Performance Of Healthcare Organizations Research Articles

The Effect of Internal Control Components on Mitigating the Impact of COVID-19 Risks in Healthcare Organizations in Ethiopia

The COVID-19 pandemic hit the world’s economy and created significant risks from which many sectors, including the healthcare sector, are adversely affected. This study is aimed to evaluate the reliability of internal control systems in healthcare organizations and the effect of internal control components on mitigating the impacts of risks created by the pandemic. The study used a cross-sectional primary data collected from 241 healthcare organizations in Addis Ababa, Ethiopia. Descriptive statistics and ordered logistic regression analysis methods was applied. Internal control system in the Ethiopian healthcare organizations is found to be moderately reliable. In addition, the ordered logistic regression results show that control environment, risk assessment, control activities, information and communication, and monitoring activities have a statistically significant and negative effect on impact of COVID-19 risks. This implies as the reliability of internal control components increases, the impact of COVID-19 risks on the overall performance of healthcare organizations decreases.

Cultural approach to healthcare risk management - an Italian experience with look-alike, sound-alike drugs

Risk management is fundamental in healthcare organisations at both the institutional (organisations) and sectorial (health) levels, not only as an operational technique but also as part of a managerial model. Thus, it is essential to highlight the strategic importance of the cultural impact, both clinically and financially, of correct risk integration between professional and organisational functioning. This research presents a case study of the Casa di Cura Tortorella S.p.a. (Salerno, Italy), which adopted a unique solution to handle logistical risks concerning medicines that have the potential to lead to dangerous confusions due to their similar names, dosages, packaging, and other elements (i.e., look-alike, sound-alike [LASA] drugs). Using the case study technique, the investigation highlights that the adoption of an operational mechanism for risk management, although useful, is limited if it is not supported by thorough training (for every operator) and a new organisational and cultural role, i.e., 'nursing team leaders', with responsibility for coordination and reporting, and has direct and indirect impacts on the financial performance of healthcare organisations.

Cultural approach to healthcare risk management - an Italian experience with look-alike, sound-alike drugs

Risk management is fundamental in healthcare organisations at both the institutional (organisations) and sectorial (health) levels, not only as an operational technique but also as part of a managerial model. Thus, it is essential to highlight the strategic importance of the cultural impact, both clinically and financially, of correct risk integration between professional and organisational functioning. This research presents a case study of the Casa di Cura Tortorella S.p.a. (Salerno, Italy), which adopted a unique solution to handle logistical risks concerning medicines that have the potential to lead to dangerous confusions due to their similar names, dosages, packaging, and other elements (i.e., look-alike, sound-alike [LASA] drugs). Using the case study technique, the investigation highlights that the adoption of an operational mechanism for risk management, although useful, is limited if it is not supported by thorough training (for every operator) and a new organisational and cultural role, i.e., 'nursing team leaders', with responsibility for coordination and reporting, and has direct and indirect impacts on the financial performance of healthcare organisations.

Bir Diş Kliniğinin Performansını Etkileyen Faktörlerin Analizi

Quality and productivity management in healthcare has received considerable attention over the past four decades. Many research papers dealing with various aspects of healthcare performance have been published in the literature. However, medical organizations and hospitals are still lacking enough technical knowledge related to performance and quality improvement tools. This paper presents a procedure to study the effects of various factors on healthcare performance measures in a dental clinic. Particularly, we have analyzed a dental clinic system and investigated the effects of treatment types, dentist experience, and the patient age on treatment times using design of experiment and related analysis. The procedure presented here demonstrates a useful application of performance and quality improvement tools in healthcare organizations for healthcare managers.

Surgical site infections in a tertiary hospital over 10 years. The effect of hospital accreditation strategy implementation.

Objectives:To analyze the rate of surgical site infections (SSIs), the type, and the frequency of the commonly-associated microorganisms.Methods:A retrospective study was conducted in King Fahd Hospital of the University, Al Khobar, Saudi Arabia between December 2018 and June 2019 comprising data from August 2008 to August 2018 from patients with culture-confirmed surgical site infection at a tertiary hospital.Results:Out of 2716 wound infection cases during the study period, a total of 289 patients were diagnosed with SSI. The rate of SSI in the tertiary hospital decreased from 20 per 1000 operations in 2009 to 3.5 per 1000 operations in 2018. A significant decrease in the rate of SSIs was observed in 2014 and 2015 when self-assessment strategies in preparation for the accreditation of the hospital were implemented. A significant shift in the SSI rate from type I and II wounds to type IV wounds was observed coinciding with implementation of accreditation procedures. Escherichia coli was the most common pathogen. Antibiotic susceptibility patterns showed reduced resistance to ceftazidime and tazocin, while Acinetobacter baumannii was resistant to most of the antibiotics over 10 years.Conclusion:This study describes, for the first time, the status of SSI over the past 10 years in Saudi Arabia. The study also demonstrated the effect of hospital accreditation on healthcare organization performance regarding infection control and antibiogram pattern.

Value that matters: intellectual capital and big data to assess performance in healthcare. An empirical analysis on the European context

PurposeThe aim of this paper is to analyze and measure the effects of intellectual capital (IC), i.e. human capital (HC), relational capital (RC) and structural capital (SC), on healthcare industry organizational performance and understanding the role of data analytics and big data (BD) in healthcare value creation (Wang et al., 2018). Through the assessment of determined variables specific for each component of IC, the paper identifies the guidelines and suggests propositions for a more efficient response in terms of services provided to citizens and, specifically, patients, as well as predicting effective strategies to improve the care management efficiency in terms of cost reduction.Design/methodology/approachThe study has a twofold approach: in the first part, the authors operated a systematic review of the academic literature aiming to enquire the relationship between IC, big data analytics (BDA) and healthcare system, which were also the descriptors employed. In the second part, the authors built an econometric model analyzed through panel data analysis, studying the relationship between IC, namely human, relational and structural capital indicators, and the performance of healthcare system in terms of performance. The study has been conducted on a sample of 28 European countries, notwithstanding the belonging to specific international or supranational bodies, between 2011 and 2016.FindingsThe paper proposes a data-driven model that presents new approach to IC assessment, extendable to other economic sectors beyond healthcare. It shows the existence of a positive impact (turning into a mathematical inverse relationship) of the human, relational and structural capital on the performance indicator, while the physical assets (i.e. the available beds in hospitals on total population) positively mediates the relationship, turning into a negative impact of non-IC related inputs on healthcare performance. The result is relevant in terms of managerial implications, enhancing the opportunity to highlight the crucial role of IC in the healthcare sector.Research limitations/implicationsThe relationship between IC indicators and performance could be employed in other sectors, disseminating new approaches in academic research. Through the establishment of a relationship between IC factors and performance, the authors implemented an approach in which healthcare organizations are active participants in their economic and social value creation. This challenges the views of knowledge sharing deeply held inside organizations by creating “new value” developed through a more collaborative and permeated approach in terms of knowledge spillovers. A limitation is given by a fragmented policymaking process which carries out different results in each country.Practical implicationsThe analysis provides interesting implications on multiple perspectives. The novelty of the study provides interesting implications for managers, practitioners and governmental bodies. A more efficient healthcare system could provide better results in terms of cost minimization and reduction of hospitalization period. Moreover, dissemination of new scientific knowledge and drivers of specialization enhances best practices sharing in the healthcare sector. On the other hand, an improvement in preventive medicine practices could help in reducing the overload of demand for curative treatments, on the perspective of sharply decreasing the avoidable deaths rate and improving societal standards.Originality/valueThe authors provide a new holistic framework on the relationship between IC, BDA and organizational performance in healthcare organizations through a systematic review approach and an empirical panel analysis at a multinational level, which is quite a novelty regarding the healthcare. There is little research focussed on healthcare industries' organizational performance, and, specifically, most of the research on IC in healthcare delivered results in terms of theoretical contribution and qualitative analyzes. The authors even contributed to analyze the healthcare industry in the light of the possible existence of synergies and networks among countries.

A systems approach to mapping performance in Indian healthcare organizations

ABSTRACT Objective: The aim of the study is to quantify the determinants of hospital performance indicators from a patient’s perspective based on two parameters – patient safety and satisfaction. Methods: A qualitative and quantitative assessment was done using questionnaires and semi-structured interviews that occurred over a period of eight consecutive weeks. A system dynamics model of the hospital was developed incorporating the determinants of the two significant hospital performance indicators which are patient satisfaction and safety. Results: The model developed dynamically quantifies the patient satisfaction and safety level upon variation in the model parameters. This has managerial implications on effective capacity utilization within the premises based on supply and demand. The model addresses the problem of aggregate waiting time in hospitals which is a major cause of dissatisfaction among patients in India. Conclusion: Our model depicts a hospital functioning in a specialty cluster in India, with modest resources and is exposed to similar risks as in our model. The use of electronic medical records data and analytics are not considered in the model as those are still in the infancy stage in most of the government and private run hospitals in India and major improvements are needed to generate new insights and to have an impact on performance measurement. Originality: The development of a unique comprehensive model for measuring patient satisfaction and safety in a healthcare facility considering the possibilities of risks and related occurrences contributes to the research in healthcare sector.

Measuring social capital of healthcare organizations reported by employees for creating positive workplaces - validation of the SOCAPO-E instrument

BackgroundIn highly segmented and complex healthcare organizations social capital is assumed to be of high relevance for the coordination of tasks in healthcare. So far, comprehensively validated instruments on social capital in healthcare organizations are lacking. The aim of this work is to validate an instrument measuring social capital in healthcare organizations.MethodsThis validation study is based on a cross-sectional survey of 1050 hospital employees from 49 German hospitals which specialize in breast cancer care. Social capital was assessed by a six-item scale. Reliability analyses and confirmatory factor analyses were conducted to determine the content validity of items within the theory-driven one-dimensional scale structure. The scale’s associations with measures of the social aspects of the work environment (identification, social support, open communication climate) were estimated to test convergent validity. Criterion-related validity was evaluated by conducting structural equation modelling to examine the predictive validity of the scale with measures of work engagement, well-being and burnout.ResultsA one-dimensional structure of the instrument could be identified (CFI = .99; RMSEA = .06). Convergent validity was shown by hypothesis-consistent correlations with social support offered by supervisors and colleagues, a climate of open communication, and employee commitment to the organization. Criterion-related validity of the social capital scale was proved by its prediction of employee work engagement (R2 = .10–.13 for the three subscales), well-being (R2 = .13), and burnout (R2 = .06–.11 for the three subscales).ConclusionsThe confirmed associations between social capital and work engagement, burnout as well as well-being stress the importance of social capital as a vital resource for employee health and performance in healthcare organizations. In healthcare organizations this short instrument can be used as an efficient instrument to measure the organizations’ social capital.

Development and Validation of a Knowledge Management Questionnaire for Hospitals and Other Healthcare Organizations

Sustainable societies need to consider the connection between knowledge management (KM) and healthcare as a critical issue for social development. They need to investigate how to create knowledge and identify possible predictors of knowledge-sharing behavior that can support a hospital’s sustainable knowledge-management strategy. KM strategies could help managers to increase the performance of hospitals and other healthcare organizations. The purpose of this paper is to present a valid and reliable questionnaire about KM in healthcare organizations. We develop a new knowledge-management questionnaire based on the use of an extensive literature review and health professionals’ consensus. The Applied Knowledge Management Instrument (AKMI) questionnaire was pilot tested and retested on a small group of employees of healthcare organizations (n = 31). After the pilot process, a larger group of health professionals (n = 261) completed the questionnaire. Further investigation resulted in item reduction and verification of the dimensions of AKMI. Finally, we explore the psychometric properties of the developed tool. The developed questionnaire seems to be reliable, valid, and suitable to be used for studying the suggested nine dimensions of KM: perceptions of KM, intrinsic and extrinsic motivations, knowledge synthesis and sharing, cooperation, leadership, organizational culture, and barriers. The developed questionnaire can help policymakers and hospital administrators collect information about KM processes in healthcare organizations and this can result in higher performance of health organizations.

Impact of accreditation on performance of healthcare organizations

PurposeThe purpose of this paper is to review the accreditation research in specific to its effect on the performance of healthcare organizations.Design/methodology/approachA comprehensive search and analysis of literature on the effect of healthcare accreditation were conducted between June 2017 and May 2018. The study identified 62 empirical research studies that examined the effect of healthcare accreditation programmes. Study particulars such as year of publication, objectives, focus of the study, research settings and key findings were recorded. A content analysis was performed to identify the frequency of the main themes in the literature. Knowledge gaps needing further examination were identified.FindingsMajority of the accreditation impact studies were carried out in the developed nations (n = 49). The thematic categories, that is the impact on “patient safety and healthcare quality” (n = 26), “healthcare professionals’ views” (n = 28) and “clinical process and outcomes” (n = 17) were addressed more times. Whereas the other two thematic categories “organizational performance” and “consumers’ views or satisfaction,” each was examined less than 10 instances. This review reveals mixed views on effect of healthcare accreditation. The varied quality of studies and the availability of a few studies on consumers’ perception of accreditation effectiveness were the important limiting factors of this review.Originality/valueThe findings are valuable to healthcare managers and hospital administrators in accreditation decisions, whereas findings are of value to researchers and academicians in terms of gaps identified for future research studies pertaining to the impact of healthcare accreditation. Future studies need to consider holistic theoretical frameworks for assessing the effect of accreditation on performance of healthcare organizations to achieve precise results.

The Impact of Strategic Management on the Performance of Health CareOrganizations (A Study of Three Selected Tertiary Health Care Center ofKarachi, Pakistan)

The Economic environment is dynamic, for survival of organization it is necessary to compete the market. Strategic management is a tool over come on the market driven challenges. Strategic management is a process for continuous improvement which manage and assess organizational environment in which they involved, assess their competitors and set goals and strategies to overcome on all of the challenges and then re-examine each of the strategy frequently to decide how it has been implemented either it fits or need to cope up with change. There was no such significant research work carried out in Karachi. As it is very important sector of nation economy and now Health care business is one of the top 10 businesses. So there was huge gap, which was tried to cover in this. The objective was to find out that which type of Management is practicing by Tertiary Health Care Centers, to explore the relationship between the level of competition and adoption of the strategies of the strategic management and to assess the relationship adoption of strategic management and organizational performance. There were three hypotheses. The research is depends on quantitative data and is typically descriptive, and questionnaire adopted and adapted as per requirement of the study. The sample size was 30 and questionnaire was distributed in three different tertiary care hospitals. The response rate was 100%. For the analysis regression model and chi-square was used. All hypotheses were accepted and the model was fit, which means that tertiary health care centers are stared to adopt the tools of strategic management and there is strong positive impact of strategic management on level of competition and organizational performance and growth. Study recommends that in current competent and dynamic economic scenario tertiary healthcare centers must adopt the tools of strategic management and give a cutting edge.

Leadership and organizational performance: Is it essential in healthcare systems improvement? A review of literature.

Neoteric studies have called attention to the prominence of management in healthcare sectors. Positive relationship have been noticed between performance management, clinical performance, and clinical outcome. However, there is still debate related to which managers have to lead healthcare organizations, and what kind of management should be followed, we are now about to analyze. Systematic review of the literature is a starting point to present and discuss the current of information concerning with how management can affect the quality and perpetuity of health systems. Through in-depth analysis of 27 studies, we concluded that the performance of healthcare systems and organizations positively consistent with leadership, management practices, manager characteristics, and cultural features that are related to values and administrative approaches. There was also testimony that doctors who lead healthcare organizations show excellence in performance better than others. Finally, this review acting as roadmap which indicating how do the relationship between the management and performance of healthcare systems, and organizations can be furtherly investigated.

Nursing Staff' Perception Regarding Factors Influencing Their Performance in General Hospital

Background: Health care organizations cannot succeed without productive nursing staff. In order to enhance efficiency in health interventions, improving the productivity and performance of health care workers is a major challenge. Performance of health care organizations depends on the knowledge, skills and motivation of individual employees. Aim of the study: To identify nursing staff perception regarding factors influencing their performance at Minia General Hospital. Design: Descriptive research design was utilized. Setting: The study was conducted at all departments of Minia General Hospital in Minia city. Sample: All nursing staffs who working at Minia General Hospital was included. Tools: Data was collected using one tool which was modified by researcher. Results: The nursing staffs of Minia General Hospital perceived the most factors influencing on their performance were; organization policies, work environment and supplies, reward effect, management style, work relation, job design influence and the last one was training and development opportunities. Also, there were highly positive statistically significant correlations between personal data regarding age and experience with training and development; in addition the reward effect had a highly statistically significant correlation with most performance factors and its dimensions except work relation factor and work environment and supplies. Conclusion: The majority of nursing staffs at Minia General Hospital had “moderate level” of perception about the whole factors influence on their performance. Recommendation: Developing and implementing training and development programs are necessary to acquire skills and knowledge about their competence which has a positive effect on staff performance.

Management of Open Innovation in Healthcare for Cost Accounting Using EHR

The diffusion of the New Public Management philosophy determines an increasing innovation in the public field. The need for open innovation management is relevant to improve and also increase performance in healthcare organizations. Moreover, this is strictly connected with an efficient accounting and information system able to process, store and share data. Through an inductive approach to the consideration of needs, this paper deals with the social open innovation theory, the innovation of cycle theory, and the microcosting approach. Our analysis allows us to create a new framework which includes both theories and provides results for health managers and health decision-makers.

Exploring leadership styles in government hospitals in Kuwait.

This paper aims to determine and assess leadership styles in six government general hospitals. This is a cross-sectional study that uses a self-administered questionnaire to determine the leadership styles by self or followers' rating. The participants were 66 leaders and 1,626 followers. The data were analyzed using suitable statistical methods. The prevailing leadership style of hospitals' leaders is the transformational style, where self-rating as transformational is higher than followers' rating. The demographic characteristics of leaders are statistically insignificant. Other health-care settings were not included in the study. In addition, the study is designed to determine the relationship between variables, not to identify cause and effect. However, effective leadership has a substantial value and impact in health care. The paper confirms the existence of a transformational style effect on all organizational outcomes and represents a baseline for future studies in determining leadership styles and organizational culture types to highlight improvement areas. The paper recommends designing training programs to improve transformational leadership behavior. Moreover, investment in research is needed to understand how to build transformational leaders. In addition, leaders' recruitment must be conditioned by obtaining a leadership certification. This topic is under-researched in Kuwait health-care system. The use of leadership style as an indicator for a health-care organization's performance is still not well known in Kuwait.

Measuring the organisational health of acute sector healthcare organisations: Development and validation of the Healthcare-OH survey

ABSTRACT Healthy organisations have a strong provision of the vital elements required for long-term sustainable success and proponents of organisational health concern themselves with the recognition and measurement of these elements. However, despite many leading companies focussing on organisational health in addition to organisational performance there has been very limited work within the context of healthcare to date. This is the first study to look specifically at the measurement of organisational health within the context of acute sector healthcare organisations. The Healthcare-OH survey was developed in three sequential stages. In the first, a qualitative interview study was used to establish the elements of organisational health within acute sector healthcare organisations. The second stage involved item generation to formulate a draft questionnaire which was then piloted across a sample of healthcare staff and analysed by way of exploratory factor analysis to create the final questionnaire. The third stage comprised a final round of pilot testing with confirmatory factor analysis to confirm data model fit. We believe that the Healthcare-OH survey provides an innovative and novel way of considering the performance of healthcare organisations.

Sustainable organizational performance

Purpose The purpose of this paper is to identify factors affecting sustainable organizational performance, to build a framework for the United Arab Emirates (UAE) public health-care sector to facilitate sustainable organizational performance and to prioritize the factors for sustainable organizational performance. Design/method/approach The method used in this research is the quantitative method called the analytical hierarchal process (AHP) to help the decision makers in the public health-care sector to prioritize the factors that are affecting sustainable organizational performance. The method will also help to deal with the complexity of the sustainable organizational performance issue by interviewing nine experts in the field. Findings The findings of this research showed 21 sub-factors for sustainable organizational performance in the public health-care sector in UAE. It emphasizes that patient safety and quality of care are the most important factors for sustainable organizational performance. Research limitations/implications This study can be repeated by targeting other private hospitals in UAE. The novelty of this research means that it is the first study done in sustainable organizational performance in the health-care sector in UAE. Practical implications Health-care management can benefit from this research in many ways: Medical errors have a high impact on the hospital’s reputation and these determine the customer demand. Thus, the hospital’s management should give more attention to minimize the medical errors in order to have a sustainable organizational performance. This can be accomplished through clear protocols and procedures that may affect patients’ lives, the hospital’s reputation and organizational performance. Nevertheless, the policymakers should focus on society engagement; focus on social sustainability should be an integral part of their operational and business strategy. According to Abu Dhabi Health Authority (HAAD), the UAE has a highest rate of chronic diseases, such as diabetes, obesity and cardiovascular disease. Cardiovascular disease itself accounted for 36.7% of all 2013 deaths. The health-care sector should focus more on educating the community by conducting workshops, seminars and awareness campaigns across the UAE. In addition, decision makers in the health-care sector should spend more on continued improvement by focusing on lean activities that focus on waste minimization and linking the service quality to the hospital outcomes and patient satisfaction. The fourth highest overall priority weight for both transformational leadership and for the waiting time sub-criteria should also be considered by top management to focus more on hiring, retaining, and developing their transformational leaders, and to keep an eye on the waiting time and improving customer service. This will result in the sustainable organizational performance. Interestingly, all of the HR processes showed the lowest overall weights at 1%, which is a bit strange. HR should play more of a role in sustainable organizational performance, equal to the other sub-factors. Originality/value Originality of this research stems from a reliable and valid framework that can be subsequently used for measuring the organizational performance of health care organizations.

Impact of public release of performance data on the behaviour of healthcare consumers and providers.

It is becoming increasingly common to publish information about the quality and performance of healthcare organisations and individual professionals. However, we do not know how this information is used, or the extent to which such reporting leads to quality improvement by changing the behaviour of healthcare consumers, providers, and purchasers. To estimate the effects of public release of performance data, from any source, on changing the healthcare utilisation behaviour of healthcare consumers, providers (professionals and organisations), and purchasers of care. In addition, we sought to estimate the effects on healthcare provider performance, patient outcomes, and staff morale. We searched CENTRAL, MEDLINE, Embase, and two trials registers on 26 June 2017. We checked reference lists of all included studies to identify additional studies. We searched for randomised or non-randomised trials, interrupted time series, and controlled before-after studies of the effects of publicly releasing data regarding any aspect of the performance of healthcare organisations or professionals. Each study had to report at least one main outcome related to selecting or changing care. Two review authors independently screened studies for eligibility and extracted data. For each study, we extracted data about the target groups (healthcare consumers, healthcare providers, and healthcare purchasers), performance data, main outcomes (choice of healthcare provider, and improvement by means of changes in care), and other outcomes (awareness, attitude, knowledge of performance data, and costs). Given the substantial degree of clinical and methodological heterogeneity between the studies, we presented the findings for each policy in a structured format, but did not undertake a meta-analysis. We included 12 studies that analysed data from more than 7570 providers (e.g. professionals and organisations), and a further 3,333,386 clinical encounters (e.g. patient referrals, prescriptions). We included four cluster-randomised trials, one cluster-non-randomised trial, six interrupted time series studies, and one controlled before-after study. Eight studies were undertaken in the USA, and one each in Canada, Korea, China, and The Netherlands. Four studies examined the effect of public release of performance data on consumer healthcare choices, and four on improving quality.There was low-certainty evidence that public release of performance data may make little or no difference to long-term healthcare utilisation by healthcare consumers (3 studies; 18,294 insurance plan beneficiaries), or providers (4 studies; 3,000,000 births, and 67 healthcare providers), or to provider performance (1 study; 82 providers). However, there was also low-certainty evidence to suggest that public release of performance data may slightly improve some patient outcomes (5 studies, 315,092 hospitalisations, and 7502 providers). There was low-certainty evidence from a single study to suggest that public release of performance data may have differential effects on disadvantaged populations. There was no evidence about effects on healthcare utilisation decisions by purchasers, or adverse effects. The existing evidence base is inadequate to directly inform policy and practice. Further studies should consider whether public release of performance data can improve patient outcomes, as well as healthcare processes.

Association Between Physician Burnout and Patient Safety, Professionalism, and Patient Satisfaction

Physician burnout has taken the form of an epidemic that may affect core domains of health care delivery, including patient safety, quality of care, and patient satisfaction. However, this evidence has not been systematically quantified. To examine whether physician burnout is associated with an increased risk of patient safety incidents, suboptimal care outcomes due to low professionalism, and lower patient satisfaction. MEDLINE, EMBASE, PsycInfo, and CINAHL databases were searched until October 22, 2017, using combinations of the key terms physicians, burnout, and patient care. Detailed standardized searches with no language restriction were undertaken. The reference lists of eligible studies and other relevant systematic reviews were hand-searched. Quantitative observational studies. Two independent reviewers were involved. The main meta-analysis was followed by subgroup and sensitivity analyses. All analyses were performed using random-effects models. Formal tests for heterogeneity (I2) and publication bias were performed. The core outcomes were the quantitative associations between burnout and patient safety, professionalism, and patient satisfaction reported as odds ratios (ORs) with their 95% CIs. Of the 5234 records identified, 47 studies on 42 473 physicians (25 059 [59.0%] men; median age, 38 years [range, 27-53 years]) were included in the meta-analysis. Physician burnout was associated with an increased risk of patient safety incidents (OR, 1.96; 95% CI, 1.59-2.40), poorer quality of care due to low professionalism (OR, 2.31; 95% CI, 1.87-2.85), and reduced patient satisfaction (OR, 2.28; 95% CI, 1.42-3.68). The heterogeneity was high and the study quality was low to moderate. The links between burnout and low professionalism were larger in residents and early-career (≤5 years post residency) physicians compared with middle- and late-career physicians (Cohen Q = 7.27; P = .003). The reporting method of patient safety incidents and professionalism (physician-reported vs system-recorded) significantly influenced the main results (Cohen Q = 8.14; P = .007). This meta-analysis provides evidence that physician burnout may jeopardize patient care; reversal of this risk has to be viewed as a fundamental health care policy goal across the globe. Health care organizations are encouraged to invest in efforts to improve physician wellness, particularly for early-career physicians. The methods of recording patient care quality and safety outcomes require improvements to concisely capture the outcome of burnout on the performance of health care organizations.

Association Between Estimated Mortality Risk and Measured Quality of Care in Older Adults

Quality measures based on processes of care (e.g., breast cancer screening) are frequently used to compare performance of providers and healthcare organizations in a value-based reimbursement system, but using these measures to make performance comparisons could penalize clinicians caring for older adults with multiple comorbidities. These clinicians may more frequently withhold recommended care based on limited prognosis, patient preference, or potential adverse effects and, as a result, may incur financial penalties because of poor measured performance. Alternatively, they may need to perform additional administrative work to exclude patients from quality measurement. To examine the potential performance handicap associated with caring for complex populations, we cross-sectionally examined the association between broad outpatient processes of care and 5-year mortality risk in a nationally representative older adult sample (≥ 65) from the 2002 to 2015 Medical Expenditure Panel Survey (n=26,006). In adjusted analyses, performance score based on process-of-care measures was significantly worse in the high-risk group (5-year mortality risk ≥50; adjusted performance score 67.4%; adjusted absolute difference 6.7%, 95% confidence interval (CI)=5.3-8.1%, p<.001) and in the intermediate-risk group (5-year mortality risk 25-49%; adjusted performance score 71.7%; adjusted absolute difference 2.4%, 95% CI=1.7-3.1%, p<.001) than in the low-risk group (5-year mortality risk <25%); adjusted performance score 74.1% following <25%. The trend was overall constant across types of care processes and was more prominent in the younger age brackets of our sample. These results suggest that use of process-of-care measures can lead to disproportionate burden for clinicians and organizations primarily taking care of complex populations.