Burnout and self-reported suboptimal patient care amongst health care workers providing HIV care in Malawi

Abstract

BackgroundThe well-documented shortages of health care workers (HCWs) in sub-Saharan Africa are further intensified by the increased human resource needs of expanding HIV treatment programs. Burnout is a syndrome of emotional exhaustion (EE), depersonalization (DP), and a sense of low personal accomplishment (PA). HCWs’ burnout can negatively impact the delivery of health services. Our main objective was to examine the prevalence of burnout amongst HCWs in Malawi and explore its relationship to self-reported suboptimal patient care.MethodsA cross-sectional study among HCWs providing HIV care in 89 facilities, across eight districts in Malawi was conducted. Burnout was measured using the Maslach Burnout Inventory defined as scores in the mid-high range on the EE or DP subscales. Nine questions adapted for this study assessed self-reported suboptimal patient care. Surveys were administered anonymously and included socio-demographic and work-related questions. Validated questionnaires assessed depression and at-risk alcohol use. Chi-square test or two-sample t-test was used to explore associations between variables and self-reported suboptimal patient care. Bivariate analyses identified candidate variables (p < 0.2). Final regression models included variables with significant main effects.ResultsOf 520 HCWs, 62% met criteria for burnout. In the three dimensions of burnout, 55% reported moderate-high EE, 31% moderate-high DP, and 46% low-moderate PA. The majority (89%) reported engaging in suboptimal patient care/attitudes including making mistakes in treatment not due to lack of knowledge/experience (52%), shouting at patients (45%), and not performing diagnostic tests due to a desire to finish quickly (35%). In multivariate analysis, only burnout remained associated with self-reported suboptimal patient care (OR 3.22, [CI 2.11 to 4.90]; p<0.0001).ConclusionBurnout was common among HCWs providing HIV care and was associated with self-reported suboptimal patient care practices/attitudes. Research is needed to understand factors that contribute to and protect against burnout and that inform the development of strategies to reduce burnout.

Prevalence of Burnout Among Physicians

“…1 Since then, the term burnout has been used to characterize job-related stress in any health practice environment, from hospitals in urban communities to global health settings. 2,3 This expansion of the scope of burnout has made it useful for describing the shared experience and stress of medical practice, particularly in conjunction with research demonstrating elevated levels of depressive symptoms among physicians. 4,5 Building on foundational work by Maslach et al 6 in the 1980s, researchers have described burnout as a combination of emotional exhaustion, depersonalization, and low personal accomplishment caused by the chronic stress of medical practice.…”

Influence of workload, mental health and professional quality of life on healthcare workers’ hand hygiene behavior in medical aid during COVID-19 pandemic

“…It also has been shown that nurses who cared for MERSinfected or suspected patients have higher level of negative aspect of ProQOL in outbreak of MERS-CoV [21]. Furthermore, with the higher risk of negative aspect of ProQOL, HCWs were more likely to behave with poor quality of care, including poor quality and safety measures, unprofessional behavior and suboptimal patient care practice [4,22].Colindres and Manomenidis found that negative aspect of ProQOL was a negative predictor of adherence with infection control measures including hand hygiene [23,24].…”

Reflections on Resilience during the COVID-19 Pandemic: Six Lessons from Working in Resource-Denied Settings

“…Many in this situation may attempt to take on the fragility of the health system single-handedly, only to be quickly overwhelmed. 7 Despite the prominent role of the Plan-Do-Study-Act cycles in quality improvement literature, 8 many healthcare systems do not allow sufficient time for personal self-reflection. Yet a resilient healthcare provider finds time to reflect on past mistakes, grow as a practitioner, and learn to avoid future pitfalls.…”