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Physician Burnout, Well-being, and Work Unit Safety Grades in Relationship to Reported Medical Errors

      Abstract

      Objective

      To evaluate physician burnout, well-being, and work unit safety grades in relationship to perceived major medical errors.

      Participants and Methods

      From August 28, 2014, to October 6, 2014, we conducted a population-based survey of US physicians in active practice regarding burnout, fatigue, suicidal ideation, work unit safety grade, and recent medical errors. Multivariate logistic regression and mixed-effects hierarchical models evaluated the associations among burnout, well-being measures, work unit safety grades, and medical errors.

      Results

      Of 6695 responding physicians in active practice, 6586 provided information on the areas of interest: 3574 (54.3%) reported symptoms of burnout, 2163 (32.8%) reported excessive fatigue, and 427 (6.5%) reported recent suicidal ideation, with 255 of 6563 (3.9%) reporting a poor or failing patient safety grade in their primary work area and 691 of 6586 (10.5%) reporting a major medical error in the prior 3 months. Physicians reporting errors were more likely to have symptoms of burnout (77.6% vs 51.5%; P<.001), fatigue (46.6% vs 31.2%; P<.001), and recent suicidal ideation (12.7% vs 5.8%; P<.001). In multivariate modeling, perceived errors were independently more likely to be reported by physicians with burnout (odds ratio [OR], 2.22; 95% CI, 1.79-2.76) or fatigue (OR, 1.38; 95% CI, 1.15-1.65) and those with incrementally worse work unit safety grades (OR, 1.70; 95% CI, 1.36-2.12; OR, 1.92; 95% CI, 1.48-2.49; OR, 3.12; 95% CI, 2.13-4.58; and OR, 4.37; 95% CI, 2.06-9.28 for grades of B, C, D, and F, respectively), adjusted for demographic and clinical characteristics.

      Conclusion

      In this large national study, physician burnout, fatigue, and work unit safety grades were independently associated with major medical errors. Interventions to reduce rates of medical errors must address both physician well-being and work unit safety.

      Abbreviations and Acronyms:

      DP (depersonalization), EE (emotional exhaustion), IQR (interquartile range), OR (odds ratio), PA (personal accomplishment), SI (suicidal ideation)
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      References

      1. Kohn L.T. Corrigan J.M. Donaldson M.S. To Err Is Human: Building a Safer Health System. National Academy Press, Washington, DC2000
        • Makary M.A.
        • Daniel M.
        Medical error—the third leading cause of death in the US.
        BMJ. 2016; 353: i2139
        • Hogan H.
        • Zipfel R.
        • Neuburger J.
        • Hutchings A.
        • Darzi A.
        • Black N.
        Avoidability of hospital deaths and association with hospital-wide mortality ratios: retrospective case record review and regression analysis.
        BMJ. 2015; 351: h3239
        • Shojania K.G.
        • Dixon-Woods M.
        Estimating deaths due to medical error: the ongoing controversy and why it matters.
        BMJ Qual Saf. 2017; 26: 423-428
        • James J.T.
        A new, evidence-based estimate of patient harms associated with hospital care.
        J Patient Saf. 2013; 9: 122-128
        • Landrigan C.P.
        • Parry G.J.
        • Bones C.B.
        • Hackbarth A.D.
        • Goldmann D.A.
        • Sharek P.J.
        Temporal trends in rates of patient harm resulting from medical care.
        N Engl J Med. 2010; 363 ([published correction appears in N Engl J Med. 2010;363(26):2573]): 2124-2134
        • Vincent C.
        • Aylin P.
        • Franklin B.D.
        • et al.
        Is health care getting safer?.
        BMJ. 2008; 337: a2426
        • Shanafelt T.D.
        • Hasan O.
        • Dyrbye L.N.
        • et al.
        Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014.
        Mayo Clin Proc. 2015; 90 ([published correction appears in Mayo Clin Proc. 2016;91(2):276]): 1600-1613
        • O'Donnell E.P.
        • Humeniuk K.M.
        • West C.P.
        • Tilburt J.C.
        The effects of fatigue and dissatisfaction on how physicians perceive their social responsibilities.
        Mayo Clin Proc. 2015; 90: 194-201
        • Shanafelt T.D.
        • Balch C.M.
        • Dyrbye L.
        • et al.
        Special report: suicidal ideation among American surgeons.
        Arch Surg. 2011; 146: 54-62
        • Center C.
        • Davis M.
        • Detre T.
        • et al.
        Confronting depression and suicide in physicians: a consensus statement.
        JAMA. 2003; 289: 3161-3166
        • Hall L.H.
        • Johnson J.
        • Watt I.
        • Tsipa A.
        • O'Connor D.B.
        Healthcare staff wellbeing, burnout, and patient safety: a systematic review.
        PLoS One. 2016; 11: e0159015
        • Cimiotti J.P.
        • Aiken L.H.
        • Sloane D.M.
        • Wu E.S.
        Nurse staffing, burnout, and health care-associated infection.
        Am J Infect Control. 2012; 40 ([published correction appears in Am J Infect Control. 2012;40(7):680]): 486-490
        • Tawfik D.S.
        • Sexton J.B.
        • Kan P.
        • et al.
        Burnout in the neonatal intensive care unit and its relation to healthcare-associated infections.
        J Perinatol. 2017; 37: 315-320
        • Welp A.
        • Meier L.L.
        • Manser T.
        Emotional exhaustion and workload predict clinician-rated and objective patient safety.
        Front Psychol. 2014; 5: 1573
        • de Oliveira Jr., G.S.
        • Chang R.
        • Fitzgerald P.C.
        • et al.
        The prevalence of burnout and depression and their association with adherence to safety and practice standards: a survey of United States anesthesiology trainees.
        Anesth Analg. 2013; 117: 182-193
        • Shanafelt T.D.
        • Bradley K.A.
        • Wipf J.E.
        • Back A.L.
        Burnout and self-reported patient care in an internal medicine residency program.
        Ann Intern Med. 2002; 136: 358-367
        • West C.P.
        • Huschka M.M.
        • Novotny P.J.
        • et al.
        Association of perceived medical errors with resident distress and empathy: a prospective longitudinal study.
        JAMA. 2006; 296: 1071-1078
        • Shanafelt T.D.
        • Balch C.M.
        • Bechamps G.
        • et al.
        Burnout and medical errors among American surgeons.
        Ann Surg. 2010; 251: 995-1000
        • Kwah J.
        • Weintraub J.
        • Fallar R.
        • Ripp J.
        The effect of burnout on medical errors and professionalism in first-year internal medicine residents.
        J Grad Med Educ. 2016; 8: 597-600
        • Linzer M.
        • Manwell L.B.
        • Williams E.S.
        • et al.
        Working conditions in primary care: physician reactions and care quality.
        Ann Intern Med. 2009; 151 (W6-W9): 28-36
        • Garrouste-Orgeas M.
        • Perrin M.
        • Soufir L.
        • et al.
        The Iatroref study: medical errors are associated with symptoms of depression in ICU staff but not burnout or safety culture.
        Intensive Care Med. 2015; 41: 273-284
        • West C.P.
        • Tan A.D.
        • Habermann T.M.
        • Sloan J.A.
        • Shanafelt T.D.
        Association of resident fatigue and distress with perceived medical errors.
        JAMA. 2009; 302: 1294-1300
        • Baldwin P.J.
        • Dodd M.
        • Wrate R.W.
        Young doctors' health—I. How do working conditions affect attitudes, health and performance?.
        Soc Sci Med. 1997; 45: 35-40
        • Heyhoe J.
        • Birks Y.
        • Harrison R.
        • O'Hara J.K.
        • Cracknell A.
        • Lawton R.
        The role of emotion in patient safety: are we brave enough to scratch beneath the surface?.
        J R Soc Med. 2016; 109: 52-58
        • Croskerry P.
        • Abbass A.
        • Wu A.W.
        Emotional influences in patient safety.
        J Patient Saf. 2010; 6: 199-205
        • Austin J.M.
        • D'Andrea G.
        • Birkmeyer J.D.
        • et al.
        Safety in numbers: the development of Leapfrog's composite patient safety score for U.S. hospitals.
        J Patient Saf. 2014; 10: 64-71
      2. Pakyz AL, Wang H, Ozcan YA, Edmond MB, Vogus TJ. Leapfrog Hospital Safety Score, Magnet designation, and healthcare-associated infections in United States hospitals [published online ahead of print April 27, 2017]. J Patient Saf. https://doi.org/10.1097/PTS.0000000000000378.

        • Smith S.N.
        • Reichert H.A.
        • Ameling J.M.
        • Meddings J.
        Dissecting Leapfrog: how well do Leapfrog Safe Practices Scores correlate with hospital compare ratings and penalties, and how much do they matter?.
        Med Care. 2017; 55: 606-614
        • Gonzalez A.A.
        • Ghaferi A.A.
        Hospital Safety Scores: do grades really matter?.
        JAMA Surg. 2014; 149: 413-414
        • Shanafelt T.D.
        • Dyrbye L.N.
        • Sinsky C.
        • et al.
        Relationship between clerical burden and characteristics of the electronic environment with physician burnout and professional satisfaction.
        Mayo Clin Proc. 2016; 91: 836-848
        • Maslach C.
        • Jackson S.E.
        • Leiter M.P.
        Maslach Burnout Inventory Manual.
        3rd ed. Consulting Psychologists Press, Palo Alto, CA1996
        • Ware J.E.
        • Kosinski M.
        • Turner-Bowker D.M.
        • Gandek B.
        How to Score Version 2 of the SF-12 Health Survey.
        QualityMetric Inc, Lincoln, RI2002
        • Whooley M.A.
        • Avins A.L.
        • Miranda J.
        • Browner W.S.
        Case-finding instruments for depression: two questions are as good as many.
        J Gen Intern Med. 1997; 12: 439-445
        • Ware Jr., J.
        • Kosinski M.
        • Keller S.D.
        A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity.
        Med Care. 1996; 34: 220-233
        • Rafferty J.P.
        • Lemkau J.P.
        • Purdy R.R.
        • Rudisill J.R.
        Validity of the Maslach Burnout Inventory for family practice physicians.
        J Clin Psychol. 1986; 42: 488-492
        • Lee R.T.
        • Ashforth B.E.
        A meta-analytic examination of the correlates of the three dimensions of job burnout.
        J Appl Psychol. 1996; 81: 123-133
        • West C.P.
        • Dyrbye L.N.
        • Satele D.V.
        • Sloan J.A.
        • Shanafelt T.D.
        Concurrent validity of single-item measures of emotional exhaustion and depersonalization in burnout assessment.
        J Gen Intern Med. 2012; 27: 1445-1452
        • West C.P.
        • Shanafelt T.D.
        • Kolars J.C.
        Quality of life, burnout, educational debt, and medical knowledge among internal medicine residents.
        JAMA. 2011; 306: 952-960
        • West C.P.
        • Dyrbye L.N.
        • Sloan J.A.
        • Shanafelt T.D.
        Single item measures of emotional exhaustion and depersonalization are useful for assessing burnout in medical professionals.
        J Gen Intern Med. 2009; 24: 1318-1321
        • Dyrbye L.N.
        • Satele D.
        • Sloan J.
        • Shanafelt T.D.
        Utility of a brief screening tool to identify physicians in distress.
        J Gen Intern Med. 2013; 28: 421-427
        • Dyrbye L.N.
        • Satele D.
        • Sloan J.
        • Shanafelt T.D.
        Ability of the Physician Well-Being Index to identify residents in distress.
        J Grad Med Educ. 2014; 6: 78-84
        • Spitzer R.L.
        • Williams J.B.
        • Kroenke K.
        • et al.
        Utility of a new procedure for diagnosing mental disorders in primary care: the PRIME-MD 1000 study.
        JAMA. 1994; 272: 1749-1756
        • Buchbinder S.B.
        • Wilson M.
        • Melick C.F.
        • Powe N.R.
        Primary care physician job satisfaction and turnover.
        Am J Manag Care. 2001; 7: 701-713
        • Shanafelt T.D.
        • Boone S.
        • Tan L.
        • et al.
        Burnout and satisfaction with work-life balance among US physicians relative to the general US population.
        Arch Intern Med. 2012; 172: 1377-1385
        • Kessler R.C.
        • Berglund P.
        • Borges G.
        • Nock M.
        • Wang P.S.
        Trends in suicide ideation, plans, gestures, and attempts in the United States, 1990-1992 to 2001-2003.
        JAMA. 2005; 293: 2487-2495
        • Kessler R.C.
        • Borges G.
        • Walters E.E.
        Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey.
        Arch Gen Psychiatry. 1999; 56: 617-626
        • Cooper-Patrick L.
        • Crum R.M.
        • Ford D.E.
        Identifying suicidal ideation in general medical patients.
        JAMA. 1994; 272: 1757-1762
      3. Hospital Survey on Patient Safety Culture. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/sops/quality-patient-safety/patientsafetyculture/hospital/index.html. Accessed June 13, 2018.

        • Weingart S.N.
        • Callanan L.D.
        • Ship A.N.
        • Aronson M.D.
        A physician-based voluntary reporting system for adverse events and medical errors.
        J Gen Intern Med. 2001; 16: 809-814
        • O'Neil A.C.
        • Petersen L.A.
        • Cook E.F.
        • Bates D.W.
        • Lee T.H.
        • Brennan T.A.
        Physician reporting compared with medical-record review to identify adverse medical events.
        Ann Intern Med. 1993; 119: 370-376
        • Hayashino Y.
        • Utsugi-Ozaki M.
        • Feldman M.D.
        • Fukuhara S.
        Hope modified the association between distress and incidence of self-perceived medical errors among practicing physicians: prospective cohort study.
        PLoS One. 2012; 7: e35585
        • Chen K.Y.
        • Yang C.M.
        • Lien C.H.
        • et al.
        Burnout, job satisfaction, and medical malpractice among physicians.
        Int J Med Sci. 2013; 10: 1471-1478
        • Prins J.T.
        • van der Heijden F.M.
        • Hoekstra-Weebers J.E.
        • et al.
        Burnout, engagement and resident physicians' self-reported errors.
        Psychol Health Med. 2009; 14: 654-666
        • Williams E.S.
        • Manwell L.B.
        • Konrad T.R.
        • Linzer M.
        The relationship of organizational culture, stress, satisfaction, and burnout with physician-reported error and suboptimal patient care: results from the MEMO study.
        Health Care Manage Rev. 2007; 32: 203-212
        • Fahrenkopf A.M.
        • Sectish T.C.
        • Barger L.K.
        • et al.
        Rates of medication errors among depressed and burnt out residents: prospective cohort study.
        BMJ. 2008; 336: 488-491
        • Gander P.H.
        • Merry A.
        • Millar M.M.
        • Weller J.
        Hours of work and fatigue-related error: a survey of New Zealand anaesthetists.
        Anaesth Intensive Care. 2000; 28: 178-183
        • Marmon L.M.
        • Heiss K.
        Improving surgeon wellness: the second victim syndrome and quality of care.
        Semin Pediatr Surg. 2015; 24: 315-318
        • Lewis E.J.
        • Baernholdt M.B.
        • Yan G.
        • Guterbock T.G.
        Relationship of adverse events and support to RN burnout.
        J Nurs Care Qual. 2015; 30: 144-152
        • Davidson J.E.
        • Agan D.L.
        • Chakedis S.
        Exploring distress caused by blame for a negative patient outcome.
        J Nurs Adm. 2016; 46: 18-24
        • O'Beirne M.
        • Sterling P.
        • Palacios-Derflingher L.
        • Hohman S.
        • Zwicker K.
        Emotional impact of patient safety incidents on family physicians and their office staff.
        J Am Board Fam Med. 2012; 25: 177-183
        • Van Gerven E.
        • Vander Elst T.
        • Vandenbroeck S.
        • et al.
        Increased risk of burnout for physicians and nurses involved in a patient safety incident.
        Med Care. 2016; 54: 937-943
        • Shapiro J.
        • Galowitz P.
        Peer support for clinicians: a programmatic approach.
        Acad Med. 2016; 91: 1200-1204
        • Shanafelt T.
        • Lightner D.J.
        • Conley C.R.
        • et al.
        An organization model to assist individual physicians, scientists, and senior health care administrators with personal and professional needs.
        Mayo Clin Proc. 2017; 92: 1688-1696
        • Profit J.
        • Sharek P.J.
        • Amspoker A.B.
        • et al.
        Burnout in the NICU setting and its relation to safety culture.
        BMJ Qual Saf. 2014; 23: 806-813
        • Sexton J.B.
        • Sharek P.J.
        • Thomas E.J.
        • et al.
        Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout.
        BMJ Qual Saf. 2014; 23: 814-822

      Linked Article

      • Burnout is Not Associated With Increased Medical Errors
        Mayo Clinic ProceedingsVol. 93Issue 11
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          In the abstract conclusion of Tawfik et al’s article1 on the relationship between physician burnout and reported medical errors, the authors report that “physician burnout, fatigue, and work unit safety grades were independently associated with major medical errors.” Yet burnout in health care providers, although associated with self-reported medical errors, does not appear to be associated with actual medical errors when measured objectively through chart audits, official error reports, and observation.
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