Healthcare provider burnout linked to poor quality of care

Published literature has shown an association between burnout in healthcare professionals and poor quality of care, but the true effect size may be smaller than reported, according to a systematic review and meta-analysis.

The investigators searched Medline, PsycINFO, Health and Psychosocial Instruments (EBSCO), Mental Measurements Yearbook (EBSCO), Embase, and Web of Science from inception through 28 May 2019 for peer-reviewed publications, in any language, quantifying healthcare provider burnout in relation to quality of patient care.

Two reviewers independently selected studies and extracted measures of association of burnout and quality of care. The loannidis (excess significance) and Egger (small-study effect) tests were used to assess potential bias.

Of the 11,703 citations identified, 123 publications with 142 study populations including 241,553 healthcare providers were selected. Quality-of-care outcomes were categorized as follows: best practices (n=14), communication (n=5), medical errors (n=32), patient outcomes (n=17), and quality and safety (n=74).

The associations between burnout and quality of care were highly varied (I², 93.4–98.8 percent). A total of 114 unique burnout–quality combinations were found, of which 58 indicated burnout related to poor-quality care, six indicated burnout associated with high-quality, and 50 showed no significant effect.

There was a clear excess significance (73 percent of studies observed vs 62 percent predicted to have statistically significant results; p=0.011), which was most prominent for the least-rigorous quality measures of best practices and quality and safety.

“Future studies should prespecify outcomes to reduce the risk for exaggerated effect size estimates,” the investigators said.

This review was limited by studies that were mostly observational and that neither causality nor directionality could be determined.