Physician burnout is at least equally responsible for
medical errors as unsafe medical workplace conditions, if not more so,
according to a study led by researchers at the Stanford University School of

“If we are trying to maximise the safety and quality of
medical care, we must address the factors in the work environment that lead to
burnout among healthcare providers,” said Tait Shanafelt, MD, director of
the Stanford WellMD Center and associate dean of the School of Medicine.
“Many system-level changes have been implemented to improve safety for
patients in medical workplaces. What we find in this study is that physician
burnout levels appear to be equally, if not more, important than the work unit
safety score to the risk of medical errors occurring.”

The study is published today (9 July) in the Mayo Clinic Proceedings.

Up until now, limited research has focused on how physician
burnout contributes to these errors, according to the new study.

The researchers sent surveys to physicians in active
practice across the United States. Of the 6695 who responded, 3574 ( 55%)
reported symptoms of burnout. Ten percent also reported that they had made at
least one major medical error during the prior three months, a figure
consistent with previous published research, the study said. The physicians
were also asked to rank safety levels in the hospitals or clinics where they
worked using a standardised question to assess work unit safety.

“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 organisations 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 healthcare providers if we are truly going to create the
high-quality healthcare 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.”

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.”