Background: Consistent with national reports, post-pandemic burnout rates for the >100 hospitalist faculty at our institution were noted to be disproportionally high relative to the department1. Hospitalists engage in a wide range of non-clinical work including QI projects and committees embedded in the structure of efficient and high-quality inpatient care2. Building off literature in which engagement has been described as an antithesis to burnout3-4, we sought to assess QI interest, activity, and perceptions as well as its relationship to work engagement and burnout.
Methods: In spring of 2022, a survey was administered to all hospitalists to assess QI interest and quantify the activities, projects, and committees in which they were engaged. Hospitalists also indicated their interest or completion of LEAN training (formal QI training available at our institution) and perceived barriers to QI work. Hospitalists rated quality metrics on importance and feasibility for improvement both at the group and individual level. Hospitalists also ranked the aspects of their work by which they personally defined their value/contribution. A validated single-item measure of burnout5 and the Utrecht Work Engagement Scale (UWES)6 were utilized. Categorical variables were compared using Fisher’s exact test and chi-square test. Continuous variables were analyzed using the Kruskal-Wallis test.
Results: 66 responses were obtained, a response rate of 48%. 22.4% of respondents reported current involvement in QI work and 40.8% interest in becoming involved. 46.9% of respondents reported being a member of a QI committee. 27.1% reported current or prior LEAN training, with another 35.4% interested. Overall burnout was a mean of 2.5, with a score >=2 indicating symptoms of burnout. There was no significant difference in presence of burnout with respect to being involved in a QI project (p=0.481), a member of a committee (p=0.989), or interest in becoming involved (p=0.139). Hospitalists with burnout were more likely to cite leadership support as a barrier to QI (p=0.005). There was no significant difference in work engagement (measured by UWES total) in those involved in a QI project vs not (p=0.917). However, work engagement was higher in the group without burnout (UWES total mean 4.4 vs 3.3, p= < 0.001).On average, respondents rated patient safety as “very” important with “moderate” ability to control and clinical processes of care as “very” important with “a lot” of ability to control. In contrast, discharge by noon was rated “a little” important with “moderate” ability to control and 30-day readmission “moderately” important with “little” ability to control. While hospitalists rated clinical excellence/outcomes as how they most defined their value/contribution in hospital medicine, they perceived their department to most value RVUs/productivity.
Conclusions: It is noteworthy that overall burnout was not correlated to involvement in QI projects or committees. However, those faculty members without burnout did have higher work engagement. How this relates to nonclinical activities of hospitalists needs further evaluation.In establishing inpatient quality programs, it is important to take the pulse of the group for interest and values. A key principle of QI methodology is stakeholder alignment. In the current milieu of overflowing hospitals needing to shorten length of stay and decrease cost, it is critical that hospitalist leaders not only align with the C suite but with also with individual hospitalists.
