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The Burnout Effect on Healthcare Staff

Alyssa Fisher

University of North Florida

HSC4730 Public Health Research

Professor Amber Barnes

December 04, 2020

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Abstract

Healthcare professionals of all specialties and fields hold the responsibility of providing

exceptional care and treatment for patients in need of their service at any time of the given

practice. With patient care and the business that the medical profession brings in overshadowing

the wellbeing of healthcare professionals, the effect of burnout on healthcare staff may be

detrimental to the well-being and safety of healthcare professionals and their current and future

patients. The term burnout is a psychological event due to emotional exhaustion,

depersonalization, and dissatisfaction of accomplishment at one’s occupation. There are various

issues correlated with falling victim to burnout. Some examples include a lowered concern and

care for patients, an increase in malpractice cases, and interpersonal strain, etc. This paper will

go over the drastic impact of burnout and the effects it has on individuals within the healthcare

field.
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Background

In the year 2020, the coronavirus disease is otherwise known as SARS-CoV-2 officially,

made its way to the United States from China. This disease in its detriment left numerous

individuals sick and cause countless deaths in its path. In the United States specifically, there

have been over ~7.91M cases with about ~216k deaths as of late. With many people falling ill

and needing healthcare assistance to combat this disease, it led to an overwhelming mass number

of patients flooding into hospitals, clinics, and other healthcare facilities. As the continuation of

patients builds up, the ratio between patients and healthcare professionals such as doctors,

physicians, nurses, etc. have become significantly uneven. As loads of patients increase without

numbers in staff changing in size as well to support these crowds, negative repercussions for

healthcare staff, patients, and healthcare systems are occurring. The Society of Critical Care

Medicine conducted a survey considering about 9,500 healthcare providers working in critical

care (Bradley et al., 2020). The survey’s outcome showed the median of stress self-reported by

the providers changing from a score of three to an increased score of eight. In the workplace

stress and the stressors lead to physical, emotional, and mental turmoil such as anxiety and

depression which overall lead to burnout. The main stressors acting as a precursor to burnout

include anxiety relating to the risk of infection onto oneself and their family, social isolation, and

hardships of economic consequences. In a 22-item questionnaire conducted by the Maslach

Burnout Inventory, they found the prevalence of burnout to be about 40% in healthcare

occupations (Bradley et al., 2020). This questionnaire was able to collect data by measuring three

dominant associations with burnout. The three domains included low personal accomplishment,

depersonalization or interpersonal strain, and emotional exhaustion (Bradley et al., 2020).

As the effects of negative physical, emotional, and mental strain accumulate the
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consequences of burnout prove to be the unfavorable tipping point for all those involved whether

experienced first or second hand. There was an association found between burnout and an

increase in medical error rates with a decrease in healthcare provider productivity (Bradley et al.,

2020). The associations to burnout lead to improper patient care putting them at risk due to

unintentional negligence and turn into a precursor for malpractice. Malpractice has been founded

to be the third leading cause of death under cardiovascular diseases (like heart disease) and

cancer in the United States (Elflein, 2020). Malpractice is considered a negligent professional

activity by an official in medicine, law, or high public position. The frequency of malpractice

dilemmas has been an issue even before COVID-19 and has not been dealt with successfully to

this day. Patients tragically experiencing such cases are subjected to unnecessary tests,

consultations, and surgeries. The term burnout has multiple layers, and it is important to

understand why the extent of such a term occurs. Specifically, in physician burnout, there have

been links to both alcohol abuse and suicidal ideologies which also causes a sense of

depersonalization and interpersonal strain on the healthcare provider. An interpersonal strain

occurs when there is discomfort associated with creating or continuing a relationship with people

at one’s occupation from excessive pressures both socially and emotionally (Chiara, 2014). A

survey study was created and carried out nationwide sought to find stress prevalence in 6,880

physicians across various specialties (Shanafelt et al., 2014). The results found that 54.4% of

physicians reported 1 or more symptoms of burnout and was compared to the 2011 data where

the percentage was at a lower 45.5% (Shanafelt et al., 2014). It was also recorded that many

physicians felt disconnected from their patients and viewed them as objects rather than people as

well. All these events as mentioned previously are due to issues involving frenzied work

environment, pressure on time and productivity, and forgotten autonomy to name a few, resulting
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in negative drastic outcomes for everyone involved.

Burnout has been disregarded for many years and action must be taken to eliminate this

situation from occurring, especially with the increase of patients needing care in this unfortunate

time. The profession of a physician is drastically dropping due to the intensity of burnout.

Physicians when compared to the general population on the topic of suicides were found to be

higher. It was found that about ~400 physicians in the United States alone fall victim to suicide a

year (Chiara, 2014). With an increase in turnover rates, substance abuse disorders, malpractice

claims, absentees, and low productivity the occupation of being a physician is astronomically

dangerous (Gardner et al., 2018). The healthcare system is also deeply affected since the cost of

replacing a physician is about $250,000 to a million dollars (Gardner et al., 2018). Tackling

burnout before future cases would improve the healthcare system for the better and not only

protect its patients but its workers too. Research has been conducted on how to combat burnout

such as through stress management training, exercise/small group programs (Bradley et al.,

2020). The first step of prevention however is to simply reach out with the next step to promote

resources to help with the feeling of burnout. Strategies organizations should evaluate and

consider implementing for the wellbeing of their employees struggling include limiting the work

hours, debriefing sessions for ending shifts, and promote values of the community for

connectedness and unity.

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Pilot Study

Research will be conducted through a repeated cross-sectional study to evaluate the

proportion of physicians in the Duval County suffering from burnout. A ten-question

questionnaire was created through Google Forms and emailed or directly messaged through

social media platforms such as Facebook, YouTube, Twitter, Instagram, etc. of verified

physicians in the Duval County area. Fifteen physicians in a “first come first serve” basis, who

filled out the survey were taken into consideration for the study. Participation for both the survey

and the study was purely optional and voluntary for every individual.

There was a total of fifteen physicians who filled out the survey, however, only ten of

them filled out the survey in its entirety. The other five physicians skipped or failed to answer a

question or two on the survey. Questions in this survey dealt with both professional and personal

matters regarding the physicians’ satisfaction with work-life balance, staff shortage, rushed

patient interaction, sufficient sleep, etc. This survey was created to gather information on trends

relating to factors that may result to burnout in healthcare and whether there was an association.

From the preliminary analysis of my dataset, I was able to analyze numerous instances of

problems within the realm of the physician occupation about both work and individual self. A

high 93% was found to have experienced exhaustion or stress during a shift. This makes sense,

especially when comparing the 80% of respondents saying they work forty plus hours a week. It

was surprising to find out that 73% of respondents felt rushed when interacting with patients

which complement 66% of those working with a staff shortage. Lastly, it is no surprise that 66%

were not averaging seven hours of sleep a week which finds itself full circle to why an individual

may feel stress or exhausted; along with the other factors mentioned.
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Pilot Study Data Analysis

Collected data from the survey shows the number of individuals who experienced stress

or exhaustion during a shift. This can be shown in Figure 1. Of the twenty survey respondents,

fourteen (93%) experienced exhaustion/stress during or after a shift and one (7%) did not

experience exhaustion/stress during or after a shift.

Figure 1

The collected data from the survey also showed the number of individuals who worked forty

or more hours which is shown on Figure 2. Of the survey respondents, twelve (80%) work more

than forty hours a week and three (20%) do not work more than forty hours a week.
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Figure 2

Most of the participants in the study conducted answered the questions or factors that

favored or correlated with burnout. Of the survey respondents, eleven (73%) experienced rushed

patient interaction, three (20%) did not experience rushed patient interaction, and one (7%) did

not answer. Of the survey respondents, ten (66%) has witnessed staff shortage, four (27%) did

not witness staff shortage, and one (7%) did not answer. Of the survey respondents, five (33%)

were averaging seven hours of sleep daily and ten (66%) were not averaging seven hours of sleep

daily.

Methods

This study will be conducted by the initial investigator, the co-investigator, Dr. Amber N.

Barnes, MPH, and a team of 3 research assistants. Participants will be given a survey consisting

of ten questions to fill out and the first fifteen to respond will be chosen to participate in this

study. The same procedure will be conducted the following year with a new set of fifteen

participating physicians. The questions, however, will remain the same. This research study will

have a total of 350 participants who all have the title of a physician living in Duval County,

Florida. This specific population was chosen to determine what factors may be associated to
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burnout in the field of healthcare, particularly in physicians. This population will give the

information needed to determine what factors are associated with burnout in the physician

occupation. The criteria for this study include being a resident in Duval County, Florida and is a

certified physician. Anything but the two criteria stated previously may not be considered as a

participant for this study.

Each individual participant in the study will be asked to fill out an online ten

question questionnaire sent to them through email or social media inboxes. The questionnaire

was made by the initial investigator through Google Forms. Prior to taking the survey a consent

form will be presented at the beginning of the questionnaire. It will also state that doing this

survey is purely optional and participants can stop at any moment of time. An incentive of a $5

visa gift card will be distributed to the participants. There is no payment to be a participant,

anyone can become a participant free of charge. Once the study has been conducted and finalized

every participant will be able to see the overall results.

Once the study has conceded and the results reviewed on the first year conducted,

175 physicians/participants will be accepted to partake in this research study. This action will be

carried out the same exact way the following year. The study will be done as a repeated cross-

sectional survey design by re-surveying representatives from the same population source, in this

case, physicians, in a two-year different time frame. Both years where data will be collected,

different sets of participants will be selected. This design study will allow a visualization of

trends in the population over a period of time without interference of individual changes.

Questions relating to both personal and professional satisfaction will be recorded once survey is

completed for each participant. Participants who did not completely fill out the survey will not be

chosen as a participant as to avoid any issues with data analysis.

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Problems this research study may encounter is difficulties obtaining the lists of

the full population because of the simple random sample method chosen. Though simple random

sample is simple and lack major biases, finding a whole list may be difficult especially in a

healthcare setting since specific companies may be unwilling to give out information about

employees due to privacy policies. This is the reason as to why social media platforms will be

used to distribute the questionnaire as to bypass this problem. Many physicians have taken onto

social media to discuss their practice and in doing so allows for this research study to be

conducted without interference of company private policy. Another problem may occur if a

participant does not fill out the entire survey. This can be dealt with by exempting participants

with missed or ignored question/s from the research study.

This research study will be a repeated cross-sectional study looking to determine

whether there is a casual relationship between burnout and negative associations in a physician’s

personal and professional life.

Dissemination Plan

Once the study has been finalized, findings will be published in an open peer review

journal available to all, free of charge. With the rise of social media, the study will also be linked

on a Twitter/Facebook account to interact with individuals both within and beyond academia to

reach a wider audience. This said link will be the URL to access to peer review journal. The

description bar on both social media sites will contain information such as the current study, past

and current research done, and possible affiliations in a short and concise manner for the

follower to obtain the information in a quick and easy manner. Using such social media will

allow for a possible engagement between potential policy makers or researchers through a

common interest which will involve a “follow” for updated information. The made account will
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also be spread through hashtags and those already associated with such hashtags will be more

likely to click on the account and reshare to further followers. Both Twitter and Facebook make

groups on similar topics and with this, the study will have yet another pathway to attract more

people.
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Supporting Information

Survey Instrument
1. Do you work more than 40 hours a week? Yes No
2. Are you averaging 7 hours of sleep daily? Yes No
3. Do you get a break in addition to your lunch? Yes No
4. Is your work life balance up to your standards? Yes No
5. Are you comfortable with the use of technology in your place of work? Yes No
6. Is there a staff shortage at your place of work?
7. Do you feel rushed when interacting with patients?
8. Do you experience exhaustion/stress at any time during or after a shift?
9. Does your place of work offer mental health programs?
10. Knowing what you know now, would you still have chosen this profession?

Budget

Personnel Salary Benefits % Time Total

Person A $12/hr. Primary researcher is 5 hours for a total of $27,000
responsible for overall 450 days
investigation/execution,
team leadership, and
ensure ethical human
resources for both team
and participants

Person B $11/hr. Graduate 4 hours for a total of $19,800

Student/Research 450 days
Assistant is responsible
for distributing the
surveys to the participants
via email and social
media inboxes

Person C $11/hr. Graduate 4 hours for a total of $19,800

Student/Research 450 days
Assistant is responsible
for updating website
content and organize
budget/progress

Person D $11/hr. Graduate 4 hours for a total of $19,800

Student/Research 450 days
Assistant is responsible
for summarizing findings
and prepare progress
reports
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Personnel Salary Benefits % Time Total

Other Expenses / / / /

Equipment and
Supplies: Computers $30,000/yr. / 2 years $60,000

Office Space Lease $1,200/mth. / 2 years $28,800

Travel / / / /
Other Cost / / / /
Participant Incentives $5/person / 700 $3,500
Total Direct Cost / / 2 years $208,400
Total Indirect Cost / / / /
Total Requested / / 2 years $208,400

Timeline

Year One Year Two

Activity Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

Create questions for survey and have it

reviewed by a panel of experts

Distribute survey through email/social media

inboxes

Recruit 350 participants from an array of 5+

locations

Analyze data

Begin writing manuscript draft for peer review

journal

Distribute survey through email/social media

inboxes

Recruit 350 participants from an array of 5+

locations

Analyze data and records from

previous/current study

Finish manuscript draft

Present to OAP
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References

Bradley, M., & Chahar, P. (2020). Burnout of healthcare providers during COVID-19.

https://doi.org/10.3949/ccjm.87a.ccc051

Consiglio, C. (2014). Interpersonal strain at work: A new burnout facet relevant for the health of

hospital staff. https://doi.org/10.1016/j.burn.2014.07.002

Gardner, R. L., Cooper, E., Haskell, J., Harris, D. A., Poplau, S., Kroth, P. J., & Linzer, M. (2018).

Physician stress and burnout: The impact of health information technology. Journal of the

American Medical Informatics Association, 26(2), 106-114.

https://doi.org/10.1093/jamia/ocy145

Hall, L., Johnson, J., Watt, I., Tsipa, A., & O’Connor, D. (2016). Healthcare Staff Wellbeing,

Burnout, and Patient Safety: A Systematic Review.

https://doi.org/10.1371/journal.pone.0159015

Panel, A. L. (2014). Burnout and HealthCare – Editorial.

https://doi.org/10.1016/j.burn.2014.08.002

Patel, R. S., Bachu, R., Adikey, A., Malik, M., & Shah, M. (2018). Factors Related to Physician

Burnout and Its Consequences: A Review. Behavioral sciences (Basel, Switzerland), 8(11),

98. https://doi.org/10.3390/bs8110098

Reith, T. (2018). Burnout in United States Healthcare Professionals: A Narrative Review.

https://dx.doi.org/10.7759%2Fcureus.3681

Squires, A., Finlayson, C., Gerchow, L., Cimiotti, J. P., Matthews, A., Schwendimann, R.,

Sermeus, W. (2014). Methodological considerations when translating "burnout".

https://doi.org/10.1016/j.burn.2014.07.001
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West, C. P., Dyrbye, L. N., Sloan, J. A., & Shanafelt, T. D. (2009). Single item measures of

emotional exhaustion and depersonalization are useful for assessing burnout in medical

professionals. https://doi.org/10.1007/s11606-009-1129-z