Surgeon Burnout, Patient Safety and Quality of Care: Contributors, Consequences and Possible Solutions

Research has linked increased staff burnout to poorer patient safety in healthcare settings. Surgeons, in particular, are more inclined to suffer from burnout whereas surgeons often suffer silently when they are experiencing stress and burnout and do not ask for help which make the issue not clear. There needs to be more research on surgeon burnout, how it affects them and how to enhance their well-being. This thesis aimed to improve understanding of surgeon burnout and identify potential solutions. This thesis reports five studies. The first was a systematic review and meta�analysis which aimed to investigate the association between surgeon burnout and 1) patient safety and 2) surgical professionalism. The results of a systematic review provided important insights into the existing evidence base on surgeon’s burnout and identified gaps in knowledge, one of which is that there is not enough qualitative study to give a deep understanding of how surgeons experience and deal with burnout. Hence, the next two studies used semi-structured interviews to explore the main factors that lead to surgeon burnout and to examine how surgeons cope with burnout at work (Study 2) and to understand how burnout affects surgeons and the care they provide (Study 3). The systematic review also revealed that there is no evidence regarding the link between surgeon burnout and patient safety in the UK, to address this, the fourth study used questionnaire survey methods to investigate the association between surgeon burnout and patient safety outcomes. This study also tested whether surgeons' burnout levels varied over the first six months of the COVID-19 pandemic. The fifth study, ../ qualitative methods, investigated the effects of the COVID-19 pandemic on surgeons' mental health. Key findings This thesis found a significant link between surgeon burnout and patient care. The systematic review and meta-analysis (Study 1) results showed that burnout was associated with a 2.5-fold increased risk of medical error. Study 3 identified four themes about how burnout affects patient care: first, burnout weakens surgeon–patient relationships; second, burnout affects patient safety; third, burnout hurts staff relationships; and fourth, burnout makes vi surgeons less motivated to improve. Burnout was also associated with patient safety in the survey study (Study 4), and the longitudinal findings indicated a bi-directional connection between burnout and patient safety perceptions (Study 4). Regarding the main factors that can lead to burnout in surgeons, the thematic analysis identified several factors captured in the following themes: rising to the challenge of surgical work; interpersonal conflict at work; greater demands than resources; the challenge of work-life balance; and the devastating impact of errors and poor patient outcomes (Study 2). The analyses also revealed various strategies surgeons employed to cope with burnout: cognitive restructuring; seeking social support; stepping aside or down from the job; and prioritising personal health. Additionally, some surgeons also reported using maladaptive coping (Study 2). A second qualitative analysis also found three themes in surgeons' experiences of burnout: first, burnout is common but frequently not recognised nor understood; second, burnout is a personal crisis; and third, burnout creates vulnerability at work (Study 3). The impact of the COVID-19 pandemic on surgeons was also investigated in this thesis (Studies 4 and 5). Qualitative thematic analysis identified four major themes: a changing and challenging work environment due to the COVID-19 pandemic; professional development and life challenges; personal change and loss, and emotional and psychological repercussions (Study 5). Quantitative analyses found that burnout increased during the pandemic's first (June 2020) to second waves (January 2021) (Study 4). In conclusion, surgeons suffer from a high level of burnout, especially after the COVID-19 pandemic (Study 4). Without a defined retention plan, the problem affects not only surgeons through bad habits such as substance abuse, but also organisations through workforce loss due to surgeons leaving. It may also increase risks to patient safety.