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

Maria Panagioti, Keith Geraghty, Judith Johnson
JAMA Intern Med. 2018;178(10):1317-1330.
doi:10.1001/jamainternmed.2018.3713

Abstract

Objective  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.

Data Sources  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.

Study Selection  Quantitative observational studies.

Data Extraction and Synthesis  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.

Main Outcomes and Measures  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.

Results  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).

Conclusions and Relevance  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 Physician Burnout and Patient Safety, Professionalism, and Patient Satisfaction: A Systematic Review and Meta-analysis.

Maria Panagioti, PhD; Keith Geraghty, PhD; Judith Johnson, PhD; et al
JAMA Intern Med. Published online September 4, 2018.
doi:10.1001/jamainternmed.2018.3713

Abstract

Importance  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.

Objective  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.

Data Sources  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.

Data Extraction and Synthesis  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.

Main Outcomes and Measures  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.

Results  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).

Conclusions and Relevance  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.

The research is here.

Doctors’ mental health at tipping point

Chris Hemmings
BBC.co.uk
Originally posted September 3, 2018

Here is an excerpt:

'Last taboo'

Dr Gerada says the lack of confidentiality is a barrier and wants NHS England to extend the London approach to any doctor who needs support.

She believes acknowledging that doctors also have mental health problems is "the last taboo in the NHS".

Louise Freeman, a consultant in emergency medicine, says she left her job after she felt she could not access appropriate support for her depression.

"On the surface you might think 'Oh, doctors will get great mental health care because they'll know who to go to'.

"But actually we're kind of a hard-to-reach group. We can be quite worried about confidentiality," she said, adding that she believes doctors are afraid of coming forwards in case they lose their jobs.

"I was absolutely desperate to stay at work. I never wavered from that."

One of the biggest issues, according to Dr Gerada, is the effect on doctors of complaints from the public, which she says can "shatter their sense of self".

The info is here.

When Doctors Struggle With Suicide, Their Profession Often Fails Them

Blake Farmer
NPR.org
Originally posted July 31, 2018

Here is an excerpt:

A particular danger for doctors trying to fend off suicidal urges is that they know exactly how to end their own lives and often have easy access to the means.

Wenger remembers his friend and colleague as the confident professional with whom he had worked in emergency rooms all over Knoxville — including the one where she died. That day three years ago still makes no sense to him.

"She was very strong-willed, strong-minded, an independent, young, female physician," says emergency doctor Betsy Hull, a close friend. "I don't think any of us had any idea that she was struggling as much personally as she was for those several months."

That day she became part of a grim set of statistics.

A harsh reality

An estimated 300 to 400 doctors kill themselves each year, a rate of 28 to 40 per 100,000 or more than double that of general population. That is according to a review of 10 years of literature on the subject presented at the American Psychiatry Association annual meeting in May.

The information is here.

Physicians aren’t ‘burning out.’ They’re suffering from moral injury

Simon G. Talbot and Wendy Dean
STAT News
Originally published July 26, 2018

Here is an excerpt:

The term “moral injury” was first used to describe soldiers’ responses to their actions in war. It represents “perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations.” Journalist Diane Silver describes it as “a deep soul wound that pierces a person’s identity, sense of morality, and relationship to society.”

The moral injury of health care is not the offense of killing another human in the context of war. It is being unable to provide high-quality care and healing in the context of health care.

Most physicians enter medicine following a calling rather than a career path. They go into the field with a desire to help people. Many approach it with almost religious zeal, enduring lost sleep, lost years of young adulthood, huge opportunity costs, family strain, financial instability, disregard for personal health, and a multitude of other challenges. Each hurdle offers a lesson in endurance in the service of one’s goal which, starting in the third year of medical school, is sharply focused on ensuring the best care for one’s patients. Failing to consistently meet patients’ needs has a profound impact on physician wellbeing — this is the crux of consequent moral injury.

The information is here.

The Burnout Crisis in American Medicine

Rena Xu
The Atlantic
Originally published May 11, 2018

Here is an excerpt:

In medicine, burned-out doctors are more likely to make medical errors, work less efficiently, and refer their patients to other providers, increasing the overall complexity (and with it, the cost) of care. They’re also at high risk of attrition: A survey of nearly 7,000 U.S. physicians, published last year in the Mayo Clinic Proceedings, reported that one in 50 planned to leave medicine altogether in the next two years, while one in five planned to reduce clinical hours over the next year. Physicians who self-identified as burned out were more likely to follow through on their plans to quit.

What makes the burnout crisis especially serious is that it is hitting us right as the gap between the supply and demand for health care is widening: A quarter of U.S. physicians are expected to retire over the next decade, while the number of older Americans, who tend to need more health care, is expected to double by 2040. While it might be tempting to point to the historically competitive rates of medical-school admissions as proof that the talent pipeline for physicians won’t run dry, there is no guarantee. Last year, for the first time in at least a decade, the volume of medical school applications dropped—by nearly 14,000, according to data from the Association of American Medical Colleges. By the association’s projections, we may be short 100,000 physicians or more by 2030.

The article is here.

Double warning on impact of overworking on academic mental health

Sophie Inge
The Times of Higher Education
Originally published on April 4, 2018

Fresh calls have been made to tackle a crisis of overwork and poor mental health in academia in the wake of two worrying new studies.

US academics who conducted a global survey found that postgraduate students were more than six times more likely to experience depression or anxiety compared with the general population, with female researchers being worst affected.

Meanwhile, a survey of more than 5,500 staff in Norwegian universities found that academics reported higher levels of workaholism than their administrative colleagues and revealed that the group appears to be among the occupations most prone to workaholism in society as a whole. Young and female academics were more likely than their senior colleagues to indicate that this had an impact on their family life.

The information is here.

Why We Don’t Let Coworkers Help Us, Even When We Need It

Mark Bolino and Phillip S. Thompson
Harvard Business Review
Originally published March 15, 2018

Here is the conclusion:

Taken together, our studies suggest that employees who are unwilling to accept help when they need it may undermine their own performance and the effectiveness of their team or unit. In light of those potential costs, managers should directly address the negative beliefs that people are harboring. For instance, research shows that employees tend to look to their leaders to determine who is trustworthy and who isn’t. So, to build people’s trust in their coworkers’ motives and competence, managers can demonstrate their faith in those employees by giving them challenging assignments, ownership of certain decisions, direct access to sensitive information or valuable stakeholders, and so on. Further, since giving help and receiving it go hand in hand, managers should create an environment where assisting one another is encouraged and recognized. They can do this by calling attention to successful collaborations and explaining how they’ve contributed to the organization’s larger goals and mission. And they should show their own willingness to help and be helped, since employees are more likely to see the merits of citizenship behaviors when they observe their leaders engaging in such behaviors themselves.

Finally, it’s important not to send mixed messages. If employees who go it alone get ahead more quickly than those who give and receive support, people will pick up on that discrepancy — and they’ll go back to looking out for number one, to their detriment and the organization’s.

The article is here.

Burnout in mental health providers

Practice Research and Policy Staff
American Psychological Association Practice Organization
Originally published January 25, 2018

Burnout commonly affects individuals involved in the direct care of others, including mental health practitioners. Burnout consists of three components: emotional exhaustion, depersonalization of clients and feelings of ineffectiveness or lack of personal accomplishment (Maslach, Jackson & Lieter, 1997). Emotional exhaustion may include feeling overextended, being unable to feel compassion for clients and feeling unable to meet workplace demands. Depersonalization is the process by which providers distance themselves from clients to prevent emotional fatigue. Finally, feelings of ineffectiveness and lack of personal accomplishment occur when practitioners feel a negative sense of personal and/or career worth.

Studies estimate that anywhere between 21 percent and 61 percent of mental health practitioners experience signs of burnout (Morse et al., 2012). Burnout has been associated with workplace climate, caseload size and severity of client symptoms (Acker, 2011; Craig & Sprang, 2010; Thompson et al., 2014). In contrast, studies examining burnout prevention have found that smaller caseloads, less paperwork and more flexibility at work are associated with lower rates of burnout (Lent & Schwartz, 2012). Burnout results in negative outcomes for both practitioners and their clients. Symptoms of burnout are not solely psychological; burnout has also been linked to physical ailments such as headaches and gastrointestinal problems (Kim et al., 2011).

The following studies examine correlates and predictors of burnout in mental health care providers. The first study investigates burnout amongst practitioners working on posttraumatic stress disorder clinical teams in Veterans Affairs (VA) health care settings. The second study examines correlates of burnout in sexual minority practitioners, and the third study investigates the impact of personality on burnout. Finally, the fourth study examines factors that may prevent burnout.

The information is here.

Antecedents and Consequences of Medical Students’ Moral Decision Making during Professionalism Dilemmas

Lynn Monrouxe, Malissa Shaw, and Charlotte Rees
AMA Journal of Ethics. June 2017, Volume 19, Number 6: 568-577.

Abstract

Medical students often experience professionalism dilemmas (which differ from ethical dilemmas) wherein students sometimes witness and/or participate in patient safety, dignity, and consent lapses. When faced with such dilemmas, students make moral decisions. If students’ action (or inaction) runs counter to their perceived moral values—often due to organizational constraints or power hierarchies—they can suffer moral distress, burnout, or a desire to leave the profession. If moral transgressions are rationalized as being for the greater good, moral distress can decrease as dilemmas are experienced more frequently (habituation); if no learner benefit is seen, distress can increase with greater exposure to dilemmas (disturbance). We suggest how medical educators can support students’ understandings of ethical dilemmas and facilitate their habits of enacting professionalism: by modeling appropriate resistance behaviors.

Here is an excerpt:

Rather than being a straightforward matter of doing the right thing, medical students’ understandings of morally correct behavior differ from one individual to another. This is partly because moral judgments frequently concern decisions about behaviors that might entail some form of harm to another, and different individuals hold different perspectives about moral trade-offs (i.e., how to decide between two courses of action when the consequences of both have morally undesirable effects). It is partly because the majority of human behavior arises within a person-situation interaction. Indeed, moral “flexibility” suggests that though we are motivated to do the right thing, any moral principle can bring forth a variety of context-dependent moral judgments and decisions. Moral rules and principles are abstract ideas—rather than facts—and these ideas need to be operationalized and applied to specific situations. Each situation will have different affordances highlighting one facet or another of any given moral value. Thus, when faced with morally dubious situations—such as being asked to participate in lapses of patient consent by senior clinicians during workplace learning events—medical students’ subsequent actions (compliance or resistance) differ.

The article is here.

Top 10 lies doctors tell themselves

Pamela Wible
www.idealmedicalcare.org
Originally published December 27, 2017

Here is an excerpt:

Sydney Ashland: “I must overwork and overextend myself.” I hear this all the time. Workaholism, alcoholism, self-medicating. These are the top coping strategies that we, as medical professionals, use to deal with unrealistic work demands. We tell ourselves, “In order to get everything done that I have to get done. In order to meet expectations, meet the deadlines, then I have to overwork.” And this is not true. If you believe in it, you are participating in the lie, you’re enabling it. Start to claim yourself. Start to claim your time. Don’t participate. Don’t believe that there is a magic workaround or gimmick that’s going to enable you to stay in a toxic work environment and reshuffle the deck. What happens is in that shuffling process you continue to overcompensate, overdo, overextend yourself—and you’ve moved from overwork on the face of things to complicating your life. This is common. Liberate yourself. You can be free. It’s not about overwork.

Pamela Wible: And here’s the thing that really is almost humorous. What physicians do when they’re overworked, their solution for overwork—is to overwork. Right? They’re like, “Okay. I’m exhausted. I’m tired. My office isn’t working. I’ll get another phone line. I’ll get two more receptionists. I’ll add three more patients per day.” Your solution to overwork, if it’s overwork, is probably not going to work.

The interview is here.

Professional Self-Care to Prevent Ethics Violations

Claire Zilber
The Ethical Professor
Originally published December 4, 2017

Here is an excerpt:

Although there are many variables that lead a professional to violate an ethics rule, one frequent contributing factor is impairment from stress caused by a family member's illness (sick child, dying parent, spouse's chronic health condition, etc.). Some health care providers who have been punished by their licensing board, hospital board or practice group for an ethics violation tell similar stories of being under unusual levels of stress because of a family member who was ill. In that context, they deviated from their usual behavior.

For example, a surgeon whose son was mentally ill prescribed psychotropic medications to him because he refused to go to a psychiatrist. This surgeon was entering into a dual relationship with her child and prescribing outside of her area of competence, but felt desperate to help her son. Another physician, deeply unsettled by his wife’s diagnosis with and treatment for breast cancer, had an extramarital affair with a nurse who was also his employee. This physician sought comfort without thinking about the boundaries he was violating at work, the risk he was creating for his practice, or the harm he was causing to his marriage.

Physicians cannot avoid stressful events at work and in their personal lives, but they can exert some control over how they adapt to or manage that stress. Physician self-care begins with self-awareness, which can be supported by such practices as mindfulness meditation, reflective writing, supervision, or psychotherapy. Self-awareness increases compassion for the self and for others, and reduces burnout.

The article is here.

Physician licensing laws keep doctors from seeking care

Bab Nellis
Mayo Clinic New Network

Despite growing problems with psychological distress, many physicians avoid seeking mental health treatment due to concern for their license. Mayo Clinic research shows that licensing requirements in many states include questions about past mental health treatments or diagnoses, with the implication that they may limit a doctor's right to practice medicine. The findings appear today in Mayo Clinic Proceedings.

“Clearly, in some states, the questions physicians are required to answer to obtain or renew their license are keeping them from seeking the help they need to recover from burnout and other  emotional or mental health issues,” says Liselotte Dyrbye, M.D., a Mayo Clinic physician and first author of the article.

The researchers examined the licensing documents for physicians in all 50 states and Washington, D.C., and renewal applications from 48 states. They also collected data in a national survey of more than 5,800 physicians, including attitudes about seeking mental health care.

Nearly 40 percent of respondents said they would hesitate in seeking professional help for a mental health condition because they feared doing so could have negative impacts on their medical license.

The article is here.

The target article is here.

How to Recognize Burnout Before You’re Burned Out

Kenneth R. Rosen
The New York Times
Originally published September 5, 2017

Here is an excerpt:

In today’s era of workplace burnout, achieving a simpatico work-life relationship seems practically out of reach. Being tired, ambivalent, stressed, cynical and overextended has become a normal part of a working professional life. The General Social Survey of 2016, a nationwide survey that since 1972 has tracked the attitudes and behaviors of American society, found that 50 percent of respondents are consistently exhausted because of work, compared with 18 percent two decades ago.

Where once the term burnout was applied exclusively to health care workers, police officers, firefighters, paramedics or social workers who deal with trauma and human services — think Graham Greene’s novel “A Burnt-Out Case,” about a doctor in the Belgian Congo, a book that gave rise to the term colloquially — the term has since expanded to workers who are now part of a more connected, hyperactive and overcompensating work force.

But occupational burnout goes beyond needing a simple vacation or a family retreat, and many experts, psychologists and institutions, including the Centers for Disease Control and Prevention, highlight long-term and unresolvable burnout as not a symptom but rather a major health concern. (Though it does not appear in the Diagnostic and Statistical Manual of Mental Disorders, which outlines psychiatric disorders, it does appear in the International Statistical Classification of Diseases and Related Health Problems, a classification used by the World Health Organization.)

“We’re shooting ourselves in the foot,” Ms. Seppala told me. “Biologically we are not meant to be in that high-stress mode all the time. We got lost in this idea that the only way to be productive is to be on the go-go-go mode.”

The article is here.

Over half of doctors have symptoms of burn-out: survey

Lynn Desjardins
Radio Canada International
Originally published August 28, 2017

A recent survey suggests that 54 per cent of Canadian doctors have symptoms of burn-out and it’s a problem that physicians themselves don’t like to talk about. This was a topic much discussed at the annual meeting of the Canadian Medical Association which represents more than 80,000 doctors.

‘Very frustrating and annoying’ interventions required

“First and foremost, it’s about the inability that physicians have sometimes to get what the patient actually needs in a timely way,” says Dr. Granger Avery, immediate past president of the Canadian Medical Association.

“So, that’s whether looking for a consultation, following up on an operation, whether it’s transferring a patient from one level of service to another, these things often require the doctor to make repeated phone calls, repeated interventions to get what should be a relatively simple piece of work done. So, that’s very frustrating and annoying for a physician who’s been brought up and trained and focused on helping people, not doing that administrative work.”

The article and the podcast are here.

Burnout at Work Isn’t Just About Exhaustion. It’s Also About Loneliness

Emma Seppala and Marissa King
Harvard Business Review

First published June 29, 2017

More and more people are feeling tired and lonely at work. In analyzing the General Social Survey of 2016, we found that, compared with roughly 20 years ago, people are twice as likely to report that they are always exhausted. Close to 50% of people say they are often or always exhausted due to work. This is a shockingly high statistic — and it’s a 32% increase from two decades ago. What’s more, there is a significant correlation between feeling lonely and work exhaustion: The more people are exhausted, the lonelier they feel.

This loneliness is not a result of social isolation, as you might think, but rather is due to the emotional exhaustion of workplace burnout. In researching the book The Happiness Track, we found that 50% of people — across professions, from the nonprofit sector to the medical field — are burned out. This isn’t just a problem for busy, overworked executives (though the high rates of loneliness and burnout among this group are well known). Our work suggests that the problem is pervasive across professions and up and down corporate hierarchies.

Loneliness, whether it results from social isolation or exhaustion, has serious consequences for individuals. John Cacioppo, a leading expert on loneliness and coauthor of Loneliness: Human Nature and the Need for Social Connection, emphasizes its tremendous impact on psychological and physical health and longevity. Research by Sarah Pressman, of the University of California, Irvine, corroborates his work and demonstrates that while obesity reduces longevity by 20%, drinking by 30%, and smoking by 50%, loneliness reduces it by a whopping 70%. In fact, one study suggests that loneliness increases your chance of stroke or coronary heart disease — the leading cause of death in developed countries — by 30%. On the other hand, feelings of social connection can strengthen our immune system, lengthen our life, and lower rates of anxiety and depression.

The article is here.

Moral distress in physicians and nurses: Impact on professional quality of life and turnover

Austin, Cindy L.; Saylor, Robert; Finley, Phillip J.
Psychological Trauma: Theory, Research, Practice, and Policy, Vol 9(4), Jul 2017, 399-406.

Abstract

Objective: The purpose of this study was to investigate moral distress (MD) and turnover intent as related to professional quality of life in physicians and nurses at a tertiary care hospital.

Method: Health care providers from a variety of hospital departments anonymously completed 2 validated questionnaires (Moral Distress Scale–Revised and Professional Quality of Life Scale). Compassion fatigue (as measured by secondary traumatic stress [STS] and burnout [BRN]) and compassion satisfaction are subscales which make up one’s professional quality of life. Relationships between these constructs and clinicians’ years in health care, critical care patient load, and professional discipline were explored.

Results: The findings (n = 329) demonstrated significant correlations between STS, BRN, and MD. Scores associated with intentions to leave or stay in a position were indicative of high verses low MD. We report highest scoring situations of MD as well as when physicians and nurses demonstrate to be most at risk for STS, BRN and MD. Both physicians and nurses identified the events contributing to the highest level of MD as being compelled to provide care that seems ineffective and working with a critical care patient load >50%.

Conclusion: The results from this study of physicians and nurses suggest that the presence of MD significantly impacts turnover intent and professional quality of life. Therefore implementation of emotional wellness activities (e.g., empowerment, opportunity for open dialog regarding ethical dilemmas, policy making involvement) coupled with ongoing monitoring and routine assessment of these maladaptive characteristics is warranted.

The article is here.

Antecedents and Consequences of Medical Students’ Moral Decision Making during Professionalism Dilemmas

Lynn Monrouxe, Malissa Shaw, and Charlotte Rees
AMA Journal of Ethics. June 2017, Volume 19, Number 6: 568-577.

Abstract

Medical students often experience professionalism dilemmas (which differ from ethical dilemmas) wherein students sometimes witness and/or participate in patient safety, dignity, and consent lapses. When faced with such dilemmas, students make moral decisions. If students’ action (or inaction) runs counter to their perceived moral values—often due to organizational constraints or power hierarchies—they can suffer moral distress, burnout, or a desire to leave the profession. If moral transgressions are rationalized as being for the greater good, moral distress can decrease as dilemmas are experienced more frequently (habituation); if no learner benefit is seen, distress can increase with greater exposure to dilemmas (disturbance). We suggest how medical educators can support students’ understandings of ethical dilemmas and facilitate their habits of enacting professionalism: by modeling appropriate resistance behaviors.

The article is here.

There’s a Right Way and a Wrong Way to Do Empathy

By Sarah Watts
The Science of Us
Originally published May 18, 2017

Here is an excerpt:

When we talk about empathy, we tend to talk about it as an unqualified good thing. Research has shown that empathy is associated with kindness and helping behaviors, while its absence, clinically referred to as psychopathy, is associated with manipulation and criminal deviance. Empathy, some scientists have concluded, allows us to function well with others and survive as a species.

But what people often don’t talk about is how even a good thing like empathy can still be emotionally draining. Empathic people who easily take on other people’s feelings can spend their days feeling overwhelmed, hurt, and heavyhearted. Empathy, in other words, can be downright stressful. So would it be fair to say that sometimes it’s unhealthy?

A paper published earlier this month in the Journal of Experimental Psychology set out to answer exactly that. According to the authors, there are “two routes” to empathy. The first is imagining how someone else might feel in a given circumstance, called “imagine-other-perspective-taking,” or IOPT. The second is actually imagining yourself in the other person’s situation, called “imagine-self-perspective-taking,” or ISPT. With IOPT, you acknowledge another person’s feelings; with ISPT, you take on that person’s feelings as your own.

The article is here.

The Associations between Ethical Organizational Culture,Burnout, and Engagement: A Multilevel Study

Mari Huhtala, Asko Tolvanen, Saija Mauno, and Taru Feldt
J Bus Psychol
DOI 10.1007/s10869-014-9369-2

Abstract/Purpose

Ethical culture is a specific form of organizational culture (including values and systems that can promote ethical behavior), and as such a socially constructed phenomenon. However, no previous studies have investigated the degree to which employees’ perceptions of their organization’s ethical culture are shared within work units (departments), which was the first aim of this study. In addition, we studied the associations between ethical culture and occupational well-being (i.e., burnout and work engagement) at both the individual and work-unit levels.

Design/Methodology/Approach

The questionnaire data were gathered from 2,146 respondents with various occupations in 245 different work units in one public sector organization. Ethical organizational culture was measured with the corporate ethical virtues scale, including eight sub-dimensions.

Findings

Multilevel structural equation modeling showed that 12–27 % of the total variance regarding the dimensions of ethical culture was explained by departmental homogeneity (shared experiences). At both the within and between levels, higher perceptions of ethical culture associated with lower burnout and higher work engagement.

Implications

The results suggest that organizations should support ethical practices at the work-unit level, to enhance work engagement, and should also pay special attention to work units with a low ethical culture because these work environments can expose employees to burnout.

Originality/Value

This is one of the first studies to find evidence of an association between shared experiences of ethical culture and collective feelings of both burnout and work engagement.

A copy of the article is here.