Staff burnout and patient satisfaction with the quality of dialysis care

Abstract

Background: Although there has been increasing interest in assessing patient satisfaction with health care during the past year, relatively few studies investigated hemodialyzed patient satisfaction.

Study design: Cross-sectional study of the relationship between burnout in nephrologists and nurses and patient satisfaction with their care.

Setting & participants: Nephrologists (n = 68), nurses (n = 334), and hemodialyzed patients (n = 695) from 10 dialysis centers across northern Italy.

Predictor: Staff burnout was assessed using the Maslach Burnout Inventory. Three staff burnout subscales were developed by using factor analysis: Emotional Exhaustion, Depersonalization, and Personal Accomplishment.

Outcomes: Patient satisfaction was assessed by means of a multichoice questionnaire that incorporated 4 patient satisfaction dimensions: (1) completeness of medical information, (2) emotional relationship with health care staff, (3) performance of dialysis center staff, and (4) organizational aspects of health care service. Each item was scored on a 4-point scale ranging from 1 (very dissatisfied) to 4 (very satisfied). Spearman rank-order correlation was used to examine relationships between patient satisfaction and each of the 3 staff burnout subscales for each dialysis center.

Results: Overall, burnout scores were lower than the Italian normative sample, with no significant differences between physicians and nurses. However, considering each dialysis center separately, in 2 centers, nurses registered higher emotional exhaustion levels compared with physicians, with statistically significant differences (P = 0.004 and P = 0.003, respectively). Analysis of patient overall satisfaction assessments showed general appreciation for the "courtesy" and "kindness" of staff, but evidence of problems regarding organizational aspects and structural factors. However, the most critical dimension was for "information." There was a significant positive correlation between staff personal accomplishment and client satisfaction (P < 0.01) and a significant negative correlation between staff emotional exhaustion and patient satisfaction (P < 0.01). No significant correlation was found between staff depersonalization and patient satisfaction level.

Limitations: Factor analysis should be considered exploratory and confirmed in future use of the questionnaire.

Conclusion: Our results suggest that high levels of burnout in physicians and nurses are associated with poor patient satisfaction in dialysis units. Identifying and preventing staff burnout may increase patient satisfaction with health care.