ObjectiveTo determine whether there is an association between healthcare professionals’ wellbeing and burnout, with patient safety.DesignSystematic research review.Data SourcesPsychInfo (1806 to July 2015), Medline (1946 to July 2015), Embase (1947 to July 2015) and Scopus (1823 to July 2015) were searched, along with reference lists of eligible articles.Eligibility Criteria for Selecting StudiesQuantitative, empirical studies that included i) either a measure of wellbeing or burnout, and ii) patient safety, in healthcare staff populations.ResultsForty-six studies were identified. Sixteen out of the 27 studies that measured wellbeing found a significant correlation between poor wellbeing and worse patient safety, with six additional studies finding an association with some but not all scales used, and one study finding a significant association but in the opposite direction to the majority of studies. Twenty-one out of the 30 studies that measured burnout found a significant association between burnout and patient safety, whilst a further four studies found an association between one or more (but not all) subscales of the burnout measures employed, and patient safety.ConclusionsPoor wellbeing and moderate to high levels of burnout are associated, in the majority of studies reviewed, with poor patient safety outcomes such as medical errors, however the lack of prospective studies reduces the ability to determine causality. Further prospective studies, research in primary care, conducted within the UK, and a clearer definition of healthcare staff wellbeing are needed.ImplicationsThis review illustrates the need for healthcare organisations to consider improving employees’ mental health as well as creating safer work environments when planning interventions to improve patient safety.Systematic Review RegistrationPROSPERO registration number: CRD42015023340.

IMPORTANCE Physician burnout has taken the form of an epidemic that may affect core domains of health care delivery, including patient safety, quality of care, and patient satisfaction. However, this evidence has not been systematically quantified.OBJECTIVE To examine whether physician burnout is associated with an increased risk of patient safety incidents, suboptimal care outcomes due to low professionalism, and lower patient satisfaction.DATA SOURCES MEDLINE, Embase, PsycInfo, and CINAHL databases were searched until October 22, 2017, using combinations of the key terms physicians, burnout, and patient care. Detailed standardized searches with no language restriction were undertaken. The reference lists of eligible studies and other relevant systematic reviews were hand-searched.STUDY SELECTION Quantitative observational studies.DATA EXTRACTION AND SYNTHESIS Two independent reviewers were involved. The main meta-analysis was followed by subgroup and sensitivity analyses. All analyses were performed using random-effects models. Formal tests for heterogeneity (I 2 ) and publication bias were performed. MAIN OUTCOMES AND MEASURESThe core outcomes were the quantitative associations between burnout and patient safety, professionalism, and patient satisfaction reported as odds ratios (ORs) with their 95% CIs. RESULTSOf the 5234 records identified, 47 studies on 42 473 physicians (25 059 [59.0%] men; median age, 38 years [range, 27-53 years]) were included in the meta-analysis. Physician burnout was associated with an increased risk of patient safety incidents (OR, 1.96; 95% CI, 1.59-2.40), poorer quality of care due to low professionalism (OR, 2.31; 95% CI, 1.87-2.85), and reduced patient satisfaction (OR, 2.28; 95% CI, 1.42-3.68). The heterogeneity was high and the study quality was low to moderate. The links between burnout and low professionalism were larger in residents and early-career (Յ5 years post residency) physicians compared with middle-and late-career physicians (Cohen Q = 7.27; P = .003). The reporting method of patient safety incidents and professionalism (physician-reported vs system-recorded) significantly influenced the main results (Cohen Q = 8.14; P = .007). CONCLUSIONS AND RELEVANCEThis meta-analysis provides evidence that physician burnout may jeopardize patient care; reversal of this risk has to be viewed as a fundamental health care policy goal across the globe. Health care organizations are encouraged to invest in efforts to improve physician wellness, particularly for early-career physicians. The methods of recording patient care quality and safety outcomes require improvements to concisely capture the outcome of burnout on the performance of health care organizations.

We present experiments and theory on the melt dynamics of monodisperse entangled polymers of H-shaped architecture. Frequency-dependent rheological data on a series of polyisoprene H-polymers are in good agreement with a tube model theory that combines path-length fluctuation (like that of star polymer melts) at high frequency, with reptation of the self-entangled “cross-bars” at low frequencies (like that of linear polymer melts). We account explicitly for mild polydispersity. Nonlinear step-strain and transient data in shear and extension confirm the presence of a relaxation time not seen in linear response, corresponding to the curvilinear stretch of the cross-bars. This time is very sensitive to strain due to the exponential dependence of the branch-point friction constants on the effective dangling path length. Strain-induced rearrangements of the branch points are confirmed by small-angle neutron scattering (SANS) on stretched and quenched partially deuterated samples. We develop an extension of melt-scattering theory to deal with the presence of deformed tube variables to interpret the SANS data.