Work stress, burnout, and perceived quality of care: a cross-sectional study among hospital pediatricians

Eur J Pediatr. 2015 Sep;174(9):1237-46. doi: 10.1007/s00431-015-2529-1. Epub 2015 Apr 7.


Poor hospital work environments affect physicians' work stress. With a focus on hospital pediatricians, we sought to investigate associations between work stress, burnout, and quality of care. A cross-sectional study was conducted in N = 96 pediatricians of a German academic children's hospital (response rate = 73.8 %). All variables were assessed with standardized questionnaires. Multivariate regression analyses were applied to investigate associations after adjusting for potential confounders. Critically high work stress (effort/reward ratio, ERR > 1.0) was reported by N = 25 (28.4 %) participants. Pediatricians in inpatient wards had significantly more work stress than their colleagues in intensive care units and outpatient wards; 10.2 % of surveyed pediatricians reported critically high burnout. Again, inpatient ward staff reported significantly increased emotional exhaustion. After controlling for several confounders, we found that pediatricians with high work stress and emotional exhaustion reported reduced quality of care. Mediation analyses revealed that especially pediatricians' emotional exhaustion partially mediated the effect of work stress on quality of care.

Conclusion: Results demonstrate close relationships between increased work stress and burnout as well as diminished quality of care. High work stress environments in pediatric care influence mental health of pediatricians as well as quality of patient care.

What is known: • The quality of pediatricians' work environment in the hospital is associated with their work stress and burnout. • The consequences of pediatricians' work life for the quality of care need to be addressed in order to inform interventions to improve work life and care quality.

What is new: • Our study shows associations between increased work stress and burnout with mitigated quality of care. • Beyond indirect effects of work stress through emotional exhaustion on quality of care we also observed direct detrimental effects of pediatricians' work stress on mitigated care quality.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Burnout, Professional / epidemiology*
  • Child
  • Cross-Sectional Studies
  • Female
  • Germany / epidemiology
  • Hospitals, Pediatric*
  • Humans
  • Incidence
  • Male
  • Physicians / psychology*
  • Quality of Health Care*
  • Stress, Psychological / epidemiology*
  • Surveys and Questionnaires