Published studies may exaggerate the effect of burnout on quality of patient care

While higher burnout is associated with lower-quality health care, the magnitude or clinical significance of the relationship is still not clear due to variability and confounding in the existing research, according to a systematic review.


Studies may exaggerate how much burnout among health care professionals affects quality of patient care, a systematic review found.

Researchers reviewed 145 studies of the relation between burnout and quality of care over 25 years that included 241,553 health care professionals. Quality-of-care measures were grouped into five categories: best practices, communication, medical errors, patient outcomes, and quality and safety. The systematic review was published Oct. 8 by Annals of Internal Medicine.

Relationships between burnout and quality of care were highly heterogeneous, the review found. Of 114 unique burnout-quality combinations, 58 indicated that burnout was related to poor quality of care, six indicated that burnout was related to high quality of care, and 50 showed no significant effect. Excess significance was apparent, the authors wrote, and was most prominent for the least rigorous quality measures of best practices and quality and safety.

According to the researchers, these findings imply that the true magnitude of the effect of burnout on quality of care may be smaller than reported. The studies that attempted to lower the risk of bias demonstrated fewer significant associations than the evidence base as a whole.

The authors of an accompanying editorial said that the heterogeneity in the studies included in the review was likely due to variability in methods used to measure burnout and outcomes and inattention to potential confounders. The editorial stated, “Considering the limitations of the available literature, prior reviews, and [the] current meta-analysis, we conclude that higher burnout is associated with lower quality, but we are left without clear answers about of the magnitude or clinical significance of the relationship.”