The Relationship between Health Care Provider Burnout and Quality of Patient Care

1. Increased provider burnout has been associated with poor quality of patient care.

2. The true effect size of this relationship was thought to be smaller than previously reported

Evidence Rating Level: 2 (Good)

Study Rundown: Nearly half of health care providers experience burnout, which has been linked to suicidality, decreased productivity, and increasingly unprofessional behavior. The purpose of this study was to investigate the relationship between provider burnout and subsequent quality of patient care. The secondary goal was to understand if the estimate of this relationship was previously overestimated in the literature. Peer-reviewed publications were reviewed to assess the estimates reported in previous studies. Overall, two independent reviewers extracted measures of burnout and quality of care from this cohort of papers and found that the true effect size reported previously may have been an overestimate. Furthermore, the relationship between burnout and quality of care was highly heterogeneous. Because this paper primarily reviewed observational studies, causality and directionality could not be determined. In the future, by specifying pre-specified outcomes in studies, the effect sizes can be estimated without the risk of over-estimation.

In-Depth [systematic review]: A systematic review of the literature was conducted. Peer reviewed publications in all languages were included. Six databases were utilized and 123 publications, from 1994 to 2019, were analyzed in this study. Studies that only used patient satisfaction as a measure of quality of care to reduce bias from non-provider related factors, as well as studies that were purely qualitative were excluded. The most frequently reported effect related emotional exhaustion to lower quality care, mainly in quality and safety and medical errors, and the opposite effect on communication. The outcomes to assess quality of care were grouped into the following categories: best practices (n=14), medical errors (n=32), patient outcomes (n=17) and quality and safety (n=74). The findings supported the theory that potential bias exists in studies that are the least rigorous when compared to the studies with best practices. Statistically significant results were seen in 73% of studies, but were only predicted to be seen in 62%. Overall, the association between provider burnout and quality of care provided was highly heterogeneous and suggestive that the true effect size may be smaller than what has been reported.