Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.
3 Extent and Consequences of Clinician Burnout âThe moment I found myself envious of the man lying down on the operating room table was a startling and dark admis- sion of the effects of my fatigue. I think of that time when I realize I have again ignored my own well-being....â (Night in OR #5, Rishi Doshi)1 In this chapter, the committee describes various instruments used to measure the extent of burnout among clinicians and discusses the literature on the prevalence of burnout and its consequences for clinicians, health organizations (e.g., job retention and turnover), and the quality of care. Chapter 8 describes the extent and consequences of burnout among learn- ers and summarizes the evidence about the system factors that contribute to learner burnout and well-being. MEASURING BURNOUT As discussed in Chapter 2, burnout is a multi-dimensional construct that has been studied for nearly 50 years across various occupations (Maslach et al., 2001; Schaufeli et al., 2009). Thorough reviews of the 1 Excerpted from the National Academy of Medicineâs Expressions of Clinician Well- Being: An Art Exhibition. To see the complete work by Rishi Doshi, visit https://nam.edu/Â expressclinicianwellbeing/#/artwork/199 (accessed January 30, 2019). 63
64 TAKING ACTION AGAINST CLINICIAN BURNOUT psychometric properties of various instruments used to measure burnout and of the factors to consider in selecting the optimal instrument for local use have recently been published and are publicly available on the National Academy of Medicineâs website.2 Briefly, Maslachâs theoretical framework considers burnout to be a syn- drome consisting of emotional exhaustion, depersonalization (also referred to as cynicism or disengagement), and a low sense of personal accomplish- ment from work that is driven largely by factors within the work environ- ment. The Maslach Burnout Inventories (MBIs) (Maslach et al., 1996) are the most widely used measures of burnout (Schaufeli et al., 2009). Most of the studies included in this report used the MBIâHuman Services Survey, Medical Professionals (MBIâHSS [MP]), which is widely considered the criterion standard, although some studies used the MBIâGeneral Survey (MBIâGS), developed for use in other workers, or the MBIâStudent Survey (MBIâSS), developed for use in learners. Other studies have used Oldenburg Burnout Inventory, the Copenhagen Burnout Inventory, or the Stanford Professional Fulfillment Index (Demerouti and Bakker, 2008; Dyrbye et al., 2018; Kristensen et al., 2005; Trockel et al., 2018). The Oldenburg Burnout Inventory evaluates physical, cognitive, and affective exhaustion and disengagement from work (Demerouti and Bakker, 2008). The Copen- hagen Burnout Inventory evaluates personal work-related and client-related burnout (Kristensen et al., 2005). The Stanford Professional Fulfillment Index evaluates emotional exhaustion, interpersonal disengagement, and professional fulfillment (NAM, 2018; Trockel et al., 2018). Although sin- gle-item measures of burnout are frequently used, the ability of such items to measure the holistic construct of burnout are unclear, their validity data are less robust, and their use cannot be recommended at the present time. The preferred analytical approach is to treat each dimension (e.g., emotional exhaustion, depersonalization), or sub-scale within the scale, separately as a continuous variable. However, low, average, and high cut- off scores for each sub-scale have been established for the MBI, and these are commonly used instead of continuous variables. Investigators often dichotomize into burnout/no burnout, but there is no accepted standard definition of where burnout begins (Dyrbye et al., 2009). A common ap- proach is to consider individuals as having at least one symptom of burn- out if they have high scores in either the emotional exhaustion (â¥27) or the depersonalization (â¥10) sub-scale of the MBIâHSS. Evidence indicates that high scores on these sub-scales can distinguish the clinically burned out from the non-burned out (Schaufeli et al., 2001), and this approach 2 See https://nam.edu/valid-reliable-survey-instruments-measure-burnout-well-work-Ârelated- dimensions (accessed March 15, 2019) and https://nam.edu/a-pragmatic-approach-for-Â organizations-to-measure-health-care-professional-well-being (accessed March 15, 2019).
EXTENT AND CONSEQUENCES OF CLINICIAN BURNOUT 65 identifies individuals whose degree of burnout places them at an increased risk of potentially serious personal and professional consequences (Dyrbye et al., 2008, 2010; Shanafelt et al., 2002, 2011, 2016b; West et al., 2006, 2009b). Because there is evidence that higher scores in either the emotional exhaustion or depersonalization domain decrease the quality of care pro- vided by clinicians, high degrees of burnout in either of these domains is cause for concern. An alternative option is to consider individuals to have burnout if they have a high emotional exhaustion score along with either a high depersonalization score or a low personal accomplishment score (Dyrbye et al., 2009) or else high scores in all three domains. There is no established approach to dichotomizing results from the Oldenburg Burn- out Inventory or the Copenhagen Burnout Inventory, but threshold scores for dichotomizing results from the Stanford Professional Fulfillment Index have been published (Demerouti and Bakker, 2008; Dyrbye et al., 2018; Kristensen et al., 2005; Trockel et al., 2018). As mentioned above, the data concerning the validity of various burn- out measures have recently been summarized (Dyrbye et al., 2018; NAM, 2018). Briefly, the strongest construct validity data for the 22-item MBIâ Â HSS (MP) are for U.S. physicians and other clinicians. An abbreviated two-item version of the MBI is available and has been shown to correlate strongly with the emotional exhaustion and depersonalization sub-domains of the full-length instrument (West et al., 2009a, 2012a), and there is strong evidence for its validity from large samples of U.S. physicians. There are less robust validity data available for the remaining measures, especially for use in U.S. physicians, nurses, and dentists. The MBI, the Oldenburg Burnout Inventory, the Copenhagen Burnout Inventory, and the Stanford Professional Fulfillment Index instruments can be used across the health care professions broadly, including with physi- cians, nurses, advanced practice providers, social workers, and pharmacists. The MBI is proprietary, and individuals or organizations must pay a fee to use it for operational or research purposes. Both the Oldenburg Burnout Inventory and the Copenhagen Burnout Inventory are also proprietary, but they are free to use. The Stanford Professional Fulfillment Index is also available at no cost for use by not-for-profit organizations for research or operational assessment. These instruments are often embedded within anonymous surveys and can be part of a large survey assessing multiple dimensions of professional well-being. It should be noted that, depending on the time interval being assessed, the various burnout instruments may not be equally sensitive to change. Items on the MBI are rated on a frequency scale with the low end of the continuum anchored by âneverâ and âa few times per yearâ and the more frequent end of the continuum anchored by âevery day.â Although the MBI is largely designed to detect changes over intervals of at least 12 months,
66 TAKING ACTION AGAINST CLINICIAN BURNOUT studies have effectively used it to evaluate changes over 6-month intervals (Panagioti et al., 2018; West et al., 2016). In contrast, the items in the Oldenburg Burnout Inventory are assessed on a four-point agreement scale with options ranging from âtotally disagreeâ to âtotally agree,â and items in the Copenhagen Burnout Inventory are rated on a frequency scale with options ranging from âneverâ to âalways.â Accordingly, the time interval over which the Oldenburg and Copenhagen Burnout Inventories can be used to measure change may be imprecise, and less is known about their ability to detect meaningful effect size from an intervention. The Stanford Professional Fulfillment Index assesses symptoms over the past 2 weeks, and preliminary data suggest that it may be sensitive to change over short time intervals (Trockel et al., 2018). There is substantial heterogeneity in the research methods employed by investigators studying burnout, including variability in the measures used to evaluate burnout symptoms and the approaches to dichotomizing burn- out. Studies have also varied widely in sample size, the types of clinicians included (e.g., single occupation versus multiple health care disciplines), practice settings, participation rates, and adjustment for potential con- founders (Rotenstein et al., 2018). Similar issues exist for other instruments used to subjectively measure aspects of well-being or mental and emotional health, including depression (Mata et al., 2015). These factors have created variability in the reported burnout prevalence. Nonetheless, the definition of burnout, its conceptual framework, and its links to personal and profes- sional consequences are well established (Schaufeli et al., 2009). PREVALENCE OF CLINICIAN BURNOUT Numerous studies have evaluated the prevalence of clinician burnout by occupation, specialty, practice setting, career stage, and demographic characteristics. Among clinicians the most extensive data on prevalence comes from studies of physicians and nurses. Rates of burnout among U.S. nurses have typically ranged between 35 and 45 percent (Aiken et al., 2002, 2012; McHugh et al., 2011; Moss et al., 2016), although many studies have employed only the emotional exhaustion sub-scale of the MBI, resulting in an incomplete picture. In national studies of U.S. physicians us- ing the MBI, rates of burnout have ranged from 40 to 54 percent over the past decade (Shanafelt et al., 2009a, 2012a, 2015, 2019). Limited national data are available on rates of burnout among U.S. nurse practitioners, physician assistants, and pharmacists, and many of these studies have not used standardized or validated instruments (Bell et al., 2002; Benson et al., 2016; Coplan et al., 2018; Hoff et al., 2019; Jones et al., 2017; Lahoz and Mason, 1990; Tetzlaff et al., 2018). Contemporary studies of the prevalence
EXTENT AND CONSEQUENCES OF CLINICIAN BURNOUT 67 of burnout among U.S. dentists are limited; however, data from other coun- tries suggest a substantial burden of burnout among dentists (e.g., Choy, 2015). Given that burnout is due to work-related stressors, the prevalence of burnout among clinicians would be expected to vary substantially among countries and health care delivery systems; thus, we have not included prevalence data from clinicians outside the United States. Limited data are available on long-term trends in the prevalence of burnout among health care clinicians in the United States. National studies of U.S. physicians in 2011, 2014, and 2017 found a substantial increase in burnout between 2011 and 2014, with a subsequent improvement between 2014 and 2017 (Shanafelt et al., 2012a, 2015, 2019). When assessed using the MBI, 43.9 percent (2,147 of 4,893) of the physicians reported at least one symptom of burnout in 2017, compared with 54.4 percent (3,680 of 6,767) in 2014 and 45.5 percent (3,310 of 7,227) in 2011. Extensive evidence also shows variation by practice setting and spe- cialty within a given profession (Balch et al., 2011; Shanafelt et al., 2009a, 2012a, 2015, 2019). Among nurses, those practicing in hospitals or nursing homes appear to have higher rates of burnout than those in other practice settings (McHugh et al., 2011). Among physicians, individuals in private practice models appear to be at a roughly 30 percent higher risk for burn- out than those in academic practice settings (Shanafelt et al., 2015, 2019). Wide variation in burnout exists by physician specialty, and many of the specialties at highest risk are those with substantial direct patient care re- sponsibilities at the frontline of access to the health care delivery system, such as emergency medicine, family medicine, general internal medicine, and neurology (Balch et al., 2011; Busis et al., 2017; Shanafelt et al., 2009a, 2012a, 2015, 2019). The relationship between specialty area and burnout among nurses is less clear (Hooper et al., 2010). A number of demographic factors also appear to relate to burnout. Studies both inside and outside of health care have found a greater risk of burnout among younger workers (Dyrbye et al., 2011; El-Ibiary et al., 2017; Kuerer et al., 2007; Lahoz and Mason, 1990; Poncet et al., 2007; Shanafelt et al., 2009a,b, 2012a, 2014a, 2015, 2016a). This is not due to a generational effect as it has been consistently observed from studies both inside and outside of health care workers over the past 20 to 30 years. Younger workers face a number of distinct challenges as they establish themselves in their career and deal with the complex interplay between per- sonal and professional life as they begin relationships and care for children. Studies also demonstrate that women are at increased risk for burnout relative to their male colleagues after adjusting for other personal and pro- fessional factors (El-Ibiary et al., 2017; Lahoz and Mason, 1990; Shanafelt et al., 2012a,b, 2014a, 2015, 2016a; Templeton et al., 2019). There also
68 TAKING ACTION AGAINST CLINICIAN BURNOUT appear to be subtle differences in the way that burnout is manifest by gender, with burnout in women more likely to manifest as emotional ex- haustion than in men and men more likely than women to experience depersonalization. Although these patterns have been observed at the popu- lation level, they are not absolute and must be considered to be a group- level generalization. Having children has also been shown to reduce the risk of burnout both inside and outside of the health professions, although the impact likely varies based on the age of the child (Dyrbye et al., 2011; El-Ibiary et al., 2017; Shanafelt et al., 2009a, 2014a). Life events such as a personal illness, an illness in a loved one, the birth of a child, or the death of a close loved one also are related to burnout risk (Dyrbye et al., 2006). PERSONAL CONSEQUENCES OF BURNOUT Burnout has a number of personal and professional repercussions. Studies from outside health care have demonstrated that individual work- ers experiencing burnout are at an increased risk for cardiovascular disease (Appels and Schouten, 1991; Toker et al., 2012; Toppinen-Tanner et al., 2009), as well as a host of other health consequences, including hypercho- lesterolemia, type 2 diabetes, coronary heart disease, hospitalization due to cardiovascular disorder, musculoskeletal pain, changes in pain experiences, prolonged fatigue, headaches, gastrointestinal issues, respiratory problems, and severe injuries (Salvagioni et al., 2017). Burnout was also found to be associated with shorter overall survival among individuals less than age 45 in a prospective cohort study of more than 7,000 individuals (Ahola et al., 2010) and with an increased risk of severe occupational injuries in a pro- spective cohort study of more than 10,000 workers who were followed for 8 years (Ahola et al., 2013). Other studies suggest that the increased risk of occupational injury extends to health care workers. For example, resident physicians with burnout are at increased risk for needle sticks, bodily fluid exposures, and motor vehicle accidents (West et al., 2012b). Multiple studies have found a correlation between burnout and rates of de- pression (Maslach and Leiter, 2016). Although these two conditions frequently co-exist, not all individuals with symptoms of burnout experience depression, and not all individuals with depression are burned out (Maslach and Leiter, 2016). Prospective longitudinal studies suggest that burnout may predispose one to depression rather than the converse (Hakanen and Schaufeli, 2012). Burnout may also contribute to the increased risk of suicide that exists among health care workers (Davidson et al., 2018; Feskanich et al., 2002; Hawton et al., 2011; Hem et al., 2005; Katz, 1983; Petersen and Burnett, 2008; Roberts et al., 2013; Schernhammer and Colditz, 2004; Stack, 2001).
EXTENT AND CONSEQUENCES OF CLINICIAN BURNOUT 69 Cross-sectional studies of physicians have found burnout to be associated with a nearly 200 percent greater chance of suicidal ideation (Shanafelt et al., 2011). A doseâresponse relationship between burnout and suicidal ideation, independent of depression, has also been found in multiple studies Â (Dyrbye et al., 2008; Shanafelt et al., 2011; van der Heijden et al., 2008). Longitudinal studies also suggest that suicidal thoughts attenuate when burnout improves, providing some evidence of causality between burnout and suicidal thoughts (Dyrbye et al., 2008). Accordingly, occupational burnout may be one of the reasons for the increased rates of suicide ob- served in some health care occupations (Center et al., 2003). Other studies Â have found higher rates of problematic alcohol use among health care c Â linicians experiencing burnout (Balayssac et al., 2017; Jackson et al., 2016; Oreskovich et al., 2012, 2015; Pedersen et al., 2016; Sargent et al., 2004). Although the direction of effect is unknown, this association may be related to self-medicating as a means of coping with occupational distress. Connections Heal Patients and Clinicians a One cannot endure in palliative medicine without the willing- ness to deeply know oneâs patientsâto know their diseases and symptoms, trials and tribulations, fears and hopes, and, if one is very lucky, their spirits and hearts. a Excerpted from the National Academy of Medicineâs Expressions of Clinician Well- Being: An Art Exhibition. To see the complete work by Erin FitzGerald, visit https://nam. edu/expressclinicianwellbeing/#/artwork/359 (accessed January 30, 2019). SOURCE: Medicine Woman (poetry), Erin FitzGerald, Albuquerque, NM.
70 TAKING ACTION AGAINST CLINICIAN BURNOUT EFFECTS OF BURNOUT ON TURNOVER AND CLINICAL WORK EFFORT Those with burnout are more likely to be dissatisfied with their cur- rent job and to consider leaving. Multiple studies of physicians and nurses have demonstrated that burnout is associated with an increased likelihood of considering a change in position (Aiken et al., 2002; Fida et al., 2018; Pantenburg et al., 2016; Shanafelt et al., 2011, 2014b). Similarly, one study of nurse anesthetists in Europe reported a relationship between burnout and intent to leave the current job (Meeusen et al., 2011). Studies from the Cleveland Clinic, Stanford University, and the University of California, San Francisco, have found that physicians experiencing burnout are approxi- mately twice as likely to actually depart the organization as non-burned-out colleagues (Hamidi et al., 2018; Willard-Grace et al., 2019; Windover et al., 2018). Turnover has a potentially large economic cost to organizations due both to the cost to recruit and replace individuals once they depart and also the lost revenue from caring for patients during the transition (Shanafelt et al., 2017). Health care clinicians with burnout may also be more likely to leave their profession altogether and pursue a nonâhealth careârelated career (Sinsky et al., 2017). Even when clinicians with burnout stay in their current job, there are often adverse individual and organizational job consequences. Prospective longitudinal studies have demonstrated that individuals experiencing burn- out are more likely to cut their professional work effort over the next 12 to 24 months (Shanafelt et al., 2016c). Burnout has also been associated with increased absenteeism (sick days) among nurses (Parker and Kulik, 1995). In other studies, individuals with burnout may show up for work but demon- strate sub-optimal performance even though present (so-called presenteeism) (Salvagioni et al., 2017). Collectively, the combination of all these factors has a major impact on the ability of health care organizations to maintain an ad- equate professional workforce. Burnout may also be decreasing the adequacy of the health care professional workforce precisely at a time when the nation is facing large shortages of some types of health care clinicians, particularly physicians (AAMC, 2017) and nurses (AACN, 2017). The effects of burn- out on turnover and productivity also have a tremendous economic cost at the organization and societal levels. A recent estimate of the societal cost of turnover and reduced productivity due to burnout among the physicians in the United States was greater than $4 billion annually (Han et al., 2019). Although the societal cost of burnout in other health care clinicians has not, to the committeeâs knowledge, been modeled (due to the required underlying data being insufficient to do so accurately), it is no doubt substantial.
EXTENT AND CONSEQUENCES OF CLINICIAN BURNOUT 71 EFFECTS OF BURNOUT ON JOB PERFORMANCE AND QUALITY OF CARE Extensive research across diverse occupations has demonstrated a link between burnout and job performance (Wright and Bonett, 1997). Studies Â of nurses have demonstrated a correlation between nurse burnout and supervisor ratings of nurse performance (Parker and Kulik, 1995). Other studies involving 198,500 employees across nearly 8,000 work units have demonstrated a relationship between engagement (the positive antithesis of burnout) at the work unit level and customer satisfaction, safety, and productivity (Harter et al., 2002). Burnout among health care clinicians has also been shown to have po- tentially profound effects on quality of care. The data from health care are consistent with the broad body of organizational science across disciplines (Salvagioni et al., 2017; Schaufeli et al., 2009; Wright and Bonett, 1997). Studies of nurses have demonstrated a relationship between nurse burnout and nurse rating of the hospitalâs safety culture (Halbesleben et al., 2008) and quality of care (Poghosyan et al., 2010). The aggregate nurse burnout score at the hospital level has been shown to correlate with publicly reported hos- pital quality measures, such as surgical site and urinary-catheter-associated infection rates (Cimiotti et al., 2012). Similarly, emotional exhaustion among nurses has been found to increase the likelihood that patients will rate the hospital poorly, will not recommend the hospital for care, and will perceive their communication with nurses unfavorably (Aiken et al., 2012). Multiple studies of physicians and nurses have demonstrated a relation- ship between burnout and perceived medical errors (Garrouste-Orgeas et al., 2015; Holden et al., 2011; Leiter and Spence Laschinger, 2006; Lu et al., 2015; Oskrochi et al., 2016; Shanafelt et al., 2002, 2010; Tawfik et al., 2018; West et al., 2006, 2009b; Williams et al., 2007). Except in egregious situations, it can be difficult to establish a link between individual provider actions (or inactions) and ultimate patient outcomes (Garrouste-Orgeas et al., 2015; Linzer et al., 2009; Panagioti et al., 2018). Nonetheless, multiple systematic reviews and meta-analyses have concluded that burnout affects quality of care in a variety of ways (Dewa et al., 2017; Panagioti et al., 2018; Salyers et al., 2017). For example, one meta-analysis of 47 studies (2002â2017) involving 42,473 physicians concluded that physician burnout was associated with an increased risk of patient safety incidents (OR [odds ratio] 1.96; 95% CI [confidence interval] 1.59â2.40), poorer quality of care due to low professionalism (OR 2.31; 95% CI 1.87â2.40), and reduced patient satisfaction (OR 2.28; 95% CI 1.42â3.68). (Panagioti et al., 2018, p. E1)
72 TAKING ACTION AGAINST CLINICIAN BURNOUT A study in nursing homes found that nurses who were experiencing burnout (as measured by the emotional exhaustion sub-scale of the MBI) were five times more likely to omit necessary care (OR = 4.97; 95% CI = 2.56â9.66) (White et al., 2019). Other studies have found strong links between burnout and unprofes- sional behavior leading to undesirable patient experiences (Windover et al., 2018). Burnout appears to erode communication between patients and clinicians. Burnout has also been associated with malpractice claims, which is another potential source of economic risk to the organization (Balch et al., 2011; McAbee et al., 2015; Oskrochi et al., 2016). It is possible that this increased risk may be related to sub-optimal communication and lower empathy among individuals with burnout. A doseâresponse relationship has been observed between burnout and validated scores that predict a physicianâs risk of future malpractice litigation, suggesting that individuals who are burned out are at increased risk for future litigation (Hamidi et al., 2018). Physicians with burnout are also less likely to espouse a commit- ment to direct patient care and clinical practice (Tak et al., 2017). Historical studies of satisfaction and distress broadly (as opposed to burnout specifi- cally) have found a correlation with physiciansâ prescribing practices (Grol et al., 1985; Melville, 1980), which indicates a potential insidious effect of burnout on quality of care. Unfortunately, there are not yet any empirical studies examining the relationship between work-related stress or burnout and dentistsâ and pharmacistsâ clinical performance (Plessas et al., 2018). One study looking at the aggregate level of burnout in all members of the health care team working on a given unit have found a correlation with the adjusted mortality rates of the patients cared for by that team of health care clinicians (Welp et al., 2015). Like many studies of burnout, the explana- tion for this association could be directional in either (or both) directions and may well be influenced by other unknown factors that may in fact be the driver of the association. For example, it is possible that a poorly resourced unit is bad both for the patients cared for on that unit and the clinicians for them. Collectively, these effects on quality, patient satisfaction, and litigation risk can also have potential broad effects on health care organizations by affecting referrals, reputation in the community, reimbursement, and con- tracting. The associated economic costs from these dimensions compound the costs associated with turnover, productivity, quality, and patient satis- faction and further strengthen the business case for health care organiza- tions to address this issue (Shanafelt et al., 2017). KEY FINDINGS Burnout is highly prevalent among health care clinicians and has im- portant personal and professional consequences as well as negative effects
EXTENT AND CONSEQUENCES OF CLINICIAN BURNOUT 73 on the organizations in which they work and on society as a whole. Personal consequences include occupational injury, detrimental alcohol use, and a risk of suicide. Professional consequences include effects on the quality of care, the patient experience, and patient outcomes. Burnout has clear and profound impacts on staffing, including absenteeism, presenteeism, reduced productivity, turnover, and clinicians leaving the profession. These aspects have not only a substantial impact on health care organizations but also profound consequences for the adequacy of the U.S. health care workforce. In addition to the potentially tragic consequences for patients and clinicians, there are substantial economic costs to society and health care organizations. In aggregate, the facts make a compelling case for ac- tion to address health care professional burnout at the organization and societal levels. REFERENCES AACN (American Association of Colleges of Nursing). 2017. Fact sheet: Nursing shortage. https://www.aacnnursing.org/News-Information/Fact-Sheets/Nursing-Shortage (accessed July 11, 2019). AAMC (Association of American Medical Colleges). 2017. 2017 state physician workforce data report. Washington, DC: Association of American Medical Colleges. Ahola, K., A. Vaananen, A. Koskinen, A. Kouvonen, and A. Shirom. 2010. Burnout as a pre- dictor of all-cause mortality among industrial employees: A 10-year prospective register- linkage study. Journal of Psychosomatic Research 69(1):51â57. Ahola, K. S., S. Toppenin-Tanner, S. Koskinen, and A. Vaananen. 2013. Occupational burnout and severe injuries: An eight-year prospective cohort study among Finnish forest industry workers. Journal of Occupational Health 55(6):450â457. Aiken, L. H., S. P. Clarke, D. M. Sloane, J. Sochalski, and J. H. Silber. 2002. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA 288(16):1987â1993. Aiken, L. H., W. Sermeus, K. Van Den Heede, D. M. Sloane, R. Busse, M. McKee, L. Bruyneel, A. M. Rafferty, P. Griffiths, M. T. Moreno-Casbas, C. Tishelman, A. Scott, T. Brzostek, J. Kinnunen, R. Schwendimann, M. Heinen, D. Zikos, I. S. Sjetne, H. L. Smith, and A. Kutney-Lee. 2012. Patient safety, satisfaction, and quality of hospital care: Cross sec- tional surveys of nurses and patients in 12 countries in Europe and the United States. BMJ (Online) 344(7851). Appels, A., and E. Schouten. 1991. Burnout as a risk factor for coronary heart disease. Â ehavioral Medicine 17(2):53â59. B Balayssac, D., B. Pereira, J. Virot, A. Collin, D. Alapini, D. Cuny, J. M. Gagnaire, N. Authier, and B. Vennat. 2017. Burnout, associated comorbidities and coping strategies in French community pharmaciesâBOP study: A nationwide cross-sectional study. PLOS ONE 12(8):e0182956. Balch, C. M., T. D. Shanafelt, J. A. Sloan, D. V. Satele, and J. A. Freischlag. 2011. Distress and career satisfaction among 14 surgical specialties, comparing academic and private practice settings. Annals of Surgery 254(4):558â568. Bell, R. B., M. Davison, and D. Sefcik. 2002. A first survey. Measuring burnout in emergency medicine physician assistants. Journal of the American Academy of Physician Assistants 15(3):40â42.
74 TAKING ACTION AGAINST CLINICIAN BURNOUT Benson, M. A., T. Peterson, L. Salazar, W. Morris, R. Hall, B. Howlett, and P. Phelps. 2016. Burnout in rural physician assistants: An initial study. Journal of Physician Assistant Education 27(2):81â83. Busis, N. A., T. D. Shanafelt, C. M. Keran, K. H. Levin, H. B. Schwarz, J. R. Molano, T. R. Vidic, J. S. Kass, J. M. Miyasaki, J. A. Sloan, and T. L. Cascino. 2017. Burnout, career satisfaction, and well-being among U.S. neurologists in 2016. Neurology 88(8):797â808. Center, C., M. Davis, T. Detre, D. E. Ford, W. Hansbrough, H. Hendin, J. Laszlo, D. A. Litts, J. Mann, P. A. Mansky, R. Michels, S. H. Miles, R. Proujansky, C. F. Reynolds, 3rd, and M. M. Silverman. 2003. Confronting depression and suicide in physicians: A consensus statement. JAMA 289(23):3161â3166. Cimiotti, J. P., L. H. Aiken, D. M. Sloane, and E. S. Wu. 2012. Nurse staffing, burnout, and health care-associated infection. American Journal of Infection Control 40(6):486â490. Coplan, B., T. C. McCall, N. Smith, V. L. Gellert, and A. C. Essary. 2018. Burnout, job satisfaction, and stress levels of PAs. Journal of the American Academy of Physician Assistants 31(9):42â46. Davidson, J., J. Mendis, A. R. Stuck, G. DeMichele, and S. Zisook. 2018. Nurse suicide: Breaking the silence. NAM Perspectives. Discussion paper. Washington, DC: National Academy of Medicine. Demerouti, E., and A. Bakker. 2008. The Oldenburg Burnout Inventory: A good alternative to measure burnout and engagement. In J. R. B. Halbesleben (ed.), Handbook of stress burnout in health care. Hauppauge, NY: Nova Science. Pp. 51â63. Dewa, C. S., D. Loong, S. Bonato, and L. Trojanowski. 2017. The relationship between physi- cian burnout and quality of healthcare in terms of safety and acceptability: A systematic review. BMJ Open 7(6). Dyrbye, L. N., M. R. Thomas, J. L. Huntington, K. L. Lawson, P. J. Novotny, J. A. Sloan, and T. D. Shanafelt. 2006. Personal life events and medical student burnout: A multicenter study. Academic Medicine 81(4):374â384. Dyrbye, L. N., M. R. Thomas, F. S. Massie, D. V. Power, A. Eacker, W. Harper, S. Durning, C. Moutier, D. W. Szydlo, P. J. Novotny, J. A. Sloan, and T. D. Shanafelt. 2008. Burn- out and suicidal ideation among U.S. medical students. Annals of Internal Medicine 149(5):334â341. Dyrbye, L. N., C. P. West, and T. D. Shanafelt. 2009. Defining burnout as a dichotomous variable. Journal of General Internal Medicine 24(3):440; author reply 441. Dyrbye, L. N., F. S. Massie, Jr., A. Eacker, W. Harper, D. Power, S. J. Durning, M. R. Thomas, C. Moutier, D. Satele, J. Sloan, and T. D. Shanafelt. 2010. Relationship between burnout and professional conduct and attitudes among U.S. medical students. JAMA 304(11):1173â1180. Dyrbye, L. N., T. D. Shanafelt, C. M. Balch, D. Satele, J. Sloan, and J. Freischlag. 2011. Relationship between workâhome conflicts and burnout among American surgeons: A comparison by sex. Archives of Surgery 146(2):211â217. Dyrbye, L. N., D. Meyers, J. Ripp, N. Dalal, S. B. Bird, and S. Sen. 2018. A pragmatic ap- proach for organizations to measure health care professional well-being. NAM Perspec- tives. Discussion paper. Washington, DC: National Academy of Medicine. https://nam. edu/a-pragmatic-approach-for-organizations-to-measure-health-care-professional-well- being (accessed July 11, 2019). El-Ibiary, S. Y., L. Yam, and K. C. Lee. 2017. Assessment of burnout and associated risk fac- tors among pharmacy practice faculty in the United States. American Journal of PharmaÂ ceutical Education 81(4):75. Feskanich, D., J. L. Hastrup, J. R. Marshall, G. A. Colditz, M. J. Stampfer, W. C. Willett, and I. Kawachi. 2002. Stress and suicide in the Nursesâ Health Study. Journal of Epidemiol- ogy and Community Health 56(2):95â98.
EXTENT AND CONSEQUENCES OF CLINICIAN BURNOUT 75 Fida, R., H. K. S. Laschinger, and M. P. Leiter. 2018. The protective role of self-efficacy against workplace incivility and burnout in nursing: A time-lagged study. Health Care Manage- ment Review 43(1):21â29. Garrouste-Orgeas, M., M. Perrin, L. Soufir, A. Vesin, F. Blot, V. Maxime, P. Beuret, G. Troche, K. Klouche, L. Argaud, E. Azoulay, and J. F. Timsit. 2015. The Iatroref study: Medical errors are associated with symptoms of depression in ICU staff but not burnout or safety culture. Intensive Care Medicine 41(2):273â284. Grol, R., H. Mokkink, A. Smits, J. van Eijk, M. Beek, P. Mesker, and J. Mesker-Niesten. 1985. Work satisfaction of general practitioners and the quality of patient care. Family Practice 2(3):128â135. Hakanen, J. J., and W. B. Schaufeli. 2012. Do burnout and work engagement predict depres- sive symptoms and life satisfaction? A three-wave seven-year prospective study. Journal of Affective Disorders 141(2â3):415â424. Halbesleben, J. R. B., B. J. Wakefield, D. S. Wakefield, and L. B. Cooper. 2008. Nurse burnout and patient safety outcomes: Nurse safety perception versus reporting behavior. Western Journal of Nursing Research 30(5):560â577. Hamidi, M. S., B. Bohman, C. Sandborg, R. Smith-Coggins, P. de Vries, M. S. Albert, M. L. Murphy, D. Welle, and M. T. Trockel. 2018. Estimating institutional physician turnover attributable to self-reported burnout and associated financial burden: A case study. BMC Health Services Research 18(1):851. Han, S., T. D. Shanafelt, C. A. Sinsky, K. M. Awad, L. N. Dyrbye, L. C. Fiscus, M. Trockel, and J. Goh. 2019. Estimating the attributable cost of physician burnout in the United States. Annals of Internal Medicine 170(11):784â790. Harter, J. K., F. L. Schmidt, and T. L. Hayes. 2002. Business-unit-level relationship between employee satisfaction, employee engagement, and business outcomes: A meta-analysis. Journal of Applied Psychology 87(2):268â279. Hawton, K., E. Agerbo, S. Simkin, B. Platt, and R. J. Mellanby. 2011. Risk of suicide in medi- cal and related occupational groups: A national study based on Danish case population- based registers. Journal of Affective Disorders 134(1â3):320â326. Hem, E., T. Haldorsen, O. G. Aasland, R. Tyssen, P. Vaglum, and O. Ekeberg. 2005. Suicide rates according to education with a particular focus on physicians in Norway, 1960â 2000. Psychological Medicine 35(6):873â880. Hoff, T., S. Carabetta, and G. E. Collinson. 2019. Satisfaction, burnout, and turnover among nurse practitioners and physician assistants: A review of the empirical literature. Medical Care Research and Revew 76(1):3â31. Holden, R. J., M. C. Scanlon, N. R. Patel, R. Kaushal, K. H. Escoto, R. L. Brown, S. J. Alper, J. M. Arnold, T. M. Shalaby, K. Murkowski, and B. T. Karsh. 2011. A human factors framework and study of the effect of nursing workload on patient safety and employee quality of working life. BMJ Quality & Safety 20(1):15â24. Hooper, C., J. Craig, D. R. Janvrin, M. A. Wetsel, and E. Reimels. 2010. Compassion satisfac- tion, burnout, and compassion fatigue among emergency nurses compared with nurses in other selected inpatient specialties. Journal of Emergency Nursing 36(5):420â427. Jackson, E. R., T. D. Shanafelt, O. Hasan, D. V. Satele, and L. N. Dyrbye. 2016. Burn- out and alcohol abuse/dependence among U.S. medical students. Academic Medicine 91(9):1251â1256. Katz, R. M. 1983. Causes of death among registered nurses. Journal of Occupational Medicine 25(10):760â762. Kristensen, T. S., M. Borritz, E. Villadsen, and K. B. Christensen. 2005. The Copenhagen Burn- out Inventory: A new tool for the assessment of burnout. Work & Stress 19(3):192â207.
76 TAKING ACTION AGAINST CLINICIAN BURNOUT Kuerer, H. M., T. J. Eberlein, R. E. Pollock, M. Huschka, W. F. Baile, M. Morrow, F. Michelassi, S. E. Singletary, P. Novotny, J. Sloan, and T. D. Shanafelt. 2007. Career satisfaction, practice patterns and burnout among surgical oncologists: Report on the quality of life of members of the Society of Surgical Oncology. Annals of Surgical Oncology 14(11):3043â3053. Lahoz, M. R., and H. L. Mason. 1990. Burnout among pharmacists. American Pharmicist 30(8):28â32. Leiter, M. P., and H. K. Spence Laschinger. 2006. Relationships of work and practice environ- ment to professional burnout: Testing a causal model. Nursing Research 55(2):137â146. Linzer, M., L. B. Manwell, E. S. Williams, J. A. Bobula, R. L. Brown, A. B. Varkey, B. Man, J. E. McMurray, A. Maguire, B. Horner-Ibler, and M. D. Schwartz. 2009. Working condi- tions in primary care: Physician reactions and care quality. Annals of Internal Medicine 151(1):28â36. Lu, D. W., S. Dresden, C. McCloskey, J. Branzetti, and M. A. Gisondi. 2015. Impact of burnout on self-reported patient care among emergency physicians. Western Journal of Emergency Medicine 16(7):996â1001. Maslach, C., and M. P. Leiter. 2016. Understanding the burnout experience: Recent research and its implications for psychiatry. World Psychiatry 15(2):103â111. Maslach, C., S. Jackson, and M. Leiter. 1996. Maslach Burnout Inventory manual, 3rd ed. Palo Alto, CA: CPP, Inc. Maslach, C., W. B. Schaufeli, and M. P. Leiter. 2001. Job burnout. Annual Reviews of Psy- chology 52:397â422. Mata, D. A., M. A. Ramos, N. Bansal, R. Khan, C. Guille, E. Di Angelantonio, and S. Sen. 2015. Prevalence of depression and depressive symptoms among resident physicians: A systematic review and meta-analysis. JAMA 314(22):2373â2383. McAbee, J. H., B. T. Ragel, S. McCartney, G. M. Jones, L. M. Michael, II, M. DeCuypere, J. S. Cheng, F. A. Boop, and P. Klimo, Jr. 2015. Factors associated with career satisfac- tion and burnout among U.S. neurosurgeons: Results of a nationwide survey. Journal of Neurosurgery 123(1):161â173. McHugh, M. D., A. Kutney-Lee, J. P. Cimiotti, D. M. Sloane, and L. H. Aiken. 2011. Nursesâ widespread job dissatisfaction, burnout, and frustration with health benefits signal prob- lems for patient care. Health Affairs 30(2):202â210. Meeusen, V. C. H., K. Van Dam, C. Brown-Mahoney, A. A. J. Van Zundert, and H. T. A. Knape. 2011. Understanding nurse anesthetistsâ intention to leave their job: How burn- out and job satisfaction mediate the impact of personality and workplace characteristics. Health Care Management Review 36(2):155â163. Melville, A. 1980. Job satisfaction in general practice: Implications for prescribing. Social Science & Medicine, Part A; Medical Psychology & Medical Sociology 14A(6):495â499. Morgan Jones, G., N. A. Roe, L. Louden, and C. R. Tubbs. 2017. Factors associated with burnout among U.S. hospital clinical pharmacy practitioners: Results of a nationwide pilot survey. Hospital Pharmacy 52(11):742â751. Moss, M., V. S. Good, D. Gozal, R. Kleinpell, and C. N. Sessler. 2016. An official Critical Care Societies Collaborative statement: Burnout syndrome in critical care healthcare profes- sionals: A call for action. Critical Care Medicine 44(7):1414â1421. NAM (National Academy of Medicine). 2018. Validated instruments to assess work-related dimensions of well-being. https://nam.edu/valid-reliable-survey-instruments-measure- burnout-well-work-related-dimensions/#purpose (accessed April 17, 2019). Oreskovich, M. R., K. L. Kaups, C. M. Balch, J. B. Hanks, D. Satele, J. Sloan, C. Meredith, A. Buhl, L. N. Dyrbye, and T. D. Shanafelt. 2012. Prevalence of alcohol use disorders among American surgeons. Archives of Surgery 147(2):168â174.
EXTENT AND CONSEQUENCES OF CLINICIAN BURNOUT 77 Oreskovich, M. R., T. Shanafelt, L. N. Dyrbye, L. Tan, W. Sotile, D. Satele, C. P. West, J. Sloan, and S. Boone. 2015. The prevalence of substance use disorders in American physicians. American Journal of Addiction 24(1):30â38. Oskrochi, Y., M. Maruthappu, M. Henriksson, A. H. Davies, and J. Shalhoub. 2016. Beyond the body: A systematic review of the nonphysical effects of a surgical career. Surgery 159(2):650â664. Panagioti, M., K. Geraghty, J. Johnson, A. Zhou, E. Panagopoulou, C. Chew-Graham, D. Peters, A. Hodkinson, R. Riley, and A. Esmail. 2018. Association between physician burnout and patient safety, professionalism, and patient satisfaction: A systematic review and meta-analysis. JAMA Internal Medicine 178(10):1317â1330. Pantenburg, B., M. Luppa, H. H. KÃ¶nig, and S. G. Riedel-Heller. 2016. Burnout among young physicians and its association with physiciansâ wishes to leave: Results of a survey in Saxony, Germany. Journal of Occupational Medicine and Toxicology 11(1):2. Parker, P. A., and J. A. Kulik. 1995. Burnout, self- and supervisor-rated job performance, and absenteeism among nurses. Journal of Behavioral Medicine 18(6):581â599. Pedersen, A. F., J. K. SÃ¸rensen, N. H. Bruun, B. Christensen, and P. Vedsted. 2016. Risky alcohol use in Danish physicians: Associated with alexithymia and burnout? Drug and Alcohol Dependence 160:119â126. Petersen, M. R., and C. A. Burnett. 2008. The suicide mortality of working physicians and dentists. Occupational Medicine (London) 58(1):25â29. Plessas, A., M. B. Delgado, M. Nasser, Y. Hanoch, and D. R. Moles. 2018. Impact of stress on dentistsâ clinical performance. A systematic review. Community Dental Health 35(1):9â15. Poghosyan, L., S. P. Clarke, M. Finlayson, and L. H. Aiken. 2010. Nurse burnout and qual- ity of care: Cross-national investigation in six countries. Research in Nursing & Health 33(4):288â298. Poncet, M. C., P. Toullic, L. Papazian, N. Kentish-Barnes, J. F. Timsit, F. Pochard, S. Chevret, B. Schlemmer, and E. Azoulay. 2007. Burnout syndrome in critical care nursing staff. American Journal of Respiratory and Critical Care Medicine 175(7):698â704. Roberts, S. E., B. Jaremin, and K. Lloyd. 2013. High-risk occupations for suicide. Psychologi- cal Medicine 43(6):1231â1240. Rotenstein, L. S., M. Torre, M. A. Ramos, R. C. Rosales, C. Guille, S. Sen, and D. A. Mata. 2018. Prevalence of burnout among physicians: A systematic review. JAMA 320(11):1131â1150. Salvagioni, D. A. J., F. N. Melanda, A. E. Mesas, A. D. Gonzalez, F. L. Gabani, and S. M. Andrade. 2017. Physical, psychological and occupational consequences of job burnout: A systematic review of prospective studies. PLOS ONE 12(10):e0185781. Salyers, M. P., K. A. Bonfils, L. Luther, R. L. Firmin, D. A. White, E. L. Adams, and A. L. Rollins. 2017. The relationship between professional burnout and quality and safety in healthcare: A meta-analysis. Journal of General Internal Medicine 32(4):475â482. Sargent, M. C., W. Sotile, M. O. Sotile, H. Rubash, and R. L. Barrack. 2004. Stress and cop- ing among orthopaedic surgery residents and faculty. Journal of Bone and Joint Surgery 86(7):1579â1586. Schaufeli, W. B., A. B. Bakker, K. Hoogduin, C. Schaap, and A. Kladler. 2001. On the clini- cal validity of the Maslach Burnout Inventory and the burnout measure. Psychological Health 16(5):565â582. Schaufeli, W. B., M. P. Leiter, and C. Maslach. 2009. Burnout: 35 years of research and prac- tice. Career Development International 14(3):204â220. Schernhammer, E. S., and G. A. Colditz. 2004. Suicide rates among physicians: A quan- titative and gender assessment (meta-analysis). American Journal of Psychiatry 161(12):2295â2302.
78 TAKING ACTION AGAINST CLINICIAN BURNOUT Shanafelt, T. D., K. A. Bradley, J. E. Wipf, and A. L. Back. 2002. Burnout and self-reported patient care in an internal medicine residency program. Annals of Internal Medicine 136(5):358â367. Shanafelt, T. D., C. M. Balch, G. J. Bechamps, T. Russell, L. Dyrbye, D. Satele, P. Collicott, P. J. Novotny, J. Sloan, and J. A. Freischlag. 2009a. Burnout and career satisfaction among American surgeons. Annals of Surgery 250(3):463â470. Shanafelt, T. D., C. P. West, J. A. Sloan, P. J. Novotny, G. A. Poland, R. Menaker, T. A. Rummans, and L. N. Dyrbye. 2009b. Career fit and burnout among academic faculty. Archives of Internal Medicine 169(10):990â995. Shanafelt, T. D., C. M. Balch, G. Bechamps, T. Russell, L. Dyrbye, D. Satele, P. Collicott, P. J. Novotny, J. Sloan, and J. Freischlag. 2010. Burnout and medical errors among American surgeons. Annals of Surgery 251(6):995â1000. Shanafelt, T. D., C. M. Balch, L. Dyrbye, G. Bechamps, T. Russell, D. Satele, T. Rummans, K. Swartz, P. J. Novotny, J. Sloan, and M. R. Oreskovich. 2011. Special report: Suicidal ideation among American surgeons. Archives of Surgery 146(1):54â62. Shanafelt, T. D., S. Boone, L. Tan, L. N. Dyrbye, W. Sotile, D. Satele, C. P. West, J. Sloan, and M. R. Oreskovich. 2012a. Burnout and satisfaction with workâlife balance among U.S. physicians relative to the general U.S. population. Archives of Internal Medicine 172(18):1377â1385. Shanafelt, T. D., M. R. Oreskovich, L. N. Dyrbye, D. V. Satele, J. B. Hanks, J. A. Sloan, and C. M. Balch. 2012b. Avoiding burnout: The personal health habits and wellness practices of U.S. surgeons. Annals of Surgery 255(4):625â633. Shanafelt, T. D., W. J. Gradishar, M. Kosty, D. Satele, H. Chew, L. Horn, B. Clark, A. E. Hanley, Q. Chu, J. Pippen, J. Sloan, and M. Raymond. 2014a. Burnout and career satisfaction among U.S. oncologists. Journal of Clinical Oncology 32(7):678â686. Shanafelt, T. D., M. Raymond, M. Kosty, D. Satele, L. Horn, J. Pippen, Q. Chu, H. Chew, W. B. Clark, A. E. Hanley, J. Sloan, and W. J. Gradishar. 2014b. Satisfaction with workâ life balance and the career and retirement plans of U.S. oncologists. Journal of Clinical Oncology 32(11):1127â1135. Shanafelt, T. D., O. Hasan, L. N. Dyrbye, C. Sinsky, D. Satele, J. Sloan, and C. P. West. 2015. Changes in burnout and satisfaction with workâlife balance in physicians and the general U.S. working population between 2011 and 2014. Mayo Clinic Proceedings 90(12):1600â1613. Shanafelt, T. D., L. N. Dyrbye, C. Sinsky, O. Hasan, D. Satele, J. Sloan, and C. P. West. 2016a. Relationship between clerical burden and characteristics of the electronic envi- ronment with physician burnout and professional satisfaction. Mayo Clinic Proceedings 91(7):836â848. Shanafelt, T. D., L. N. Dyrbye, C. P. West, and C. A. Sinsky. 2016b. Potential impact of burnout on the U.S. physician workforce. Mayo Clinic Proceedings 91(11):1667â1668. Shanafelt, T. D., M. Mungo, J. Schmitgen, K. A. Storz, D. Reeves, S. N. Hayes, J. A. Sloan, S. J. Swensen, and S. J. Buskirk. 2016c. Longitudinal study evaluating the association between physician burnout and changes in professional work effort. Mayo Clinic Pro- ceedings 91(4):422â431. Shanafelt, T., J. Goh, and C. Sinsky. 2017. The business case for investing in physician well- being. JAMA Internal Medicine 177(12):1826â1832. Shanafelt, T. D., C. P. West, C. Sinsky, M. Trockel, M. Tutty, D. V. Satele, L. E. Carlasare, and L. N. Dyrbye. 2019. Changes in burnout and satisfaction with workâlife integration in physicians and the general U.S. working population between 2011 and 2017. Mayo Clinic Proceedings.
EXTENT AND CONSEQUENCES OF CLINICIAN BURNOUT 79 Sinsky, C. A., L. N. Dyrbye, C. P. West, D. Satele, M. Tutty, and T. D. Shanafelt. 2017. Pro- fessional satisfaction and the career plans of U.S. physicians. Mayo Clinic Proceedings 92(11):1625â1635. Stack, S. 2001. Occupation and suicide. Social Science Quarterly 82(2):384â396. Tak, H. J., F. A. Curlin, and J. D. Yoon. 2017. Association of intrinsic motivating factors and markers of physician well-being: A national physician survey. Journal of General Internal Medicine 32(7):739â746. Tawfik, D. S., J. Profit, T. I. Morgenthaler, D. V. Satele, C. A. Sinsky, L. N. Dyrbye, M. A. Tutty, C. P. West, and T. D. Shanafelt. 2018. Physician burnout, well-being, and work unit safety grades in relationship to reported medical errors. Mayo Clinic Proceedings 93(11):1571â1580. Templeton, K., C. A. Bernstein, L. M. Nora, C. Newman, H. Burstin, and L. Schwarze. 2019. Gender-based differences in burnout: Issues faced by women physicians. NAM Perspec- tives. Discussion paper. Washington, DC: National Academy of Medicine. Tetzlaff, E. D., H. M. Hylton, L. DeMora, K. Ruth, and Y. N. Wong. 2018. National study of burnout and career satisfaction among physician assistants in oncology: Implications for team-based care. Journal of Oncology Practice 14(1):e11âe22. Toker, S., S. Melamed, S. Berliner, D. Zeltser, and I. Shapira. 2012. Burnout and risk of coro- nary heart disease: A prospective study of 8,838 employees. Psychosomatic Medicine 74(8):840â847. Toppinen-Tanner, S., K. Ahola, A. Koskinen, and A. VÃ¤Ã¤nÃ¤nen. 2009. Burnout predicts hos- pitalization for mental and cardiovascular disorders: 10-year prospective results from industrial sector. Stress and Health 25(4):287â296. Trockel, M., B. Bohman, E. Lesure, M. S. Hamidi, D. Welle, L. Roberts, and T. Shanafelt. 2018. A brief instrument to assess both burnout and professional fulfillment in physi- cians: Reliability and validity, including correlation with self-reported medical errors, in a sample of resident and practicing physicians. Academic Psychiatry 42(1):11â24. van der Heijden, F., G. Dillingh, A. Bakker, and J. Prins. 2008. Suicidal thoughts among medi- cal residents with burnout. Archives of Suicide Research 12(4):344â346. Welp, A., L. L. Meier, and T. Manser. 2015. Emotional exhaustion and workload predict clinician-rated and objective patient safety. Frontiers in Psychology 5:1573. West, C. P., M. M. Huschka, P. J. Novotny, J. A. Sloan, J. C. Kolars, T. M. Habermann, and T. D. Shanafelt. 2006. Association of perceived medical errors with resident distress and empathy: A prospective longitudinal study. JAMA 296(9):1071â1078. West, C. P., L. N. Dyrbye, J. A. Sloan, and T. D. Shanafelt. 2009a. Single item measures of emotional exhaustion and depersonalization are useful for assessing burnout in medical professionals. Journal of General Internal Medicine 24(12):1318â1321. West, C. P., A. D. Tan, T. M. Habermann, J. A. Sloan, and T. D. Shanafelt. 2009b. Association of resident fatigue and distress with perceived medical errors. JAMA 302(12):1294â1300. West, C. P., L. N. Dyrbye, D. V. Satele, J. A. Sloan, and T. D. Shanafelt. 2012a. Concurrent validity of single-item measures of emotional exhaustion and depersonalization in burn- out assessment. Journal of General Internal Medicine 27(11):1445â1452. West, C. P., A. D. Tan, and T. D. Shanafelt. 2012b. Association of resident fatigue and distress with occupational blood and body fluid exposures and motor vehicle incidents. Mayo Clinic Proceedings 87(12):1138â1144. West, C. P., L. N. Dyrbye, P. J. Erwin, and T. D. Shanafelt. 2016. Interventions to prevent and reduce physician burnout: A systematic review and meta-analysis. The Lancet 388(10057):2272â2281. White, E. M., L. H. Aiken, and M. D. McHugh. 2019. Registered nurse burnout, job dissat- isfaction, and missed care in nursing homes. Journal of the American Geriatrics Society [Epub ahead of print].
80 TAKING ACTION AGAINST CLINICIAN BURNOUT Willard-Grace, R., M. Knox, B. Huang, H. Hammer, C. Kivlahan, and K. Grumbach. 2019. Burnout and health care workforce turnover. Annals of Family Medicine 17(1):36â41. Williams, E. S., L. B. Manwell, T. R. Konrad, and M. Linzer. 2007. The relationship of organizational culture, stress, satisfaction, and burnout with physician-reported error and suboptimal patient care: Results from the MEMO study. Health Care Management Review 32(3):203â212. Windover, A. K., K. Martinez, M. B. Mercer, K. Neuendorf, A. Boissy, and M. B. Rothberg. 2018. Correlates and outcomes of physician burnout within a large academic medical center. JAMA Internal Medicine 178(6):856â858. Wright, T. A., and D. G. Bonett. 1997. The contribution of burnout to work performance. Journal of Organizational Behavior 18(5):491â499.