Karolina Doulougeri

“Diagnosing” burnout among healthcare professionals: Can we find consensus?

Abstract Burnout is an established phenomenon across cultures and occupations. The Maslach Burnout Inventory (MBI) is the most commonly used measure of burnout. The MBI delineates burnout according to three components (emotional exhaustion, depersonalization and reduced personal accomplishment) and provides the opportunity to assign a classification of burnout. However, the criteria of what constitutes burnout and/or low, medium or high burnout varies considerably. In the following paper, we have systematically reviewed studies of healthcare professionals that specifically “diagnose” burnout. Results indicate multiple approaches to assigning different levels of burnout. The need for a consensus on how to classify different degrees of burnout is discussed.

How) do medical students regulate their emotions

BackgroundMedical training can be a challenging and emotionally intense period for medical students. However the emotions experienced by medical students in the face of challenging situations and the emotion regulation strategies they use remains relatively unexplored. The aim of the present study was to explore the emotions elicited by memorable incidents reported by medical students and the associated emotion regulation strategies.MethodsPeer interviewing was used to collect medical students’ memorable incidents. Medical students at both preclinical and clinical stage of medical school were eligible to participate. In total 104 medical students provided memorable incidents. Only 54 narratives included references to emotions and emotion regulation and thus were further analyzed.ResultsThe narratives of 47 clinical and 7 preclinical students were further analyzed for their references to emotions and emotion regulation strategies. Forty seven out of 54 incidents described a negative incident associated with negative emotions. The most frequently mentioned emotion was shock and surprise followed by feelings of embarrassment, sadness, anger and tension or anxiety. The most frequent reaction was inaction often associated with emotion regulation strategies such as distraction, focusing on a task, suppression of emotions and reappraisal. When students witnessed mistreatment or disrespect exhibited towards patients, the regulation strategy used involved focusing and comforting the patient.ConclusionsThe present study sheds light on the strategies medical students use to deal with intense negative emotions. The vast majority reported inaction in the face of a challenging situation and the use of more subtle strategies to deal with the emotional impact of the incident.

Implementing action research in hospital settings: a systematic review.

PURPOSE Health care organizations and hospitals in particular are highly resistant to change. The reasons for this are rooted in professional role behaviors, hierarchical structures and the influence of hidden curricula that inform organizational culture. Action research (AR) has been identified as a promising bottom-up approach that has the potential to address the significant barriers to change. However, to date no systematic review of the field in health care exists. The paper aims to discuss these issues. DESIGN/METHODOLOGY/APPROACH A systematic review of the literature was conducted. Studies were reviewed with regard to the four stages of AR; problem identification, planning, implementation and evaluation. FINDINGS Only 19 studies were identified that fit the inclusion criteria. Results revealed significant heterogeneity with regard to theoretical background, methodology employed and evaluation methods used. RESEARCH LIMITATIONS/IMPLICATIONS Only studies published and written in the English language were included. PRACTICAL IMPLICATIONS The field of AR interventions would benefit from a theoretical framework that has the ability to guide the methodology and evaluation processes. ORIGINALITY/VALUE This is the first systematic review of AR in hospitals.

Organizational Health Intervention Research in Medical Settings

Medical settings, especially hospitals, represent a challenging environment in which to conduct organizational health interventions. This is due to the fact that healthcare professionals tend to hold pathogenic rather than salutogenic views about health and well-being. Additionally, healthcare professional identity and sense of coherence is deeply embedded in role behaviors (i.e., I am a doctor) rather than organizational awareness (i.e., The purpose of the hospital is…). Worksite health promotion interventions in medical settings, despite their prominent character, have yielded mixed results regarding their effectiveness. One of the major challenges is to be both theoretically sound and, at the same time, context appropriate. The proposed chapter will; (1) conceptualize what a health medical organization (hospital) should look like, (2) review organizational health interventions in medical settings in terms of theoretical focus and practical outcomes, (3) identify the salutogenic factors that promote well-being, (4) review the cultural and contextual factors that are barriers to interventions, and (5) reflect on how health intervention researchers can address process and context (intervention) issues in medical setting. All medical settings will be reviewed, but special focus will be given to hospitals and the use of action research which has been extensively used in medical settings.

Burnout: Why Interventions Fail and What Can We Do Differently

Job burnout can have serious personal consequences for individuals, including broken relationships, problematic alcohol use and suicidal ideation. At an organizational level, it is related to reduced productivity, increased absenteeism, job turnover and early retirement. Unfortunately, burnout is noteworthy in that interventions to address it have been largely unsuccessful. Typically, interventions are either person-directed or organization-directed, or a combination of both. Even interventions that are initially successful see positive effects diminish over time. However, the accumulated evidence strongly suggests that the conditions that contribute to the development of burnout are more related to the characteristics of organizations than those of individuals per se. The most probable reason for this is that burnout represents a symptom of organizational dysfunction, not a bona fide outcome per se. In the following chapter we will locate the “real” place of burnout within the organizational system, review the reasons why interventions to address burnout have failed, identify the process and content mechanisms as to why they fail, and argue that Action Research has significant potential to address burnout in organizations.