Journal of Public Health International

Journal of Public Health International

Current Issue Volume No: 7 Issue No: 3

Literature-review Article Open Access
  • Available online freely Peer Reviewed
  • Health Practitioner Burnout, Safety Implications, And Programmatic Fixes: A Systematic Literature Review Of Current Literature Reviews—200 Proof*

    1 Research PA-C/Research Coordinator University of Texas MD Anderson Cancer Center. Chaplain Texas Medical Center Catholic Chaplaincy Corps. 

    Abstract

    High rates of workplace psychological stress and burnout have been chronic among Healthcare Practitioners. Research shows that Healthcare Practitioner psychological stress / burnout is related to poor quality of care and a high probability of making medical errors and mishaps resulting in harm to patients and even workers themselves. In response, relatively impactful programs have been developed to address Practitioner burnout. To derive a better understanding of the subject and inform best practices and policy regarding the problem and its fixes, this article reports findings from a novel study of a systematic (PRISMA-based) literature review of current (circa ~10 years <) literature reviews; or a distillation of reviews already at 100 proof then undergoing a further distillation into a review of 200 proof.* This study employed a grounded theoretic qualitative methodology to iteratively generate and enumerate descriptive themes from the study s literature review articles. This article reports on what is currently known regarding the precipitants of Health Practitioner Burnout, Burnout itself, its relationship to Safety lapses and mishaps, and Programmatic Interventions (i.e., Fixes). The primary conclusion is that Health Practitioners are the foundation of healthcare organizations and key to quality care and management / leadership should be concerned for their wellbeing; and this article provides a general blueprint in terms of addressing burnout and safety. Study Limitations and Future research are also discussed.

    Author Contributions
    Received Feb 10, 2025     Accepted Feb 18, 2025     Published Feb 27, 2025

    Copyright© 2025 J Johnson Ralph.
    License
    Creative Commons License   This work is licensed under a Creative Commons Attribution 4.0 International License. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    Competing interests

    The authors have no conflict of interest to declare.

    Funding Interests:

    Citation:

    J Johnson Ralph (2025) Health Practitioner Burnout, Safety Implications, And Programmatic Fixes: A Systematic Literature Review Of Current Literature Reviews—200 Proof* Journal of Public Health International. - 7(3):14-27
    DOI 10.14302/issn.2641-4538.jphi-25-5436

    Introduction

    Introduction / Background

    Considerable concern regarding Healthcare Practitioner burnout and related secondary mental distress (e.g., anxiety, depression, depersonalization, emotional exhaustion, disengagement, etc…) continues to be voiced.12 Though the issue is complex and multi-faceted, research has reported widespread levels of burnout that are substantially higher for Health Care Practitioners than the general population regardless of demographic characteristics and other personal factors.2 For example, there are estimates of more than half the nurses working in the U.S. and one in ten worldwide experience burnout with other health professions more or less mirroring these rates.2, (also see 3456) Reports in the literature suggest that those in the healthcare field, in general, and frontline practitioners like nurses specifically, are particularly prone to burnout and psychological ill-health due to extraordinary workloads, emotional draining demands, and work conditions.12456789

    A paramount concern is that Healthcare Practitioners experiencing a high degree of psychological distress and burnout may be inattentive and prone to medical errors endangering patients and even themselves or co-workers.256789101112131415 Compounding this concern are other healthcare organizational-level effects and astronomical costs of burnout such as disengagement and diminished productivity, intention to leave, turnover, attrition, and erosion of team morale. 21215 Indeed, the problem of Healthcare Practitioner burnout, safety, and their fixes is so staggering that hundreds of peer-reviewed research studies have been published regarding various aspects. This then raises the question of how to best address the problem.145678101113161718192021.

    The subject of Healthcare Practitioner psychological stress, burnout, safety implications, and ameliorative interventions coincided with the advent and development of electronic medical literature repositories and databases such as PubMed, Cochranes, Psych Lit, Google Scholar, and Scopious—to name a few. 1258910111214161718192021 Their accelerated, comprehensive, and thorough literature search engines vastly enhanced the ability to conduct more comprehensive yet exacting and systematic reviews of the scholarly literature regarding the subject. 36810111516182021

    In order to provide a current and more formative grasp regarding the state of the research on the subject matter of Healthcare Practitioner psychological distress and burnout, safety implications, and corrective interventions, the intent of this article is to report findings from a novel study that conducted a theoretic grounded qualitative systematic 22 literature review of literature reviews in the past 10 years or less. The uniqueness of this study is there are so few systematic literature reviews on literature reviews in the scientific scholarly literature it is extremely difficult to pin down a number and they are not considered a category of review in the health field.23 This report considers the following components of the burnout, safety, and intervention “equation” in their logical sequence: (1) Contributing Work-related Precipitants; (2) Psychological Distress / Burnout; (3) Safety Implications / Mishaps; and (4) Interventions (see Process Diagram 1).

    This diagram shows a process model of (1) the precipitants of Psychological Distress and Burnout leading to, (2) the condition of Psychological Distress / Burnout, which in turn leads to Safety mishaps. The dashed line depicts the tenuousness of that relationship between (2) and (3). And finally (4) depicts the Intervention Programs breaking the connection between (1) and (2) by addressing / disrupting the precipitant conditions necessary for Psychological Distress / Burnout to occur and at minimum reasonably containing them.

    Discussion

    Discussion / Conclusion

    This article provided a firmer grasp on the current state of science and best practices regarding Healthcare Practitioner burnout precipitants, actual burnout, safety implications, and corrective interventions through a theoretical grounded literature review of literature reviews on an extensively researched subject. Healthcare Practitioners play a fundamental role in quality of care and safety and are the foundation of healthcare organizations—hence, management / leadership should be concerned for their wellbeing. Poor healthcare work environments create psychological distress and burnout in Healthcare Practitioners, specifically, environments characterized by excessive workloads, shift work, value incongruence, low control over the job, inordinate time pressures, communications overload, incessant interruptions, negative / uncivil professional relationships, a toxic social climate, and uninvolved, uncaring, unsympathetic, and unsupportive management. The mental condition of burnout renders the Health Practitioners prone to making inattentive medical errors that place patients, co-workers and even themselves in jeopardy and harm. Fundamental Organizational fixes addressing the precipitants of Health Practitioner burnout, though very powerful, can be impractical and unaffordable. There are also impactful Psychological Intervention programs aimed at addressing and ameliorating the psychological distress and burnout itself through: Cognitive Behavioral Mindfulness and Resilience Training. Also, in a Culture of Safety there is a promising powerful multi-faceted and complicated intervention. Singularly, in combination, or with Fundamental Organizational fixes, they have been shown to be extremely powerful remedies in reducing Health Practitioner psychological distress and burnout.

    What seems to make these Psychological Interventions work are the aspects they have in common, specifically: they are training and learning programs that emphasize teamwork and common purpose, management / leadership s involvement and support / concern / caring, workers assuming a degree of control over their jobs, related job condition improvement, cohesive positive interdisciplinary communications, mutual professional respect and civility, and overall consciousness raising in terms of psychological distress and burnout avoidance.

    There are vetted programs available to help Health Practitioners and health organizations improve workplace mental health in the interest of quality patient care and safety as well as worker well-being and safety.

    Limitations

    There was a discordance between the methodology of grounded iterative thematic enumeration of all variants and the aim of the study to produce a purer synthesis of already synthesized materials.242526 Nevertheless, the method ensured a comprehensive identification, organization, and solid descriptive accounting of what is currently known, and the state of the science and best practices regarding the study s subject matter. Another inherent limitation of the grounded methodology is the possibility of some extreme obscure variant escaping detection or being overlooked.2526 Nevertheless, the final product represented a staggering number of original peer-reviewed research study reports and probably nearly exhausted variants. Although this study only included peer-reviewed articles, missing the grey literature reviews (e.g., in-house program evaluations or trade journal articles), there was a degree quality control assurance regarding findings in terms of scientific merit. Another methodological limitation was that, as the study was a descriptive / qualitative inventory and not quantitative, findings were given equal weight; so there could be no effect size comparisons.14. Future research should consider meta-analysis. Similarly, there was no formal estimate of the quality of research articles included. Nevertheless, 16 of the 21 studies (77%) specifically adhered to PRISMA guidelines ensuring literature review quality.

    It would be expected that restricting the key words for search articles would exclude journals using synonyms or foreign journals using different words; but this did not appear to be the case, as there was diversity of different terms and different nations from which articles came. Though most articles did come from the Western world, they represented a variety of Western nations, and even a Third World comparison nation was included in one of the journal articles. Of course, there is the issue to limiting the reviewed articles language to either English or translated English. Future research should similarly explore non-English speaking literature reviews as a comparison. Furthermore, treating Health Practitioners in the aggregate created a lack of heterogeneity, making generalizability to sub-groups difficult, but not impossible. This is another area that could benefit from future research. However, recent research reports indicate that all Health Practitioner sub-groups are more or less similarly affected by burnout and are at risk for making medical mistakes, and could benefit from programmatic interventions. 145691118

    Recommendations / Future Research

    Probably the most profound recommendation derived from this work is that, before a healthcare workplace plunges in a downward spiral and that devolves into an overwhelming morass of Health Practitioner burnout and related problems, leadership / management must act quickly and follow the scientific research based best practice blueprint contained in this research report and reach for that near 200 proof. * Preventive intervention is generally less expensive than curative remediation.

    Besides gaps in knowledge already identified in this review, other similar systematic literature reviews should be conducted on other high stress occupations where safety is a premium as a comparison to verify the universality of this study s findings. For the same reason, cross-national literature review studies of literature reviews should be conducted too.

    *Note: Moonshiners commonly refer to double-distilled near 200 proof spirits in common parlance as White Lightening. 27

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