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Mossburg SE, Himmelfarb CD. J Patient Saf. 2018;17:e1307-e1319.
Professional burnout is an evolving threat to workforce well-being, health care costs, and patient safety. Leaders of the National Academy of Medicine, Association of American Medical Colleges, and Accreditation Council for Graduate Medical Education recently established a collaborative to promote clinician well-being and resilience. This systematic review explored the relationships between clinician burnout, clinician engagement, organizational safety culture, and patient outcomes. Burnout was consistently associated with self-reported errors. However, when researchers assessed errors objectively, burnout did not reflect an increase in error rates. Few studies have addressed the relationship between burnout and staff engagement or safety culture. An Annual Perspective further explores how to address and prevent health care worker burnout.
Melnyk BM, Orsolini L, Tan A, et al. J Occup Environ Med. 2018;60:126-131.
Burnout and poor staff well-being impede a strong culture of safety. This large cross-sectional study determined that nurses who self-reported a physical or mental illness were more likely to also report involvement in a medical error compared to their healthier peers. In a recent PSNet interview, Linda Aiken discusses the relationship between nursing workforce issues and safety.
Montgomery A. Burn Res. 2014;1.
Many health care professionals exhibit symptoms of burnout, and national studies have shown that approximately one-third of practicing physicians and nurses display hallmark symptoms of emotional exhaustion and diminished sense of personal accomplishment. This commentary explores how medical schools, organizational culture, and working while sick can contribute to physician burnout. The author advocates for a systematic bottom-up approach to address the problem.

Brice JH, Patterson PD, eds. Prehosp Emerg Care. 2012;16:1-108.  

This special issue contains articles exploring safety improvement efforts in emergency medical services.
Nasca TJ, Day SH, Amis S, et al. N Engl J Med. 2010;363:e3.
This article summarizes the Accreditation Council for Graduate Medical Education's proposed new regulations on housestaff duty hours. The recommendations are perhaps most notable for what they do not contain—a reduction in the 80-hour weekly limit. Rather than narrowly focusing on duty-hour restrictions, the recommendations take a broad approach to maximizing patient safety in training environments through targeted reductions in work hours for first-year residents, enhanced supervision by attending physicians, standardizing expectations around handoffs and signouts, and engaging residents in safety and quality improvement efforts. Although the current 80-hour work week will be preserved, the new regulations would eliminate extended-duration shifts for first-year residents (as was recommended in a 2008 Institute of Medicine report). The current regulations, implemented in 2003, have improved residents' quality of life but have not positively impacted patient safety or educational outcomes. The ACGME acknowledged this evidence in crafting recommendations that seek to establish a culture of safety within residency programs and focus more broadly on enhancing supervision for early-stage residents while allowing more autonomy for senior trainees.
Intern J Health Care Qual Assur. 2007;20(7):555-632.
This special issue includes articles by authors from Australia, Israel, France, Iran, and Belgium that explore ideas such as building a culture of safety, replacing medical equipment, and measuring safety improvements.
Following surgery, a woman on a patient-controlled analgesia pump is found to be lethargic and incoherent, with a low respiratory rate. The nurse contacted the attending physician, who dismisses the patient's symptoms and chastises the nurse for the late call.
Bagnara S; Tartaglia R; Wears RL; Perry SJ; Salas E; Rosen MA; King H; Carayon P; Alvarado CJ; Hundt AS; Healey AN; Vincent CA; Falzon P; Mollo V; Friesdorf W; Buss B; Marsolek I; Barach P; Bellandi T; Albolino S; Tomassini CR.
This special issue contains articles focusing on ergonomic research areas that intersect with patient safety, such as team management, work design, and safety culture.
Matlow A; Laxer RM; Morath JM; Sharek PJ; Classen D; Keatings M; Martin M; McCallum A; Lewis J; Stevens P; Harrison C; Scanlon MC; Karsh BT; Densmore EM; Luria JW; Muething SE; Schoettker PJ; Kotagal UR; Parshuram CS; Kozer E; Berkovitch M; Koren G; Lehmann C; Kim GR; Streitenberger K; Breen-Reid K; Harris C; Flores G; Ngui E; Dunn KL; Moulden A; McDougall P; Bowes G; Curley MAQ; Schwalenstocker E; Deshpande JK; Ganser CC; Bertoch D; Brandon J; Kurtin P; Stevens P.
This special issue examines patient safety through the perspectives of parents, hospital leadership, human factors experts, and clinicians.
Rockville, MD: Agency for Healthcare Research and Quality; December 2009. AHRQ Publication No. 10-M008.
This tip sheet provides 10 practical steps hospitals can undertake to improve patient safety, based on research funded by the Agency for Healthcare Research and Quality. The tips can be grouped into three areas: 1) reducing health care-acquired infections and retained surgical instruments through use of specific clinical practices; 2) improving drug safety by ensuring access to accurate drug information; and 3) improving the culture of safety through appropriate staffing and work hours for nurses and residents. These tips are based on high-quality research studies documenting the effectiveness of these interventions at reducing errors and improving safety for a broad range of patients.
Sexton JB. BMJ. 2002;320.
This study describes self-reported perceptions of teamwork among operating room and intensive care unit staff as well as those of an airline cockpit crew. In the medical setting, investigators discovered tremendous variation in teamwork perceptions that followed traditional hierarchies. While surgical attendings and residents rated teamwork high, anesthesiology attendings rated it lower, as did surgical nurses and anesthesia residents in decreasing order. The authors also note that discussing errors seems to be a greater challenge in medicine than in aviation, which may derive from the fact that aviation participants acknowledged that fatigue and stress negatively impact job performance. While the findings draw only from survey results and make no connection to actual errors in practice, they do generate support for a safety culture in medicine similar to that of the aviation field.