Burnout in Singapore's public primary healthcare workers: a cross-sectional study

Burnout in healthcare workers results in higher staff turnover and poorer patient care. Knowledge of burnout and its associated factors among polyclinics' (public primary care clinics) healthcare workers in Singapore is lacking. This study aims to evaluate the extent of burnout and identify associated factors in polyclinic staff.

This was a cross-sectional study conducted in Singapore's National University Polyclinics. From 11 July to 4 September 2024, an anonymous self-administered online questionnaire was sent to eligible doctors, nurses, and allied health staff. The Maslach Burnout Inventory Human Services Survey (MBI-HSS) with domains of emotional exhaustion, depersonalisation, and personal accomplishment was used to measure extent of burnout and tested for associations with staffs' demographics, working-related factors, patient-related experiences, lifestyle, resilience levels (measured by the Brief Resilience Scale), and intention to quit using multivariable linear regression.

Of the 228 participants, 82 were doctors, 79 were nurses, and 67 were allied health. Mean total MBI-HSS scores were 25.98 (SD = 12.40, min-max = 1-53) for emotional exhaustion, 10.22 (SD = 7.24, min-max = 0-30) for depersonalisation, and 31.69 (SD = 8.33, min-max = 8-48) for personal accomplishment. Emotional exhaustion was associated with being a doctor (B = 4.55, SE = 1.60, p = 0.005) and nurse (B=-4.16, SE = 1.70, p = 0.015) compared to allied health workers. Emotional exhaustion was also associated with fewer average hours of exercise a week (B=-0.51, SE = 0.22, p = 0.024), and lower levels of resilience (B=-4.44, SE = 1.12, p < 0.001). Depersonalisation was associated with being a doctor (B = 2.56, SE = 0.97, p = 0.009) and perception of less recognition by patients (verbally or in writing) (B=-6.25, SE = 2.56, p = 0.016 for neutral; B=-8.99, SE = 2.54, p < 0.001 for agree; B=-8.69, SE = 2.82, p = 0.002 for strongly agree). Personal accomplishment was associated with being male (B = 3.38, SE = 1.37, p = 0.015), having full-time domestic help (B = 3.12, SE = 1.17, p = 0.008), being a member of a teamlet (B = 3.02, SE = 1.33, p = 0.024), perceiving greater recognition by patients (B = 8.60, SE = 3.21, p = 0.008 for agree; B = 12.46, SE = 3.55, p < 0.001 for strongly agree), and higher levels of resilience (B = 0.60, SE = 0.13, p < 0.001).

The study highlighted the extent of burnout in healthcare workers in Singapore's public primary care and its associated factors. Strategies that could potentially manage burnout include improving patient-provider relationships, improving work environment, increasing resilience in healthcare workers, and optimising team-based care models.