First look at emergency medical technician wellness in India: Application of the Maslach Burnout Inventory in an unstudied population

PLOS ONE RESEARCH ARTICLE First look at emergency medical technician wellness in India: Application of the Maslach Burnout Inventory in an unstudied population Kathryn W. Koval ID1*, Benjamin Lindquist2, Christine Gennosa3, Aditya Mahadevan4, Kian Niknam2, Sanket Patil ID5, G. V. Ramana Rao6, Matthew C. Strehlow2, Jennifer A. Newberry2 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 1 Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC, United States of America, 2 Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA, United States of America, 3 College of Medicine, Medical University of South Carolina, Anderson, SC, United States of America, 4 University of San Diego, San Diego, CA, United States of America, 5 National Reference Simulation Centre, SGT University, Budhera, Gurugram Haryana, India, 6 GVK Emergency Management and Research Institute, Devar Yamzal, Secunderabad, Telangana, India * Abstract OPEN ACCESS Citation: Koval KW, Lindquist B, Gennosa C, Mahadevan A, Niknam K, Patil S, et al. (2020) First look at emergency medical technician wellness in India: Application of the Maslach Burnout Inventory in an unstudied population. PLoS ONE 15(3): e0229954. https://doi.org/10.1371/journal. pone.0229954 Editor: Andrew Carl Miller, East Carolina University Brody School of Medicine, UNITED STATES Introduction Professional wellness is critical to developing and maintaining a health care workforce. Previous work has identified burnout as a significant challenge to professional wellness facing emergency medical technicians (EMTs) in many countries worldwide. Our study fills a critical gap by assessing the prevalence of burnout among emergency medical technicians (EMTs) in India. Received: October 29, 2019 Accepted: February 17, 2020 Methods Published: March 10, 2020 This was a cross-sectional survey of EMTs within the largest prehospital care organization in India. We used the Maslach Burnout Inventory (MBI) to measure wellness. All EMTs presenting for continuing medical education between July-November 2017 from the states of Gujarat, Karnataka, and Telangana were eligible. Trained, independent staff administered anonymous MBI-Medical Personnel Surveys in local languages. Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: https://doi.org/10.1371/journal.pone.0229954 Copyright: © 2020 Koval et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: A copy of the survey instrument, univariate, and multivariate regression analyses are included in the supplementary files. Results Of the 327 EMTs eligible, 314 (96%) consented to participate, and 296 (94%) surveys were scorable. The prevalence of burnout was 28.7%. Compared to EMTs in other countries, Indian EMTs had higher levels of personal accomplishment but also higher levels of emotional exhaustion and moderate levels of depersonalization. In multivariate regression, determinants of burnout included younger age, perceived lack of respect from colleagues and administrators, and a sense of physical risk. EMTs who experienced burnout were four times as likely to plan to quit their jobs within one year. PLOS ONE | https://doi.org/10.1371/journal.pone.0229954 March 10, 2020 1 / 14 PLOS ONE Further access to the data is available by request. The Stanford study group has thoroughly considered the ethical implications of sharing deidentified data publicly. Due to the size of our data set, full disclosure is thought to risk the identity of the participants, jeopardizing their anonymity with the employer and others, and compromising the conditions under which they agreed to participate. For data requests, please contact the ethics committee below and cite IRB#41940. Stanford IRB, 1705 El Camino Real, Palo Alto, CA 94306, (650) 724-7141 Funding: The author(s) received no specific funding for this work. Competing interests: The authors have declared that no competing interests exist. First look at EMT wellness in India: Application of the MBI in an unstudied population Conclusion This is the first assessment of burnout in EMTs in India and adds to the limited body of literature among low- and middle-income country (LMIC) prehospital providers worldwide. Burnout was strongly associated with an EMT’s intention to quit within a year, with potential implications for employee turnover and healthcare workforce shortages. Burnout should be a key focus of further study and possible intervention to achieve internationally recognized targets, including Sustainable Development Goal 3C and WHO’s 2030 Milestone for Human Resources. Introduction Human capital is arguably the most valuable resource in a health system. Health providers have been shown to directly impact population health outcomes [1,2]. Consequently, the development community has increasingly recognized the importance of the workforce in achieving the Sustainable Development Goals (SDG). SDG 3C calls for a “substantial increase [in] health financing and recruitment, development, training and retention of the health workforce in developing countries.” In solidarity, the World Health Organization (WHO) has set this same goal as one of six milestones for its Global Strategy on Human Resources for Health 2030 [3]. The burden of workforce shortages in low and middle-income countries (LMIC) continues to be a crisis, and India is no exception [4]. By focusing on the retention and wellness of healthcare providers, there is an opportunity for health delivery organizations to improve quality of care and reduce the need for and cost of introductory training and onboarding [5,6]. One way to address provider wellness and limit attrition is through burnout prevention. The concept of burnout popularized by psychologist Freudenberger in 1974 was initially described as “becoming exhausted by making excessive demands on energy, strength, or resources” resulting in a physical and behavioral syndrome from the workplace. His initial study involved workers at a demanding free clinic in New York City [7]. Maslach et al standardized the measurement of burnout in the late 1970’s refining its definition to a state of exhaustion, cynicism, and diminished professional efficacy that results from long-term involvement in work situations that are emotionally demanding [8]. More recent research has focused on clarifying the relationships between stress, burnout, depression, and post-traumatic stress disorder to better understand their distinctions as well as the personality fac (...truncated)