Occupational well-being, resilience, burnout, and job satisfaction of surgical teams

Perioperative teams

A well-functioning perioperative surgical team is central to achieving the quadruple aim. ^, Superior outcomes can only occur when surgical team members are well and engaged in the process of improved patient outcomes. Surgical high-performance results from a relatively permanent or persistent change of behavior or behavior potential resulting from instruction, training, and practice (intentional learning) or experience (incidental learning). The overall “health” of the surgical team is determined when there is trust, respect, collaboration, psychological safety, and a willingness for mutual support among the members of the group. While team output is determined by the sum of its component parts, there are key knowledge, skills and attributes which guarantee or contribute to the overall wellness within the surgical environment. While much can be done to improve and optimize the performance of each surgical team, there are many innate traits and behaviors of individual members which can reduce tension and stress within a team. Resilience, motivation, and work satisfaction, all of which can be measured and improved, are key elements to the success of the group. Group resilience can be measured using ethnographic and qualitative methods and is a great asset for all surgical teams to possess. Individual plasticity, ability to learn, change and mental ‘resilience’ are at least as useful as hard work, superior work skills, and stamina in producing exceptional results in a joyful milieu.

Work climate

Hospitals are complex social–cultural organizations defined by their operational volatility, uncertainty, complexity, ambiguity, and interdependency. A strong casual link between the organization of care and patient outcomes has been found in several studies. ^, Complex organizations rely on authentic inputs and interactions while they deliver an array of clinical services. Numerous initiatives have been promoted to enhance the quality of the patient's journey when in hospital and after their discharge, and yet at least one in three postsurgical patients suffers adverse events. The impact of organizational culture on quality, reporting of data, and safety in nonmedical organizations is well documented. A positive work climate can result in highly engaged teams and increased job satisfaction. Work climate refers to the perceptions of individuals on how well the organization is realizing their full potential and enabling their ability to comfortably speak up. Monitoring staff perceptions of their work environment and their organizational culture is used by managers to discover what is deemed meaningful and makes organizational sense to employees. Leggat et al. have consistently demonstrated a positive relationship between high-performance workplaces and organizational outcomes also applies to patient outcomes in healthcare organizations.

Hackman and Oldham determined that the opportunity for team growth emerges as an important determinant of employee job satisfaction. Jobs with a high motivating potential often offered additional opportunities for learning. Empowering employees to expand their potential and positive work climate has been demonstrated to enhance job satisfaction, health, retention and can mitigate against burnout. Maslach posited that burnout is particularly relevant for medical professions where the gaps between demands and resources often leads to exhaustion. Burnout exists in all occupations but is more prevalent in medicine, and “people work” fields, such as police work, social work, nursing, and teaching professionals.

Kristof et al. introduced the term “Fit for the Job” defined as a match of perceptions between personal competence and well-being versus work environment and organisational requirements. The level of being “fit for the job” influences job satisfaction, organizational commitment, turnover intention, well-being, and performance. In practice, it is important to create the right work climate by providing the essential job resources that effectively buffer the negative aspects of the job and stimulate staff motivation. ^, Motivational models introduced by Maslow, Herzberg, Hackman and Oldham, and Karasek and Bakker, the founders of most modern motivation theories, demonstrate that five work context factors are considered important (demands and resources) in understanding staff burnout:

• Job demands: physical and/or mental effort;

• Decision latitude or job control: acquired knowledge and skills enabling decision-making;

• Social support, the important factor determining employees' resilience;

• Physical/environmental risk factors; and

• Job insecurity: labor market requirements for particular skills and possibilities targeting future career development.

Identifying and anticipating the demands of clinicians is crucial in order to better apply resources effectively and prevent negative outcomes. Job ‘resources’ constitute the physical, organizational, and social aspects of the job that help in achieving work goals, reducing job demands, and stimulating personal growth, learning, and development. ^,