SAFE MEDICATION
Burnout, well-being, and patient safety By Jia Hui (Jay) Zhao, Rajiv Rampersaud, Christy Mak, and Certina Ho ealthcare can be a very meaningful career, but at times, it can also be a stressful field to work in. What happens when this “stressful” feeling has become too burdensome, to the point when the demands of the job extend beyond your ability to perform in a safe and sustainable manner? Quite often, health care providers can be at risk for burnout.
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BURNOUT
According to a 2018 study conducted using the Maslach Burnout Inventory Human Services Survey (MBI-HSS) in the United States, more than 50 per cent of health-system pharmacists reported that they were at risk for burnout. In another 2018 national survey published by the Canadian Medical Association, it was found that 30 per cent of physicians experienced burnout. Burnout can be characterized by: (1) emotional exhaustion where emotional resources are drained and no longer emotionally available; (2) depersonalization where negative and cynical attitudes are developed towards your job; and (3) reduced personal accomplishment where healthcare providers feel unsatisfied and unhappy about their job. There are different instruments that one can use to measure burnout and the MBI-HSS is a very commonly used tool in health professions. Healthcare provider burnout may be a consequence of several factors, ranging from individual, organiza-
tional, and environmental. Using community pharmacy practice as an example, from an individual perspective, a lack of control over stressful working conditions, including long hours and heavy workloads, may lead to burnout. At an organizational level, the administrative or managerial expectations to meet billing quotas for clinical and/or professional services may increase the rate at which burnout occurs. Lastly, environmental factors, such as new or revised reimbursement models (e.g. drug plan or insurance coverage changes for medications and/or medical devices), may create additional stress for pharmacy professionals who are often tasked with understanding and clarifying the details of insurance or third-party drug/device coverage to patients. With all these demands in mind, it is evident that healthcare providers (e.g. pharmacists) may face many challenges that may limit their ability to carry out their core responsibility of providing patient-centred care, and ultimately lead to burnout.
IMPACT OF BURNOUT ON PATIENT SAFETY AND HEALTHCARE SYSTEM
Burnout has an extensive impact on the individual and those around them. Individuals who experience burnout may endure depression, strained relationships, substance use disorders, or suicidal ideation. In addition to the impact on personal well-being, healthcare provider burnout is often associ-
ated with increased medical errors and poor quality of patient care. In fact, a 2016 study published by the Canadian Pharmacists Journal found that community pharmacists who were expected to meet monthly billing quotas for professional services reported a substantial negative impact on their perceived patient safety in practice. On the other hand, burnout also creates an economic burden on the healthcare system. According to a 2014 publication, the total cost of burnout was estimated to be over $200 million, most of which was attributed to early retirement and reduced clinical hours from Canadian physicians. Overall, the impact of healthcare provider burnout on productivity, efficiency, quality, and patient safety of the healthcare system cannot be underestimated.
WELL-BEING
Early identification of deteriorating mental and physical health can facilitate timely interventions to minimize the impact of burnout to healthcare providers’ competence, professionalism, career satisfaction, and their quality and safety of patient care. Therefore, monitoring and supporting the overall well-being of healthcare professionals is essential, as well-being encompasses not only the negative elements (such as burnout), but also positive elements, for instance, engagement, happiness, quality of life, and physical health of an individual. Similar to the measurement of burnout, there are various tools and
resources where one can use to measure well-being. The 5-item World Health Organization Well-Being Index (WHO-5), a short, self-administered survey that has been translated into more than 30 languages, is likely the most widely used instrument for assessing individual well-being across the world. It may be quite challenging for healthcare professionals to address burnout in a systematic approach, especially when they are confronted with multiple competing priorities within a complex healthcare system. In 2019, Deloitte Insights shared “a blueprint for workplace mental health programs” where return on investment (ROI) in overall employee well-being (to minimize burnout) can be realized through certain organizational initiatives, such as, having managers/leaders listening to the needs of employees, implementing resilience and mindfulness training, and providing sufficient support to promote positive cultural change, etc. Other potential ROI in workplace mental health programs or cost saving benefits may include improved staff retention rates, stronger talent attraction/recruitment, and more effective risk management. As healthcare professionals, it is important that we take care of our own well-being and also recognize the potential contributing factors and risks for burnout, so that we can be diligent and consistently provide quality and H safe patient care. ■
Jia Hui (Jay) Zhao and Rajiv Rampersaud are PharmD graduates at the Leslie Dan Faculty of Pharmacy (LDFP), University of Toronto; Christy Mak is a PharmD student at the LDFP, and Certina Ho is an Assistant Professor at the Department of Psychiatry and the LDFP, University of Toronto. www.hospitalnews.com
FEBRUARY 2021 HOSPITAL NEWS 29
