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The Association Between Professional Burnout and Engagement With Patient Safety Culture and Outcomes

A Systematic Review

Mossburg, Sarah E., MS; Dennison Himmelfarb, Cheryl, PhD

doi: 10.1097/PTS.0000000000000519
Review Article: PDF Only

Objectives In the last 20 years, there have been numerous successful efforts to improve patient safety, although recent research still shows a significant gap. Researchers have begun exploring the impact of individual level factors on patient safety culture and safety outcomes. This review examines the state of the science exploring the impact of professional burnout and engagement on patient safety culture and safety outcomes.

Methods A systematic search was conducted in CINAHL, PubMed, and Embase. Studies included reported on the relationships among burnout or engagement and safety culture or safety outcomes.

Results Twenty-two studies met inclusion criteria. Ten studies showed a relationship between both safety culture and clinical errors with burnout. Two of 3 studies reported an association between burnout and patient outcomes. Fewer studies focused on engagement. Most studies exploring engagement and safety culture found a moderately strong positive association. The limited evidence on the relationship between engagement and errors depicts inconsistent findings. Only one study explored engagement and patient outcomes, which failed to find a relationship.

Conclusions The burnout/safety literature should be expanded to a multidisciplinary focus. Mixed results of the relationship between burnout and errors could be due to a disparate relationship with perceived versus observed errors. The engagement/safety literature is immature, although high engagement seems to be associated with high safety culture. Extending this science into safety outcomes would be meaningful, especially in light of the recent focus on an abundance-based approach to safety.

From the Johns Hopkins University School of Nursing, Baltimore, Maryland.

Correspondence: Sarah E. Mossburg, MS, Johns Hopkins University School of Nursing, 525 N. Wolfe St, Baltimore, MD, 21205 (e-mail:

Conflicts of Interest and Source of Funding: The authors disclose no conflict of interest.

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