“We found that physicians with burnout had more than twice the odds of self-reported medical error, after adjusting for specialty, work hours, fatigue and work unit safety rating,” Tawfik said. “We also found that low safety grades in work units were associated with three to four times the odds of medical error.”
Shanafelt said, “This indicates both the burnout level as well as work unit safety characteristics are independently related to the risk of errors.”
Physician burnout has become a national epidemic, with multiple studies indicating that about half of all doctors experience symptoms of exhaustion, cynicism and feelings of reduced effectiveness. The new study notes that physician burnout also influences quality of care, patient safety, turnover rates and patient satisfaction.
“Today, most organizations invest substantial resources and have a system-level approach to improve safety on every work unit. Very few devote equal attention to address the system-level factors that drive burnout in the physicians and nurses working in that unit,” Shanafelt said. “We need a holistic and systems-based approach to address the epidemic of burnout among health care providers if we are truly going to create the high-quality health care system we aspire to.”
The study also showed that rates of medical errors actually tripled in medical work units, even those ranked as extremely safe, if physicians working on that unit had high levels of burnout. This indicates that burnout may be an even a bigger cause of medical error than a poor safety environment, Tawfik said.
“Up until just recently, the prevailing thought was that if medical errors are occurring, you need to fix the workplace safety with things like checklists and better teamwork,” Tawfik said. “This study shows that that is probably insufficient. We need a two-pronged approach to reduce medical errors that also addresses physician burnout.”
Impact on physicians
In addition to their effect on patients, both errors and burnout can also have serious personal consequences for physicians. “We also know from our previous work that both burnout and medical errors independently double the risk of suicidal thoughts among physicians,” Shanafelt said. “This contributes to the higher risk of death by suicide among physicians relative to other professionals.”
Jochen Profit, MD, associate professor of pediatrics at Stanford, and researchers at the Mayo Clinic also contributed to the study.
The work was supported by the National Institutes of Health (grants R01HD084679 and K24HD053771), the Jackson Vaughan Critical Care Research Fund, the Mayo Clinic Program on Physician Well-Being and the American Medical Association and the Mayo Clinic Program on Physician Well-Being.
Stanford’s Department of Medicine also supported the work.