Intended for healthcare professionals


Burnout in healthcare: the case for organisational change

BMJ 2019; 366 doi: (Published 30 July 2019) Cite this as: BMJ 2019;366:l4774
  1. A Montgomery, professor in work and organizational psychology1,
  2. E Panagopoulou, associate professor2,
  3. A Esmail, professor of general practice3,
  4. T Richards, senior editor, BMJ patient partnership initiative4,
  5. C Maslach, professor5
  1. 1University of Macedonia, Thessaloniki, Greece
  2. 2Hygiene Laboratory, Aristotle Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
  3. 3Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
  4. 4BMJ, London, UK
  5. 5University of California, Berkeley, CA, USA
  1. Correspondence to: A Montgomery monty5429{at}

Burnout is an occupational phenomenon and we need to look beyond the individual to find effective solutions, argue A Montgomery and colleagues

Burnout has become a big concern within healthcare. It is a response to prolonged exposure to occupational stressors, and it has serious consequences for healthcare professionals and the organisations in which they work.1 Burnout is associated with sleep deprivation,2 medical errors,345 poor quality of care,67 and low ratings of patient satisfaction.8 Yet often initiatives to tackle burnout are focused on individuals rather than taking a systems approach to the problem.

Evidence on the association of burnout with objective indicators of performance (as opposed to self report) is scarce in all occupations, including healthcare.9 But the few examples of studies using objective indicators of patient safety at a system level confirm the association between burnout and suboptimal care. For example, in a recent study, intensive care units in which staff had high emotional exhaustion had higher patient standardised mortality ratios, even after objective unit characteristics such as workload had been controlled for.10

The link between burnout and performance in healthcare is probably underestimated: job performance can still be maintained even when burnt out staff lack mental or physical energy11 as they adopt “performance protection” strategies to maintain high priority clinical tasks and neglect low priority secondary tasks (such as reassuring patients).12 Thus, evidence that the system is broken is masked until critical points are reached. Measuring and assessing burnout within a system could act as a signal to stimulate intervention before it erodes quality of care and results in harm to patients.

Burnout does not just affect patient safety. Failing to deal with burnout results in higher staff turnover, lost revenue associated with decreased productivity, financial risk, …

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