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Organizational support during pandemic strengthens loyalty, reduces burnout among internists

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Nearly one in eight report report high levels of moral distress, study finds

Hospitals and other health care organizations can build loyalty and reduce burnout among clinicians during the COVID-19 pandemic by demonstrating support through actions such as providing them with personal protective equipment (PPE).

That is one of the findings to emerge from two recent studies examining the pandemic’s impact on doctors’ mental health. Both studies are based on results of a 2020 national online survey of internists who are members of the American College of Physicians.

One of the studies set out to identify health care organizations’ policies and actions associated, either positively or negatively, with “perceived organizational support” (POS)—the belief among doctors that their employer values them and cares about their well-being-- and to measure the association between POS and adverse mental health outcomes, burnout and intention to quit practice.

After controlling for all other support policies and potential confounders, the researchers found three policies that were positively associated with POS: offering opportunities to discuss ethical questions that arise when caring for COVID-19 patients, access to adequate PPE, and ensuring that leadership listens to employees’ concerns regarding COVID-19 generally.

Conversely, warning or sanctioning employees who refused pandemic-related assignments or spoke out about safety issues, was associated with lower POS.

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“The COVID-19 pandemic has unleashed a flood of moral dilemmas for frontline clinicians,” Jeffrey Sonis, MD, MPH, associate professor of family medicine at the University of North Carolina-Chapel Hill and the study’s lead author said in an accompanying news release. “It’s not surprising that offering opportunities to discuss ethical concerns was strongly related to internists’ perceptions that their organization supported them.”

The goal of the other study was to determine the predictors, intensity and outcomes of moral distress, which the authors define as “the discomfort that health workers feel when they are prevented by persons, institutions or situations from doing what they believe is morally right.” Among health care workers, it is associated with anxiety and guilt, depression, and burnout and job attrition. The study’s main findings were:

  • While the overall intensity of moral distress among survey participants was low, more than 13% had distress levels that were in the “distressing,” “intense,” or “worst possible” range,
  • Nearly 75% of respondents experienced at least one episode of compromised care during the two worst weeks of the pandemic in their community,
  • Frequency of compromised care during the worst two weeks was moderately associated with the respondent’s current moral distress intensity,
  • The number of patients seen face-to-face with COVID-19 and perceived risk of death, if infected were associated with higher levels of moral distress while adequacy of PPE access and perceived organizational support were associated with lower levels, and
  • moderate and high levels of moral distress intensity were associated with substantially to markedly increased odds of adverse outcomes, including anxiety, depression, PTSD, burnout and intention to leave direct patient care in the next five years.

The authors say their findings demonstrate that health care organizations need to focus on identifying doctors with moderate and high levels of moral distress. “Moral distress of any severity is concerning but low levels are associated only weakly with anxiety but no other outcomes while high levels are associated with dramatically increased odds of all adverse outcomes,” they write.

The study “Effects of Healthcare Organization Actions and Policies Related to COVID-19 on Perceived Organizational Support Among U.S. Internists” appears in the May/June 2022 issue of the Journal of Healthcare Management. “A national study of moral distress among U.S. internal medicine physicians during the COVID-19 pandemic” appears in the journal PLOS ONE.


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