An Organizational Intervention to Reduce Physician Burnout

Abstract

Burnout is an individual's specific, personal, and intimate stress reaction to the workplace, characterized by emotional exhaustion, depersonalization, and reduced self-efficacy. Even though it particularly affects the helping professions, there has been relatively little exploration into the causes and determinants of burnout among physicians; instead, the focus has been on documenting the prevalence and consequences of physician burnout. Furthermore, while the theory of burnout is based on the relationship between the individual and his or her workplace, interventions have focused on improving the resilience of an individual to withstand this imbalance rather than identifying and ameliorating the cause.This study observed a natural experiment to measure changes in primary care providers' burnout before and after the implementation of a workload intervention that changed the work process within primary care clinics. Four clinics received the intervention, while four others served as comparisons. Among physicians in clinics receiving the intervention, the results show significant impacts, with an improvement in workload of 0.61 units (p = 0.037) and a decrease in the emotional exhaustion dimension of burnout of 6.989 units (p = 0.039).Self-care interventions are inconsistent with the theory of burnout; success of such interventions may be due to participants self-selecting these interventions, and individuals' inability to change their workplace without management approval. Leaders need to consider the impact of the workplace itself on physicians, in addition to results or outcomes.

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“…In our study, after 12 months of applying Asimov's coping strategy, none of the eight scales (according to the Lazarus questionnaire) showed a high coping intensity compared to the beginning of the intervention (points [13][14][15][16][17][18]. Also, the average levels on the scales of "confrontive coping" and "seeking social support" gave way to low indicators, which indicates the adaptive version of coping.…”

“…Efforts on the management of burnout-associated states are often aimed at improving resistance to a given condition, but not at identifying and eliminating the cause. However, without an understanding of the cause of burnout, the development of measures to reduce it will be unsuccessful 18 . In this regard, methods such as improving self-awareness and the development of self-control (based on reducing stress itself) have been recognized as effective methods to diminish negative consequences 25 .…”

“…In a study conducted by Gregory et al, doctors were asked to reduce their workload in order to decrease the main symptoms of burnout 18 . According to the results of this study, the indicators of emotional exhaustion and depersonalization were diminished (after 3 and 6 months).…”

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“…The imbalance between job demands and job control may be a trigger for burnout [4,5,21] rather than burnout being a problem of the individual's limitations [12]. Unfortunately, many interventions have focused on increasing the resilience of the individual instead of addressing the workload and control factors [33]. Research studies show that organizational factors such as workload and insufficient personal control contribute to burnout [5,21].…”

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“…Measurement of changes in primary care providers' burnout before and after the implementation of improvements in work process and workload reduced emotional exhaustion [21]. The availability of resources should enable the elimination of any sustained work overloads.…”