Surgeon Burnout, Patient Safety and Quality of Care: Contributors, Consequences and Possible Solutions

Research has linked increased staff burnout to poorer patient safety in healthcare settings. Surgeons, in particular, are more inclined to suffer from burnout whereas surgeons often suffer silently when they are experiencing stress and burnout and do not ask for help which make the issue not clear. There needs to be more research on surgeon burnout, how it affects them and how to enhance their well-being. This thesis aimed to improve understanding of surgeon burnout and identify potential solutions. This thesis reports five studies. The first was a systematic review and meta�analysis which aimed to investigate the association between surgeon burnout and 1) patient safety and 2) surgical professionalism. The results of a systematic review provided important insights into the existing evidence base on surgeon’s burnout and identified gaps in knowledge, one of which is that there is not enough qualitative study to give a deep understanding of how surgeons experience and deal with burnout. Hence, the next two studies used semi-structured interviews to explore the main factors that lead to surgeon burnout and to examine how surgeons cope with burnout at work (Study 2) and to understand how burnout affects surgeons and the care they provide (Study 3). The systematic review also revealed that there is no evidence regarding the link between surgeon burnout and patient safety in the UK, to address this, the fourth study used questionnaire survey methods to investigate the association between surgeon burnout and patient safety outcomes. This study also tested whether surgeons' burnout levels varied over the first six months of the COVID-19 pandemic. The fifth study, ../ qualitative methods, investigated the effects of the COVID-19 pandemic on surgeons' mental health. Key findings This thesis found a significant link between surgeon burnout and patient care. The systematic review and meta-analysis (Study 1) results showed that burnout was associated with a 2.5-fold increased risk of medical error. Study 3 identified four themes about how burnout affects patient care: first, burnout weakens surgeon–patient relationships; second, burnout affects patient safety; third, burnout hurts staff relationships; and fourth, burnout makes vi surgeons less motivated to improve. Burnout was also associated with patient safety in the survey study (Study 4), and the longitudinal findings indicated a bi-directional connection between burnout and patient safety perceptions (Study 4). Regarding the main factors that can lead to burnout in surgeons, the thematic analysis identified several factors captured in the following themes: rising to the challenge of surgical work; interpersonal conflict at work; greater demands than resources; the challenge of work-life balance; and the devastating impact of errors and poor patient outcomes (Study 2). The analyses also revealed various strategies surgeons employed to cope with burnout: cognitive restructuring; seeking social support; stepping aside or down from the job; and prioritising personal health. Additionally, some surgeons also reported using maladaptive coping (Study 2). A second qualitative analysis also found three themes in surgeons' experiences of burnout: first, burnout is common but frequently not recognised nor understood; second, burnout is a personal crisis; and third, burnout creates vulnerability at work (Study 3). The impact of the COVID-19 pandemic on surgeons was also investigated in this thesis (Studies 4 and 5). Qualitative thematic analysis identified four major themes: a changing and challenging work environment due to the COVID-19 pandemic; professional development and life challenges; personal change and loss, and emotional and psychological repercussions (Study 5). Quantitative analyses found that burnout increased during the pandemic's first (June 2020) to second waves (January 2021) (Study 4). In conclusion, surgeons suffer from a high level of burnout, especially after the COVID-19 pandemic (Study 4). Without a defined retention plan, the problem affects not only surgeons through bad habits such as substance abuse, but also organisations through workforce loss due to surgeons leaving. It may also increase risks to patient safety

The influence of cost of quality on the performance of food manufacturing companies: an empirical study

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.Purpose: Due to the ever-increasing competitive and complex business environments, food manufacturing companies have to maintain high-quality products while simultaneously minimizing customers' costs. Cost of quality (COQ) plays a crucial role in enhancing companies' efficiency and reducing expenditures that can contribute to companies' competitive performance. This paper investigates the underlying relationship between the level of COQ practices adoption (prevention, appraisal, internal, and external failure costs) and organizational performance in Palestinian Food Manufacturing Companies (PFMC). Design/Methodology/Approach: A quantitative research methodology using a structured questionnaire collected data from 119 PFMC. Partial least squares structural equation modeling was used to analyze collected data. Findings: Results indicated that COQ adoption has a significant positive effect on the organizational performance of PFMC. Besides, prevention, external, and internal failure costs were all associated with a positive impact on organizational performance of PFMC, whereas appraisal cost did not affect organizational performance. Originality: This study is considered one of the first studies to investigate COQ practices' effect on organizational performance in food manufacturing companies in a developing country context. Thus, it adds significant value to literature responding to calls to tackle competitiveness issues in current complex business environments. Keywords: Cost of quality, quality costing system, TQM, food manufacturing, developing country, organizational performance, Palestine

Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Weaponizing Cost of Quality of Food Manufacturers: Implications for Organizational Performance

Owing to the current business environment, food manufacturers must provide high-quality products while simultaneously providing competitive prices for their customers. Cost of quality (COQ) can play a crucial role in fostering organizational competitive performance through reduced costs. The aim of this paper is to analyze the interrelationship between the application of COQ and organizational performance in the context of Palestinian Food Manufacturing Organizations (PFMO). The study employs a questionnaire through which data is collected from 119 PFMO. The collected data is analyzed using the partial least square structural equation modeling (PLS-SEM) technique. The results of this study suggest that application of COQ practices has a strong effect on the organizational performance of PFMO. External, internal, and prevention costs were all found to have a positive impact on organizational performance of PFMO. However, appraisal cost has no impact on organizational performance. The study provides significant value to quality management literature on the role of COQ practices in enhancing performance of food manufacturers in a developing country context and responds to calls for enhancing organizational efficiency in today’s complex business environments