Organizational strategies to reduce physician burnout: a systematic review and meta-analysis.

Item request has been placed! ×
Item request cannot be made. ×
loading   Processing Request
  • Author(s): De Simone S;De Simone S; Vargas M; Vargas M; Servillo G; Servillo G
  • Source:
    Aging clinical and experimental research [Aging Clin Exp Res] 2021 Apr; Vol. 33 (4), pp. 883-894. Date of Electronic Publication: 2019 Oct 09.
  • Publication Type:
    Journal Article; Meta-Analysis; Review; Systematic Review
  • Language:
    English
  • Additional Information
    • Source:
      Publisher: Springer Country of Publication: Germany NLM ID: 101132995 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1720-8319 (Electronic) Linking ISSN: 15940667 NLM ISO Abbreviation: Aging Clin Exp Res Subsets: MEDLINE
    • Publication Information:
      Publication: <2013-> : Berlin : Springer
      Original Publication: Milano, Italy : Editrice Kurtis, c2002-
    • Subject Terms:
    • Abstract:
      Background: The growing "process" of burnout impair performance and quality of professional services, with consequences for physicians, healthcare care organization, and patient's outcomes.
      Aims: We aim to evaluate which strategy of intervention, individual or organization directed, is more effective to reduce physician burnout and to provide management suggestions in terms of actual organizational strategies and intensity leading to reductions in physician burnout.
      Methods: The meta analysis was conducted according to the PRISMA guidelines. We included physicians of any specialty in the primary, secondary, or intensive care setting, including residents and fellows. Eligible interventions were any intervention designed to relieve stress and/or improve the performance of physicians and reported burnout outcomes, including physician-directed interventions and organization-directed interventions. The electronic search strategy applied standard filters for identification of the different studies. Databases searched were the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), MEDLINE (from inception to September 2018), and EMBASE (from beginning to September 2018). Meta analysis was performed with mixed random effect using DerSimonian and Laird method. The standardized mean difference (SMD) and 95% CI for each outcome were separately calculated for each trial pooling data when needed, according to an intention-to-treat principle.
      Results: Pooled interventions were associated with small significant reductions in burnout (SMD = - 0.289; 95% CI, - 0.419 to - 0.159; I2 = 29%) (Fig. 2). Organization-directed interventions were associated with a medium reduction in burnout score (SMD = - 0.446; 95% CI, - 0.619 to - 0.274; I2 = 8%) while physician-directed interventions were associated with a moderate reduction in burnout score (SMD = - 0.178; 95% CI, - 0.322 to - 0.035; I2 = 11%).
      Discussion: This systematic review and meta-analysis showed that (1) organization-directed interventions were associated with moderate reduction in burnout score, (2) physician-directed interventions were associated with small reduction in burnout score, (3) organization-directed interventions reduced more the depersonalization than physician-directed interventions, (4) organization-directed interventions were related to a more improvement of the personal accomplishment than physician-directed interventions.
      Conclusions: This meta analysis found that physicians could gain important benefits from interventions to reduce burnout, especially from organizational strategies, by viewing burnout rooted in issues related to the working environment and organizational culture.
    • References:
      Freudenberger HJ (1974) Staff Burn-Out. J Soc Issues 30:159–165.
      Vargas M, Spinelli G, De Simone S et al (2018) Il Burn-out. In: Marinangeli F, Ciccone A, Ranieri MV (eds) Rischi Medico-legali in Rianimazione e Terapia Intensiva. Responsabilità Professionale in una Sanità che cambia. Momento Medico, Salerno, pp 73–76.
      De Simone S (2014) A conceptual framework for the organizational analysis in health care contexts. Int J Humanit Soc Sci 4:46–52.
      De Simone S (2015) Wellbeing at work: a survey on perception of health care workers. Rivista Internazionale di Scienze Sociali 4:412–495.
      Maslach C, Schaufeli WB, Leiter MP (2001) Job burnout. Annu Rev Psychol 52:397–422. (PMID: 1114831111148311)
      Maslach C, Jackson SE (1981) The measurement of experienced burnout. J Organ Behav 2:99–113.
      Wallace JE, Lemaire JB, Ghali WA (2009) Physician wellness: a missing quality indicator. Lancet 374:1714–1721. (PMID: 19914516)
      Awa WL, Plaumann M, Walter U (2010) Burnout prevention: a review of intervention programs. Patient Educ Couns 78:184–190. (PMID: 19467822)
      Dyrbye LN, Shanafelt TD (2011) Physician burnout: a potential threat to successful health care reform. JAMA 305:2009–2010. (PMID: 21586718)
      Dewa CS, Loong D, Bonato S et al (2014) How does burnout affect physician productivity? a systematic literature review. BMC Health Serv Res 14:325. (PMID: 250663754119057)
      Shanafelt TD, Mungo M, Schmitgen J et al (2016) Longitudinal study evaluating the association between physician burnout and changes in professional work effort. Mayo Clin Proc 91:422–431. (PMID: 27046522)
      Shanafelt TD, Balch CM, Bechamps G et al (2010) Burnout and medical errors among American surgeons. Ann Surg 251:995–1000. (PMID: 19934755)
      Bakker AB, Demerouti E, Euwema MC (2005) Job resources buffer the impact of job demands on burnout. J Occup Health Psychol 10:170–180. (PMID: 15826226)
      Bakker AB, Demerouti E, Verbeke W (2004) Using the job demands resources model to predict burnout and performance. Hum Resour Manag 43:83–104.
      Kalani SD, Azadfallah P, Oreyzi H et al (2018) Interventions for physician Burnout: a systematic review of systematic reviews. Int J Prev Med 9:1–12.
      Panagioti M, Panagopoulou E, Bower P et al (2017) Controlled interventions to reduce burnout in physicians: a systematic review and meta-analysis. JAMA Intern Med 177:195–205. (PMID: 27918798)
      Higgins JP, Altman DG, Gotzschge PC et al (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomized trials. BMJ 343:d5928. (PMID: 31962453196245)
      Peters JL, Sutton AJ, Jones DR et al (2006) Comparison of two methods to detect publication bias in meta-analysis. JAMA 295:676–680. (PMID: 16467236)
      Moher D, Liberati A, Tetzlaff J, PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097. (PMID: 1962107219621072)
      Ali NA, Hammersley J, Hoffmann SP et al (2011) Midwest Critical Care Consortium. Continuity of care in intensive care units: a cluster-randomized trial of intensives staffing. Am J Respir Crit Care Med 184:803–808. (PMID: 21719756)
      Amutio A, Martinez-Taboada C, Delgado LC et al (2015) Acceptability and effectiveness of a long-term educational intervention to reduce physicians’ stress-related conditions. J Contin Educ Health Prof 35:255–260. (PMID: 26953856)
      Asuero AM, Queralt JM, Pujol-Ribera E et al (2014) Effectiveness of a mindfulness education program in primary health care professionals: a pragmatic controlled trial. J Contin Educ Health Prof 34:4–12. (PMID: 24648359)
      Bragard I, Etienne AM, Merckaert I et al (2010) Efficacy of a communication and stress management training on medical residents’ self-efficacy, stress to communicate and burnout. J Health Psychol 15:1075–1081. (PMID: 20453053)
      Butow P, Brown R, Aldridge J et al (2015) Can consultation skills training change doctors’ behaviour to increase involvement of patients in making decisions about standard treatment and clinical trials: a randomized controlled trial. Health Expect 18:2570–2583. (PMID: 24975503)
      Butow P, Cockburn J, Girgis A et al (2008) CUES Team. Increasing oncologists’ skills in eliciting and responding to emotional cues: evaluation of a communication skills training program. Psychooncology 17:209–218. (PMID: 17575560)
      Garland A, Roberts D, Graff L (2012) Twenty-four-hour intensivist presence: a pilot study of effects on intensive care unit patients, families, doctors, and nurses. Am J Respir Crit Care Med 185:738–743. (PMID: 22246176)
      Gunasingam N, Burns K, Edwards J et al (2015) Reducing stress and burnout in junior doctors: the impact of debriefing sessions. Postgrad Med J 91:182–187. (PMID: 25755266)
      Linzer M, Poplau S, Grossman E et al (2015) A cluster randomized trial of interventions to improve work conditions and clinician burnout in primary care: results from the Healthy Work Place (HWP) study. J Gen Intern Med 30:1105–1111. (PMID: 257245714510236)
      Lucas BP, Trick WE, Evans AT et al (2012) Effects of 2- vs 4-week attending physician inpatient rotations on unplanned patient revisits, evaluations by trainees, and attending physician burnout: a randomized trial. JAMA 308:2199–2207. (PMID: 23212497)
      Margalit APA, Glick SM, Benbassat J et al (2005) Promoting a biopsychosocial orientation in family practice: effect of two teaching programs on the knowledge and attitudes of practising primary care physicians. Med Teach 27:613–618. (PMID: 16332553)
      Martins AE, Davenport MC, Del Valle MP et al (2011) Impact of a brief intervention on the burnout levels of pediatric residents. J Pediatr 87:493–498.
      Milstein JM, Raingruber BJ, Bennett SH et al (2009) Burnout assessment in house officers: evaluation of an intervention to reduce stress. Med Teach 3:338–341.
      Parshuram CS, Amaral ACKB, Ferguson ND et al (2015) Canadian Critical Care Trials Group. Patient safety, resident well-being and continuity of care with different resident duty schedules in the intensive care unit: a randomized trial. CMAJ 187:321–329. (PMID: 256672584361104)
      Ripp JA, Bellini L, Fallar R et al (2015) The impact of duty hours restrictions on job burnout in internal medicine residents: a three-institution comparison study. Acad Med 90:494–499. (PMID: 25607940)
      Shea JA, Bellini LM, Dinges DF et al (2014) Impact of protected sleep period for internal medicine interns on overnight call on depression, burnout, and empathy. J Grad Med Educ 6:256–263. (PMID: 249491284054723)
      Verweij H, Waumans RC, Smeijers D et al (2016) Mindfulness-based stress reduction for GPs: results of a controlled mixed methods pilot study in Dutch primary care. Br J Gen Pract 66:99–105.
      Weight CJ, Sellon JL, Lessard-Anderson CR et al (2013) Physical activity, quality of life, and burnout among physician trainees: the effect of a team-based, incentivized exercise program. Mayo Clin Proc 88:1435–1442. (PMID: 24290117)
      West CP, Dyrbye LN, Rabatin JT et al (2014) Intervention to promote physician well-being, job satisfaction, and professionalism: a randomized clinical trial. JAMA Intern Med 174:527–533. (PMID: 24515493)
      Ireland MJ, Clough BC, Gill K et al (2017) A randomized controlled trial of mindfulness to reduce stress and burnout among intern medical practitioners. Med Teach. https://doi.org/10.1080/0142159X.2017.1294749. (PMID: 10.1080/0142159X.2017.129474928379084)
      De Simone S (2013) Organizational climate and organizational behaviour, in XIV Workshop dei docenti e dei Ricercatori di Organizzazione Aziendale Organizing in turbulent times: the challenges ahead. Sapienza, Rome, pp 30–31.
      De Simone S (2016) Leadership behaviors in organizations. Int J Bus Soc Sci 7(4):59–64.
      Korczak D, Huber B, Kister C (2010) Differential diagnostic of the burnout syndrome. GMS Health Technol Assess 6:1–9.
    • Contributed Indexing:
      Keywords: Meta-analysis; Organizational-directed interventions; Physician burnout; Systematic review; Wellbeing
    • Publication Date:
      Date Created: 20191011 Date Completed: 20210503 Latest Revision: 20210503
    • Publication Date:
      20231215
    • Accession Number:
      10.1007/s40520-019-01368-3
    • Accession Number:
      31598914