Date of Award

1-13-2022

Degree Type

Thesis

Degree Name

Master of Health Policy and Management

First Advisor

Mr. Waqas Hameed

Second Advisor

Dr. Bushra Khan

Third Advisor

Ms. Ambreen Tharani

Department

Community Health Sciences

Abstract

Introduction: Burnout is a major public health concern for healthcare workers worldwide. Working in the Emergency department involves high work pressure and stress due to the demanding nature of work and witnessing human suffering. Burnout doesn’t only affect physical or mental health, but it also has work-related consequences including job dissatisfaction, medical errors, absenteeism, poor delivery of services, and intention to leave the profession. Research Question 1. What is the prevalence of burnout among healthcare professionals in the Emergency department in a tertiary care public and private hospital in Karachi? 2. What are the underlying causes (or drivers) of burnout and coping strategies used for the management of occupational burnout?
Methodology: A mixed-method sequential explanatory design was used to estimate the prevalence and drivers (causes) of burnout among healthcare workers of the Emergency department in a tertiary care public and private hospital in Karachi. For the quantitative study, a cross-sectional study was conducted in Karachi from May to September 2022 that comprised a total of 154 doctors, nurses, and technicians in both hospitals who had at least 1 year of working experience in the emergency department of tertiary care public and private hospitals in Karachi. Maslach Burnout Inventory GAD-2 and PHQ-2 were used to measure burnout, depression, and anxiety, respectively. Data were analyzed using SPSS 17. For the qualitative component, a descriptive explanatory design was used to explore the drivers (causes) of burnout along with the coping strategies used for the management of burnout. For this purpose, a semi-structured interview guide was developed in accordance with the conceptual framework. Data analysis and findings of audio-recorded in-depth interviews were also organized accordingly. The interview guide collected information on several themes that include respondent characteristics, their daily routine experiences of burnout, driving forces, and coping mechanisms. All in-depth interviews took place from August to September. The data were manually analyzed through thematic analysis using excel.
Results: Results revealed a high level of burnout among medical staff in the emergency room in both public and private hospitals; 31% experienced high levels of emotional exhaustion, 50% experienced high levels of depersonalization, and 63% experienced low levels of personal accomplishment. Healthcare professionals in private hospitals showed 26.1% depressive symptoms, whereas those at public hospitals showed 25.8%. Healthcare professionals, on the other hand, displayed significant levels of anxiety symptoms in public hospitals, 25.8% compared to private hospitals, 21.7%. From the qualitative part, we identified three major themes of burnout which are individual (workload, role conflict, work-life balance, maladaptive coping strategies, and emotional distress) environmental (high patient influx, workplace violence, poor workplace security, poor understanding of triage, and lack of resources) and organizational (understaffing, poor appreciation at the workplace, fear of making mistakes and unfairness at the workplace) factors contributing to burnout. We also found that informally healthcare professionals used adaptive (use of support groups, positive reframing, relaxation activities, and acceptance) and maladaptive coping strategies (social withdrawal, and substance abuse) for the management of burnout.
Conclusion: The study showed a very high prevalence of burnout among healthcare professionals working in the Emergency department. Among all the three categories, low personal accomplishment was reported as very high 63%, followed by Depersonalization 50% and Emotional exhaustion 31%. Healthcare providers also reported symptoms of depression which was 25.8% in public and 26.1% in private hospitals whereas anxiety was reported 25.8% in public and 21.7% in private hospitals. This high prevalence was driven by individual, environmental, and organizational factors. Informally, healthcare professionals use adaptive and maladaptive coping strategies for the management of burnout. There is an urgent need for health system intervention to address this issue of high burnout.

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