Burnout is associated with adverse outcomes including medical errors and lower quality of care. While many studies have focused on physician or nurse burnout, the COVID-19 pandemic increased stress across the healthcare workforce, including support staff and healthcare teams who have a crucial role in patient care. A new study of 206 healthcare organizations led by investigators from Brigham and Women’s Hospital, a founding member of the Mass General Brigham healthcare system, identified high levels of burnout, intent to leave the profession, and work overload across all members of the healthcare workforce. Their results are published in the Journal of General Internal Medicine.
“Teams are crucial for good healthcare delivery and our study emphasizes a need to improve the well-being of the many role types that comprise our healthcare teams,” said corresponding author Lisa S. Rotenstein, MD, MBA, a primary care physician at the Brigham and Assistant Professor of Medicine at Harvard Medical School. “We need to support all roles within the healthcare environment in order to provide high-quality patient care.”
Rotenstein’s team analyzed burnout, intent to leave the profession, and feelings of work overload reported in the American Medical Association’s Coping with COVID Survey from April to December 2020. Through the survey, 43,026 responses were collected from 206 healthcare organizations.
Respondents included over 15,000 physicians and 11,000 nurses. They also included over 5,000 other clinical staff such as pharmacists, nursing assistants, therapists, medical assistants, or social workers and over 11,000 non-clinical staff including housekeeping, administrative staff, lab technicians, or food service staff.
“Individuals in other clinical roles or non-clinical roles such as technicians, food service workers or nursing assistants may be more likely to be from underrepresented minority groups or hold multiple jobs,” Rotenstein said. “They may be less likely to be in a position to speak up about their own working conditions.”
Approximately 50 percent of all respondents reported burnout, with the highest levels among nurses (56 percent) and other clinical staff (54.1 percent) reporting burnout. Intent to leave the job was reported by 28.7 percent of healthcare workers, with 41 percent of nurses, 32.6 percent of non-clinical staff and 31.1 percent of clinical staff reporting the sentiment. The intent to leave was higher for both physicians and nurses in an in-patient setting compared to out-patient settings.
The prevalence of perceived work overload ranged from 37.1 percent among physicians to 47.4 percent in other clinical staff and this work overload was significantly associated with both burnout and intent to leave the job.
“That is something potentially actionable. There isn’t a standard way to quantify work overload in the healthcare setting,” said Rotenstein. “There's an opportunity here to both identify and address workload across all role types.”
Rotenstein advocates for more innovative approaches that do not simply shift responsibilities from some members of the health care workforce to others, but to automate or reimagine some of these responsibilities.
Survey completion was voluntary, so the population is not necessarily representative of the healthcare workforce. Additionally, the data were collected at the height of the pandemic, and levels of burnout could have changed. Still, the survey responses underscore the importance of looking at the experience of all healthcare workers.
“We are acutely seeing the effects of burnout across the workforce,” Rotenstein said. “There are staffing shortages in healthcare facilities across the country and it's not just physicians. It is nurses, medical assistants, and more. We need to take care of all types of healthcare workers.”
Disclosures: Co-author Mark Linzer was supported through his employer Hennepin Healthcare, and by the AMA. His other scholarly work is supported by NIH and AHRQ. Rotenstein has received research support from the American Medical Association, FeelBetter Inc., and AHRQ. Linzer is also supported through his employer for work on burnout reduction projects for IHI, ABIM, ACP, Optum Office for Provider Advancement, Essentia Health Systems, Gillette Children’s Hospital, and the California AHEC System, and consults for Harvard University on a grant assessing relationships between work conditions and diagnostic accuracy (consultation funds donated to Hennepin Healthcare Foundation).
Paper cited: Rotenstein, L et al. “The Association of Work Overload with Burnout and Intent to Leave the Job Across the Healthcare Workforce during COVID-19” Journal of General Internal Medicine DOI: https://doi.org/10.1007/s11606-023-08153-z
