Skip to main content

Advertisement

Log in

Work stress, burnout, and perceived quality of care: a cross-sectional study among hospital pediatricians

European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Poor hospital work environments affect physicians’ work stress. With a focus on hospital pediatricians, we sought to investigate associations between work stress, burnout, and quality of care. A cross-sectional study was conducted in N = 96 pediatricians of a German academic children’s hospital (response rate = 73.8 %). All variables were assessed with standardized questionnaires. Multivariate regression analyses were applied to investigate associations after adjusting for potential confounders. Critically high work stress (effort/reward ratio, ERR > 1.0) was reported by N = 25 (28.4 %) participants. Pediatricians in inpatient wards had significantly more work stress than their colleagues in intensive care units and outpatient wards; 10.2 % of surveyed pediatricians reported critically high burnout. Again, inpatient ward staff reported significantly increased emotional exhaustion. After controlling for several confounders, we found that pediatricians with high work stress and emotional exhaustion reported reduced quality of care. Mediation analyses revealed that especially pediatricians’ emotional exhaustion partially mediated the effect of work stress on quality of care.

Conclusion: Results demonstrate close relationships between increased work stress and burnout as well as diminished quality of care. High work stress environments in pediatric care influence mental health of pediatricians as well as quality of patient care.

What is Known:

The quality of pediatricians’ work environment in the hospital is associated with their work stress and burnout.

The consequences of pediatricians’ work life for the quality of care need to be addressed in order to inform interventions to improve work life and care quality.

What is New:

Our study shows associations between increased work stress and burnout with mitigated quality of care.

Beyond indirect effects of work stress through emotional exhaustion on quality of care we also observed direct detrimental effects of pediatricians’ work stress on mitigated care quality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abbreviations

ERI:

Effort-reward imbalance

ERR:

Effort-reward ratio

ICU:

Intensive care unit

OR:

Odd ratio

M:

Mean

SD:

Standard deviation

References

  1. Alarcon G, Eschleman KJ, Bowling NA (2009) Relationships between personality variables and burnout: a meta-analysis. Work Stress 23(3):244–263

    Article  Google Scholar 

  2. Bourbonnais R, Brisson C, Vezina M (2011) Long-term effects of an intervention on psychosocial work factors among healthcare professionals in a hospital setting. Occup Environ Med 68(7):479–486

    Article  PubMed  Google Scholar 

  3. Buddeberg-Fischer B, Klaghofer R, Stamm M, Siegrist J, Buddeberg C (2008) Work stress and reduced health in young physicians: prospective evidence from Swiss residents. Int Arch Occup Environ Health 82(1):31–38

    Article  PubMed  Google Scholar 

  4. Büssing A, Perrar KM (1992) Measurement of burnout. The German version of the Maslach Burnout Inventory (MBI-D). Diagnostica 38:328–353

    Google Scholar 

  5. Fahrenkopf AM, Sectish TC, Barger LK, Sharek PJ, Lewin D, Chiang VW, Edwards S, Wiedermann BL, Landrigan CP (2008) Rates of medication errors among depressed and burnt out residents: prospective cohort study. BMJ 336(7642):488–491

    Article  PubMed Central  PubMed  Google Scholar 

  6. Garcia TT, Garcia PC, Molon ME, Piva JP, Tasker RC, Branco RG, Ferreira PE (2014) Prevalence of burnout in pediatric intensivists: an observational comparison with general pediatricians. Pediatr Crit Care Med 15(8):e347–e353

  7. Kleijweg JH, Verbraak MJ, Van Dijk MK (2013) The clinical utility of the Maslach Burnout Inventory in a clinical population. Psychol Assess 25(2):435–441

    Article  PubMed  Google Scholar 

  8. Klein J, Grosse Frie K, Blum K, von dem Knesebeck O (2011) Psychosocial stress at work and perceived quality of care among clinicians in surgery. BMC Health Serv Res 11:109

    Article  PubMed Central  PubMed  Google Scholar 

  9. Landrigan CP, Fahrenkopf AM, Lewin D, Sharek PJ, Barger LK, Eisner M, Edwards S, Chiang VW, Wiedermann BL, Sectish TC (2008) Effects of the accreditation council for graduate medical education duty hour limits on sleep, work hours, and safety. Pediatrics 122(2):250–258

    Article  PubMed  Google Scholar 

  10. Lee RT, Seo B, Hladkyj S, Lovell BL, Schwartzmann L (2013) Correlates of physician burnout across regions and specialties: a meta-analysis. Hum Resour Health 11:48

    Article  PubMed Central  PubMed  Google Scholar 

  11. Li J, Weigl M, Glaser J, Petru R, Siegrist J, Angerer P (2013) Changes in psychosocial work environment and depressive symptoms: a prospective study in junior physicians. Am J Ind Med 56(12):1414–1422

    Article  PubMed  Google Scholar 

  12. Mache S, Vitzthum K, Klapp BF, Groneberg DA (2012) Improving quality of medical treatment and care: are surgeons’ working conditions and job satisfaction associated to patient satisfaction? Langenbeck’s Arch Surg 397(6):973–982

    Article  Google Scholar 

  13. Maslach C, Schaufeli WB, Leiter MP (2001) Job burnout. Annu Rev Psychol 52:397–422

    Article  CAS  PubMed  Google Scholar 

  14. Pantaleoni JL, Augustine EM, Sourkes BM, Bachrach LK (2014) Burnout in pediatric residents over a 2-year period: a longitudinal study. Acad Pediatr 14(2):167–172

    Article  PubMed  Google Scholar 

  15. Paquet M, Courcy F, Lavoie-Tremblay M, Gagnon S, Maillet S (2013) Psychosocial work environment and prediction of quality of care indicators in one Canadian health center. Worldviews Evid Based Nurs 10(2):82–94

    Article  PubMed  Google Scholar 

  16. Preacher KJ, Hayes AF (2008) Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods 40(3):879–891

    Article  PubMed  Google Scholar 

  17. Shanafelt TD, Bradley KA, Wipf JE, Back AL (2002) Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med 136(5):358–367

    Article  PubMed  Google Scholar 

  18. Shrout PE, Bolger N (2002) Mediation in experimental and nonexperimental studies: new procedures and recommendations. Psychol Methods 7(4):422–445

    Article  PubMed  Google Scholar 

  19. Shugerman R, Linzer M, Nelson K, Douglas J, Williams R, Konrad R (2001) Pediatric generalists and subspecialists: determinants of career satisfaction. Pediatrics 108(3):E40

    Article  CAS  PubMed  Google Scholar 

  20. Siegrist J, Shackelton R, Link C, Marceau L, von dem Knesebeck O, McKinlay J (2010) Work stress of primary care physicians in the US, UK and German health care systems. Soc Sci Med 71(2):298–304

    Article  PubMed Central  PubMed  Google Scholar 

  21. Siegrist J, Starke D, Chandola T, Godin I, Marmot M, Niedhammer I, Peter R (2004) The measurement of effort-reward imbalance at work: European comparisons. Soc Sci Med 58(8):1483–1499

    Article  PubMed  Google Scholar 

  22. Thomas NK (2004) Resident burnout. JAMA 292(23):2880–2889

    Article  CAS  PubMed  Google Scholar 

  23. Tyssen R, Vaglum P (2002) Mental health problems among young doctors: an updated review of prospective studies. Harv Rev Psychiatry 10(3):154–165

    Article  PubMed  Google Scholar 

  24. Virtanen M, Kurvinen T, Terho K, Oksanen T, Peltonen R, Vahtera J, Routamaa M, Elovainio M, Kivimaki M (2009) Work hours, work stress, and collaboration among ward staff in relation to risk of hospital-associated infection among patients. Med Care 47(3):310–318

    Article  PubMed  Google Scholar 

  25. Wallace JE, Lemaire JB, Ghali WA (2009) Physician wellness: a missing quality indicator. Lancet 374(9702):1714–1721

    Article  PubMed  Google Scholar 

  26. Weigl M, Hornung S, Angerer P, Siegrist J, Glaser J (2013) The effects of improving hospital physicians working conditions on patient care: a prospective, controlled intervention study. BMC Health Serv Res 13:401

    Article  PubMed Central  PubMed  Google Scholar 

  27. Weigl M, Hornung S, Petru R, Glaser J, Angerer P (2012) Depressive symptoms in junior doctors: a follow-up study on work-related determinants. Int Arch Occup Environ Health 85(5):559–570

    Article  PubMed  Google Scholar 

  28. West CP, Huschka MM, Novotny PJ, Sloan JA, Kolars JC, Habermann TM, Shanafelt TD (2006) Association of perceived medical errors with resident distress and empathy: a prospective longitudinal study. JAMA 296(9):1071–1078

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The study was partly funded by the Munich Center of Health Sciences (MC-Health). We gratefully acknowledge Tina Arenz, Andrea Schwarzer, and Christian Schröter for their support in study preparation and data collection. We also thank Jake Burns for his support in preparing the manuscript.

Ethics approval

This study was conducted with the approval of the Ethics Committee of the Medical Faculty of the Ludwig Maximilian University of Munich (no. 124/07).

Conflict of interest statement

The authors declare that they have no conflict of interest.

Authors’ contribution

MW, PA and FH contributed to the study conception and design and the acquisition and interpretation of the data. MW, AS, FH, and PA contributed to the research model, analysis and interpretation of the data. MW and AS drafted the article and revised it in concordance with the suggestions of the other authors. All authors contributed to the critical revision of the manuscript and approved the final version for publication.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to M. Weigl.

Additional information

Communicated by Jaan Toelen

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Weigl, M., Schneider, A., Hoffmann, F. et al. Work stress, burnout, and perceived quality of care: a cross-sectional study among hospital pediatricians. Eur J Pediatr 174, 1237–1246 (2015). https://doi.org/10.1007/s00431-015-2529-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-015-2529-1

Keywords

Navigation