Identifying Contextual Workplace Stressors in a Division of Plastic and Reconstructive Surgery

Abstract

Background: Healthcare professionals in plastic and reconstructive surgery (PRS) face unique stressors that contribute to burnout, increasing the risk of errors and compromising patient care. Despite this, there is limited research on PRS burnout in the United States. This study aimed to measure burnout rates and identify high-impact improvement targets within a PRS division at a US academic medical center.

Methods: A sequential mixed-methods study was conducted, involving systems analysis and contextual design methods. All surgeons (n = 5) and nonsurgeons (n = 9) were invited to participate (total n = 14). Burnout rates were measured, and workplace stressors were identified using surveys, focus groups, and contextual inquiries. High-impact, low-effort improvement targets were determined through impact-effort matrices.

Results: Survey data from 13 respondents revealed an 85% burnout rate. Three focus groups and 14 contextual inquiries were conducted. After 13 participants validated and prioritized 2 affinity diagrams and provided 24 high-priority stressors, 8 respondents completed 2 surveys that yielded 6 high-impact/low-effort targets for organizational improvement efforts.

Conclusions: This study highlights the high prevalence of burnout in PRS and identifies specific improvement targets for both surgeons and nonsurgeons. Findings suggest strategies such as improving respect and recognition for surgeons and streamlining clinic flow for nonsurgeons. Implementing these targeted improvements can enhance the well-being of healthcare professionals and ultimately improve patient care. The study's methods can be replicated by other healthcare organizations to identify and address burnout-related issues effectively.

Fig. 1.

Study overview. Starting from NAM’s theoretical work-system factors, the survey measured burnout and gathered data on the perceived severities and priority ratings for each workplace stressor. Focus groups then allowed participants to interact with viewpoints other than their own and gathered group-level contextual insights into the highest severity stressors from the survey. CIs then provided a deeper contextual understanding of stressors through observation and interview. Consolidation of data points and modeling of data points allowed researchers to identify common themes and provided participants with ordered groups of breakdowns that they could validate. Finally, participants rated their highest priority stressors for impact and effort, and impact-effort matrices allowed the identification of high-impact stressors that can be targeted for organizational improvement initiatives.

Fig. 2.

Impact-effort matrices for surgeons (A) and nonsurgeons (B).