Burnout syndrome in academic anaesthesiology Belgrade study results Miodrag Milenovic MD, Ph. D Chair, WFSA Education Committee University of Belgrade School of Medicine Clinical Centre of Serbia, Emergency Centre
Objectives • • • The concept Operationalization Dimensions Definition of burnout - symptoms List of risk factors Belgrade study results
The Concept of Burnout • Reaction to chronic, job-related stress • “collapse of the human spirit” (Storlie 1979) • “psychological withdrawal from work in response to excessive stress and dissatisfaction” (Cherniss 1980)
Three degree model on burnout 1. Failure to keep up and gradual loss of reality 2. Accelerated physical and emotional deterioration (sleeping problem, loss of energy, gain or lose weight) 3. Major physical and psychological breakdown (heart attack, ulcer, mental illness, depression) Simendinger EA, Moore TF. Organizational burnout in Health care facilites: Strategies for prevention and change. Rockville: Aspen Syst Co. 1985.
Edelwich’s five stages of disillusionment
Operationalization of Burnout Authors Jones (1980) Maslach i Jackson (1986) Instruments Domains Area of aplic. Staff Burnout Scale for • Dissatisfact. at work • Psychological and Health Professionals interpersonal tension • Negative consequ. of (SBS-HP) stress • Unprofessional relation with patients Maslach Burnout Inventory (MBI) • Emotional Exhaustion • Depersonalization • Personal accomplishment Health care Mattews (1990) Mattews Burnout • Attitudes about work • Adjustment of role Welfare Scale for Employees • Locus of control and coping skills • Personal professions (MBSE) adjustment and temperament in general Moreno. Questionnaire for • Background • Professional Wear • Resistant Health Jiménez, Garrosa burnout in nursing Personality • Confrontation • Consequences i González (2000) (CDPE) Gil-Monte (2005) Assessment Questions for Burnout Syndrome at Work (CESQT) • Illusion for the job • Psychic wear • Indolence • Guilt Welfare professions in general Moreno-Jiménez JC, Flores M, Tovar L, Vilchis F. Evolution of the Concept and Models of Work Exhaustion (Burnout): The Research in Mexico. International Business Research 2014; 7: 45 -66.
Three Burnout dimensions Emotional Exhaustion Personal accomplish. Depersonaliz. / Cynicism
Problems • Psychosomatic high blood pressure, headaches, heart disease, increased secretion of stress hormones and other hormonal disorders, stomach problems • Psychic chronic anxiety, anger, depression, apathy, frequent mood changes, loss of memory or concentration
Manifestations of Burnout • Disturbed interpersonal relationships – Self-isolation and loss of real communication with associates, friends and family members • Dissatisfaction – with the results achieved, the professional achievements or position at work
Symptoms of Burnout • Physical • Mental/Emotional • Behavioral
Physical symptoms and signs • Low energy/exhaustion • Change in appetite or sleep habits • Headaches, back pain muscle aches • Cardio-vascular dis. • Digestive dis. Frequent urination Shakiness and trembling Frequent colds Undefined feeling of illness • Decreased sexual drive • •
Emotional symptoms and signs • • • Self-doubt and failure Helpless, trapped and defeated Detachment and loneliness Loss of motivation Increasingly cynical and negative outlook Low satisfaction and sense of accomplishment
Behavioral symptoms and signs • • Accident prone Irritable/angry Tearful Withdrawn Unresponsive Unproductive Cynical • Changes in relationships • Increased use of medication • Alcohol and drug abuse • Increased use of sick days
Implications • Many important implications: divorce, suicide, job turnover, drug and alcohol abuse for – Practitioners – Recipients of health care • Knowledge of stress and burnout developing is important • Understanding helps prevention
Addiction • 10 – 14 % MDs become addicted during career • Alcohol is primary choice • Addiction is cause for impairment over 70% of the time
Stress or Burn-out? Stress “too much” • • • Over-engagement Emotions over-reactive Urgency and hyperactivity Loss of energy Anxiety disorders Primary damage is physical Burnout “not enough” Disengagement Emotions are blunted Helpless and hopeless Loss of motivation Detachment and depression • Primary damage is emotional • • •
Stress, Burnout & Productivity Prolonged Stress nc Fu Pr od ng ni cli St uct re ive ss De n tio No Stress Situat. Stressed Burnout Dysfunction
Six causes of Burnout 1. 2. 3. 4. 5. Work overload Lack of control Insufficient reward Unfairness Community breakdown 6. Value conflict Maslach & Leiter, 1997. “The Truth About Burnout” Losek D. Pediatr Emerg Care. 1994 Oct; 10(5): 256 -9.
Burnout “. . . burnout thrive in the workplace. Burnout is always more likely when there is a major mismatch between the nature of the job and the nature of the person who does the job. ” Christina Maslach
Burnout syndrome - MBI • Emotional Exhaustion • Depersonalization/Cynicism • Low personal accomplishment / Sense of Inefficacy
Emotional Exhaustion • “I feel drained. . . ” • Result of high workload and time pressure • Precursor to Depersonalization/ Cynicism
Depersonalization • Distance Self from Patients / Colleagues • Ignore unique qualities of Patients / Colleagues • Creation of “other” – Easier to manage demands – Protects self from emotional demands of work
Low personal accomplishment • “I’m not doing a good job. . . ” • “My boss and colleagues don’t recognize my efforts” • Concurrent with exhaustion/cynicism • Linked to lack of resources
Risk Factors • Individual – demographics, personality, attitudes • Situational – job, occupation, organization Situational risks are more predictive than individual risks
Attitudes • High job expectations – nature of work – achievement • Unclear - if this correlates with burnout
Recent publication related Burnout of Anaesthesiologists Eur J Anaesthesiol 2016; 33: 187– 194
Cross- sectional study in Belgrade University Anaesthesia departments • Population of 272 anaesthesiologists • 75. 4% (205) completed questionnaire • Age min. 34 • Age max. 64 • Mean 48. 2 145 70. 7 % 60 29. 3 % • SD 8. 3 Milenovic M. Investigation of burnout syndrome among anesthesiol. in tertiary level health care in Belgrade. Ph. D research 2013
Study Instruments General questioner Meshach Burnout Inventory - HSS Beck’s Depression Inventory Generic measure for self evaluation of health related quality of life SF 36 • Krupp’s fatigue inventory • •
Belgrade Burnout Study Statistical Methodology MBI-HSS EE, DP, PA i “Total Burnout” Relations MBI-HSS, SF-36, Beck’s and Krupp’s inventory • descriptive and inferential statistics • “Total Burnout“ = (0. 4 x. EE)+(0. 3 x. DP)+(0. 3 x. PA) • Multivariate Logistic Regression • Pearson’s Chi-square test or Independent t-test • levene's test equality of variance • Kolmogorov-Smirnov test with Lilliefor’s correction of significancy • Shapiro-Wilk Test • Pearson’s correlation analysis • Speraman’s coeficijent correlation • T-test • ANOVA test
Socio-demographic characteristics Males 29. 3% Females 70. 7% The average of 48. 2 years. (SD 31. 8) The average length of work experience 16. 6 years. (SD = 8. 98) • Senior management positions 36. 6% Average 6. 6 year(SD = 5. 04) • Additional Academic education 31. 2% • •
Socio-demographic characteristics related to a sex Variable Female Male N % Total N % Statistically significant 6, 073** Marital Status not in a relationship 49 33, 8 10 10, 7 59 28, 8 in a relationship 96 66, 2 50 83, 3 146 71, 2 antly n signific 9, 345*** Working experience ts has bee esiologis th le anaes 15 up to 41 28, 3 28 46, 7 69 33, 7 Ma : oftenfrom 16 to 25 hip 55 37, 9 11 18, 3 66 32, 2 o 33, 8 ri nce relati 26 ns 49 expe 21 e 35, 0 70 34, 1 In a over • Workingess working Conditions ki g co • With l wor 17 n 28, 3 38 18, 5 th Unsatisfieded wi 21 14, 5 isfi es sat • LNotssatisfied / not 62 42, 8 25 47, 7 87 42, 4 6, 174** unsatisfied 62 42, 8 18 30, 0 80 39, 0 Legend: ** significant 0, 05; *** significant 0, 01. Statistically significantt realized Pearson’s Chi-square test or Independent t-test
Anaesthesiology Burnout at the Belgrade University Hospitals „Total Burnout“ is 6. 34%. LOW
Modeling of the dependent variable EE Socio-demographic characteristics Statistical Significancelikely ss 45. 6% le Gender logists are men o naesthesi ea Malfemale red to wo • mpa male ess EE, co , 087* expr to. Academic Education. siologists anesthe Basic academic education ied h tisf, 096*wit Additional academiclogist are sa esio education obability of h Work conditions the anest • If ns, the pr itio not king cond satisfied y 355. 7% r b wo increases not elopingnot dissatisfied / EE , 201 ev dsatisfied , 001*** Legend: * significance 0, 10; *** significance 0, 01
Modeling of the dependent variable DP increases Statistical u ademic ed Significance tional ac eveloping • Addi Marital by 146. 2%, of d status hose with t y probabilitin a relationshipompared to c not in the DP, Burnouta relationshipducation In , 072* ic e academ sic. Academic Education ba 26", has Basic academic educationked "over that wor isacademic education 92. 1%, 064*mpared , co esthet n. Additional t bolity by • An a Work ed probas experience l-serving s decreato 15 logists with medica up h so anest 16 etoi 25 to from , 050* ears to 26 y , 092* up over 15" “ Socio-demographic characteristics cation Legend: * significance 0, 10
Modeling of the dependent variable PA 1. 4% less Socio-demographic characteristics es 7 uation giv Statisticalo the t Significance inancial si d PA, compared t Good" f • “ Work experienceduce indigent y for re li probabitot 15 ist who lives in the up thes 16 lto g es from io o 25 an , 053* ge’ in ‘avera hold. e g , 348 housover 26 ogist livin iol Balance n, probability of s Materials. Households e ane the cial situatio • If th Bad s finan household s by 59. 3% Moderate is les , 098* ed PA reduc Good , 016** Legend: * significance 0, 10; ** significance 0, 05;
Modeling of the dependent variable “Total Burnout” Socio-demographic characteristics Statistical Significance l life, "Tota f nal year o Age , 056* ch additio. th ea • Wi. Academic i. Education d by 21. 3% " ncrease nou Bur. Basic tacademic education increased Additional academic education , 051* emic edu Workiexperience d by 272. 0% nal aca “ dt • Adupito o y of “Total Burnout 15 lit probabi from 16 to 25 over 26 , 031** , 105 Legend: * significance 0, 10; ** significance 0, 05;
Beck’s Depression Inventory results Depression incidence severity of symptoms Relation to sociodemograph characteristics A higher risk of depression have Beck’s DI average value 8, 36 ± 6, 824. ut o W ith • Respondents without children (p= 0, 010) • Not satisfied with working conditions (p= 0, 015) ht lig e S M o de t ra h g Hi
Qo. L acording to SF-36 Mean score of the scales Scale SF-36 PF RP RE VT MH SF BP GH N Minimum Maximum 205 205 20, 00 25, 00 30, 00 8, 00 30, 00 100, 00 100, 00 95, 00 Mean score 78, 14 88, 29 66, 99 67, 60 58, 84 62, 39 64, 14 65, 41 SD 18, 27 16, 14 40, 42 16, 98 20, 22 29, 29 42, 52 14, 92 PF- Physical Functioning; RP- Role Limitations due to Physical Problems; BP-Bodily Payne; General Health; VT- Vitality; SF- Social Functioning; RE- Emotional Role ; MH- Mental Health
SF-36 score related to socio-demografic caracteristics TQL and composit scale TQL SF-36 scor 68. 98 ± 19. 07 PHC 74. 00 ± 17. 36 MHC 63. 96 ± 22. 28 widower/ widows p= 0. 030 Working condit. satisfaction p= 0. 005 p= 0. 012 p= 0. 010 p= 0. 004
Krupp Fatigue scale assessment results Relation to sociodemograph Dichotomous relationships characteristics Gender and working conditions significant • Female (p=0, 001) • Dissatisfied with working conditions(p=0, 001) Krupp Fatigue scale average value 33. 84 ± 15. 075
Significant relationship between applied instruments • Self-assessment of health status and MBI-HSS • significant correlation between poor self-assessment, with the scales? "Total Burnout", EE and negatively correlated with PA • Krupp's fatigue scale and MBI-HSS • statistically significant moderate positive monotonic relationship • SF-36 and MBI-HSS – Statistically significant negative correlation except PA, that has positive relation with total Qo. L • Beck’s Depression Scale and MBI-HSS – Statistically significant correlation with MBI-HSS
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