INTERNATIONAL PERSPECTIVES ON WELL-BEING AND BURNOUT WITHIN HEALTH SYSTEMS

Abstract

Objectives: To reflect on the present international culture of professional burnout
 in health care systems and the need for a radical new approach with an increased
 understanding of a person- and people-centered attitudes in the promotion of
 training in wellbeing and the prevention and management of burnout among
 physicians and health care professionals
 Methods: A literature search worldwide was undertaken for significant research
 papers on professional education related to burnout with particular reference to
 both medical staff resilience and health care system factors.
 Findings: Burnout among doctors is a global phenomenon. The incidence of
 burnout reported in a selection of studies among pediatric residents and staff are
 25% in Argentina, 37% in the United Kingdom, and 70% in Saudi Arabia. In a
 national survey in the United States where the overall rate was 59% burned out
 residents reported significantly increased stress, poorer mental health, and
 decreased empathy, mindfulness, resilience, self-compassion, and confidence in
 providing compassionate care Three levels of change that should be the focus of
 training in prevention, health promotion, and stress reduction awareness have been
 recommended to reduce the risk of burnout: (1) modifying the organizational
 structure and work processes; (2) improving the fit between the organization and
 the individual doctor through professional development programs so that better
 adaption to the work environment occurs; and (3) individual-level actions to reduce
 stress and poor health symptoms through effective coping and promoting healthy
 behavior.
 Discussion: The history of burnout shows important links with increased work
 complexity. Narrow training interventions such as debriefing after an adverse
 clinical event have not been found effective. A more comprehensive personcentered
 approach with a variety of measurable interventions has resulted in a
 reduction of 50% in the pediatric faculty in one study. A person- and
 people-centered cybernetic approach is needed with six standards are to establish
 and sustain a healthy work environment (1) authentic leadership (2) meaningful
 recognition, (3) skilled communication, (4) true collaboration, (5) effective
 decision making, and (6) appropriate staffing.
 Conclusion: With such high levels of burnout, health systems worldwide can be
 viewed as failing their populations on a grand scale. Only an organizational
 paradigm change to a person- and people cybernetic centered system that
 incorporates complexity is adaptive and integrative will a health system be
 effective in preventing and ameliorating the effects of burnout and reduce the
 increasingly unaffordable misuse of human resources.