Managing Burnout in a Prolonged Crisis: A 2-Wave Cross-Sectional Analysis of Emergency Department Personnel Over 6 Months of the COVID-19 Pandemic

Bhanja, A.; Kerrissey, M. J.; Peabody, C.; Hardy, J.; Hayirli, T. C.; Stark, N.

Study Objective: Management research suggests that inclusive leaders, problem-solving teams and clear processes might matter for addressing uncertainty, but how these factors unfold during prolonged crisis and their relationship to burnout is not well understood. The study objective was to examine associations between teamwork and leadership factors and clinician burnout as the care burden increased over 8 months of the COVID-19 pandemic. Methods: Across two California hospitals, cross-sectional surveys were administered to emergency department (ED) personnel in July and December 2020 (N1 = 328 & N2 = 356). Overall burnout (“Overall, based on your definition of burnout, how would you rate your level of burnout?”) and worsening burnout during the crisis (“Compared to your level of burnout prior to COVID, to what extent is your current level of burnout worse, improved or the same?”) were measured on a 5-point Likert scale and analyzed as binary variables. Burnout was defined as having at least some burnout (ie, reporting at least “definitely” burning out). Worsening burnout was defined as either burnout that had “gotten much worse” or “gotten a little worse” since before the COVID-19 crisis. These outcomes were assessed in relation to joint problem-solving (JPS), clear process and leader inclusiveness using logistic regressions. Models controlled for age, sex, race, location, tenure and shift, as well as county COVID-19 case burden using open-access data from John Hopkins University’s Coronavirus Resource Center. Results: The sample across both waves consisted of 75 attendings (14.79%), 50 residents/fellows (9.89%), 38 advance practice providers (5.56%), 254 registered nurses (37.13%) and 90 other ED personnel (therapists, social workers, etc.) (13.16%). Burnout increased over time, where 32.22% reported burnout in wave 1 and 56.51% in wave 2. Worsening burnout also increased over time, 57.32% to 80.52% respectively. Clear process and leader inclusiveness were significantly associated with lower odds of burnout across both time points, 0.28 (p < 0.001) and 0.45 (p < 0.05) in wave 1 and 0.30 (p <0.01) and 0.35 (p < 0.01) in wave 2, respectively (Figure 1). Joint-problem solving was significantly associated with lower odds of burnout in wave 2 only, 0.60 (p-value < 0.01). All factors were significantly associated with lower odds of worsening burnout in wave 2 only, 0.45 (p < 0.01) for JPS, 0.29 (p < 0.01) for clear process and 0.37 (p < 0.05) for leader inclusiveness (Figure 1). Conclusions: During a prolonged crisis, communicating a clear process to ED personnel, and encouraging leaders to include staff in decisions may do more to reduce burnout early on. However, solving problems together and relying on staff interchangeably may continue to prevent burnout as time goes on and the burden of disease increases. When managing burnout among ED personnel, leaders should focus initially on providing structure, and then, reinforce strong teamwork to help their staff continue on. [Formula presented]