Owen Mumford: Burnout in Healthcare

Burnout makes healthcare professionals twice as likely to compromise patient safety

Burnout is a much-used term currently, but what exactly does it mean? The World Health Organisation (WHO) defines it as an occupational phenomenon or syndrome, "chronic workplace stress that has not been successfully managed"1. According to WHO, the symptoms include:

•    "Feelings of energy depletion or exhaustion
•    Increased mental distance from one’s job, or feelings of negativism or cynicism related to one's job
•    Reduced professional efficacy."

Why burnout is particularly serious in healthcare

It is well-known that today's healthcare professionals (HCPs) are under intense and unprecedented pressure. Increasing levels of burnout in the sector are no surprise and in fact, this is a long-standing problem. Healthcare professionals have been reporting symptoms of burnout in various research studies dating back to before the COVID-19 pandemic.2

Given the WHO definition, that means workplace stress and fatigue may impact an HCP's ability to treat patients and increase the risk of medical error — and that must be a concern for patients as well. But is there any compelling evidence that burnout is impacting patient care? According to a significant research report, led by Dr Alexander Hodkinson, and published recently in the British Medical Journal (BMJ)3, the answer is a deeply troubling "yes".

Burnout is spreading like wildfire

The Hodkinson report brings together 170 previous observational studies on the links between burnout among doctors, their career engagement, and the quality of patient care. Those studies were based on the experiences of 239,246 doctors in the USA, the UK and across Africa and Asia.

The review and analysis demonstrate that the spread of burnout is a global phenomenon linked to career disengagement and potential impacts on the quality of patient care. This is supported by several UK-specific findings.

The General Medical Council’s latest annual survey of trainee UK doctors, published in July 2022, is based on responses from more than 67,000 HCPs. It found that "the risk of burnout is now the highest it has ever been” since it was first tracked in 20184. Two-thirds of trainees told the medical regulator that they “always” or “often” feel worn out at the end of their working day, with 44 percent regularly feeling “exhausted in the morning at the thought of another day at work”.

In another recent survey, this time by the UK Medical Defence Union (MDU)5, six in ten respondents said their sleep patterns had worsened during the Covid-19 pandemic. Side effects of sleep deprivation reported by doctors include poor concentration (64 percent), decision-making difficulties (40 percent), mood swings, (37 percent) and mental health problems (30 percent). These harmful side effects may affect the doctor’s ability to care for patients or result in near miss incidents.

Burnout's proven effect on patient safety

How strong is the evidence that burnout hurts patients as well as doctors? The MDU survey’s respondents mentioned almost 40 near misses and seven cases in which a patient sustained harm5. 

Furthermore, the Hodkinson report states that medical practitioners with burnout are twice as likely as their peers to be involved in patient safety incidents.  They also show low levels of professionalism and are likely to be rated poorly by patients for the quality of care provided. 

It also finds that the consequences of burnout reduce the quality of patient care and are at their worst in acute healthcare environments. These include emergency departments and intensive care units — the places where patients tend to be at their most vulnerable3.

A spike in sharps injuries is one symptom of burnout

As the problem of burnout has grown, especially since COVID-19, it is no coincidence that sharps injuries are increasingly prevalent among HCPs. 

A 2021 survey by the Royal College of Nursing (RCN)6 found that 15 percent of the 7,571 respondents had suffered a sharps injury in 2020, and that such injuries had increased by 50 percent since its previous survey in 2008. The reasons given by the RCN for the increase include low staffing levels, lack of training, and fatigue related to the pandemic. 

If we can't decrease burnout, we must enhance safety

It seems clear that the effects of burnout in the medical profession, such as tiredness and low morale, are not going away in the short term, especially as the COVID-19 pandemic continues. The increase in needlestick injuries reported by the RCN is just one outcome. This suggests that prioritising practitioner and patient safety is vital. The RCN report prescribes access to safer sharps as an important contributor6, and medical device manufacturers have a responsibility to create safe and practical devices that support HCPs and patients.

The importance of innovation in healthcare

As a leading manufacturer of medical devices for blood sampling, point-of-care testing, and drug delivery, we believe that innovation has a key role to play in keeping both practitioners and patients as safe as possible. Innovative ideas, new materials and thoughtful design can help to improve workplace safety for HCPs, especially in stressful circumstances. They can also help to deliver better clinical experiences and promote sustainability across the healthcare sector.

As Tracey Sainsbury, Group Product Manager says: "We strongly believe we can help alleviate some of the pressure with solutions designed to protect healthcare professionals and improve clinical experiences, to help them provide the best possible patient care."

1 https://www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases
2 Lee RT, Seo B,, Hladkiyi S, Lovell BL, Schwartzmann L. Correlates of physician burnout across regions and specialities: a meta-analysis. Hum Resour Health 2013, 11:doi:10.1186/1478 - 4491.11 - 48 pmid: 24074053.
3 Hodkinson A, Zhou A, Johnson J et al Associations of physical burnout with career engagement and quality of patient care, systematic review and meta-analysis. BMJ 2022: 378: e070442.
4 General Medical Council, National Training Survey 2022 results.
5 https://www.themdu.com/press-centre/press-releases/sleep-deprived-doctors-concerned-about-patient-safety.
6 https://www.rcn.org.uk/news-and-events/press-releases/pressures-of-pandemic-and-lack-of-training-see-rise-in-sharps-injuries