Engagement and burnout amonghealth professionals: Preliminary data from 7 countries Anthony Montgomery, Katerina Georganta University of Macedonia, Greece Efharis Panagopoulou, AUTH, Greece The research leading to these results has received funding from the European Union’s Seventh Framework Programme [FP7-HEALTH-2009-single-stage] under grant agreement no. .
Layout of my talk What is the ORCAB project? Progress to date Looking at the hospital as an organisation Reflections
ORCAB: Improving quality and safety in the hospital: The link between organisational culture, burnout and quality of care Relatively little systematic assessment of organisational culture or quality of care in hospitals† Job burnout is a significant problem in terms of patient safety and occupational well being*† McGowan Y, Humphries N, Morgan K, Conry M, Montgomery A, Vedhara K, Panagopoulou E, McGee H: Defining Qualityof care in hospitals: A ten year systematic review of the literature 2000-2010 (in preparation).*Montgomery, A.J., Panagopoulou, E., Kehoe, I., Valkanos, E. (2011). Connecting organisational culture and quality of carein the hospital: Is job burnout the missing link? Journal of Health Organisation and Management, 25, 108-123.
Beneficiary name Country Lead Researcher E. Panagopoulou Aristoteleio University of Greece Director of the Professional Development Unit, Thessaloniki (lead researcher) Anthony Montgomery University of Macedonia Greece Assistant Professor of Work Psychology Feride Sacaklioglou Ege University Turkey Professor of Public Health Ana Passos Centro de Investigação e Portugal Professor of Social and Intervenção Social Organisational Psychology Babes Bolyai University Adriana Baban Romania Romania Professor of Health PsychologyHealth Psychology Research Irina Todorova Bulgaria Center DirectorMedical school University of Jadranka Mustajbegovic Croatia Zagreb Professor of Public Health Jovanka Karadzinska-BislimovskaThe Institute of Occupational FYROM Director of the WHO Collaborating Center for Health Occupational Health Kavita Vedhara University of Nottingham UK Chair of Health PsychologyRoyal College of Surgeons in Hannah McGee Dean, Medical Faculty Ireland Ireland
Do hospital physicians learn? We can imagine that continuously updating education and performance would be especially desirable for doctors Recent review* on the impact of work based assessment on doctors’ education and performance found little evidence Put simply, there was little evidence that assessing work performance was leading to actual behaviour change among doctors* [BMJ 2010;341:c5064doi:10.1136/bmj.c5064]
Evidence of DeLearning *Doctors inappropriately self-medicate and self-treat at alarming high levels (even for chronic diseases!) ^Physicians feel less stressed when they conceal information*Montgomery, A.J., Bradley, C., Rochfort , A. & Panagopoulou, E. (2011). Self-treatment:a neglected occupational hazard for physicians and medical students. OccupationalMedicine, doi:10.1093/occmed/kqr098.^Panagopoulou, E., Minzitori, G., Montgomery A.J, Kapoukranidou, D., & Benos, A.(2008). Concealment of information in clinical practice: Is lying less stressful than tellingthe truth? Journal of Clinical Oncology, 28, 1175-1177.
ORCAB: Improving quality and safety in thehospital: The link between organisational culture,burnout and quality of care Phase 1: Systematic Reviews Phase 2: Focus Groups & Interviews Phase 3: Survey Organisational culture Quality of Care Job burnout/engagement Phase 4: Action Research
Sub-optimal care8-item measure* uses a 5-point scale documenting the frequency of the occurrence of different types of suboptimal care and attitudes towards practices Item 1: I found myself discharging patients to make the service manageable because the team was so busy Item 5: I did not perform a diagnostic test because of desire to discharge a patient*Shanafelt, T., Bradley, K., Wipf, J., & Back, A. (2002). Burnout and self-reported patient care in aninternal medicine residency program. Annals of Internal Medicine, 136, 358–367.
Burnout and Sub-optimal care Negative Affectivity + + + Depersonalisation Sub-optimal care Is this model invariant across countries?
Burnout and Sub-optimal care Depresonalistation is a consistent predictor in all countries Model χ2 df Δχ2 Δdf CFI ΔCFI RMSEA Country Configural model 257.14 84 .960 .030 Measurement model 374.11 108 116.97 24 .950 .010 .032 Structural model 472.97 126 215.83 42 .932 .028 .034N.B. In comparing models, one often should use a measure of fit like theTucker-Lewis Index or RMSEA index and not the chi square difference(David Kenny, http://davidakenny.net/cm/causalm.htm)
Engagement and Sub-optimalcare Positive Affectivity + _ Dedication Sub-optimal care _ Is this model invariant across countries?
No, testing for Invariance*... The Model is not invariant across countries Dedication predicts Suboptimal care only in: Romania FYROM Turkey
Please give your work area/unit in this hospital anoverall grade on patient safety* Excellent or very Acceptable Poor or failing good Greece (N = 688) 80.6% 16.8% 2.6% Portugal (N = 152) 80.2% 15.7% 4.1% Bulgaria (N = 200) 75.3% 20.1% 4.6% Romania (N = 368) 64.1% 33.6% 2.3% Turkey (N = 501) 37.4% 48.6% 14.0% Croatia (N = 198) 85.9% 8.5% 5.6% FYROM (N = 325) 77.5% 17.8% 4.7%*The Hospital Survey on Patient Safety Culture ; developed by the US Agency for Healthcare Research and Quality(AHRQ) http://www.ahrq.gov/qual/patientsafetyculture/hospcult1.htm.
Please give your work area/unit in this hospital an overallgrade on patient safety rEmotional Exhaustion .28**Depersonalisation .31**Vigour -.30**Dedication -.28****Correlation is significant at the 0.01 level
The Story so far.... Greece, Bulgaria & Turkey reporting high burnout levels Nurses and residents doing the worst DEP Sub-optimal care DED associated with less sub-optimal care
What’s next? Multilevel analysis Action Research
Reflections Ironically, “fitness-to-practice” reviews ignore the role of organisational culture How can we use our burnout and engagement data to improve patient safety? Need to shift the focus away from individuals and towards [both incident and accident reporting]