PROSPERO International prospective register of systematic reviews

Healthcare staff wellbeing, burnout, and patient safety: A systematic review

Louise Hall, Judith Johnson, Daryl O'Connor, Anastasia Tsipa, Ian Watt

Citation
Louise Hall, Judith Johnson, Daryl O'Connor, Anastasia Tsipa, Ian Watt. Healthcare staff wellbeing, burnout, and
patient safety: A systematic review. PROSPERO 2015:CRD42015023340 Available from
http://www.crd.york.ac.uk/PROSPERO_REBRANDING/display_record.asp?ID=CRD42015023340

Review question(s)
To examine whether there is an association between wellbeing and burnout in health care professionals, and the
related patient safety outcomes.

Searches
Four electronic bibliographic databases will be searched: PsycINFO, Ovid MEDLINE, EMBASE and Scopus.
Eligible studies will further be identified through hand-searching reference lists of studies identified through the
initial online searches. MeSH terms and keyword terms will both be used with a multi-field search.

Papers will be searched for those containing at least one term from each of the following blocks (although MeSH
terms may vary slightly between databases): (health personnel) AND (well?being OR occupation* stress* OR
burnout OR mental health OR “quality of life”) AND (medical error OR patient safety OR quality of care OR error?).

Types of study to be included

Articles must be quantitative, empirical studies. Exclusion criteria include qualitative studies, those not published in
English, case studies and grey literature.

Condition or domain being studied

Both burnout and wellbeing outcomes will be studied. Burnout is a syndrome that emerges from chronic occupational
stress, resulting in emotional exhaustion, depersonalisation and reduced personal accomplishment (Maslach &
Jackson, 1981). Wellbeing is less easily defined, but may be thought of as a spectrum, with optimal wellbeing, or
‘flourishing’, at one end and poor mental health, stress and depression at the other (Wood & Tarrier, 2010).

Relevant measures for burnout include the Maslach Burnout Inventory (MBI), (Maslach & Jackson, 1981) and the
Oldenburg Burnout Inventory (Demerouti & Bakker, 2008).

Measures of wellbeing are more varied, and may include measures of psychological distress, such as the General
Health Questionnaire, or more vague measures such as assessing overall of Quality of Life on a visual analogue scale
from 0-100.

Participants/ population
Articles studying the wellbeing/burnout of healthcare staff will be included. Articles involving staff who do not
directly deal with patient care (e.g. administrative staff) will be excluded.

Healthcare staff working within any setting will be eligible, including, but not limited to; hospitals, GP surgeries,
mental care hospitals, elderly care homes, and private practices.

Intervention(s), exposure(s)
Not applicable.

Comparator(s)/ control
Not applicable.

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Context
Articles must include both a measure of wellbeing or burnout in healthcare staff, and of patient safety/quality of
patient care given by the same staff or by the patients of that staff member.

Settings will include any site where healthcare service is provided, e.g. Care homes, hospitals, doctor surgeries etc.

Outcome(s)
Primary outcomes
Both the measures of wellbeing/burnout and the measures of patient care may be outcome variables.

Examples of measures of wellbeing and burnout have been mentioned above.

Possible measures of patient safety include the number of errors or near misses reported in the previous 6 months,
through either official reporting systems or though staff self-reporting.

Secondary outcomes
None

Data extraction, (selection and coding)

During abstract screening, the first 10% of abstracts will be screened by two authors (JJ and LH). A kappa statistic of
above .7 will be reached to ensure that one author (LH) can reliably screen the remaining abstracts alone. LH will
then continue to screen full texts based on the eligibility criteria mentioned earlier.

Once full texts have been screened, a data extraction table will be used to dissect the studies. The table will include
key criteria including participant characteristics, measures used, length of study and outcome results. Two researchers
will independently extract the first 10% of articles identified at the full text screening stage. Any differences of
opinion with regards to whether the article should be included or not will be resolved through discussion. If no
agreement can be met, a third researcher (JJ or DO) will perform data extraction for the article in question and make
the final decision on inclusion.

Risk of bias (quality) assessment

All articles will be assessed on their quality and risk of bias during data extraction.They will be appraised on their
methodologies, in particular, the choice of measures, risk of bias, and quality of statistical reporting.

Strategy for data synthesis

Data will be synthesized into a clear table describing key elements of each article, including; country, year, measures,
results. A narrative synthesis is planned, with studies grouped into various categories (e.g. wellbeing, burnout, quality
or safety).

Analysis of subgroups or subsets

If appropriate, studies will be explored in terms of specific measures used.

Dissemination plans
Findings will be disseminated within research group meetings at the University of Leeds and at conferences. The
review will be published in peer-reviewed journals.

Contact details for further information

Miss Hall

Room G.08 Psychology Annex

Lifton Place

School of Psychology

Faculty of Medicine and Health

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University of Leeds

Leeds

West Yorkshire

LS2 9JZ

ps13lhh@leeds.ac.uk

Organisational affiliation of the review

University of Leeds

http://medhealth.leeds.ac.uk/info/1300/school_of_psychology//

Review team
Miss Louise Hall, University of Leeds & Bradford Institute for Health Research
Dr Judith Johnson, University of Leeds & Bradford Institute for Health Research
Professor Daryl O'Connor, University of Leeds
Miss Anastasia Tsipa, University of Leeds & Leeds City Council
Professor Ian Watt, University of York

Anticipated or actual start date

19 December 2014

Anticipated completion date

19 December 2015

Funding sources/sponsors
PhD Scholarship from the University of Leeds and Bradford Institute for Health Research

Conflicts of interest
None known

Language
English

Country
England

Subject index terms status

Subject indexing assigned by CRD

Subject index terms

Health Personnel; Humans; Patient Care; Personal Satisfaction; Safety

Any other information

At the time of database searching, there are currently no reviews bringing together the literature on physician
wellbeing, burnout and patient care. The review will be beneficial to healthcare staff, management teams within
healthcare services and policy makers.

Stage of review
Completed but not published

Date of registration in PROSPERO

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 10 June 2015

Date of publication of this revision

01 February 2016

DOI
10.15124/CRD42015023340

Stage of review at time of this submission Started Completed

Preliminary searches Yes Yes
Piloting of the study selection process Yes Yes
Formal screening of search results against eligibility criteria Yes Yes
Data extraction Yes Yes
Risk of bias (quality) assessment Yes Yes
Data analysis Yes Yes

PROSPERO
International prospective register of systematic reviews
The information in this record has been provided by the named contact for this review. CRD has accepted this information in good
faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record,
any associated files or external websites.

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