Burnout, Implicit Bias and Quality of Care: A Complex Relationship

a female clinician is holding a stethoscope behind her back

Studies show that up to 70% of nurses and 50% of physicians experience burnout at some point in their careers. The negative consequences of burnout on healthcare workers range from individual effects on mental health such as depression and anxiety that lead to organizational impacts including increased absenteeism, decreased productivity, impaired decision making and so much more.

Burnout in healthcare, which is chronic workplace stress, not only exacts a toll on the mental wellbeing of healthcare professionals but also significantly impacts the quality of patient care. What makes this issue even more pressing is the intricate relationship between burnout and implicit bias, an unconscious prejudice that can lead to unfair healthcare treatment. When burnout takes hold, it acts as a catalyst, heightening implicit bias and exacerbating disparities in patient care (AMA, 2022). As clinicians and other healthcare workers grapple with burnout in healthcare, their ability to provide unbiased, high quality care diminishes, leading to worse patient outcomes. Understanding this complex interplay is essential to fostering a healthcare environment where both providers and patients thrive.

  1. Decreased empathy and compassion: Burnout in healthcare can reduce empathy and compassion in healthcare workers, making it challenging to provide personalized, high quality patient care. Physicians experiencing burnout report reduced empathy towards patients, amplifying the need for targeted interventions (AMA, 2022). Compromised care has a negative impact on the clinician patient relationship, leading to reduced trust and potentially worsened patient outcomes.
  2. Increased risk of medical errors: Burnout escalates the likelihood of medical errors due to compromised attention from workload overwhelm or other stresses. Nurses facing burnout are particularly vulnerable, leading to an increased likelihood of critical mistakes, negatively impacting the outcome of a patient (Robert Wood Johnson Foundation, 2019).
  3. Reduced patient satisfaction: Patients are less likely to be satisfied with their care when they are treated by a burned out healthcare worker. This is because burned out healthcare workers may struggle to be highly attentive to their patients’ needs leading to less personalized care, according to the Kaiser Family Foundation’s research that highlights the direct correlation between healthcare worker wellbeing and patient contentment levels (Kaiser Family Foundation, 2023).
  4. The Interplay between Burnout and Implicit Bias: Implicit bias, such as in the form of racial disparities, deeply worsens with burnout. Studies show that burnout in healthcare settings amplifies biases, and can impact healthcare worker decision making, perpetuating disparities and further amplifying biases (National Academies of Sciences, Engineering, and Medicine, 2021; American Psychological Association, 2020).

What is Implicit Bias?

Implicit bias is unconscious prejudice or discrimination that can lead to unfair treatment of others and is particularly harmful in the healthcare setting, where it can lead to disparities in care. For example, a study by the National Academies of Sciences, Engineering, and Medicine found that Black patients were more likely to be misdiagnosed and to receive lower quality care than white patients. The study also found that implicit bias was a factor in these disparities.

Implicit bias interacts with burnout to create a vicious cycle. When workers face burnout in healthcare, they may be more likely to rely on their implicit biases to make decisions about patient care. This can lead to further disparities in care. A study by the American Psychological Association found that white medical students who experienced burnout were more likely to endorse stereotypes about Black patients. This suggests that burnout may make healthcare workers more likely to stereotype patients and to provide them with lower quality care. To combat the intertwined challenges of burnout and implicit bias, healthcare organizations must:

Tackling the Issues:

To combat the intertwined challenges of burnout and implicit bias, healthcare organizations should:

  • Follow the Data: Healthcare organizations must follow the data to understand the complex interplay of burnout, implicit bias and how it correlates to patient outcomes. By partnering with technology companies supporting burnout data collection and analysis, organizations will be able to pinpoint where burnout stems from, allowing them to strategize on how to best promote a better and more supportive work environment for healthcare workers such as adequate staffing, resources, and training, fostering a positive atmosphere that values mental wellbeing, and other action plans to tackle burnout.
  • Integrate Implicit Bias Training: Raise awareness about implicit bias, its connection to burnout in healthcare, and equip the leadership team and healthcare professionals with strategies for providing unbiased patient care (National Academies of Sciences, Engineering, and Medicine, 2021).
  • Support Mental Health: Offer accessible mental health support, including counseling services and financial assistance for these services. Lastly, training the leadership team to recognize and support employees struggling with both burnout and implicit biases is crucial in creating an open and trusting organization that supports employees and puts patients first (American Psychological Association, 2020).

Recognizing the complex relationship between burnout, implicit bias, and patient care quality is crucial. By addressing these issues strategically and holistically, healthcare organizations can cultivate a compassionate, equitable, and patient centered environment, benefitting both healthcare professionals and those they serve. Addressing implicit bias within the context of burnout is essential to ensuring fair treatment, improved patient outcomes, and a thriving healthcare system.

References:

  • American Medical Association. (2022). Burnout and well being among physicians: A report from the AMA.
  • Kaiser Family Foundation. (2023). Patient satisfaction with care received from hospitals and doctors.
  • National Academies of Sciences, Engineering, and Medicine. (2021). The future of nursing, health, and care for older adults: Investing in a stronger workforce.
  • American Psychological Association. (2020). Racism and discrimination in healthcare: Impact on medical students and residents.
  • Robert Wood Johnson Foundation. (2019). The state of the US healthcare workforce: Chartbook.

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