Understanding the perception of workload in the emergency department and its impact on medical decision making

Objective: The purpose of this study is to investigate the mental workload level of physicians in outpatient practice since the normalization of prevention and control of the COVID-19 pandemic in China and explore the subtypes of physicians regarding their mental workload.Methods: A cross-sectional survey of 1,934 physicians primarily in 24 hospitals in 6 provinces in Eastern, Central, and Western China was conducted from November 2020 to February 2021. A latent profile analysis was performed to identify clusters based on the six subscales of the Chinese version of physician mental workload scale developed by our research team. Chi-square tests were performed to explore the differences in demographic characteristics of the subtypes among the subgroups, and multinomial logistic regression analysis was further conducted to identify the determinants of the subtypes of physicians.Results: Overall, the participating physicians reported high levels of task load but with high self-assessed performance (68.01 ± 14.25) while performing communication work tasks characterized by direct patient interaction in outpatient clinics. About 33.8% of the participating physicians were identified as “high workload and high self-assessment” subtype, compared to 49.7% “medium workload and medium self-assessment” subtype and 16.4% “low workload and low self-assessment” subtype. Physicians in “high workload and high self-assessment” subtype had the highest mean mental workload score. Physicians who were female, younger, married, worse health status, those who had lower educational level and an average monthly income of 5,001–10,000 RMB, those who worked in tertiary A hospitals, more hours per week and more than 40 h per week in outpatient clinics, and those who saw more outpatients per day, and spent more time per patient but with higher outpatient satisfaction were more likely to belong to “high workload and high self-assessment” subtype.Conclusion: Our findings can help provide a solid foundation for developing targeted interventions for individual differences across physicians regarding their mental workload. We suggest the hospital managers should pay more attention to those physicians with characteristics of the “high workload and high self-assessment” subtype and strengthen the management of the workload of this subtype of physicians to reduce the risks of their mental health, and to maintain their high work performance in outpatient clinics.

Section: Discussionsupporting

confidence: 88%

Identifying the Subtypes and Characteristics of Mental Workload Among Chinese Physicians in Outpatient Practice: A Latent Profile Analysis

Chen

et al. 2021

“…Compared to the objective workload, mental workload not only reflects different aspects of a human operator's workload, but also explains the relation between the nature of a work task and the characteristics of the operator ( 18 , 19 ); and currently, the European Pact for Mental Health and Welfare is devoted to conducting the mental workload assessments to promote physical and mental well-being ( 11 ). To date, various methods for quantifying mental workload have been developed, mainly including the following three large groups: subjective evaluations through rating scales, task performance measures, and physiological measures (e.g., heart rate, galvanic skin resistance, and breathing rate) ( 20 , 21 ); and the NASA-Task Load Index (NASA-TLX) scale provides a well-validated and widely-used tool for measuring or diagnosing subjective mental workload ( 22 , 23 ), and has been used to quantify perceived workload of healthcare workers in various healthcare settings ( 24 ).…”

Section: Introductionmentioning

confidence: 99%

A Latent Profile Analysis of Chinese Physicians' Workload Tethered to Paperwork During Outpatient Encounters

et al. 2022

BackgroundPhysician dissatisfaction with more time spent on related paperwork but less time available for direct interaction with patients is increasing internationally. Increased physician workload resulting from paperwork might negatively affect their interaction with patients and increase the risk for burnout. This study aimed to investigate the level of physician workload tethered to paperwork during outpatient encounters and explore its latent workload subgroups among Chinese physicians.MethodsA cross-sectional survey was conducted via online questionnaire primarily in 24 hospitals in 6 provinces in Eastern, Central, and Western China from November 2020 to February 2021. The Chinese physician mental workload scale developed by our research team was used for assessment of physician workload tethered to paperwork. Physicians were categorized into different subgroups of workload via latent profile analysis. Multinomial logistic regression was subsequently performed to examine how demographic variables differ among physicians belonging to different subgroups.ResultsA total of 1,934 valid questionnaires were received. Chinese physicians reported medium levels of workload while performing non-physician-patient communication work tasks characterized by paperwork during outpatient encounters. Four latent workload subgroups were identified: “low workload group” (8.8%), “medium workload group” (34.0%), “high workload group” (42.1%) and “very high workload group” (15.1%). Compared with the other latent workload subgroups, physicians belonging to the “very high workload group” were more likely to be younger, married, those who had worse health status, lower educational levels and lower average monthly incomes, those who worked more years in the current institution, more hours per week and longer outpatient hours per week, and those who worked in public general hospitals, tertiary B hospitals and Obstetrics and Gynecology, and saw more than 50 outpatients per day, with more time spent on per patient.ConclusionsThere exit four latent workload subgroups among Chinese physicians tethered to paperwork during outpatient encounters along with great individual variations among these subgroups. The characteristics of the latent “very high workload group” can help permit more targeted guidance for developing interventions with optimized human resource allocation to, in turn, increase the time available for direct interaction with patients, thereby resulting in improved quality of physician-patient interactions and decreased risk for physician burnout.

“…Subjective assessments concentrating on different aspects of mental workload require a human operator to distinguish a level of workload in indications on scales in post-task responses. The NASA-Task Load Index (NASA-TLX) scale, widely used in measuring or diagnosing mental workload in human factors and ergonomics, has proven to be a sensitive, valid and reliable assessment tool ( 21 , 22 ), and can be used for quantifying perceived workload in various healthcare settings ( 23 ). In the same vein, the Subjective Workload Assessment Technology (SWAT) is a subjective rating technique used for assessing mental workload ( 24 ).…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies have investigated the physician workload in various working settings [e.g., emergency department ( 16 , 23 ), clinical care ( 18 , 25 )] using single methods noted in the literature review or a combination of these methods ( 16 ); however, most of them might have failed to comprehensively assess physician workload, since they either only focused on the objective workload ( 4 ) or mental workload using single or multiple metrics, or just simply measured both objective workload and mental workload to obtain a more comprehensive assessment of physician workload ( 16 ). It is obvious that such a single or non-integrated evaluation framework will not effectively solve comprehensive assessments of physician workload.…”

Section: Introductionmentioning

confidence: 99%

“…Workload is also influenced in part by the nature of the work task in question ( 28 ). Research indicated that physician workload is increased with complexity of medical cases or medical care ( 16 , 18 , 23 , 26 , 30 , 31 ), and the well-known RBRVS (resource-based relative value scale, RBRVS) model, widely used for medical workers' performance appraisal, revealed that these patient factors such as complexity, and severity of the patient's disease had a positive impact on the physician workload. Thus, patient complexity should be considered into the comprehensive assessment framework of physician workload.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Developing an Integrated Evaluation Model for Physician Comprehensive Workload Tethered to Outpatient Practice: An Empirical Study From China

et al. 2022

BackgroundPrevious studies, often simply using either objective workload or mental workload as a measure of physician workload in various healthcare settings might have failed to comprehensively reflect the real workload among physicians. Despite this, there is little research that further explores a comprehensive workload evaluation framework with the integration of objective workload and mental workload to describe their comprehensive workload.MethodsA comprehensive evaluation framework for physician workload was proposed based on the combination of objective workload and task-level mental workload also with the consideration of quality of provided medical services and served patient complexity; and accordingly, an integrated evaluation model for physician comprehensive workload (PCW) tethered to outpatient practice was developed and further applied to perform a PCW analysis using cross-sectional data on outpatient workload of 1,934 physicians mainly from 24 hospitals in 6 provinces in Eastern, Central, and Western China. Multiple linear regression and multinomial logistic regression analyses were established to identify significant factors influencing the PCW.ResultsOverall, the average score of PCW tethered to outpatient practice Chinese physicians experienced was 811.30 (SD=494.98) with concentrating on between 200 and 1,200. Physicians who were female, from Eastern or Western China, and those who worked >60 h per week and longer outpatient hours per week were more likely to experience a higher PCW. 11.2% of participating physicians were identified as very high PCW physicians, compared with 11.6% as low PCW physicians, 45.5% as medium PCW physicians and 30.7% as high PCW physicians. Those who were female, older, from Western China, those who had lower educational levels, lower professional titles and longer working years in the current institution, and those who worked in tertiary A hospitals and Internal or Surgical, and worked >60 h per week and longer outpatient hours per week were more likely to be very high PCW physicians.ConclusionsOur work has a potential application for comprehensively assessing physician workload tethered to outpatient practice and could provide a solid foundation for hospital managers to further accurately determine and identify physicians with high workload, who would otherwise be missed in either objective workload or mental workload.