Drivers of Burnout Among Critical Care Providers: A Multicenter Mixed-Methods Study

Abstract

Background: Critical care practitioners have some of the highest levels of burnout in health care.

Research question: What are key drivers of burnout across the multidisciplinary ICU team?

Study design and methods: We conducted a multicenter mixed-methods cohort study in ICUs at three diverse hospitals. We recruited physicians, nurses, respiratory therapists, and other staff members who worked primarily in an ICU. Participants completed the Maslach Burnout Inventory for Human Services Survey for Medical Personnel (MBI) and a qualitative focus group or interview using a phenomenologic approach. MBI subscales for emotional exhaustion, depersonalization, and lack of personal accomplishment were calculated. Emergent shared themes contributing to burnout were identified from qualitative interviews.

Results: Fifty-eight providers (26 physicians, 22 nurses, six respiratory therapists, three pharmacists, and one case manager) participated. Ten participants (17.9%) described their burnout as moderate to high. However, participants scored moderate or high levels across the three MBI subscales (emotional exhaustion, 71.4%; depersonalization, 53.6%; and lack of personal achievement, 53.6%). Drivers of burnout aligned with three core themes: patient factors, team dynamics, and hospital culture. Individual drivers included medically futile cases, difficult families, contagiousness of burnout, lack of respect between team members, the increasing burden of administrative or regulatory requirements at the cost of time with patients, lack of recognition from hospital leadership, and technology. All were highly interconnected across the three larger domains. Despite differences in MBI scores, most provider types described very similar drivers of burnout.

Interpretation: High levels of burnout were identified through the MBI, but participants did not self-report high levels of burnout, suggesting a lack of awareness. Drivers of burnout were highly interconnected, but factors related to team dynamics and hospital culture were most prominent and shared across provider types. The shared drivers of burnout across multiple provider types highlights the need for interventions focused on team- and system-level drivers.

Keywords: ICUs; burnout; mixed methods; nurses; physicians; psychological distress; qualitative; respiratory therapists.

Graphical abstract

Figure 1

Venn diagram showing burnout thematic matrix. Based on qualitative interviews and focus groups, the major drivers of burnout stemmed from patient factors, team dynamics, and hospital culture. However, these three themes were highly interconnected, and drivers at one level (eg, patient factors) often affected other levels (eg, team dynamics). Participants described medically futile cases and difficult families as the primary patient-level drivers of burnout. At the team level, the contagiousness of burnout and a lack of respect among practitioner types were the primary drivers of burnout. Participants also described the burdensome nature of administrative and regulatory requirements as the cost of time spent with patients as well as a lack of recognition from hospital leadership as the primary drivers of burnout at the hospital level. The descriptions of drivers of burnout were similar across all practitioner types, suggesting a shared burnout experience in the ICU.