Is distress in physicians associated with reduced patient safety? Findings of systematic review and meta-analysis

Problem

Distress in physicians has been linked to low performance of healthcare systems, including reduced productivity, job turnover and early retirement. Beyond these specific links, there is some evidence that burnout and distress in physicians affects core domains of the healthcare delivery, including the patient safety and quality of care and the patient satisfaction with healthcare. However this evidence has not been systematically synthesized and appraised. There is a need to integrate research outputs on physician distress and quality of care/patient safety, to facilitate the delivery of safe, efficient and patient-centred care.

Approach

A systematic review and meta-analysis was conducted which examined whether distress in physicians is associated with increased risk for patient safety incidents or precursors of patient safety incidents stemming from quality of care. We also evaluated the association between physician distress and the patient satisfaction with the healthcare. Medline, Embase, CINAHL and PsycINFO were searched up to September 2016. Study design and quality were assessed. Odds ratios (OR) and 95% confidence intervals (95% CIs) were calculated for the associations between distress in physicians and three core outcomes: patient safety (such as medication and medical errors) poor quality of care and patient satisfaction. Meta-analyses using random effects models were undertaken.

Findings

42 studies were included in the review. Burnout and depression were most common measures of distress in physicians. The main meta-analyses demonstrated that distress in physicians is associated with an increased risk for patient safety incidents (OR = 3.39, 95% CI = 2.40 to 4.38), poor quality of care (OR = 2.69, 95% CI = 1.36 to 3.03) and low patient satisfaction OR = 2.52, 95% CI = 1.38 to 3.25). Subgroup analyses showed that depression and burnout have a significant independent effect on patient safety, quality of care and patient satisfaction. Statistical heterogeneity was high and the methodological quality of the studies was generally low.

Consequences

This study suggests that distress in physicians is an important driver of patient safety, quality of care and patient satisfaction. High quality studies are needed to confirm these relationships using robust methodologies. These findings emphasize the need for interventions to improve the well-being of physicians within an aim to promote effective service delivery.