Quantitative Research Report Design
The focus of this critical appraisal in quantitative studies is Salyers and cohort who research on the ways of predicting fatigue among the nursing professionals (2017). The researchers conducted a systematic review of available literature that will help in highlighting the issue. Numerous studies from CINAHL, Ovid MEDLINE, Web of Science, ProQuest, and PsycINFO were all reviewed to identify specific studies that offered appropriate measures for quality improving of health care provided to the patients. It is evident that the primary responsibility of medical health practitioners is to ensure that patients seeking their services are able to achieve the optimum level of outcomes. A total of eighty-two studies were included in the systematic review as the authors sought to illuminate the relationship between fatigue and quality care provision. Due to the lengthy shift hours that health workers have to endure as well as the provision of compassion to the patients they serve, it is likely that these professionals will tire quickly.
Hierarchy of Evidence in Reliability and Risk of Bias
The evidence-based research is at the very top of the hierarchy of evidence whereby the researchers have filtered information to identify the best practices to apply in the real-world setting. Experts have a near unanimous agreement that the higher the position of the research design on the hierarchy, the more thorough it is in revealing appropriate evidence for the research problem at hand. As a result, it is the belief that the rigor of the design reduces impact of bias. Systematic reviews and meta-analyses are at the very top of the hierarchy while anecdotal experience and expert opinion if firmly placed at the bottom. A systematic review whether or not it has included a meta-analysis is at the very top of the reliability hierarchy. Although the study provides effective data for use in practice, the findings are not absolute. For instance, the rigorous nature of evaluating literature can take numerous years and the findings may be surpassed by more recent evidence.
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Problem and Purpose of the Study
Salyers et al. (2017) recognize that the burnout of healthcare providers is a considerable factor in the provision of quality care. The researchers note that burnout can occur in many different ways from a poor sense of accomplishment, emotional fatigue, and negative attitudes. The authors systematically reviewed and quantified empirical studies as the primary objective of the research to provide a link between burnout of healthcare professionals and quality and safety. The measures used would help in understanding the magnitude and consistency in the relationship (Salyers et al., 2017). The authors note that this usually occurs when the health providers have limited resources and leading to costs to the provider. In this regard, the low resources may create concern over the limited time spent with the patient and become less collaborative in provision of care and more likely directive. Since the term burnout was introduced, there have been links with quality of care. However, Salyer and colleagues note that the research has been extensive on a wide variety of specialties in the healthcare profession, but none have conducted a comprehensive and quantitative review the relationship across disciplines and domains.
Steps of the Study
With a clear objective of systematically reviewing and quantifying available empirical evidence that links healthcare practitioner burnout and the quality of care provided, a clear identification of steps is provided to review the information. The researchers sought the input of moderators who would evaluate how the relationships would be highlighted as measures the aspect of burnout or the quality that is intended. Similar to the multidisciplinary teams used in the delivery of care the differences evident among the types of providers of care would be included from nurses and physicians to the settings including outpatients and inpatients. The authors then take us through the search for an appropriate empirical study where the entire electronic search string is provided to show how a particular article was chosen. Efforts were made to contact 63 authors of the published and unpublished material seeking additional information to complete the systematic review where 33 did not respond, three could not be found, and six were reported that either the information was unavailable or could not be included in the study. Articles that specifically examined burnout were retained and though there is a three-dimensional scale of burnout, emotional fatigue, cynicism, or declined personal accomplishment, any of the above could be utilized.
Sample Size
The study included a sample size of multiple works from 21 authors who were contacted and provided adequate data. A clear description of the steps involved in identifying the sample size is provided. The authors included a wide variety of studies that sought to identify the relationship between burnout and patient satisfaction as a measure of quality and safety (West et al., 2016). In the studies where these variables are the primary focus but there was lacking quantitative measure, the authors would be contacted to retrieve the information for analyses. More than 80% of nursing practitioners in a survey data collected from four random states demonstrated satisfaction with scheduling practices at respective hospitals. However, the increase in working shift hours of more than 13hrs showed higher levels of patient dissatisfaction (West et al., 2016). Practitioners who worked shifts longer than 10hrs were more than 2.5 times likely to experience fatigue or burnout and job dissatisfaction or job turnover.
Reliability and Validity of Measurement of Major Variables
A group of six coders working in pairs would help in coding the various articles that would be reviewed in the study (West et al., 2016). Consistency and reliability of the findings were maintained by the coders through consensus for each independent sample (Swensen & Shanafelt, 2017). From the extracted information, authors could develop measures on burnout type and measures used, quality and safety indicators, provider type including nurses, physicians, interdisciplinary, setting (outpatient, inpatient, or mixed inpatient/outpatient. Even the country coded in terms of region like North America, South America, Europe, Asia, Australia, Africa would be used (Swensen & Shanafelt, 2017). The research clearly shows that the instruments used would ensure the reliability of the information through the critical use of information available in the selected literature. Information was extracted on potential methods-related moderators including study year, unit of analysis individual, dyad, service unit,hospital/organization, and quality or safety data source provider, patient, observer, medical records (Swensen & Shanafelt, 2017).
Data Analysis
A clear description is provided on the analysis of data and how information was used to come up with the conclusions of the study. First, there was the extraction of effect size information on the burnout level and quality or safety relationship (Salyers et al., 2017). Associations were then converted to Pearson’s correlations (Dewa et al., 2017). In the case where multiple measures of the same construct are offered, the average effect size and weighted sample would be offered to maintain statistical independence. The authors also calculated the overall relationship as an effective measure of showing association between burnout and the potential quality and safety of care provided (Salyers et al., 2017). Separate meta-analyses were used as an appropriate measure of identifying the aggregated relationship at the predictor and quality indicator levels which refer to the burnout type, and quality and safety respectively (Dewa et al., 2017). Finally, the researchers conducted moderator analyses for perceived quality and safety.
Untoward Events During the study
There were no untoward events during the process of carrying out the study. The only issue that stood out was the fact that some of the researchers who had not provided quantitative data in their research process could not be reached for input. The lack of response means that numerous quality studies would be excluded when they offered appropriate information in the systematic review (Panagioti et al., 2017).
Relationship with Previous Research
The research findings of this research reaffirm previous research that indicates a positive correlation between burnout and the quality and safety of patient care. It is evident that the health providers are in a field where there is growing demand for patient safety and perceived quality of care provided. The long shift hours and reduced resources could significantly increase the potential for burnout among the medical workers. The findings also show that there has been a significant rise in the number of cases of health provider fatigue. In this regard, it is likely that the concern for perceived quality and safety will only increase in the near future.
Impact on Clinical Practice
The findings of this research have been of particular importance in clinical practice. The increasing rate of health provider burnout should sound out a cause for alarm due to the safety risk involved. The providers also reported perceptions of reduced quality arising from the incidence of fatigue. Errors and adverse events have been reported regularly in the medical field and could potentially be from increased fatigue levels. As a result, the involved authorities should develop safety measures that protect providers from experiencing fatigue or prevent adversity from taking place (Dewa et al., 2017). While the effect size may seem quite small as it is about 3% of the variance, it is important to note that small statistical effects are immense in the real-world as the burnout of health providers could be detrimental to the patients. The implications for patient healthcare and well-being will translate to greater liability for health institutions that will face multiple lawsuits.
References
Dewa, C. S., Loong, D., Bonato, S., & Trojanowski, L. (2017). The relationship between physician burnout and quality of healthcare in terms of safety and acceptability: a systematic review. BMJ Open, 7 (6), e015141.
Hall, L. H., Johnson, J., Watt, I., Tsipa, A., & O’Connor, D. B. (2016). Healthcare staff wellbeing, burnout, and patient safety: a systematic review. PloS one, 11 (7), e0159015.
Panagioti, M., Panagopoulou, E., Bower, P., Lewith, G., Kontopantelis, E., Chew-Graham, C. ... & Esmail, A. (2017). Controlled interventions to reduce burnout in physicians: a systematic review and meta-analysis. JAMA internal medicine, 177 (2), 195-205.
Salyers, M. P., Bonfils, K. A., Luther, L., Firmin, R. L., White, D. A., Adams, E. L., & Rollins, A. L. (2017). The relationship between professional burnout and quality and safety in healthcare: a meta-analysis. Journal of general internal medicine, 32 (4), 475-482.
Swensen, S. J., & Shanafelt, T. (2017). An organizational framework to reduce professional burnout and bring back the joy in practice. Joint Commission journal on quality and patient safety, 43 (6), 308-313.
West, C. P., Dyrbye, L. N., Erwin, P. J., & Shanafelt, T. D. (2016). Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. The Lancet, 388 (10057), 2272-2281.
