mitigate burnout and improve work performance.

Burnout trajectories among healthcare workers during a pandemic, and predictors of change

BACKGROUND

While several cross-sectional studies have suggested high burnout levels among health-care workers (HCW) during the Covid-19 pandemic, fewer studies have examined longitudinal trajectories of burnout.

OBJECTIVES

To examine (1) trajectories of change in levels of burnout among Norwegian HCW during a one-year period in the mid-phase of the Covid-19 pandemic (second, third, and fourth incidence rate peaks), and (2) how demographic and occupational variables, and pandemic-related experiences (e.g., own infection, severe infection in family, friend, or colleague, caring for deceased patient with Covid-19) were associated with such change.

METHODS

Burnout was measured by the Copenhagen Burnout Inventory. Latent growth curve modeling was used to estimate trajectories of burnout symptoms, and predictors of starting point and rate of change in burnout levels.

RESULTS

Starting points of burnout scores were, on average, low-to-moderate. Women, younger HCW, those living alone, and nurses had higher initial scores. Overall, burnout scores remained mostly unchanged across the study period. However, lower burnout scores at the initial assessment were associated with increasing scores over time. Being exposed to patients with Covid-19 and having a Covid-19 infection were associated with increased burnout over time.

CONCLUSIONS

While burnout symptoms among frontline health workers remained stable across the peaks of the Covid-19 pandemic overall, the study identified higher risk of worsening symptoms over time among certain demographic (younger personnel, females, and nurses) and highly exposed individuals and groups. These findings may be helpful for identifying frontline workers at particular risk of burnout during future public health emergencies.

Assessing burnout and quality of life among residents and fellows in a high-stress environment: a cross-sectional study

BACKGROUND

Postgraduate medical trainees (PGMT) are at increased risk of burnout and diminished quality of life (QoL) due to the intense demands of medical training, especially in conflict-affected regions where additional stressors prevail. This study evaluates burnout and QoL levels among PGMT in a tertiary medical center and identifies associated predictors.

METHODS

A cross-sectional study conducted among 112 PGMT between May and June 2024 used the Maslach Burnout Inventory Human Services Survey (MBI-HSS) and the WHOQOL-BREF to assess burnout and QoL, respectively. Bivariate and multivariable analyses identified predictors of MBI-HSS subscales (emotional exhaustion (EX), depersonalization (DP), and professional efficacy (PE)) and WHOQOL-BREF domains (physical, psychological, social and environmental) respectively.

RESULTS

This study found that 58% of the participants exhibited high levels of emotional EX, 28% showed high levels of DP, and 50% reported low levels of PE. QoL scores across physical, psychological, social, and environment domains ranged from 57.7 to 58.7. Social isolation, chronic disease, and financial challenges had statistically significant positive associations with burnout subscales and reduced QoL in various domains.

CONCLUSION

Burnout levels among PGMT are more favorable than expected but EX and low PE levels remain concerns. QoL perceptions across various domains were moderately satisfactory, yet issues such as social isolation, mental health problems, and financial difficulties negatively impacted trainees' well-being. Targeted interventions to manage burnout and enhance QoL remain essential for trainees' well-being and the effective functioning of medical institutions.

Organizational interventions to support and promote the mental health of healthcare workers during pandemics and epidemics: a systematic review

BACKGROUND

Understanding organizational mechanisms that protect the mental health of the healthcare workforce during pandemics and epidemics is critical to support decision-making related to worker health and safety. This systematic review aimed to identify organizational-level factors, strategies or interventions that support the mental health of healthcare workers during pandemics or epidemics.

METHODS

A comprehensive search was used, including online databases, a grey literature review, and handsearching of reference lists. Studies were eligible for inclusion if they described implementing or testing organizational-level factors, strategies or interventions to support healthcare workers' mental health during pandemics or epidemics. There were no limitations by language, publication status, or publication date. Two reviewers independently conducted screening, data extraction, data analysis and quality appraisal, with conflicts resolved through discussion or third-party arbitration. Data analysis was guided by the Job Demands-Resources Model. A narrative synthesis is presented, given the high degree of heterogeneity across studies.

RESULTS

A total of 10,805 articles from database searches and 190 records from other sources were screened. The final review included 86 articles. Studies were of low (n = 11), moderate (n = 39), and high quality (n = 36). Regarding job demands, 40 studies explored high work pressure or heavy workload factors, with the majority investigating working hours (n = 32). Increased working hours may be associated with an increased risk of diverse mental health outcomes. Regarding job resources, leadership factors, strategies (support, appreciation, responsiveness; n = 19) and leadership interventions (n = 3) may be associated with decreased burnout, anxiety, stress, and increased well-being. The availability and adequacy of personal protective equipment (n = 20) may be associated with decreased burnout, anxiety, depression, and stress. Mixed findings were reported on associations between diverse mental health outcomes and training and education (n = 28) or peer support (n = 3). Results should be interpreted cautiously given the high heterogeneity among factors, strategies, and interventions assessed and outcomes measured.

CONCLUSIONS

Organizational-level mechanisms can critically influence the mental health of healthcare workers' during pandemics and epidemics. More focused attention is needed to explore and act on the integral role of leadership and the availability of protective equipment to support healthcare workers' mental health.

Burnout and risk factors among anesthesia residents and fellows in a conflict-affected context: A national cross-sectional survey

BACKGROUND

Burnout is an occupational hazard caused by chronic exposure to excessive work-related stress, negatively impacting both clinicians' well-being and patient safety. Anesthesiology is particularly demanding, and this stress is further exacerbated in regions affected by conflict, where residents and fellows are confronted with additional stressors beyond the usual challenges of medical training. This study aims to assess the proportion and predictors of burnout among anesthesia residents and fellows in Lebanon, a conflict-affected context, by identifying specific drivers of burnout in this population, while also evaluating their association with sociodemographic characteristics.

METHODS

A cross-sectional study involving electronic, voluntary, and anonymous survey was sent to all Lebanese anesthesiology residents and fellows at all levels of training, between May and October 2024. The survey utilized the Copenhagen Burnout Inventory (CBI) in addition to other questions. Bivariate and multivariable analyses identified predictors of CBI subscales (personal, work-related, and client-related burnout respectively). An alpha of 0.05 was used to determine statistical significance.

RESULTS

Approximately 71% of participants reported personal burnout, with 32% classified as having a high level. Additionally, 68% reported work-related burnout, with 22% in the high category, and 36% experienced client-related burnout, with 5% classified as high. Moreover, experiencing mental health problems, reporting the need for pharmaceutical or psychological assistance, living with family and covering night shifts were found to be significantly and positively associated with different burnout dimensions.

CONCLUSION

Burnout levels among anesthesiology residents in conflict-affected areas appear elevated in reference to international studies, which is concerning given the additional stressors associated with ongoing regional conflict. The continuous escalation of these challenges is likely to exacerbate burnout over time. Targeted interventions to manage burnout are crucial for trainees' well-being and the effective functioning of medical institutions, particularly in conflict-affected regions where the stressors are compounded.

Person-directed burnout intervention for nurses: A systematic review of psychoeducational approaches

BACKGROUND

Nurse burnout is a pervasive issue impacting their well-being and patient care quality. Recognized by the World Health Organization as an "occupational phenomenon," burnout results from inadequately managed chronic workplace stress and manifests as emotional exhaustion, depersonalization, and reduced personal accomplishment. This can lower the quality of life and increase turnover. Effective interventions are vital to overcome nurse burnout and its consequences.

OBJECTIVE

This systematic review explored and analyzed the effectiveness of person-directed psychoeducational interventions in reducing nurse burnout.

MATERIALS AND METHODS

A comprehensive search of five databases was conducted for studies published between 2014 and 2023, following PRISMA guidelines. Eligible studies that reported outcomes of psychoeducational interventions using validated evaluation tools were included. Data were extracted using standardized forms, and quality was assessed with Joanna Briggs Institute critical appraisal tools. A thematic narrative synthesis was performed.

RESULTS

27 studies met the inclusion criteria. Interventions including mindfulness-based interventions and cognitive-behavioral therapy, delivered either in combination or on their own, were shown to be effective in reducing nurses' burnout in 24 studies. However, the sustainability of these effects varied, with limited long-term follow-up data. Additionally, delivery formats (physical, digital, or combined), also influenced effectiveness, suggesting the importance of tailored interventions to specific contexts and needs of the target population.

CONCLUSIONS

Psychoeducational interventions effectively reduce nurse burnout but need further investigation to ensure long-term sustainability. Future research should target diverse settings, incorporate objective and subjective outcome measures, and explore a broader range of interventions to strengthen evidence of burnout management strategies.

The great wall against burnout: CSR's influence in China's hospitality services sector

In the dynamic arena of China's hospitality industry, understanding employee well-being has emerged as a paramount concern. The primary purpose of this study is to explore the intricate dynamics between Corporate Social Responsibility (CSR) and the pervasive issue of employee burnout, particularly within Beijing and Shanghai, the country's hospitality nerve centers. Hypothesizing that CSR can act as a protective shield against burnout, we further postulate that employee happiness and intrinsic motivation play intermediary roles in this relationship. Data collection spanned Beijing and Shanghai's diverse hospitality organizations, using a rigorous three-wave approach that culminated in insights from 385 valid responses. Through advanced structural equation modeling, the findings robustly validate our hypotheses, revealing the profound influence of CSR on burnout, mediated by happiness and motivation. This research not only elevates the academic discourse on workplace well-being and CSR in the Chinese context but also bears significant practical implications, emphasizing the strategic importance of employee-centric CSR initiatives for sustained organizational success in the hospitality sector.

Mitigating Burnout: The Role of Healthcare Organizations

Even before the coronavirus disease (COVID-19) pandemic, burnout in healthcare providers had reached crisis levels, with up to 50% of nurses and 40% of physicians experiencing symptoms of burnout. Because of the immense work-related stress during the pandemic, healthcare providers' burnout dramatically escalated, with percentages reaching as high as 70-90%, and many healthcare providers started to leave their profession. As a result, patients are beginning to experience the deleterious impact of extreme staffing shortages in healthcare facilities. Burnout interventions are defined as either organizational or individually focused. Organizational interventions address problems such as electronic medical records, documentation, or billing systems. Individual interventions provide the necessary skills to address specific job-related stressors. Ideally, the most effective interventions would combine these two categories by teaching healthcare providers to cope with job-related stressors in a safe community that is supported by the healthcare organization. The adoption of combined organizational and individual programs will improve healthcare providers' job satisfaction, decrease burnout and other forms of psychological distress, enhance job retention, and return joy to health care. The resulting decreased turnover rates would also reduce some of the skyrocketing healthcare costs, as turnover is expensive for healthcare organizations. Ultimately, enhancing healthcare providers' well-being would improve the care we deliver to our patients. In this article, I explain why it is a critical time in health care and highlight four general principles that frame the development of specific well-being interventions. Finally, I discuss several interventions that could enhance the well-being of healthcare providers and ultimately transform the culture of health care.

Toward better prevention of physician burnout: insights from individual participant data using the MD-specific Occupational Stressor Index and organizational interventions

Background

Physician burnout has become a public-health crisis. The need is dire for robust organizational solutions, focusing on reduction of specific stressors. The physician-specific Occupational Stressor Index (OSI) based on cognitive ergonomics can help. Individual-participant data (IPD) from different studies addressing physician burnout are lacking.

Aims

To perform IPD analysis regarding job stressors and their relation to physician burnout and to utilize the IPD results to inform a systematic review of the stressors that show an association with physician burnout, focusing on intervention studies.

Methods

PRISMA guidelines are followed for the IPD analysis and systematic review of intervention studies on the implicated stressors, taking the COVID-19 pandemic into consideration. The IPD analysis is performed on studies using the physician-specific OSI vis-à-vis burnout assessed by the Copenhagen Burnout Inventory (CBI). Odds ratios (OR) ± 95% confidence-intervals (CI) are reported, adjusting for age, gender and caring for patients with suspected COVID-19 infection.

Results

Three studies fulfilled the inclusion criteria, providing complete IPD data for 95 physicians. Thirty-two (33.7%) physicians had total OSI scores >88, for which intervention is urgently needed. Unit-change in the total stressor burden assessed via OSI yielded OR = 1.11 (95%CI: 1.03-1.18) (p = 0.003) for personal burnout, OR = 1.17 (95%CI: 1.08-1.26) (p = 0.0001) for work-related burnout and OR = 1.07 (95%CI: 1.01-1.15) (p = 0.03) for patient-related burnout. Caring for patients with suspected COVID-19 infection showed significant multivariable results (p = 0.04) only for personal burnout. Twenty distinct work stressors revealed multivariable associations with CBI. Systematic examination via PUBMED, CINAHL and OVID Medline yielded 33 publications mitigating those stressors among physicians. Adequate staffing was pivotal. Clerical staff off-loaded administrative burden. Information-technology staff helped diminish interruptions, enhancing workflow. Cross-coverage reduced time constraints, ensured separate periods for non-clinical tasks, and ≥1 work-free day/week. Several interventions impacted physician burnout, as did recognition of physicians' efforts/achievements. Other OSI-identified stressors were insufficiently examined in intervention studies: e.g. vacation; appropriately-timed, cross-covered restbreaks; and counter-measures for emotionally-disturbing aspects of MD's work, particularly during the pandemic.

Conclusions

Further participatory-action research is needed in well-controlled intervention trials to alleviate physician burnout.

Association between burnout and working motivation among rehabilitation doctors: a multicentre cross-sectional study in China

Burnout and working motivation are two interconnected concepts that significantly influence doctors' working performance and overall well-being. However, the relationship between burnout and working motivation among rehabilitation doctors remain unclear. Therefore, the purpose of this study was to explore the association between burnout and working motivation among rehabilitation doctors in China. A multistage sampling scheme was employed to select rehabilitation doctors as study participants. A total of 220 participants from 21 medical institutions in 7 cities in China were included in the final analysis. The measurement included working motivation, burnout, and general characteristics (such as age, sex, educational level, title, working experience, etc.). Structural equation modelling (SEM) was used to analyse the association between burnout and working motivation among rehabilitation doctors. Among 220 rehabilitation doctors, the mean age of participants was 37.0 years (SD: 7.7), and 43.6% were male. The prevalence of emotional exhaustion, depersonalisation, and lack of personal accomplishment was 20.9, 16.4, and 24.1%. The average total score of working motivation was 47.7 (SD: 8.0). SEM results indicate that burnout had a negatively correlation with working motivation (β = -0.63, 95% CI -0.77, -0.50) after controlling confounders. Burnout decreases the working motivation among rehabilitation doctors. The strategies to balance burnout and enhance working motivation should be strengthened.

The work environment and hospitalist work well-being and burnout

BACKGROUND

Hospital medicine is the largest growing specialty in the United States. It is important to understand factors that are related to burnout and work well-being (WWB), both predictors of workforce retention.

OBJECTIVE

To examine the relationship between work environment factors and hospitalist burnout and WWB.

METHODS

An online cross-sectional survey was completed by hospitalists in July-October 2020. Burnout was assessed using the Mini-Z burnout scale and the Abbreviated Maslach Burnout Inventory. WWB was assessed using the Work Well-Being Scale. Work structure variables included hours worked per week, frustration at work, safety level of clinical workload, lack of control over schedule, lack of control over daily work, continuity of patient care, and ability to optimize license. The current desire to practice medicine was also examined.

RESULTS

Eight-eight hospitalists participated. There were statistically significant differences between levels of safety of workload (F(2,85) = 9.70, p ≤.005), frustration at work (F(2,85) = 12.29, p ≤.005), control over schedule (F(2,85) = 3.17, p = .04), control over daily work (F(2,85) = 6.17, p = .003), and desire to practice medicine (F(2,85) = 42.34, p = <.005) with WWB. There were statistically significant associations between the presence of burnout and the safety of workload (χ2 = 8.167, p = .017), frustration at work (χ2 = 15.29, p = .005), control over daily work (χ2 = 12.48, p = .002), and desire to practice medicine (χ2 = 7.12, p = .03). WWB was positively associated with years as a hospitalist (r = .249, p = .02).

CONCLUSION

Work environment factors are associated with WWB and burnout. Modifiable work environment factors may offer a point of intervention for reducing burnout and enhancing WWB among hospitalists.

Burnout in medical education: interventions from a co-creation process

INTRODUCTION

The high prevalence of burnout in medical education indicates an urgent need to develop and implement effective interventions at both the individual and organisational levels. Currently, there is a shortage of studies that include perspectives from multiple stakeholders, such as medical students, trainees and university staff. Our objective is to identify and discuss interventions from various stakeholders using a bottom-up approach to guide future implementation.

METHODS

A co-creation methodology was adopted, including workshops and a Delphi session, engaging 96 participants. The study included 12 workshops with medical students and trainees in Flanders (Belgium): first-year bachelor students (n = 12), first-year master students (n = 13), first-year General Practice (GP) trainees (n = 14) and first-year specialist trainees (n = 39). Additionally, one Delphi session was held with 18 other relevant stakeholders, including university staff. All workshops were transcribed verbatim and thematically analysed using NVivo.

RESULTS

Our results identified interventions to prevent and mitigate burnout among medical students and trainees. On the individual level, participants discussed personalized coaching, annual health assessments and training sessions. On the organisational level, a distinction was made between interventions intended for universities, and those for hospitals and GPs involved in medical training. Six interventions focused on preventing burnout in all contexts (i.e., onboarding programs); three were meant for universities only (i.e., pass-fail system), and six were tailored for hospitals and GPs (i.e., flexibility in scheduling).

CONCLUSION

Through an iterative multistakeholder co-creation process, this study identified interventions to prevent and mitigate burnout within medical education. These interventions span individual and organisational levels, targeting universities, hospitals and GPs. While organisational interventions are increasingly recognized as crucial to address burnout, individual-focused interventions remain predominant in current research. There is a pressing need to further investigate organisational interventions and their combination with individual-focused strategies.

Impact of a multimodal intervention on junior and senior hospital physicians' job satisfaction and wellbeing: a matched pre- and post-intervention study

BACKGROUND

Physician wellbeing has a direct impact on patient care. Meta-analyses have concluded that interventions are moderately effective at reducing physician burnout, but new studies are needed to target populations at higher risk (e.g. young physicians) and determine which interventions might be most effective.   METHOD: Using matched questionnaires, we conducted a cross-sectional pre-post study of a multimodal intervention to promote physician wellbeing. The intervention involved a change in institutional culture, information on occupational wellbeing, and the organisation of undisturbed lunch breaks and short breaks during the day. The primary outcome was the proportion of physicians satisfied with their job (scoring >3 points  on the Work-Related Quality of Life [WRQoL] scale). Secondary outcomes were overall WRQoL score, WRQoL subscale scores, number of short breaks taken during the working day, number of lunch breaks taken, physicians' likeliness of recommending their job to peers, monthly overtime hours worked and monthly sick days. Subgroup analyses included women vs men, residents vs chief residents/senior physicians, and participants with vs without children. We also explored potential factors influencing WRQoL in the pre-intervention population.

RESULTS

Pre- and post-intervention questionnaires were returned by 134 (63%) and 87 (42%) physicians, respectively, with 75 responding to both (matched). The intervention significantly increased the proportion of physicians satisfied with their job (from 49/75 [65%] to 58/75 [77%], p = 0.02), median overall WRQoL score (from 3.3 [IQR: 2.8-3.8] to 3.5 [IQR: 3.1-3.8], p <0.01), median Home-Work Interface subscale score (from 2.7 [IQR: 2.0-3.3] to 3.0 [IQR: 2.3-3.7], p = 0.01) and median General Well-Being subscale score (from 3.4 [IQR: 2.6-4.0] to 3.6 [IQR: 3.0-4.0], p <0.01). Residents showed a greater increase in overall WRQoL median score (from 3.2 [IQR: 2.7-3.6] to 3.5 [IQR: 3.3-3.8]) than chief residents/senior physicians (3.3 [IQR: 2.9-3.9] to 3.4 [IQR: 3.0-3.8], p <0.01 for group difference). No significant differences were seen in other subgroups or secondary outcomes in the matched population. Among the 134 participants in the pre-intervention period, those taking a daily lunch break, sleeping 7 hours or more or self-reporting doing sports activities on weekdays had higher overall WRQoL scores.

CONCLUSIONS

This wellbeing intervention increased physicians' WRQoL scores. However, the difference was small and its relevance remains uncertain.

Working with people living with motor neurone disease and the impact on professionals' emotional and psychological well-being: A scoping review

BACKGROUND

Integrated multidisciplinary care is required to manage the progressive and debilitating symptoms associated with motor neurone disease. Professionals can find providing the level of care required by this population clinically and emotionally challenging. To support those working with these patients it is important to understand the experience of the entire multidisciplinary team involved and the impact of working with motor neurone disease on their emotional and psychological well-being.

AIM

To identify what is known about (1) healthcare professionals' experience of working with motor neurone disease and (2) the impact of this work on their emotional and psychological well-being.

DESIGN

Scoping review. Review protocol registered on Open Science Framework.

SOURCES

Five electronic databases were searched in January 2023 and 2024. Grey literature and hand searches were completed.

RESULTS

Fifty-one sources published between 1990 and 2023 were included. A total of 1692 healthcare professionals are represented. Three main categories were identified: (1) The demands of providing motor neurone disease care. (2) Factors influencing professionals' ability to provide desired levels of care. (3) The emotional impact of working with motor neurone disease. Subcategories are depicted within these.

CONCLUSION

Positive experiences included job satisfaction, enhanced perspective and receiving gratitude, while negative implications such as stress, emotional exhaustion and burnout also featured. The demands of motor neurone disease patient care, the organisation of services and resources required to meet patient and family needs and the emotional burden for professionals involved, warrant greater recognition in clinical practice, guidelines and future research.

Physician wellbeing in a national rehabilitation hospital, a qualitative study utilizing Maslow's hierarchy of needs as a framework for analysis

BACKGROUND

Globally, healthcare systems are experiencing a workforce crisis which has been exacerbated by the COVID19 pandemic. Numerous reports have documented the deterioration of healthcare professional wellbeing with burnout being called the new pandemic. Rehabilitation Medicine Physicians are among the most likely specialties to experience burnout. There is a strong association between staff and patient experience and global and national policies and strategies have recognized the importance of ensuring staff wellbeing in healthcare organisations. Although there have been many publications on interventions focusing on wellbeing, these have been directed mainly at personal rather than organisational factors. Maslow's hierarchy of needs, an integrated hierarchy of human needs, has been utilised as a framework to assess wellbeing in doctors but not heretofore in Rehabilitation Medicine. This study aimed to explore Rehabilitation Medicine Physician wellbeing in a complex specialist rehabilitation setting.

METHODS

Qualitative deductive content analysis (an approach to reanalyzing existing data in a new context) was the approach used. Maslow's hierarchy of needs was used as the categorization matrix. Qualitative data from three different data sources were systematically analysed.

RESULTS

Using Maslow's five needs (psychological, safety, social, esteem, and self-actualisation needs), the analysis demonstrated that Rehabilitation Medicine Consultants' needs were not being met at any of the five levels. The data revealed what constitutes relative deprivation and organisational injustice.

CONCLUSIONS

In order to enable the flourishing of the Rehabilitation Medicine Consultants, the organisation needs to focus on satisfying not just basic needs but creating the conditions for them to function at the highest level. The adapted Maslow framework provides a scaffolding for interventions to support such flourishing.

Burnout and organisational stressors among healthcare staff working with adults with intellectual disabilities in Ireland

BACKGROUND

The associations between organisational stressors and burnout among healthcare staff working with adults with intellectual disabilities are underexplored. This study investigated rates of burnout and associated stressors among Irish healthcare workers during the COVID-19 pandemic.

MATERIALS AND METHODS

A convenience sample of 329 Irish frontline staff supporting adults with intellectual disabilities completed a survey assessing personal, work-related, and client-related burnout, and organisational stressors. Quantitative correlational analysis assessed bivariate and multi-variate associations, while qualitative accounts were analysed thematically.

RESULTS

Compared to international data, we observed very high levels of personal and work-related burnout, with lower levels of client-related burnout. "Lack of resources" was the stressor holding the strongest association with burnout, followed by "bureaucracy" and "work-home conflict". Qualitative responses highlighted the negative impact of the pandemic on workload, service quality, and staff wellbeing.

DISCUSSION

Our findings highlight an important association between organisational stressors and burnout among frontline staff, suggesting the potential benefit of designing organisationally focused interventions to reduce stress and promote staff wellbeing.

Psychosocial Climate as Antecedent for Resources to Manage Emotional Demands at Work

BACKGROUND

Effectively managing emotional demands in the workplace is crucial in professions such as healthcare, education, and social work. Recent studies indicate that the psychosocial safety climate within an organization can significantly mitigate the negative effects associated with high emotional demands.

METHOD

This study examines whether psychosocial safety climate is associated with six practical strategies for managing emotional demands that have previously been found to be associated with less burnout. It utilizes longitudinal data from 1457 participants across 129 different workplaces in various emotionally demanding professions. The associations were analyzed using linear regression and Poisson regression techniques. All analyses incorporated cluster-robust standard errors to account for potential dependencies arising from respondents sharing the same workplace.

RESULTS

The results indicate that higher levels of psychosocial safety climate are significantly associated with the availability of practical strategies. Furthermore, the incidence rate of receiving multiple types of support increases significantly for each point increase in psychosocial safety. Additionally, these relationships remain consistent even under high work demands.

CONCLUSIONS

The results underscore the importance of fostering a psychosocial safety climate and increasing the availability of practical strategies to manage emotional demands in the workplace. This approach may safeguard employee well-being in high-demand professions.

Impact of the COVID-19 Pandemic on Retirement Among Canadian Otolaryngologists

IntroductionOtolaryngologists were among the physicians with the highest risk of exposure to SARS-CoV-2, and more than half of them reported anxiety and distress during the pandemic. Consequences of this experience on retirement plans among otolaryngologists are unknown. This study aimed to describe the effect of the pandemic on retirement plans among otolaryngologists.MethodsA cross-sectional survey assessed retirement plans of physicians in the Canadian Society of Otolaryngology-Head and Neck Surgery (CSOHNS) between May and June 2023. Participants were recruited through CSOHNS membership lists. Respondents shared demographic information and rated 4 pandemic-related factors and 13 independent factors on a 5-point Likert scale from least important to most important in influencing retirement.ResultsEighty-two members responded, of which 20 (24.4%) were females. All female participants were 65 or younger, whereas 25 (40.3%) males were 65 or older. Half of the participants were in academic practice; 39% reported no change to their anticipated retirement date prior to the pandemic, whereas 25% reported either earlier or later dates. A greater proportion of female otolaryngologists reported earlier dates of retirement than originally planned compared with males (40% vs 19.3%). The factors most commonly rated as "important" were the desire for time with loved ones (mean: 3.82, SD: 1.179), the desire to improve their quality of life (mean: 3.65, SD: 1.344), and increased workload (mean: 3.26, SD: 1.210). Significant differences were observed between genders and age groups (≤55 years vs >55 years) regarding increased workload, desire for improved quality of life, personal and loved ones' health concerns, pandemic-related concerns, psychological/emotional issues, and burnout (P < .05).ConclusionsPandemic-related factors play a limited role in retirement decisions made by otolaryngologists. More females reported earlier retirement dates after the pandemic, which may further exacerbate preexisting gender inequalities in the otolaryngology workforce.

Protocol of randomized-controlled trial to examine the effectiveness of three different interventions to reduce healthcare provider burnout

BACKGROUND

Burnout is among the greatest challenges facing healthcare today. Healthcare providers have been found to experience burnout at significant rates, with COVID-19 exacerbating the challenge. Burnout in the healthcare setting has been associated with decreases in job satisfaction, productivity, professionalism, quality of care, and patient satisfaction, as well as increases in career choice regret, intent to leave, and patient safety incidents. In this context, there is a growing need to reduce provider burnout through targeted interventions, yet little is known about what types of interventions may be most effective. The present study aims to contribute to and extend prior literature by using rigorous randomized controlled trial (RCT) methodology with a parallel group design to examine the effectiveness of different interventions in decreasing mental distress, increasing self-efficacy and attenuating inefficiencies and dissatisfiers in the work environment to achieve sustainable improvement.'

METHODS

The present study is an ongoing randomized controlled trial (RCT) that examines the effectiveness of three different types of interventions to reduce provider burnout: an intervention targeting emotional wellbeing and resilience, Electronic Health Record (EHR) skills training, and performance improvement training, relative to a no-treatment control group. This study aims to enroll a total of 400 healthcare providers in a large urban hospital system. Outcomes will be assessed at post-treatment and 6-month follow-up. Key outcomes include burnout, emotional health, intent to leave, EHR mastery, and confidence in performance improvement. Changes in outcome measurements from baseline to post-intervention across the intervention and control groups will be conducted using linear mixed-effects models (LMM).

DISCUSSION

This study is novel in that it compares several interventions addressing both personal as well as system-level drivers of provider burnout that have been theorized to operate among healthcare providers. In addition, post-treatment and longer-term follow-up assessments will provide insight into the maintenance of effects. Another innovation is the inclusion of different types of patient-facing providers in the study population (doctors, nurses, and therapists).

TRIAL REGISTRATION

This study was registered at ClinicalTrials.gov (NCT05780892) on March 10th, 2023.

Insights into general practitioners' self-care across 38 countries during the pandemic: a cross-sectional study

BACKGROUND

The adoption of healthy self-care practices has proven necessary for professional life, as they often serve as a shield against stressors in the workplace. The COVID-19 pandemic created a high strain on general practitioners (GPs), contributing to increased workload, burnout, and anxiety. The present study aimed to identify self-care practices adopted by GPs amid the COVID-19 pandemic; and to explore the relationships between self-care practices and risk of distress.

METHODS

The current study utilized an online questionnaire arriving from the PRICOV-19 study, which was distributed among GP practices across 38 countries. The main focus was on the open-text responses where participants disclosed self-care practices employed to maintain mental health during COVID-19. The Six Domains of Self-Care theoretical framework was applied to investigate GP self-care practices across 6 domains including Physical, Professional, Relational, Emotional, Psychological, and Spiritual. The Mayo Clinic Well-Being Index (eWBI) was applied to assess mental well-being and risk of distress among GPs. The analysis was carried out using SPSS Statistics software.

RESULTS

In total, 2,949 GPs provided open-text responses on maintaining their mental health. 65.5% of GPs had an eWBI score of ≥ 2 and were considered at risk of distress. The majority of the participants prioritised physical (61.7%), followed by relational (38.0%) and psychological (34.6%) self-care practices to maintain their mental health during the pandemic. GPs who applied relational, physical, and professional self-care were significantly less likely to experience depression, stress, and emotional exhaustion, in comparison with the ones who did not apply these practices. GPs who practiced professional self-care practices had the lowest distress risk (eWBI = 1.99). Overall, 5% of GPs disclosed not applying any practices to maintain their mental health during the pandemic and were the most prone to mental health distress.

CONCLUSIONS

GPs have navigated the pandemic uniquely, and despite applying self-care practices they faced some level of impact, hence self-care interventions for healthcare professionals should be regarded as essential rather than optional. A long-term investment in strategies focused on improving GPs' self-care is necessary to increase resilience among GPs and ensure their optimal well-being levels are achieved.

Interrelationships of stress, burnout, anxiety, depression, quality of life and suicidality among Chinese residents under Standardized Residency Training: a network analysis

BACKGROUND

Chinese resident physicians confront challenges such as staff shortages and heavy workloads, leading to a heightened prevalence of mental distress. This study aims to investigate the symptom network of stress, burnout, anxiety, depression (SBAD) and adverse personal outcomes in this cohort.

METHODS

From October 2020 to April 2022, 994 physicians were recruited across China through snowball sampling. Stress, burnout, anxiety and depression were assessed using the 10-item Perceived Stress Scale, a two-item burnout questionnaire, Generalized Anxiety Disorder Scale-7 and the Patient Health Questionnaire-9, respectively. Data on adverse personal outcomes (low quality of life [QOL] and suicidal ideation) were collected. We constructed and visualized two networks, calculating expected influence (EI) and bridge EI indices to identify central and bridge symptoms.

RESULTS

In the SBAD network, perceived helplessness was the most central and critical bridge symptom connecting stress and mental distress, with emotional exhaustion identified as the secondary bridge symptom. Perceived helplessness, perceived self-efficacy and emotional exhaustion exhibited the highest negative correlations with QOL. Worthless (PHQ6) and motor (PHQ8) symptoms were strongly correlated with suicidal ideation. The estimated SBAD network showed excellent stability and accuracy.

CONCLUSIONS

Our study emphasizes that perceived helplessness may be a high-priority target for preventing and intervening in mental distress and improving QOL among residents. Burnout transcends workplace problems and is widely connected to depression, anxiety and QOL. Implementing early detection and intervention measures at three levels-the individual physician, health system and professional colleges, and external regulators-is crucial for preventing and alleviating stress and mental distress among residents.

The Mediating Role of Work-Family Interface in the Relationship Between Quantitative Workload and Interpersonal Strain: A Gender-Based Moderation Analysis

PURPOSE

The study investigates the role of work-family interface dimensions (negative work-to-family interface, NEGWIF; negative family-to-work interface, NEGFIW; positive work-to-family interface, POSWIF; and positive family-to-work interface, POSFIW) as mediators in the relationship between workload and interpersonal strain. In addition, we examined the moderating effect of gender.

DESIGN/METHODOLOGY/APPROACH

319 Italian employees working in the commercial sector participants completed a self-report questionnaire. The hypothesized models were tested using PROCESS Macro.

FINDINGS

Work-family interface dimensions totally mediated the relationship between workload and interpersonal strain. Moderating influence of gender was found. Gender moderated the relationship between workload and three work-family interface dimensions-NEGWIF, POSWIF and POSFIW-in the indirect relationship between workload and interpersonal strain.

RESEARCH LIMITATIONS/IMPLICATIONS

This study suggests to organizations that moderate workload and family-friendly policies can act as a protective factor against interpersonal strain. The limitations of the study are the use of self-report measures and the cross-sectional design.

ORIGINALITY/VALUE

This research attempted to fill the gap in interpersonal strain and relationships with the work-family interface.

Individual and organizational interventions to reduce burnout in resident physicians: a systematic review and meta-analysis

BACKGROUND

Burnout among resident physicians during training has been prevalent, prompting training centers to introduce interventions at the individual or organizational level. However, empirical evidence is crucial before implementing such programs in practice.

METHODS

A systematic review and meta-analysis was carried out to evaluate the effectiveness of individual and organizational interventions in reducing burnout among resident physicians. Searching was done across five databases-PubMed, Scopus, ScienceDirect, Embase, and Cochrane Library from 1 December 2023 to 26 August 2024. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used for our reporting of study selection process. Eligibility criteria were randomized or non-randomized designs, with prospective intervention, with a comparator group focused on individual or organizational interventions reducing burnout, in any language and publication date. The Maslach Burnout Inventory scores for emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA) were the three outcome measures. Two investigators independently extracted the data. The risk of bias was evaluated using Cochrane risk-of-bias tool for randomized trials (RoB2) and non-randomized studies of interventions (ROBINS-I). Cohen's d and heterogeneity was estimated using a random-effects DerSimonian-Laird model and visualized by forest plots. Sensitivity analyses were carried out by leave-one-out meta-analysis.

RESULTS

We identified 33 eligible studies (n = 2536), comprising 25 (75.8%) individual intervention studies and 8 (24.2%) organizational intervention studies. Cohen's d for individual intervention versus control were as follows: EE -0.25 (95% CI -0.40 to -0.11, p < 0.01, I2 = 49.3%), and DP -0.17 (95% CI -0.32 to -0.03, p = 0.02, I2 = 50.0%). The organizational intervention showed no significant association with any domain. Sensitivity analyses were robust in all outcomes, with differences in intervention description and design identified as potential contributors to heterogeneity.

CONCLUSIONS

Various interventions, including individual coaching, meditation, and organization interventions, have been implemented to improve resident burnout. The effectiveness of intervention demonstrated none to small practical significance in improving burnout. Data inconsistency and high risk of bias across studies limited the validity of the pooled results. Further studies should focus on a combined approach.

REGISTRATION

The study was registered on PROSPERO, under PROSPERO registration number CRD42022349698.

Prevalence, risk factors and clinical impact of burnout in internal medicine units: a call to action

Health workers, and in particular doctors and nurses working in internal medicine units (IMU), are at high risk of burnout. Overcrowding, complexity and severity of clinical cases, patients' social and family issues, impact of death, and "workload" are all aspects that are specific risk factors that might lead to the development of burnout in this scenario. People suffering from burnout may face several psychological problems (including extreme physical and mental fatigue, emotional exhaustion, loss of enthusiasm concerning work, feelings of cynicism, and a low sense of personal accomplishment) and are also at risk of developing some somatic diseases. Furthermore, the quality of care delivered by a worker in burnout seems to worsen and slip down. In this review, we analyzed the main risk factors and consequences of burnout in IMUs, and we propose individual and organizational measures that may be applied to be able to prevent burnout in this setting.

U.S. physician burnout and the proletarianization of U.S. doctors: A theoretical reframing

We delve into the escalating issue of U.S. physician burnout, arguing its roots lie in the proletarianization of the U.S. medical profession-a transition driven by the loss of autonomy and control under the shadow of capitalist systems. This process, aligned with Marx's concept of proletarianization, sees physicians morph from independent practitioners to exploited workers within a wage-labor system controlled by a corporatized U.S. healthcare system. We contend that contemporary factors attributed to U.S. physician burnout-loss of control, emphasis on productivity, increased clerical demands, and a diminishing sense of work's meaning-are not novel but deeply ingrained in the medical profession's socio-historical fabric. By juxtaposing burnout with proletarianization, we highlight macro-level sources of strain and advocate for reevaluating physician work through Marxist theory and, in turn, extend the argument that addressing burnout necessitates moving beyond individual or organizational solutions to encompass broader socio-economic structures as seen through the lens of work exploitation. We conclude by discussing "class consciousness" among U.S. physicians and posit that collective awareness and action could pave the way for substantial reforms for the practice of medicine, the organization of medicine as a profession, and the burnout epidemic among U.S. physicians.

Gender Differences in Domestic Responsibilities of Otolaryngologists-A Mixed-Methods Analysis

OBJECTIVES

Female otolaryngologist-head and neck surgeons (OHNS) confront unique barriers. This study examines the influence of home life, especially gendered division of household labor, on leadership, productivity, and burnout.

METHODS

A survey was distributed through social media and national society list-serv. Demographics, responsibility for household roles, and Maslach Burnout Inventory for Medical Personnel were included. Participants were invited to participate in semi-structured interviews, employing purposive sampling, with qualitative thematic analysis.

RESULTS

Response rate was 26.4% (145 of 550 of eligible participants; 38.7% women, 60.7% men). Significantly fewer women were married (64.3% vs. 92% of men, p < 0.001), and significantly more were childless (21.4% of women vs. 9.1% of men, p = 0.037). More men reported exclusive/major responsibility for five duties, including yard work and home maintenance (all p < 0.03). More women reported exclusive/major responsibility for 15 duties, including meal planning and coordinating childcare (all p < 0.03). Women had higher Emotional Exhaustion on univariate analysis (p = 0.015). Across 27 interviews, two main themes were identified, each with three associated subthemes: Theme one, "division of duties," with subthemes (1) the way household duties were divided, (2) traditional gender norms, and 3. changing duties over time/unexpected circumstances. Theme two, "impact of domestic duties," with subthemes (1) professional, (2) financial, and (3) burnout/life satisfaction.

CONCLUSIONS

Women OHNS disproportionately manage domestic responsibilities, possibly altering career trajectory for some OHNS. Burnout, especially emotional exhaustion, may be elevated due to inequitable labor. Future research should focus on identifying ways to improve equity for this group.

LEVEL OF EVIDENCE

N/A Laryngoscope, 134:S1-S12, 2024.

Implementation of Coaching to Address Burnout in Emergency Clinicians

BACKGROUND

Factors including sleep disturbances, shift work, secondary traumatization, and workplace violence make emergency nurses uniquely susceptible to burnout. A recent study cited nearly half of emergency registered nurses (49.3%) experienced moderate to severe burnout. There is an urgent need for evidence-based solutions to address burnout and turnover in emergency nurses. The objective of this quality improvement project was to determine the effectiveness of a wellness coaching program for reducing burnout and turnover in emergency nurses and advanced practice providers.

METHODS

Baseline assessments of burnout and turnover intention were measured at the beginning of the coaching program and measured again upon completion of the coaching program.

INTERVENTION

Eight registered nurses and 2 advanced practice providers from an emergency department in a west coast community hospital completed 6 to 8 weeks of wellness coaching led by a board-certified nurse coach. The wellness coaching program was an evidence-based, modular curriculum in which participants chose the number and length of sessions.

RESULTS

An average of 6 hours of individualized, 1-on-1 wellness coaching was completed over 7.5 weeks. The project resulted in a large reduction in emotional exhaustion and turnover intention, no effect on depersonalization, and a small reduction in lack of personal achievement (Cohen's d = 0.79, 1.53, -0.18, and -0.35). Ninety percent of clinicians agreed or strongly agreed that coaching helped improve their burnout and said they would consider it again in the future.

CONCLUSION

This quality improvement project demonstrates wellness coaching was an evidence-based solution for improving burnout and turnover in emergency nurses. More investigation is needed to determine duration of reduction of these outcomes.

Association of Burnout and Other Factors Within Physicians and Advanced Practice Providers in an Academic Surgery Department

BACKGROUND

Provider burnout is a work-related syndrome that is under-recognized, under-reported, and has negative repercussions on the individual, system, and patients. This study investigated burnout incidence and its association with wellness characteristics such as resilience, psychological safety, and perceptions of the workplace to inform future work in improving well-being.

METHODS

Electronic surveys were sent to 153 physicians and advanced practice providers (APPs) in the department of surgery at a single institution. Survey topics included demographics, intention to stay, engagement, and items from validated measures for workplace perceptions including work pace/stress (Mini Z), burnout, psychological safety, and resilience. Descriptive statistics, bivariate associations, and logistic regression were used to evaluate responses.

RESULTS

Overall response rate was 47%. The majority of providers reported feeling burned out (56%), and 48% indicated they would probably leave the organization within three years. Additionally, 61% reported being satisfied with their job and 55% felt that they contributed professionally in the ways they value most (meaningful work/engagement). Significant predictors for burnout included negative work environment perceptions (work pace/stress), low resilience, low meaningful work, and professional role (physician vs APP).

DISCUSSION

Maintaining a healthy workforce requires investigation into the factors that support workplace well-being. The strongest predictors of burnout were work pace/stress. Protective factors against burnout were psychological safety and resilience. An organizational culture that promotes psychological safety, as well as workplace improvements to enhance providers' sense of meaning in work, and decreasing work pace and stress may contribute to the prevention of burnout and the retention.

A Mixed-Methods Cohort Study Evaluating the Impact of a One-Day Well-Being Course for Anesthesia Providers Working in Low-Resource Settings

BACKGROUND

Burnout, depression, and anxiety are increasingly recognized as common among health care providers. Risks for these conditions are exacerbated in low-resource settings by excessive workload, high disease burden, resource shortage, and stigma against mental health issues. Based on discussions and requests to learn more about burnout during the Vital Anaesthesia Simulation Training (VAST), our team developed VAST Wellbeing, a 1-day course for health care providers in low-resource settings to recognize and mitigate burnout and to promote personal and professional well-being.

METHODS

This mixed-methods study used quantitative pre- and postcourse surveys using validated mental health measures and qualitative semistructured interviews to explore participants' experience of VAST Wellbeing during and after the course. Quantitative outcomes included burnout and professional fulfillment as measured by the Professional Fulfillment Index and general well-being as measured by the Warwick-Edinburgh Mental Wellbeing Scale.

RESULTS

Twenty-six participants from 9 countries completed the study. In the immediate postcourse survey, study participants rated the course overall as "very good" (60.7%) and "excellent" (28.6%). Quantitative analysis showed no statistical differences in levels of work exhaustion, interpersonal disengagement, burnout, professional fulfillment, or general mental well-being 2 months after the course. Five themes on the impact of VAST Wellbeing were identified during qualitative analysis: (1) raising awareness, breaking taboos; (2) not feeling alone; (3) permission and capacity for personal well-being; (4) workplace empowerment; and (5) VAST Wellbeing was relevant, authentic, and needed.

CONCLUSIONS

Causes of burnout are complex and multidimensional. VAST Wellbeing did not change measures of burnout and fulfillment 2 months postcourse but did have a meaningful impact by raising awareness, reducing stigma, fostering connection, providing skills to prioritize personal well-being, and empowering people to seek workplace change.

Burnout and Attention Failure in STEM: The Role of Self-Control and the Buffer of Mindfulness

Drawing on self-regulatory strength models of self-control, this research examined the relationship between burnout and attentional processes for STEM (science, technology, engineering, and mathematics) students. Using data from participants in STEM, burnout was found to be associated with higher levels of off-task thinking, also known as mind-wandering. Further, self-control acted as a mediator in the relationship between burnout and mind-wandering such that higher levels of burnout predicted poor self-control that subsequently increased the mind's tendency to wander. Additionally, mindfulness buffered the relationship between burnout and mind-wandering such that burnout had the most detrimental impact on attention for those students who were low in mindfulness. Using the Johnson-Neyman approach, results reveal the upper limits for the moderating impact of mindfulness. Results and implications for science and practice are discussed with a special grounding for students in the STEM context.

The effects of different types of organisational workplace mental health interventions on mental health and wellbeing in healthcare workers: a systematic review

OBJECTIVE

To determine if and which types of organisational interventions conducted in small and medium size enterprises (SMEs) in healthcare are effective on mental health and wellbeing.

METHODS

Following PRISMA guidelines, we searched six scientific databases, assessed the methodological quality of eligible studies using QATQS and grouped them into six organisational intervention types for narrative synthesis. Only controlled studies with at least one follow-up were eligible.

RESULTS

We identified 22 studies (23 articles) mainly conducted in hospitals with 16 studies rated of strong or moderate methodological quality. More than two thirds (68%) of the studies reported improvements in at least one primary outcome (mental wellbeing, burnout, stress, symptoms of depression or anxiety), most consistently in burnout with eleven out of thirteen studies. We found a strong level of evidence for the intervention type "Job and task modifications" and a moderate level of evidence for the types "Flexible work and scheduling" and "Changes in the physical work environment". For all other types, the level of evidence was insufficient. We found no studies conducted with an independent SME, however five studies with SMEs attached to a larger organisational structure. The effectiveness of workplace mental health interventions in these SMEs was mixed.

CONCLUSION

Organisational interventions in healthcare workers can be effective in improving mental health, especially in reducing burnout. Intervention types where the change in the work environment constitutes the intervention had the highest level of evidence. More research is needed for SMEs and for healthcare workers other than hospital-based physicians and nurses.

Challenges faced by human resources for health in Morocco: A scoping review

BACKGROUND

Human resources for health (HRH) play a pivotal role in effective health system operation, yet various impediments challenge sustainable development. This scoping review aimed to explore these challenges and potential solutions in aligning the health workforce to meet the evolving healthcare needs of the Moroccan population.

METHODS

We conducted a scoping review searching PubMed, Science Direct, Cairn and Google Scholar for relevant articles published between 2014 and 2023. Additionally, non-peer-reviewed literature sourced from Ministry of Health consultations and allied websites was included.

RESULTS

Among the nineteen studies meeting our inclusion criteria, the majority were cross-sectional and predominantly focused on challenges faced by nurses. While some papers delineated multiple HRH challenges (5/19), the rest addressed specific challenges. The identified challenges span organizational and personal levels. Organizationally, the focus was on training, lifelong learning, continuing education, health coverage and shortages, and job satisfaction. At a personal level, HRH in the public health sector encountered challenges such as burnout, stress, and broader occupational health concerns.

CONCLUSIONS

The reviewed publications underscored a spectrum of challenges necessitating robust policy interventions. Despite promising developments in the Moroccan healthcare system, addressing the unequal urban-rural HRH distribution, augmenting funding, and enhancing HRH quality of life stand as pivotal imperatives.

The Second Mountain: Climbing the Challenges of Midcareer Radiology

A radiologist's career can be divided into the early, middle, and late phases. The midcareer phase is a particularly difficult period and has the highest rate of burnout among radiologists. Often throughout the early phase of a radiologist's career, during residency, fellowship, and while a junior faculty member, there is an abundance of support to help in personal and professional growth, but this support often wanes as radiologists gain seniority. Unfortunately, this often leaves midcareer radiologists feeling forgotten, or "invisible." This lack of support can lead to burnout, decreased job satisfaction, and premature departure from the workforce. The purpose of this review is to bring to light the challenges, such as higher rates of burnout and career stagnation, in addition to the lack of emphasis placed on midcareer mentorship, sponsorship, and career development programs, facing radiologists while climbing the "second mountain" of their career, as well as to provide potential individual and institutional interventions to combat these challenges. In addition, emphasis will be placed on the difficulties experienced by midcareer female radiologists, whose challenges are particularly problematic and to our knowledge have received little attention in the imaging literature to date.

From burnout to behavior: the dark side of emotional intelligence on optimal functioning across three managerial levels

Introduction

Burnout has been typically addressed as an outcome and indicator of employee malfunctioning due to its profound effects on the organization, its members, and its profitability. Our study assesses its potential as a predictor, delving into how different sources of motivation-autonomous and controlled-act as mediational mechanisms in the association between burnout and behavioral dimensions of functioning (namely, organizational citizenship behaviors and work misbehaviors). Furthermore, the buffering effects of emotional intelligence across three different managerial levels were also examined.

Methods

To this end, a total non-targeted sample of 840 Romanian managers (513 first-, 220 mid-, and 107 top-level managers) was obtained.

Results

Burnout predicted motivation, which predicted work behaviors in a moderated-mediation framework. Contrary to our initial prediction, emotional intelligence augmented the negative association between burnout and motivation, exhibiting a dark side to this intelligence type. These findings are nuanced by the three managerial positions and shed light on the subtle differences across supervisory levels.

Discussion

The current article suggests a relationship between multiple dimensions of optimal (mal)functioning and discusses valuable theoretical and practical insights, supporting future researchers and practitioners in designing burnout, motivation, and emotional intelligence interventions.

Workload and GP burnout: a survey and register-based study in Danish general practice

BACKGROUND

Burnout is common among GPs. Previous studies have indicated an association between high workload and burnout among doctors.

AIM

To assess the risk of burnout among single-handed GPs in Denmark in relation to self-reported and register-based workload.

DESIGN & SETTING

Questionnaire data from 312 Danish single-handed GPs and register data on their patients and provided services.

METHOD

Burnout was measured using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). A composite burnout score of quartile points was calculated. The questionnaire provided information on working hours. Register data included number of services and patient list size. Association between composite burnout score and workload was estimated with binomial regression analyses adjusting for the GP's age and sex, and social deprivation score of their patient lists.

RESULTS

Working >5 days a week in practice increased the risk of a high burnout score (adjusted risk ratio [RR] = 2.34, 95% confidence interval [CI] = 1.62 to 3.37). Spending >7.5 hours a day on patient-related tasks increased the risk of a high burnout score. The highest score was among GPs spending 8.5-9.5 hours a day on patient-related tasks (adjusted RR = 2.01, 95% CI = 0.90 to 4.51), although not statistically significant. There was no association between number of services and risk of burnout.

CONCLUSION

Working 5 days a week in practice significantly increased the risk of burnout in Danish single-handed GPs. Spending >7.5 hours a day on patient-related tasks tended to increase the risk. We found no association between a high number of services and increased risk of burnout.

Structural Factors Contributing to Compassion Fatigue, Burnout, and Secondary Traumatic Stress Among Hospital-Based Healthcare Professionals During the COVID-19 Pandemic

High levels of burnout among healthcare providers (HCPs) have been a widely documented phenomenon, which have been exacerbated during the COVID-19 pandemic. In the United States, qualitative studies that are inclusive of HCPs in diverse professional roles have been limited. Therefore, we utilized a qualitative-quantitative design to examine professional quality of life in terms of compassion fatigue, burnout, and secondary traumatic stress among hospital-based HCPs, including social workers, hospitalists, residents, and palliative care team members during COVID-19. HCPs (n = 26) participated in virtual semi-structured focus groups or individual interviews and online surveys (n = 30) including the Professional Quality of Life (ProQOL) Scale. While ProQOL scores indicated low levels of compassion fatigue, burnout, and secondary traumatic stress, thematic analysis of our qualitative data included rich descriptions of compassion fatigue, burnout, and secondary traumatic stress. Safety concerns and value misalignment characterized structural stressors perceived to contribute to HCP compassion fatigue, burnout, and secondary traumatic stress. The discrepancy between our qualitative and quantitative findings may be indication that modifications to current screenings are warranted. These findings also suggest a need to identify and implement structural and policy changes that increase HCPs' physical and emotional safety and promote better alignment of institutional interests with HCP values.

Systematic Review and Meta-Analysis of Randomized Trials Testing Interventions to Reduce Physician Burnout

BACKGROUND

Physicians deal with intense professional pressures, which may contribute to increasing burnout. We sought to evaluate the efficacy of interventions designed to reduce burnout in physicians, physicians-in-training, and other health care professionals.

METHODS

We searched PubMed and Embase (through January 6, 2023) and reference lists. We included all randomized studies assessing an intervention designed to reduce professional burnout in physicians and other health care personnel. We adhered to the PRISMA reporting guidelines. We abstracted data on study and participant characteristics, study outcomes, and study quality. We used a random-effects model to pool mean differences in burnout change (pre- and post-intervention) between intervention and control arms.

RESULTS

Thirty-one of the 38 eligible studies (81.6%) used the Maslach Burnout Inventory (MBI) questionnaire to assess burnout. When comparing the intervention and control groups, the mean difference in the emotional exhaustion component of the MBI was -1.11 (95% confidence interval [CI], -2.14 to -0.09; I2: 74.5%; 20 studies); the mean difference in the depersonalization component of the MBI was -0.32 (95% CI, -0.63 to -0.01; I2: 54.2%; 17 studies); and the mean difference in the personal accomplishment component of the MBI was 1.11 (95% CI, -0.21 to 2.43; I2: 94.3%; 16 studies).

CONCLUSIONS

Studies testing interventions to decrease physician burnout led to significant numerical improvements in some domains of burnout, but it is unlikely that these changes result in meaningful changes in clinical burnout. Further, the limited follow-up time, biased assessments, and heterogeneity in intervention efficacy suggest that a more nuanced understanding of the causes of burnout is needed to develop more effective interventions.

A narrative review of the well-being and burnout of U.S. community pharmacists

OBJECTIVES

The purpose of this narrative review is to summarize the literature on well-being and burnout among community pharmacists in the U.S. and provide recommendations for future research.

METHODS

Relevant literature was identified by searching PubMed for combinations of keywords such as "burnout" and "well-being" combined with "pharmacists." Titles and abstracts were reviewed for relevancy, and full text articles were reviewed when applicable.

RESULTS

While burnout is defined by its 3 core symptoms of emotional exhaustion, depersonalization, and low personal accomplishment, well-being is more challenging to define and measure, which has led to it being less studied. Community pharmacists faced high rates of burnout, low quality of life (QOL), and extreme fatigue prior to the COVID-19 pandemic, a situation that has likely only worsened. Factors such as workload, the type of community pharmacy, the level of education or training of the pharmacist, and stress may be some of the contributors to high rates of burnout. Clinician burnout may be related to high rates of mental health disorders seen in pharmacists, may impact patient safety and satisfaction, and may affect productivity and costs to employers and the healthcare system overall. There has been no research into interventions or strategies to support well-being and reduce burnout among community pharmacists, but having a workplace that is perceived as supporting well-being may have some impact. Recommendations for future research include the following: (1) define well-being, (2) explore why various factors support well-being or contribute to burnout, (3) determine the impact of community pharmacists experiencing well-being or burnout, and (4) develop strategies to support well-being and reduce burnout that are specific to community pharmacy.

CONCLUSION

There is a sparsity of evidence regarding community pharmacist well-being and burnout. Further research is needed to generate the evidence needed to support interventions that are specific to the unique work setting of community pharmacists.

Burnout increased among university students during the COVID-19 pandemic: a systematic review and meta-analysis

Generally, university students are at risk of burnout. This likely was exacerbated during the COVID-19 pandemic. We aimed to investigate burnout prevalence among university students during the COVID-19 pandemic and examine its distribution across countries, sexes, fields of study, and time-period. PubMed, EMBASE, PsycINFO, World Health Organization's Global COVID-19 database, Scopus, Epistemonikos, ERIC and Google Scholar were searched (protocol: https://doi.org/10.17605/OSF.IO/BYRXW ). Studies were independently screened and extracted. Random-effects meta-analysis was performed. Study quality was appraised, and certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. We identified 44 primary studies comprising 26,500 students. Global prevalence rates were 56.3% for high emotional exhaustion (EE), 55.3% for high cynicism (CY) and 41.8% for low personal accomplishment (PA). Prevalence of EE, CY, and PA domains varied significantly across fields of study, countries and WHO and World Bank regions, but not sex. All studies demonstrated good internal validity, although substantial heterogeneity existed between studies. The certainty of evidence was rated as moderate. Considering its potentially severe consequences, burnout is a significant public health concern. The development and implementation of evidence-based localized interventions at organizational and individual levels are necessary to mitigate burnout.

Impact of social capital and perceived empowerment on burnout in health employees: A study in the shadow of the COVID-19

BACKGROUND

Social capital is an important resource that enables employees to build trust-based relationships with other individuals and groups in the workplace. Although the evidence reveals the effect of employee empowerment on burnout, the moderator role of social capital in this relationship is still unexplored. However, considering the health employees who have mental health problems and increased dissatisfaction with the COVID-19 epidemic, the importance of determining the antecedent factors that may affect burnout plays an even more critical role.

OBJECTIVE

The effect of the epidemic process on the burnout level of health employees was examined. In addition, the effect of employee empowerment on burnout was examined and the moderate role of social capital was evaluated.

METHODS

A total of 492 health employee completed the measures of social capital, perceived empowerment, and burnout. Structural equation modelling was used to evaluate the moderate variable. Dawson slope were used to visualize the results.

RESULTS

The burnout levels of health employees were low (2.00±1.34). Social capital had a moderating effect on the negative effect of employee empowerment on burnout (β= 0.191). Apart from that, employee empowerment (β= -0.192) and social capital (β= -0.508) were negatively associated with burnout level (p < 0.05).

CONLUSION

These results are expected to provide useful recommendations to management in the health sector to reduce burnout among health employees by focusing on social capital and employee empowerment.

COVID-19- related work, managerial factors and exhaustion among general practitioners in Sweden: a cross-sectional study

INTRODUCTION

A significant number of international studies show that general practitioners (GPs) suffered from burnout when working during the COVID-19 pandemic. A Swedish study found that more than 16% of GPs had exhaustion in spring 2021. Exhaustion can be regarded as an initial stage of burnout. A knowledge gap remains on GPs´ working conditions, the impact of management during the pandemic and how it was associated with exhaustion. This study aims to explore the association between severe symptoms of exhaustion and COVID-19 pandemic-related work and managerial factors among Swedish GPs and whether managerial factors have an impact on the association between exhaustion and COVID-19-related work factors.

METHODS

Cross-sectional data was drawn from the Longitudinal Occupational Health survey in Health Care Sweden (LOHHCS), which included a representative sample of practicing doctors in Sweden. The sample consisted of 6699 doctors with a response rate of 41.2%. This study constitutes a sample of doctors who reported working in primary care facilities at the time of data collection, i.e. 1013 GPs. The Burnout Assessment Tool (BAT) was used to assess severe symptoms of exhaustion. Questions were also asked about pandemic-related work and managerial factors. The data was analysed using descriptive statistics and multivariate logistic regression to identify the association between exhaustion, work and managerial factors.

RESULTS

The multivariate analysis showed that GPs who managed COVID-19 patients were about twice as likely to report severe symptoms of exhaustion. Further, GPs who reported that management was unsupportive, provided unsatisfactory working conditions and unsatisfactory policies for patient prioritisation were between two and four times more likely to report severe symptoms of exhaustion.

CONCLUSIONS

COVID-19-related work and managerial factors had a significant impact on the mental health of GPs. Furthermore, the potentially protective effect that satisfactory management actions had on mental health was limited. In the aftermath of the COVID-19 pandemic and in preparation for future major crises that have a high impact on healthcare, there is a need to investigate the measures that can be taken to enable GPs to carry out their work, while maintaining their wellbeing.

Cancer Center Staff Satisfaction: Descriptive Results of a Canadian Study

Caring for cancer patients is generally considered very rewarding work, but it can also be stressful and demanding. Therefore, it is important for oncology healthcare professionals to feel satisfied with their work environment in order to provide the best care possible. An ethics-approved 61-item staff satisfaction survey was developed in-house to gain insights regarding workplace satisfaction among all staff at The Ottawa Hospital Cancer Center. Descriptive statistics were used to analyze the responses. A total of 478 individuals completed the online survey, with 75.1% women, 23.2% men, and 1.7% preferring not to say. This represented the vast majority (>75%) of cancer center staff. The approximate breakdown according to healthcare professional type was as follows: 21% nurses, 20% radiation therapists, 18% physicians, 13% clerical staff, and 28% other types of staff. Almost all (97.4%) generally enjoyed their work, with 60% stating "very much" and 37.4% stating "a little bit", and 93.3% found working with cancer patients rewarding. The overall satisfaction level at work was high, with 30.1% reporting "very satisfied" and 54.2% "somewhat satisfied". However, in terms of their work being stressful, 18.6% stated it was "very much" and 62.1% "a little bit". Also, in terms of their workload, 61.3% stated it was "very busy" and 10% stated it was "excessively busy". The most enjoyable aspects of work were listed as interactions with colleagues, interactions with patients, and learning new things. The least enjoyable aspects of work were excessive workload, a perceived unsupportive work environment, and technology problems. Levels of satisfaction and stress at work varied according to role at the cancer center. Most cancer center staff seem to enjoy their work and find it rewarding. However, the work environment can be challenging and stressful. Areas for improvement include managing workloads, ensuring staff feel supported, and improving the user-friendliness of technology.

Addressing Burnout in the Primary Care Setting: The Impact of an Evidence-Based Mindfulness Toolkit

BACKGROUND

Burnout is insidious and manifests over prolonged, repeated exposure to occupational stressors. There is a growing crisis among health care workers (HCWs) due to high levels of burnout and associated adverse outcomes. Identifying and addressing burnout can be problematic due to extensive variances of perceived occupational stressors across HCWs.

PURPOSE

Mindfulness-based training can enhance individual HCWs' abilities to perceive and constructively respond to stresses endemic in the health care environment. It can reduce the prevalence of burnout in the primary care setting. An evidence-based multimodal Mindfulness-Based Stress Reduction toolkit (MBSR TK) was designed, implemented, and evaluated for its impact on HCWs' self-reported stress levels (SRSL).

IMPLEMENTATION STRATEGIES

A pre-post-program evaluation explored the impact of a multimodal toolkit program on HCW SRSL with the Mini-Z burnout survey (MZBS). The MBSR TK program, consisting of a 45 minute introduction and 4 biweekly 15 minute mindfulness sessions offering acupressure, meditation, journaling for gratitude, and self-compassion was designed, delivered, and evaluated with HCWs across 2 military primary care clinics in South Texas.

RESULTS

All HCWs across 2 Air Force family practice clinics were invited to participate in all toolkit components. Seventy percent of all HCWs (N = 90) attended the introduction session. Thirty-seven (41%) HCWs completed pre and post MZBSs, and these responses are included in the data analysis section. The most represented HCWs were registered nurses, physician assistants, and technicians, respectively, at 24%, 21%, and 18%. The Wilcoxon Signed-Rank test examined changes in HCWs' SRSL after participation in the MBSR TK program. HCWs who attended the introduction plus one biweekly session showed statistically significant decreases in self-reported stress (P = 0.018) and burnout (P = 0.045) and a significant increase in electronic health record proficiency (P = 0.033).

CONCLUSIONS

Multimodal mindfulness toolkits to address SRSL burnout are practical, accessible, easily implemented, adaptive to any environment, and can decrease burnout with participation with just one 15 minute session. This MBSR TK implementation effectively lowered self-reported stress in HCWs who are repeatedly challenged to adapt to various settings around the world during peacetime, wars, natural disasters, humanitarian crises, and now, pandemics.

Study protocol: assessment of the usefulness and practicability of a psychoeducational intervention to prevent the negative psychological impact of the COVID-19 pandemic on primary care health workers

BACKGROUND

The COVID-19 pandemic has constituted an extraordinarily stressful situation for healthcare professionals and has led to psychological distress and an increase in various mental disorders. In the post-pandemic context, it is necessary to provide professionals with strategies and skills to manage this stressful situation and prevent or minimize its negative impact.

METHODS

Aims: To assess the feasibility and clinical effects of a group psychoeducational program focused on preventing the adverse psychological and emotional effects of the pandemic on primary care workers, and to explore the experience and perceptions of participants with regard to the program from a qualitative perspective.

DESIGN

A single-arm, before-and-after study conducted in primary care.

SETTING

The 332 primary care centers of the Catalan Institute of Health (Catalonia, Spain) Participants: The target population of the intervention is primary care workers, including clinical profiles (e.g., nurses and doctors), and non-clinical profiles (e.g., administrative staff). The implementation strategy will also involve community psychologists, who will lead the psychoeducational groups, and the health organization promoting the implementation.

INTERVENTION

A group psychoeducational program targeting primary care workers to promote emotional well-being and the ability to cope with stressful situations. Community psychologists will deliver it in the primary care centers they are linked to.

MEASURES

Mixed-methods evaluation, combining quantitative and qualitative research. A prospective assessment of the main outcomes (professional quality of life, psychological state, and resilience) will be performed using online questionnaires before and immediately after the intervention, and at 3 and 6 months. A qualitative study will be conducted, comprising focus groups and individual in-depth interviews with the participants in the intervention and the psychologists who provide it.

ETHICS

The Research Ethics Committee of the Jordi Gol Primary Care Research Institute (IDIAP) has approved the protocol (22/086-PCV).

DISCUSSION

This project proposes an intervention to promote mental health and psychological well-being in primary care workers by learning skills and integrating them into personal and professional life. The expected results will allow us to determine the usefulness and effectiveness of this psychoeducational intervention under the conditions of real clinical practice, provide data to model and perfect it, and promote its dissemination.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT05720429; registered on 09/02/2023.

Effectiveness of interprofessional teamwork interventions for improving occupational well-being among perioperative healthcare providers: a systematic review

The occupational well-being of healthcare providers is crucial for safe and effective patient care, especially in the complex, high acuity operating room (OR) setting. There has been a recent proliferation of interventions to improve teamwork in the OR setting, but the impact of these interventions on clinician occupational well-being has yet to be systematically assessed. This systematic review aimed to summarize the impact of interprofessional teamwork interventions on occupational well-being among perioperative healthcare providers. We included all qualitative or quantitative peer-reviewed studies assessing a multidisciplinary teamwork intervention including members of at least two professions. We included seven studies which involved checklists (n = 2), simulation-based training (n = 2), and various teamwork development and training programs (n = 3). Five of the seven included studies reported no significant effect on job satisfaction, while one found a significant negative association between the intervention and job satisfaction (p < .0001), and another showed significant decrease in worker stress. Our findings highlight the gaps in our understanding of the impact of interprofessional teamwork interventions on healthcare worker well-being in the perioperative environment and the multi-level factors influencing OR teamwork, intervention implementation, and well-being across the different professions.

Organizational interventions and occupational burnout: a meta-analysis with focus on exhaustion

PURPOSE

To assess whether organizational interventions are effective to prevent or reduce exhaustion, the core dimension of occupational burnout.

METHODS

We searched in PubMed, EMBASE, PsycINFO, and Cochrane Library databases randomized and non-randomized controlled trials conducted among active workers and reporting the outcome as exhaustion score. We calculated the effect sizes using the pre-test-post-test control group design's estimate. We used the random effects model in meta-analysis and Cochrane collaboration's tool for interventions to assess the risk of bias. Overall quality of evidence was appraised using the GRADE.

RESULTS

From the 2425 identified records, we assessed 228 full texts for eligibility and included 11 original articles describing 13 studies, 11 on organizational interventions, and 2 on combined inventions. The interventions were participatory (n = 9), focused on workload (n = 2), or on work schedule (n = 2). The overall effect size was - 0.30 ((95% CI = - 0.42; - 0.18), I2 = 62.28%), corresponding to a small reduction in exhaustion with a very low quality of evidence. Combined interventions had a larger effect (- 0.54 (95% CI = - 0.76; - 0.32)) than organizational interventions. When split by type of intervention, both participatory interventions and interventions focused on workload had a benefic effect of exhaustion reduction, with an estimated effect size of - 0.34 (95% CI = - 0.47; - 0.20) and - 0.44 (95% CI = - 0.68, - 0.20), respectively.

CONCLUSION

Interventions at combined level in workplaces could be helpful in preventing exhaustion. However, the evidence is still limited, due to a high heterogeneity between studies, bias potential, and small number of eligible studies. This calls for further research, using workload interventions at organizational level, especially in sectors with high risk of job stress and exhaustion.

An Overview of Reviews to Inform Organization-Level Interventions to Address Burnout in Rheumatologists

OBJECTIVE

To identify organization-directed strategies that could be implemented to prevent burnout among rheumatologists.

METHODS

A search of English language articles published 2011 or later was conducted on Cochrane Database of Systematic Reviews, Embase, Medline, and PsycInfo on January 25, 2022. Included reviews had ≥ 1 primary studies with ≥ 10% of participants who were physicians, recorded burnout as an outcome, and described an organization-directed intervention to prevent burnout. Overlap of primary studies across reviews was assessed. The final review inclusion was determined by study quality, minimization of overlap, and maximization of intervention breadth. The A Measurement Tool to Assess Systematic Reviews (AMSTAR) 2 tool was used for quality assessment. Included studies and interventions were assessed by rheumatologists for their applicability to rheumatology.

RESULTS

A total of 17 reviews, including 15 systematic reviews, 1 realist review, and 1 umbrella review were included. AMSTAR 2 quality ratings classified 5 systematic reviews as low quality, 1 as moderate, and 9 as critically low. There was significant heterogeneity between and within reviews. Six conducted a metaanalysis and 11 provided a qualitative summary of findings. The following intervention types were identified as having possible applicability to rheumatology: physician workflow and organizational strategies; peer support and formal communication training; leadership support; and addressing stress, mental health, and mindfulness. Across interventions, mindfulness had the highest quality of evidence to support its effectiveness.

CONCLUSION

Although the quality of evidence for interventions to prevent burnout in physicians is low, promising strategies such as mindfulness have been identified.

Multidimensional stressors and protective factors shaping physicians' work environments and work-related well-being in two large US cities during COVID-19

INTRODUCTION

Clinician burnout and poor work-related well-being reached a critical inflection point during the COVID-19 pandemic. This article applies a novel conceptual model informed by the Total Worker Health® approach to identify and describe multilevel stressors and protective factors that affected frontline physicians' work environments and work-related well-being.

METHODS

We conducted a qualitative study of hospital-based physicians from multiple hospital types in Los Angeles and Miami who cared for COVID-19 patients. Semistructured interviews lasting 60-90 min were conducted over Zoom. Interview transcripts were thematically coded using Dedoose qualitative software.

RESULTS

The final sample of 66 physicians worked in 20 hospitals. Stressors in the social, political, and economic environment included dealing with the politicization of COVID-19, including vaccine hesitancy; state and federal governmental COVID-19 policies and messaging; and shifting CDC guidance. Employment and labor pattern stressors included the national nursing shortage, different policies for paid time off, furloughs, reduced pay, and layoffs. Organizational-level stressors included institutional policies, staffing constraints and high patient volume (i.e., increased number of cases and longer lengths of stay), and perceived poor leadership. At the individual worker level, stressors included concerns about viral transmission to family, strained personal relationships, and work-life fit, particularly for those with young children. Respondents identified promising protective factors at multiple levels, including responsive state leadership, job security, concrete opportunities to provide input into institutional policy, strong leadership and communication, and feeling cared for by one's institution.

CONCLUSION

Findings support a multi-level strategy that acknowledges internal organizational and external factors shaping clinicians' work-related well-being, consistent with the Total Worker Health® approach.