Stress is a double-edged sword. When managed appropriately, it can lead to peak performance in high-pressure professions, while the potential negative effects of stress are well documented, being directly related to seven of the ten leading causes of death in industrialized nations 1,2 .A major psychological manifestation of stress is burnout. Validated assessment tools, such as the Maslach Burnout Inventory, can be utilized to quantify the three components of burnout: emotional exhaustion, depersonalization, and a decreased sense of personal accomplishment 3,4 . Early signs of burnout, described by Quick et al., include declining professional performance and morale, physical and somatic symptoms, and behavioral changes. More advanced signs include self-medication and serious self-doubt 1 .In 2006, the results of a national survey of orthopaedic leaders (past, current, and acting chairs of orthopaedic departments, in addition to program directors) were presented to the American Orthopaedic Association (AOA) by Saleh et al. 5 . Numerous job stressors were identified, and the impact of these stressors was rated as moderate to severe in 70% of the leaders responding. High levels of emotional exhaustion and depersonalization were noted. A number of disturbing trends were identified. Only 15% were satisfied with their personal-professional life balance, and the percent dissatisfied with their job was increasing with time. Thirty-seven percent stated that they were moderately, very, or extremely likely to step down from their chair position within two years 5 .Stress and burnout have a substantial impact on patient care, especially an increase in medical errors. Fifty percent of physicians and 70% of the public believe that overwork, stress, and fatigue contribute to medical errors 6 . A recent survey of members of the American College of Surgeons assessed burnout among 7905 responding surgeons, 700 (8.9%) of whom reported committing a recent major medical error 7 . The commission of a major error correlated statistically with all three major burnout domains. Each 1-point increase in the depersonalization score raised the risk of error by 11%, and each 1-point increase in emotional exhaustion raised the risk of error by 5%. In addition, surgeons committing errors were twice as likely to have findings indicating depression. Factors frequently thought to be major drivers of medical errors, such as number of hours worked, frequency of night call, practice setting, and compensation, showed no statistical correlation with the likelihood of committing a major medical error 7 .In the years since the topic of stress had been discussed by the AOA, the relevance of the topic has only increased in importance. From 2007 to 2009, the Department of Justice investigation of orthopaedic device manufacturers resulted in a negative public image of the orthopaedic specialty and was the source of immense scrutiny and stress among many orthopaedic

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BackgroundThere is evidence that feedback from 360-degree surveys—combined with coaching—can improve physician team performance and quality of patient care. The Physicians Universal Leadership-Teamwork Skills Education (PULSE) 360 is one such survey tool that is used to assess work colleagues’ and coworkers’ perceptions of a physician’s leadership, teamwork, and clinical practice style. The Clinician & Group-Consumer Assessment of Healthcare Providers and System (CG-CAHPS), developed by the US Department of Health and Human Services to serve as the benchmark for quality health care, is a survey tool for patients to provide feedback that is based on their recent experiences with staff and clinicians and soon will be tied to Medicare-based compensation of participating physicians. Prior research has indicated that patients and coworkers often agree in their assessment of physicians’ behavioral patterns. The goal of the current study was to determine whether 360-degree, also called multisource, feedback provided by coworkers could predict patient satisfaction/experience ratings. A significant relationship between these two forms of feedback could enable physicians to take a more proactive approach to reinforce their strengths and identify any improvement opportunities in their patient interactions by reviewing feedback from team members. An automated 360-degree software process may be a faster, simpler, and less resource-intensive approach than telephoning and interviewing patients for survey responses, and it potentially could facilitate a more rapid credentialing or quality improvement process leading to greater fiscal and professional development gains for physicians.Questions/purposesOur primary research question was to determine if PULSE 360 coworkers’ ratings correlate with CG-CAHPS patients’ ratings of overall satisfaction, recommendation of the physician, surgeon respect, and clarity of the surgeon’s explanation. Our secondary research questions were to determine whether CG-CAHPS scores correlate with additional composite scores from the Quality PULSE 360 (eg, insight impact score, focus concerns score, leadership-teamwork index score, etc).MethodsWe retrospectively analyzed existing quality improvement data from CG-CAHPS patient surveys as well as from a department quality improvement initiative using 360-degree survey feedback questionnaires (Quality PULSE 360 with coworkers). Bivariate analyses were conducted to identify significant relationships for inclusion of research variables in multivariate linear analyses (eg, stepwise regression to determine the best fitting predictive model for CG-CAHPS ratings). In all higher order analyses, CG-CAHPS ratings were treated as the dependent variables, whereas PULSE 360 scores served as independent variables. This approach led to the identification of the most predictive linear model for each CG-CAHPS’ performance rating (eg, [1] overall satisfaction; [2] recommendation of the physician; [3] surgeon respect; and [4] clarity of the surgeon’s explanation) regressed o...

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