Systematic Review of Burnout Risk Factors among European Healthcare Professionals
Bria, Mara, Baban, Adriana, Dumitrascu, Dan L., Cognitie, Creier, Comportament
Healthcare professionals' burnout is a response to the prolonged exposure to occupational stress and affects negatively both the employee and the organization. The aim of the present review is to discuss the relevant burnout risk factors for European healthcare professionals working in hospitals and clinics. A systematic search of articles published between January 2000 and December 2011 was conducted in several databases (ISI Web of Knowledge, PsychArticles, SagePub, PubMed and Cochrane database of systematic reviews). After the analysis of the 4335 articles found, 53 met the inclusion criteria and were included in the review. Results confirm the main role of occupational and organizational risk factors while pointing out that psychosocial factors have a small yet statistically significant influence on burnout development. Socio-demographic factors, although included in the majority of studies, seem to have little impact on burnout. In conclusion, the review pointed out that although the healthcare systems across Europe are fundamentally different, healthcare professionals present similar risk factors concerning burnout.
KEYWORDS: burnout, risk factors, healthcare professionals, systematic review
Healthcare professionals are frequently exposed to occupational stress, especially due to overwhelming emotional and interpersonal interactions. This kind of long term job strain can lead to burnout symptoms such as emotional exhaustion, depersonalization, and reduced professional efficacy (Maslach, Schaufeli, & Leiter, 2001), and may have negative consequences for both the individual and the organization. Burnout among healthcare professionals has often been associated with depression (Ahola & Hakanen, 2007), insomnia (Vela-Bueno et. al., 2008), or alcohol abuse (Moustou, Montgomery, Panagopoulou, & Benos, 2010). Professional stress affects doctors' and nurses' health. Studies indicate that professional stress is associated with inflammatory markers among physicians (Poanta, Craciun, & Dumitrascu, 2010) or with increased risk of cardiovascular diseases (Melamed, Shirom, Toker, Berliner, & Shapira, 2006). Burnout also jeopardizes organizational performance in medical settings. Healthcare professionals' burnout has been related to low performance (Keijsers, Schaufeli, Le Blanc, Zwerts, & Miranda, 1995), high turnover intentions (Leiter & Maslach, 2009), suboptimal care (Shanafelt, Bradley, Wipf, & Black, 2002), and medical errors.
A recent survey shows that high levels of burnout are strongly correlated with major medical errors among American surgeons. Burnout was demonstrated to be an independent predictor of reporting medical errors, even when controlling for occupational factors like the number of overnight shifts, compensation practices, or number of working hours. More than 70% of them blamed the individual factors, and not the organization or the medical system factors (Shanafelt, et. al., 2010). The relationship between burnout and perceived medical errors is even stronger among residents. According to a longitudinal study conducted among junior doctors, all three dimensions of burnout, exhaustion, depersonalization, and reduced professional efficacy are strong predictors of perceived medical error rates reported three months later (West et al., 2006). In a meta-analysis on the link between burnout and objective performance, Taris (2006) concludes that emotional exhaustion and depersonalization have a stronger impact on reporting medical errors than on personal accomplishment. Similar results were reported by Prins et al. (2009) in a study conducted among Dutch residents from different specialties. The study also shows that perceived errors due to lack of time are more strongly linked to burnout than perceived errors due to inexperience or errors in judgment.
The literature has systematically linked workload to burnout (Lee & Ashforth, 1996) and medical errors. …