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Organizational strategies to reduce physician burnout: a systematic review and meta-analysis

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Abstract

Background

The growing “process” of burnout impair performance and quality of professional services, with consequences for physicians, healthcare care organization, and patient’s outcomes.

Aims

We aim to evaluate which strategy of intervention, individual or organization directed, is more effective to reduce physician burnout and to provide management suggestions in terms of actual organizational strategies and intensity leading to reductions in physician burnout.

Methods

The meta analysis was conducted according to the PRISMA guidelines. We included physicians of any specialty in the primary, secondary, or intensive care setting, including residents and fellows. Eligible interventions were any intervention designed to relieve stress and/or improve the performance of physicians and reported burnout outcomes, including physician-directed interventions and organization-directed interventions. The electronic search strategy applied standard filters for identification of the different studies. Databases searched were the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), MEDLINE (from inception to September 2018), and EMBASE (from beginning to September 2018). Meta analysis was performed with mixed random effect using DerSimonian and Laird method. The standardized mean difference (SMD) and 95% CI for each outcome were separately calculated for each trial pooling data when needed, according to an intention-to-treat principle.

Results

Pooled interventions were associated with small significant reductions in burnout (SMD = − 0.289; 95% CI, − 0.419 to − 0.159; I2 = 29%) (Fig. 2). Organization-directed interventions were associated with a medium reduction in burnout score (SMD = − 0.446; 95% CI, − 0.619 to − 0.274; I2 = 8%) while physician-directed interventions were associated with a moderate reduction in burnout score (SMD = − 0.178; 95% CI, − 0.322 to − 0.035; I2 = 11%).

Discussion

This systematic review and meta-analysis showed that (1) organization-directed interventions were associated with moderate reduction in burnout score, (2) physician-directed interventions were associated with small reduction in burnout score, (3) organization-directed interventions reduced more the depersonalization than physician-directed interventions, (4) organization-directed interventions were related to a more improvement of the personal accomplishment than physician-directed interventions.

Conclusions

This meta analysis found that physicians could gain important benefits from interventions to reduce burnout, especially from organizational strategies, by viewing burnout rooted in issues related to the working environment and organizational culture.

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Funding

This work was supported by the National Research Council of Italy (CNR), Research Project “Aging: molecular and technological innovations for improving the health of the elderly population” (Prot. MIUR 2867 25.11.2011)”

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Authors and Affiliations

  1. Institute for Research on Innovation and Services for Development, National Research Council of Italy, Via San Felice, Naples, Italy

    Stefania De Simone

  2. Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Pansini, Naples, Italy

    Maria Vargas & Giuseppe Servillo

Authors
  1. Stefania De Simone
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  2. Maria Vargas
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  3. Giuseppe Servillo
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Corresponding author

Correspondence to Stefania De Simone.

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Not required since this a systematic review.

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De Simone, S., Vargas, M. & Servillo, G. Organizational strategies to reduce physician burnout: a systematic review and meta-analysis. Aging Clin Exp Res 33, 883–894 (2021). https://doi.org/10.1007/s40520-019-01368-3

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