project b

The theoretical framework that will be applied in the research is the Quality Health Outcomes Model (QHOM). QHOM touches on several aspects that show the association between the context or system, client characteristics, healthcare interventions, and patient outcomes. The model posits that the quality of the provider's services is essential in ensuring excellent outcomes and patient satisfaction.

DesHarnais (2011) provides a conceptual framework and definitions of quality. The author states that Donabedian provided definitions of quality that reflect the goals and values of the current medical care system and those that encompass the broader society it serves. DesHarnais (2011) writes that Donabedian used three aspects of care, namely, structure, process, and outcomes. Rebar (2019) defines

quality, as well as its implications in the provision of care. The author provides the National Academies of Sciences, Engineering, and Medicine definition of healthcare quality. Healthcare quality is defined as the degree to which healthcare services for populations and individuals increase the likelihood of desired health outcomes consistent with current professional knowledge. Rebar writes that quality entails timeliness, patient-centeredness, equity, efficiency, and effectiveness. Patient satisfaction that is connected to the perceived quality of care drives market competition and reimbursement.

Burnout Survey

There are several burnout surveys available to use for assessing the level of burnout with staff. According to Halbesleben and Demerouti (2005), Maslach Burnout Inventory (MBI) is most commonly used, however, researchers have criticisms. The MBI uses three subscales of measurement: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). Researchers have criticized these scaled based on the EE and DP questions being negatively worded, whereas PA is positively worded and the MBI only focuses on affective components of EE (Halbesleben & Demerouti, 2005). According to Halbesleben and Demerouti (2005), several researchers believe EE should include cognitive and physical exhaustion. One downfall of using MBI for organizations is the costs.

The Oldenburg Burnout Inventory (OLBI) (Appendix A) was developed to overcome the problems with MBI. This inventory consists of 16 questions using two subscales, exhaustion and disengagement. In contrast to MBI, the exhaustion questions address both cognitive and physical components of exhaustion and the wording is balanced resulting in a broader conceptualization of burnout (Halbesleben & Demerouti, 2005). In a study done by Halbesleben and Demerouti, evidence supported the reliability, factorial validity and construct validity of OLBI making this inventory reliable for assess burnout. Tipa et al. (2019) state OLBI provides a high scale reliability and can be used as an alternative to the MBI.

Intervention Strategies

An article by Reith, T., P. (2018) focuses on burnout in the United States and provides causes, implications, and strategies to tackle the issue. The strategies include involving leadership, wise choice of incentives for practitioners, encouraging work-life balance, encouraging peer support, providing resources for mental health and self-care, and addressing burnout from the onset of medical training.

Cur (2020) states that burnout is real, and it is characterized by reduced efficiency, detachment, and exhaustion. The condition should be addressed as soon as the symptoms are identified, but the best approach is prevention. Prevention is possible if all healthcare providers develop a greater awareness of the issue. When they are burnt out, the behavior of practitioners may cause them to be shunned and criticized by their colleagues. Still, if the behavior is recognized as related to burnout, they can be supported and helped instead.

Kim et al. (2019) conducted a sub-study of a more extensive cross-sectional study to identify the factors that are associated with burnout in healthcare practitioners engaged in HIV care in Malawi. The study concluded that enhancing the supervisory capacity of health facility managers and having an environment that improved team dynamics can decrease burnout. Van Bogaert (2017) adds that nurses have access to opportunities for learning, relevant information, and personal development and supportive relationships with supervisors, interdisciplinary and peers to achieve their goals in an empowered work environment.

Ghavidel et al. (2019) explored the role of organizational management on nurse burnout. The authors proposed the use of appropriate policies in the programs while emphasizing the mental and physical health of the nurses and addressing their issues. Managers of healthcare facilities can sustain and motivate staff.

Aryankhesal et al. (2019) and Zhang et al (2020) both concluded interventions focused on self- care, mindfulness and communication had significant impacts in the reduction of burnout.

Compassion Fatigue (CF) and Burnout

In their systematic review, Cocker and Joss (2016) explore the effectiveness of interventions to reduce compassion fatigue (CF) in community service, emergency, and healthcare workers. The review concludes that evidence supporting CF interventions at social and health care employees is relatively new. The researchers recommend future studies to identify CF interventions for vulnerable workers.

Applying for a systematic review, Van Mol et al. (2015) conducted a study to assess the emotional distress experienced by healthcare practitioners in the ICU, focusing on compassion fatigue, burnout, and preventative strategies. The authors claimed that the actual prevalence of vicarious trauma, secondary traumatic stress, compassion fatigue, and burnout remain open for discussion. The study proposes that a thorough exploration of emotional distress and its correlation to ethical rounds, communication skills, and mindfulness can offer an appropriate starting point for the development of preventative strategies.

Cetrano et al. (2017) conducted a study focusing on compassion satisfaction, burnout, and Compassion Fatigue. Their analysis identified that employees require attention to time pressures, adequate ergonomics conditions, trust, training, and meetings. Addressing future insecurities is vital in addressing Compassion Satisfaction, and burnout.

COVID-19 and Burnout

COVID-19 Hu et al. (2020) conducted a big-scale cross-sectional, descriptive, correlational study design to examine mental health, which included fear, depression, anxiety, burnout, and associated factors among the frontline nurses that are caring for coronavirus patients in Wuhan, China. The study concluded that frontline nurses experienced fear and burnout. The authors of the study proposed

interventions at the organizational and national level that will improve mental health during a pandemic by managing and preventing skin lesions, building self-efficacy, and resilience, ensuring frontline work willingness and providing sufficient social support. Morgantini et al. (2020) conducted a cross-sectional survey and discovered that burnout during COVID-19 is prevalent because of high job stress, workload, limited organizational support, and time pressure. Talaee (2020) affirm that there is reliable and valid evidence for the investigation of levels of depression, anxiety, and stress among the healthcare workers engaged with the virus.

Burnout and Patient Safety

Rodrigues, Santos, and Sousa (2017) state that burnout can result in significant vulnerability and unsafe care. Garcia et al. (2019) explored the relationship between burnout and patient safety. Findings in the review demonstrated that high rates of burnout are common among nurses and physicians. It is correlated to external factors that include ineffective interpersonal relationships, long journeys, and high workloads. Excellent patient safety practices are influenced by organized workflows that allow health professionals to be autonomous. The study concluded that there is a relationship between worsening patient safety and high levels of burnout. Dewa et al. (2017) conducted a systematic review that used multiphase screening. In the study, they propose that future research should focus on burnout interventions. The authors claim that future studies should assess physicians' interventions by focusing on the safety-related quality of care to evaluate the effectiveness of the interventions. The studies should also emphasize on the relationship between dimensions of burnout and acceptability-related quality of measures.

Burnout and Patient Satisfaction

Copanitsanou, Fotos, and Brokalaki (2017), in their systematic review, focused on the effects of nurses' work environment on outcomes of both the nurses and patients. The study identified that nurses

who perceive their work environment as good have lower burnout syndrome and higher job satisfaction. Copanitsanou, Fotos, and Brokalaki (2017) conclude that a pleasant work environment has a determinant factor for high care quality and improved outcomes for the nurses. West, Dyrbye, and Shanafelt (2018) add that burnout results in lower patient satisfaction, lower recovery times, medical errors, and lower care quality.

Anagnostopoulos et al. (2012) used a cross-sectional survey in Western Greece to examine the impact of physician burnout on patient satisfaction from consultation in the primary care setting. The study results demonstrated that patient satisfaction is significantly correlated with physician depersonalization and physician emotional exhaustion. Besides, physician depersonalization and emotional exhaustion are significant factors that are associated with patient satisfaction as well as consultation.

Summary

In summary, the literature demonstrates that addressing the issue of burnout experienced by healthcare practitioners improves the quality of care provided to the patients and, in turn, improves patient satisfaction. Key areas addressed in the literature are burnout surveys, intervention strategies, compassion fatigue (CF) and burnout, COVID-19 and burnout, burnout and patient safety, and burnout, and patient satisfaction. Chen et al. (2019) state that there is a possible association between high patient satisfaction and improved outcomes in some patient populations. Using the QHOM theory, the discussion demonstrates that there are interventions that need to be in place to address burnout, which is a crucial factor in addressing patient satisfaction. Organizations need to establish working environments and policies that address the issues highlighted that contribute to burnout. Safety has been identified as a concern in the occurrence of burnout in hospital staff. The priority of leadership in a healthcare facility is accountability for effective care while protecting visitors, employees, and patients (Alert, 2017).

Addressing burnout does not entail having the healthcare leadership coming up with policies and guidelines but also involves the personnel that is affect, ensuring that the staff work together is essential. Mijakoski et al. (2018) write that teamwork can be used to safeguard workers from disengagement, depersonalization, and emotional exhaustion.