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. |
Abbreviations
- ERI:
-
Effort-reward imbalance
- ERR:
-
Effort-reward ratio
- ICU:
-
Intensive care unit
- OR:
-
Odd ratio
- M:
-
Mean
- SD:
-
Standard deviation
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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.
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Communicated by Jaan Toelen
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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
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DOI: https://doi.org/10.1007/s00431-015-2529-1