Burnout Among Hospital Non-Healthcare Staff: Influence of Job Demand-Control-Support, and Effort-Reward Imbalance

Predictive modeling of burnout dimensions based on basic socio-economic determinants in health service managers and support personnel in a resource-limited health center

Background

Burnout is a prevalent condition in the healthcare sector, and although it has been extensively studied among healthcare professionals, less is known about its impact on non-professional workers, particularly in low-resource settings. This study aimed to test a preliminary predictive model based on basic socioeconomic and sociodemographic determinants to predict symptoms of burnout among support personnel and health services managers in a resource-limited health center.

Methods

A prospective cross-sectional study was conducted. Using simple random sampling, symptoms of burnout were surveyed among health service managers and support personnel using the Maslach Burnout Inventory (MBI). Statistical analyses included correlation tests and predictive models using random forest models to identify significant associations and cast predictions.

Results

A total of 76 participants were included. Of these, 34.21% exhibited high levels of emotional exhaustion (EE), 42.11% showed elevated depersonalization (DP), and 7.89% reported low personal accomplishment (PA). Significant negative correlations were observed between household income and the EE and DP dimensions. The predictive models demonstrated acceptable performance in identifying socioeconomic factors associated with burnout, with prediction errors ranging from 7.68% to 20.31%.

Conclusions

Burnout is common among support personnel and health services managers in resource-limited settings, particularly among those with lower incomes. The findings underscore the importance of implementing policies that address both working conditions and economic well-being to mitigate the risk of burnout. More robust predictive models could serve as a valuable tool for early identification and prevention of burnout in this type of setting.

Working Conditions in Complementary and Integrative Healthcare Professions

OBJECTIVE

The study aimed to describe working conditions among complementary and integrative healthcare (CIH) providers, specifically acupuncturists, chiropractors, massage therapists, midwives, and naturopathic doctors.

METHODS

We used cross-sectional Occupational Information Network data (2013-2021) for five CIH occupations. We examined means and 95% confidence intervals (CIs) for 10 variables that represented positive conditions, ergonomic demands, psychosocial demands, and schedule demands. We compared CIH to conventional healthcare and non-healthcare occupations.

RESULTS

CIH occupations had relatively high degrees of positive conditions, moderate degrees of psychosocial demands, and moderate hours/scheduling. Massage therapists, chiropractors, and acupuncturists reported more ergonomic hazards (eg, 1-5 scale where 5 is the highest, mean bending/twisting frequency for chiropractors is 3.43 [95% CI, 3.80-4.05] compared to 2.17 for midwives [95% CI, 1.97-2.36] and 1.96 for managers [95% CI, 1.42-2.51]).

CONCLUSIONS

CIH occupations generally had healthy working conditions, although ergonomic hazards were prominent.

Investigating food retail workers' experiences during the COVID-19 pandemic: A case of effort-reward imbalance

Food retail businesses experienced a pronounced increase in sales when food hospitality outlets closed in the early stages of the COVID-19 pandemic in Canada. This study investigates how pandemic-related modifications to food retail businesses in Ontario, Canada affected the well-being of workers. Semi-structured interviews were conducted with 17 food retail employees between June 2020 and May 2021 as part of the Food Retail Environment Study for Health and Economic Resiliency (FRESHER). Transcripts were analyzed inductively, and themes were refined using the Effort Reward Imbalance Model. Themes were connected to the main components of this model: extrinsic effort, intrinsic effort, money, esteem, status control, and burnout. Results indicate that, for food retail employees, the presence of an imbalance between efforts and rewards threatens well-being via symptoms of burnout. Further study is needed to examine how this inequality and burnout among this population might be measured and addressed.

Correlation analysis between occupational stress and metabolic syndrome in workers of a petrochemical enterprise: based on two assessment models of occupational stress

BACKGROUND

Occupational stress is becoming a common phenomenon around the world. Being in a high occupational stress state for a long time may destroy the metabolic balance of the body, thereby increasing the risk of metabolic diseases. There is limited evidence regarding the correlation between occupational stress and metabolic syndrome (MetS), particularly in the petrochemical workers.

METHODS

A total of 1683 workers of a petrochemical enterprise in China were included in the survey by cluster sampling method. The occupational stress assessment was carried out by the Job Content Questionnaire and the Effort-Reward Imbalance Questionnaire, and the general demographic characteristics, work characteristics, occupational hazards, lifestyle and health examination data of the participants were collected. Logistic regression and multiple linear regression were used to analyze the correlations and influencing factors between occupational stress and its dimensions with MetS and its components.

RESULTS

A total of 1683 questionnaires were sent out, and 1608 were effectively collected, with an effective recovery rate of 95.54%. The detection rates of occupational stress in Job Demand-Control (JDC) and Effort-Reward Imbalance (ERI) models were 28.4% and 27.2%, respectively. In this study, 257 participants (16.0%) were diagnosed with MetS. Compared with the non-MetS group, body mass index (BMI), waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), triglycerides (TG) and fasting blood-glucose (FBG) levels were significantly higher in the MetS group, and high density lipoprotein-cholesterol (HDL-C) levels were significantly lower (P < 0.001). The results of multiple linear regression showed that after adjusting for nation, marital status, education, work system, smoking and drinking, and further adjusting for occupational hazards, the D/C ratio was significantly negatively correlated with SBP in the JDC model. Social support was negatively correlated with WC. In the ERI model, there was a significant positive correlation between over-commitment and FBG.

CONCLUSIONS

The detection rates of occupational stress and MetS were high in workers of a petrochemical enterprise. In the JDC model, occupational stress was negatively correlated with SBP, and social support was negatively correlated with WC. In the ERI model, there was a significantly positive correlation between over-commitment and FBG.

The influence of burnout on cardiovascular disease: a systematic review and meta-analysis

Background

Burnout is a public health problem with various health consequences, among which cardiovascular disease is the most investigated but still under debate. Our objective was to conduct a systematic review and meta-analysis on the influence of burnout on cardiovascular disease.

Methods

Studies reporting risk (odds ratio, relative risk, and hazard ratio) of cardiovascular disease following burnout were searched in PubMed, PsycINFO, Cochrane, Embase, and ScienceDirect. We performed a random-effect meta-analysis stratified by type of cardiovascular disease and searched for putative influencing variables. We performed sensitivity analyses using the most adjusted models and crude risks.

Results

We included 25 studies in the systematic review and 9 studies in the meta-analysis (4 cross-sectional, 4 cohort, and 1 case-control study) for a total of 26,916 participants. Burnout increased the risk of cardiovascular disease by 21% (OR = 1.21, 95% CI 1.03 to 1.39) using the most adjusted risks and by 27% (OR = 1.27, 95% CI 1.10 to 1.43) using crude risks. Using stratification by type of cardiovascular disease and the most adjusted risks, having experienced burnout significantly increased the risk of prehypertension by 85% (OR = 1.85, 95% CI 1.00 to 2.70) and cardiovascular disease-related hospitalization by 10% (OR = 1.10, 95% CI 1.02 to 1.18), whereas the risk increase for coronary heart disease (OR = 1.79, 95% CI 0.79 to 2.79) and myocardial infarction (OR = 1.78, 95% CI 0.85 to 2.71) was not significant. Results were also similar using crude odds ratio. The risk of cardiovascular disease after a burnout was not influenced by gender. Insufficient data precluded other meta-regressions.

Conclusions

Burnout seems to increase the risk of cardiovascular disease, despite the few retrieved studies and a causality weakened by cross-sectional studies. However, numerous studies focused on the pathophysiology of cardiovascular risk linked to burnout, which may help to build a preventive strategy in the workplace.

Flourishing and the Prioritization of Workplace Elements in General Surgery Residents

INTRODUCTION

To explore and begin to operationalize workplace elements that influence general surgery (GS) resident wellbeing. Tailoring workplace wellbeing interventions is critical to their success. Occupational science has revealed that a person-centered approach to identifying positive and negative workplace influences can inform tailoring while accounting for individual differences. To our knowledge, this approach has not been applied to the surgical training environment.

METHODS

A national sample of GS residents from 16 Accreditation Council for Graduate Medical Education training programs ranked the importance of workplace elements via an anonymous survey. Latent profile analysis was performed to identify shared patterns of workplace element prioritization and their relation to levels of flourishing, a measure of global wellbeing.

RESULTS

GS trainee respondents (n = 300, 34% response rate - average for studies with this sample population) expressed a hierarchy of workplace element importance which differed by gender and race. "Skills to manage stress" and "a team you feel a part of" were prioritized higher by non-males than males. Residents of color and residents underrepresented in medicine, respectively, prioritized "recognition of work/effort" and "skills to manage stress" more than White and overrepresented in medicine residents. Flourishing prevalence varied by 40% with small differences in the specific profile of workplace element prioritization.

CONCLUSIONS

Differences in prioritization of workplace elements reveal subtle but important differences that may guide the design of wellbeing interventions for different populations within surgery.

Burnout in emergency department staff: The prevalence and barriers to intervention

Background

Burnout impacts patient care and staff well-being. Emergency department (ED) staff are at an elevated risk for burnout. Despite an acceleration in burnout research due to the coronavirus disease 2019 (COVID-19) pandemic, there is limited data on the nature and prevalence of burnout in the South African emergency medicine setting.

Aim

This study determined the prevalence of burnout in ED staff (doctors, nurses and non-clinical staff) at Tygerberg Hospital and explored staff awareness and utilisation of interventions.

Setting

The study was conducted at Tygerberg Hospital, South Africa.

Methods

This cross-sectional study used the Maslach Burnout Inventory to assess burnout via a self-administered electronic survey in a convenience sample of 109 ED staff. Quantitative data were analysed with descriptive and inferential statistics. Qualitative data were analysed using thematic analysis.

Results

A total of 46 participants (45.10%) experienced burnout, with 73 participants (71.57%) at high risk for emotional exhaustion or depersonalisation. The prevalence of burnout in doctors was 57.89%, non-clinical staff was 25.93%, and nursing staff was 50.00%. Burnout was higher in doctors and nursing staff compared to non-clinical staff, with high emotional exhaustion and depersonalisation found in interns and specialist professional nurses. The level of intervention awareness was 41.8% and the level of intervention utilisation was 8.82%. Thematic analysis identified awareness, accessibility and reactive utilisation as barriers to utilisation with opportunities to reduce burnout and enhance resilience.

Conclusion

Coordinated health system and organisational efforts are required to optimise intervention strategies to reduce burnout.

Contribution

Guidance on the design and planning of intervention strategies considering at risk groups, intervention-related factors, and non-clinical staff.

An integrative systematic review of employee silence and voice in healthcare: what are we really measuring?

The history of inquiries into the failings of medical care have highlighted the critical role of communication and information sharing, meaning that speaking up and employee silence have been extensively researched. However, the accumulated evidence concerning speaking-up interventions in healthcare indicates that they achieve disappointing outcomes because of a professional and organizational culture which is not supportive. Therefore, there is a gap with regard to our understanding of employee voice and silence in healthcare, and the relationship between withholding information and healthcare outcomes (e.g., patient safety, quality of care, worker wellbeing) is complex and differentiated. The following integrative review is aimed at addressing the following questions; (1) How is voice and silence conceptualized and measured in healthcare?; and (2) What is the theoretical background to employee voice and silence?. An integrative systematic literature review of quantitative studies measuring either employee voice or employee silence among healthcare staff published in peer-reviewed journals during 2016-2022 was conducted on the following databases: PubMed, PsycINFO, Scopus, Embase, Cochrane Library, Web of Science, CINAHL and Google Scholar. A narrative synthesis was performed. A review protocol was registered on the PROSPERO register (CRD42022367138). Of the 209 initially identified studies for full-text screening, 76 studies met the inclusion criteria and were selected for the final review (N = 122,009, 69.3% female). The results of the review indicated the following: (1) concepts and measures are heterogenous, (2) there is no unifying theoretical background, and (3) there is a need for further research regarding the distinction between what drives safety voice versus general employee voice, and how both voice and silence can operate in parallel in healthcare. Limitations discussed include high reliance on self-reported data from cross-sectional studies as well as the majority of participants being nurses and female staff. Overall, the reviewed research does not provide sufficient evidence on the links between theory, research and implications for practice, thus limiting how research in the field can better inform practical implications for the healthcare sector. Ultimately, the review highlights a clear need to improve assessment approaches for voice and silence in healthcare, although the best approach to do so cannot yet be established.

Investigation of Demand-Control-Support Model and Effort-Reward Imbalance Model as Predictor of Counterproductive Work Behaviors

Background

Nowadays, counter-productive work behaviors (CWBs) have turned into a common and costly position for many organizations and especially health centers. Therefore, the study was carried out to examine and compare the demand-control-support (DCS) and effort-reward imbalance (ERI) models as predictors of CWBs.

Methods

The study was cross-sectional. The population was all nurses working in public hospitals in Hamadan, Iran of whom 320 were selected as the sample based on simple random sampling method. The instruments used were Job Content Questionnaire, Effort-Reward Imbalance Questionnaire, and Counterproductivity Work Behavior Questionnaire. Data were analyzed using correlation and regression analysis in SPSS18.

Results

The findings indicated that both ERI and DCS models could predict CWB (p ≤ 0.05); however, the DCS model variables can explain the variance of CWB-I and CWB-O approximately 8% more than the ERI model variables and have more power in predicting these behaviors in the nursing community.

Conclusion

According to the results, job stress is a key factor in the incidence of CWBs among nurses. Considering the importance and impact of each component of ERI and DCS models in the occurrence of CWBs, corrective actions can be taken to reduce their incidence in nurses.

Burnout, negative emotions, and wellbeing among social workers in China after community lockdowns during the COVID-19 pandemic: Mediating roles of trait mindfulness

Objective

This study aimed to investigate burnout situation of social workers (SWs) who experienced the COVID-19 pandemic-related community lockdown 1 year before, and to assess the protective value of trait mindfulness (TM) in states of burnout.

Method

We surveyed the burnout, trait mindfulness, negative emotions (NEs) and wellbeing (WB) of 182 social workers provided services to Wuhan lockdowns community by COVID-19 one year before. Burnout were measured using the Maslach Burnout Inventory-Human Services Survey; TM using the Mindful Attention Awareness Scale; NEs using the Depression Anxiety and Stress Scale-21; and WB using the General Wellbeing Schedule. We also performed correlation regression analysis and mediation test for burnout, TM, NEs, and WB.

Results

Among the 182 respondents, 75 (41.2%) still suffered from severe burnout. TM was negatively correlated with burnout (r = -0.623), negatively correlated with NEs (r = -0.560), and positively correlated with WB (r = 0.617). Burnout had a significantly positive correlation with NEs (r = 0.544) and a significantly negative correlation with WB (r = -0.666). Further, WB had significantly negative correlation with NEs (r = -0.758). After controlling for age, gender, marital status, educational level, and years of employment, burnout had a significantly positive predictive effect on NEs (β = 0.509), whereas TM had a significantly negative predictive effect on NEs (β = -0.334). TM played a partial mediating role in the effect of burnout on NEs, with a mediating effect and effect ratio of 0.088 and 39.7%, respectively. Burnout had a significantly negative predictive effect on WB (β = -0.598), whereas TM had a significantly positive predictive effect on WB (β = 0.299). TM played a partial mediating role in the effect of burnout on NEs, with a mediating effect and effect ratio of -0.164 and 30.3%, respectively. WB had a significantly negative predictive effect on NEs (β = -0.711), and it played a partial mediating role in the effect of burnout on NEs, with a mediating effect and effect ratio of 0.185 and 83.3%, respectively.

Conclusion

The current levels of burnout among local SWs remained high 1 year after the community lockdowns. TM played a mediating role in the relationship between burnout, NEs, and WB. Concomitantly, WB played a mediating role in the relationship between burnout and NEs. Therefore, in the context of burnout, TM is a protective factor for reducing emotional stress and risks of developing psychiatric disorders through the enhancement of WB.

Validation of Visual Analogue Scales of job demand and job control at the workplace: a cross-sectional study

OBJECTIVES

Work-related stress is a major concern. One of the best performing models is the Job Content Questionnaire (JCQ) of Karasek, assessing job demand and job control using 18 items. However, the JCQ is long and complex. Visual Analogue Scales (VASs) are easy to use and quick to implement. VASs have been validated to assess pain and occupational stress; however, VASs demand and control have not been evaluated. Therefore, we aimed to validate the use of VAS demand and control compared with the 18 items of the JCQ.

DESIGN

We implemented a cross-sectional observational study, by administering a self-reported questionnaire to the users of Wittyfit software, with a second test (retest) proposed 1 week later. In addition to JCQ, VAS demand and control, we measured sociodemographic outcomes, as well as characteristics of work, sleep, well-being, stress, depression and anxiety.

PARTICIPANTS

190 volunteers French workers using WittyFit software participated in the study, and 129 completed the test-retest.

RESULTS

VAS demand and VAS control correlated with the two Karasek domains from the JCQ, respectively, at 0.59 and 0.57 (p<0.001). Test-retest reliability highlighted concordance coefficients higher than 0.70. Sensitivity was higher than 70% for each VAS. External validity was acceptable. For both demand and control, VAS cut-offs were 75/100. Compared with other workers, senior executives and individuals with master's degrees had higher levels of job control but did not differ in job demand using the VAS and JCQ.

CONCLUSIONS

VAS demand and VAS control are valid, quick, easy to use, and reliable tools for the assessment of job demand and job control. They can be used in daily clinical practice for primary prevention and diagnosis. However, when results are over 75 mm on VAS, we promote the use of JCQ to be more discriminant and specific to initiate action plans to help workers.

TRIAL REGISTRATION NUMBER

NCT02596737.

The Protective Role of Job Control/Autonomy on Mental Strain of Managers: A Cross-Sectional Study among Wittyfit's Users

BACKGROUND

Karasek's Job Demand-Control-Support model is the gold standard to assess the perception of work; however, this model has been poorly studied among managers. We aimed to explore the perception of work (job demand, control, and support) in managers, and to quantify their risk of job strain (high job demand and low job control) and isostrain (job strain with low job support).

METHODS

We conducted a cross-sectional study on workers from various French companies using the Wittyfit software. Job demand, control, and support were evaluated by self-reported questionnaires, as well as sociodemographic data.

RESULTS

We included 9257 workers: 8488 employees (median age of 45 years, median seniority of 10 years, 39.4% women) and 769 managers (463 were more than 45 years old, 343 with more than 10 years of service, 33.3% women). Managers had higher mean ± SD levels than employees in job control (79.2 ± 14.9 vs. 75.4 ± 16.9) and job support (25.2 ± 5.1 vs. 24.0 ± 6.1) (p < 0.001). Compared to employees, managers had a 37% decreased risk of job strain (OR = 0.63, 95% CI 0.52 to 0.77) and a 47% decreased risk of isostrain (OR = 0.53, 95% CI 0.40 to 0.69) (p < 0.001). Workers over age 45 (OR = 1.26, 95% CI 1.14 to 1.40, p < 0.001) and women (OR = 1.12, 95% CI 1.01 to 1. 25, p = 0.03) were at greater risk of job strain. Furthermore, workers over age 45 (OR = 1.51, 95% CI 1.32 to 1.73, p < 0.001), workers with over 10 years of service (OR = 1.35, 95% CI 1.16 to 1.56, p < 0.001), and women (OR = 1.15, 95% CI 1.00 to 1.31, p = 0.04) were at greater risk of isostrain.

CONCLUSIONS

Managers seem to have higher autonomy and greater social support and therefore are less at risk of job strain or isostrain than employees. Other factors such as age, seniority, and sex may influence this relationship.

TRIAL REGISTRATION

Clinicaltrials.gov: NCT02596737.

Mindfulness as a Protective Factor Against Increased Tobacco and Alcohol Use in Hospital Workers Following the First COVID-19-Related Lockdown: a Study in Southern France

COVID-19-related national lockdowns worldwide have had repercussions on people's well-being and have led to increased substance use. Mindfulness has previously been associated with reduced psychological distress and benefits in terms of addictive behaviors. We aimed to assess whether dispositional mindfulness protected against increased tobacco and alcohol use in hospital workers after France's first lockdown started. All workers in two French hospitals were contacted by email to participate in an online survey. Three hundred eighty-five workers answered. We ran two separate logistic regression models to test for associations between the level of dispositional mindfulness and both increased tobacco and alcohol use, after adjusting for affect deterioration. Dispositional mindfulness was associated with a lower likelihood of increased tobacco (adjusted odds ratio (AOR) [95% CI] 0.71 [0.51; 0.99], p = 0.046) and alcohol (0.66 [0.50; 0.87], p = 0.004) use. The effect of mindfulness on tobacco use was partially mediated by affect deterioration. Dispositional mindfulness appeared to be a protective factor against lockdown-related tobacco and alcohol use increases in French hospital workers.

A cross-sectional study to assess job strain of emergency healthcare workers by Karasek questionnaire: The SEEK study

BACKGROUND

Emergency healthcare workers (eHCWs) are particularly at risk of stress, but data using the gold standard questionnaire of Karasek are scarce. We assessed the level of stress of eHCWs and aimed to compare it with the general population.

METHODS

This is a cross-sectional nationwide study in French Emergency Departments (EDs), using the job-content questionnaire of Karasek, compared with the 25,000 answers in the French general population (controls from the SUMER study). The descriptions of job demand, job control, and social support were described as well as the prevalence of job strain and isostrain. Putative factors were searched using mixed-method analysis.

RESULTS

A total of 166 eHCWs (37.9 ± 10.5 years old, 42% men) from five French EDs were included: 53 emergency physicians and 104 emergency paramedics, compared to 25,000 workers with other occupations. Job demand was highest for physicians (28.3 ± 3.3) and paramedics (25.9 ± 3.8), compared to controls (36.0 ± 7.2; p < 0.001). Job control was the lowest for physicians (61.2 ± 5.8) and paramedics (59.1 ± 6.8), compared to controls (70.4 ± 11.7; p < 0.001). Mean social support did not differ between groups (23.6 ± 3.4 for physicians, 22.6 ± 2.9 for paramedics, and 23.7 ± 3.6 for controls). The prevalence of job strain was massively higher for physicians (95.8%) and paramedics (84.8%), compared to controls (23.9%; p < 0.001), as well as for isostrain (45.1% for physicians, 56.8% for paramedics, and 14.3% for controls, p < 0.001). We did not find any significant impact of sociodemographic characteristics on job control, job demand, or social support.

CONCLUSION

Emergency healthcare workers have a dramatic rate of job strain, necessitating urgent promotion of policy to take care of them.

The Forgotten Health-Care Occupations at Risk of Burnout-A Burnout, Job Demand-Control-Support, and Effort-Reward Imbalance Survey

AIMS

We conducted a cross-sectional study on healthcare workers from the University Hospital in Clermont-Ferrand. They received a self-report questionnaire consisting of the Maslach Burnout Inventory, Job Demand Control Support, Effort-Reward Imbalance model, and questions about ethical conflict in order to investigate on burnout.

RESULTS

We included 1774 workers. Overinvestment was the only factor explaining the increase in emotional exhaustion, depersonalization, and the decrease in personal accomplishment. Taking into account the absence of burnout as a reference, overinvestment multiplied the risk of high burnout by 22.0 (5.10 to 94.7).

CONCLUSION

Some "forgotten" occupations among healthcare workers are at risk of burnout. Overinvestment was the main factor explaining the increase in the tree dimensions of burnout. Moreover, the two main models of stress at work were highly predictive of burnout.