Psychosocial risks (PSR) among healthcare workers: a major issue for health and quality of care

Healthcare professionals, indispensable pillars of our healthcare system, face daily challenges of rare intensity. Yet, behind their unwavering commitment lies an alarming reality: high exposure to psychosocial risks (PSRs). This issue, far from being anecdotal, is a major challenge for the mental health of those who care for us, but also for the quality and safety of care provided. In France, where expectations of hospital staff are particularly high, the phenomenon is accentuated by budgetary constraints, difficulties in finding replacements, and surges in patient numbers that weaken teams. Understanding, analyzing, and preventing these risks has become an imperative to guarantee a healthy working environment and sustainable performance of healthcare facilities.

The extent of psychosocial risks among healthcare professionals in France

The figures are telling and highlight the seriousness of the mental health situation of healthcare professionals. According to the SPS (Healthcare Professionals Support) association, a significant proportion of healthcare professionals are experiencing psychological distress: 30% of them are depressed, 25% have had suicidal thoughts, and 50 to 60% show signs of professional exhaustion (burnout). These statistics, although based on a specific association, reveal an underlying trend.

In France, hospital staff are subject to high expectations, intense stress, and constant confrontation with the suffering of patients and their families, which exposes them to numerous psychosocial risks. A European study (NEXT-PRESST) showed that in 2003, 27.8% of healthcare professionals in Europe had a high burnout score, with this percentage rising to 46% in France. When this survey was repeated in 2008 among paramedical staff at a Parisian university hospital, the burnout score remained high (2.90). The French Institute for Public Health Surveillance estimated that burnout affected more than 30,000 people among the 480,000 employees suffering from work-related psychological distress.

Excessive workload is a predominant factor in this distress. In France, work overload is exacerbated by budgetary constraints and difficulties in replacing staff. The lack of human resources, while periods of high demand are increasing, creates a vicious circle where absences for health reasons further aggravate the situation. This time pressure, associated with high psychological demand, is a key element of psychosocial risks.

The precariousness of the public hospital service in France is also an element to take into account. Due to significant budgetary constraints, public health establishments have undergone major organizational changes that can lead to suffering at work and professional stress. This job insecurity, whether related to employment, salary, or career, is a source of dissatisfaction and is associated with increased anxiety and depression.

Understand psychosocial risk factors (PSRFs): A multifactorial approach.

Psychosocial risks (PSR) are a multifactorial and subjective concept that encompasses various notions associated with malaise at work, including stress, burnout, harassment and violence, as well as work addiction. A College of Experts, chaired by Gollac and Bodier, clarified this concept by identifying six main risk factors. These factors, relevant to all professional environments, take on a particular dimension in the healthcare sector:

• Work intensity and working hours: This factor encompasses the amount of work, time pressure, and complexity of tasks. Caregivers often face work weeks exceeding the regulatory duration, a high pace of on-call shifts, and an imbalance between professional and personal life. This high workload, exacerbated by staff shortages and budgetary constraints, reduces the time for reflection and communication between caregivers, which has significant negative effects on burnout. The nursing profession, for example, is considered one of the most stressful due to the complexity of tasks and the need to manage emergency situations.
• Emotional demands: The work of healthcare professionals involves constant confrontation with intense emotions related to pain, death, and the distress of patients and their families. They must often make decisions with serious implications and experience a particularly strong "ethical" pressure. "Emotional labor" – which consists of controlling and shaping one's own emotions to better manage those of others – is a prerequisite for their function. This constant exposure to emotional demands is associated with negative feelings, job dissatisfaction, and burnout. Emotional dissonance, resulting from a conflict between the emotions felt and those required by the professional role, is also an aggravating factor.
• Lack of autonomy: This factor refers to the caregiver's "decision-making latitude", that is, their room for maneuver, the use and development of their skills, and their participation in decision-making. Lack of autonomy and empowerment, as well as the impression of not being recognized for one's work, are associated with an increase in job dissatisfaction and burnout levels among health professionals.
• Social relationships at work: This dimension encompasses the quality of relationships with colleagues and hierarchy, perceived social support, reward (recognition), organizational justice, and exposure to violence. Caregivers may face strained interpersonal relationships, exacerbated by complex hierarchies within the hospital. Lack of social support is strongly associated with burnout. In addition, nurses and paramedics are among the professions most affected by (verbal or physical) assaults from patients, which increases anxiety, burnout, and post-traumatic stress. Harassment from superiors also contributes to the occurrence of burnout.
• Conflicts of values: These conflicts arise when a healthcare professional's personal or professional values are in disagreement with those of other members of the organization or with the organization itself. This can lead to "ethical distress", particularly when the healthcare professional feels they do not have the necessary resources to perform quality work or when their "own role" (human care and performance of medical acts) is not respected. These situations increase job dissatisfaction and contribute to burnout.
• Job insecurity: This factor is based on job, salary, and career security, as well as uncontrolled changes in the work situation. Budgetary constraints in the hospital sector have led to a deterioration of working conditions (dilapidated premises, defective equipment) and salaries deemed insufficient. This increased precariousness, particularly in the French public hospital sector, is an additional factor in job dissatisfaction and promotes anxiety and depression.

The devastating consequences of PSR on the health of caregivers

Prolonged exposure to psychosocial risks (PSR) has profound repercussions on the physical and mental health of caregivers, with burnout being the most emblematic manifestation. Burnout is a state of physical, emotional, and mental exhaustion caused by intense and prolonged involvement in demanding situations. It is characterized by three main dimensions:

• Emotional exhaustion (EE): a profound demotivation and a feeling of annihilation of emotional resources.
• Depersonalization (DP): the development of impersonal and negative attitudes towards patients or colleagues, with a loss of empathy and cynicism.
• The reduction of the feeling of personal accomplishment (PA): a loss of confidence in one's skills and in the idea of being able to achieve fulfillment through one's occupation.

Studies reveal a high prevalence of these dimensions: 29% of caregivers have a high score of EE, 25.9% a high score of DP, and 36.9% a low score of AP. In Morocco, a study even showed a total burnout prevalence of 59.7% among hospital healthcare professionals.

Beyond burnout, caregivers exhibit numerous symptoms and pathologies related to chronic stress:

• Psychosomatic manifestations: neurovegetative disorders such as palpitations (37.3%), heart pain (36.6%), dry mouth, nausea, digestive disorders (31.2%), chest tightness (29.4%), sweating (27.3%), and muscle pain/aches (41.3%).
• Signs of nervous tension: headaches at the end of the day (54.8%), feelings of discomfort (51.4%), tremors in the extremities (16.9%).
• Mood disorders: anxiety (39.5%), irritability (38.5%), and depressive states (22.2%).
• Cognitive disorders: difficulties in concentration (32.6%) and memory (21.3%).
• Sleep disorders: difficulty falling asleep (46.1%), insomnia (39.4%), feeling of not having slept (31.2%).

Healthcare providers experiencing burnout also tend to adopt coping and self-medication behaviors with psychoactive or analgesic substances to try to maintain a high level of performance or reduce anxiety. Consumption of coffee/tea (>4 cups/day) is frequent (72.5%), as is the use of analgesics (46.1%) and psychotropic drugs (16.2%). Smoking and alcohol or cannabis use are also observed. These sufferings can have even more serious consequences, ranging from suicidal thoughts to suicide. The work-related distress of healthcare providers is not limited to their professional sphere; it also affects their well-being outside of work.

The impact of psychosocial risks on the quality of care and hospital performance

The link between the mental health of caregivers and the quality of care provided is unavoidable and direct. The suffering at work of hospital staff has systemic consequences that affect the entire structure and, ultimately, the patients.

One of the most critical repercussions of psychosocial risks (PSR) is the decrease in the quality of care. Studies have shown that burnout and stress are linked to reasoning errors and the occurrence of incidents involving patients. Healthcare professionals experiencing stress or burnout are more likely to make mistakes, including medication errors. The lack of clarity on the criteria for monitoring patients and the organization of care, as well as ambiguity, promote these errors.

The distress of caregivers also results in operational failures:

• Increased Absenteeism.
• High turnover rate. Burnout and stress are strongly linked to healthcare professionals' intention to leave their occupation. Healthcare professionals who left their hospital initially had higher burnout scores and more unfavorable working conditions (effort/reward ratio, quality of teamwork).
• Decreased performance and productivity.
• Tasks omitted or not completed: Staff shortages, inadequate logistical services, an inappropriate professional environment, poor teamwork, and weak administrative support contribute to the increase in the number of tasks omitted or not completed by nurses, which is linked to the occurrence of adverse events.

Patient satisfaction is also impacted. Patients treated in units where staff benefit from adequate staffing, good administrative support, and good relationships between doctors and nurses report more than double the satisfaction with care compared to other units. The overall level of burnout among nursing staff clearly affects patient satisfaction.

Poor work organization and the deterioration of professional relationships are key factors. Large team sizes, lack of familiarity between colleagues, instability of caregivers and assignments, and the absence of a common goal are recurring handicaps that can lead to errors. Communication failures are cited as the most common causes of harm to patients.

Aggravating factors and at-risk populations: An in-depth analysis

While all caregivers are potentially exposed to RPS, certain categories of professionals or certain situations significantly increase the risk of developing burnout or suffering at work.

• Gender: Several studies converge to show that women are more affected than their male counterparts by burnout. The European NEXT-PRESST survey reveals that women are twice as likely to have a high burnout score than men (adjusted OR = 2.27). This female predominance of burnout can be explained, in part, by cultural and traditional factors that require working women to also take care of their homes.
• Age and professional seniority: Caregivers at both ends of their careers appear to be the most affected. Younger (30 years or less) and older (over 50 years) individuals have higher burnout rates (71.3% and 72.2% respectively). Similarly, professional seniority reveals a similar trend: caregivers with 2 to 5 years of experience (61.1%) and those with more than 15 years (63.3%) are more affected. This vulnerability of younger individuals may be due to a lack of experience and abrupt exposure to poor working conditions early in their careers, while older individuals at the end of their careers may face professional disillusionment or an accumulation of fatigue and stress.
• Professional category: Studies highlight a disparity between professions. Nurses are statistically more affected by work-related stress, burnout, and its dimensions than physicians. This is due to a work situation that is often more precarious, lower salaries, socio-economic difficulties, greater stress, and closer and more direct contact with patients. Nursing assistants are particularly vulnerable, being twice as likely to have a high burnout score as state-certified registered nurses (adjusted OR = 2.29).
• Family situation and work/life balance: The family situation plays a crucial role. People living alone have a higher prevalence of burnout (69.1% versus 56.5% for those in couples). Being in a couple seems to stabilize anxieties and prevent burnout. The fact of being alone with child(ren) is very strongly linked to burnout (adjusted OR = 1.48). More broadly, work/family conflicts are a set of factors with a very strong explanatory value for the occurrence of burnout, with a high conflict potentially tripling or even quadrupling the occurrence of burnout (adjusted OR = 3.03). This imbalance is even considered more decisive than the length of work itself, especially since atypical hours increase the difficulty of adjusting professional and family life.
• Compensatory behaviors and lack of leisure activities: Healthcare professionals experiencing burnout tend to resort more to compensatory behaviors such as the consumption of psychoactive and/or analgesic substances. Conversely, the absence of regular sports or leisure activities significantly increases the occurrence of burnout (adjusted OR = 1.51). Sports and leisure activities play an essential role in creating a state of balance, strengthening self-esteem, and absorbing stress.

Strategies for preventing RPS in hospitals: A comprehensive, integrated approach

The prevention of psychosocial risks (PSR) in hospitals is an imperative, not only ethical but also operational, given their consequences on the health of caregivers and the quality of care. Although it is impossible to completely eliminate risky situations, it is crucial to identify and implement priority actions. The employer is required to combine appropriate workload management, training, and emotional and psychological support to help caregivers cope with the difficulties inherent in hospital work.

The analysis models have shown that the effort/reward ratio (Siegrist model) and the quality of teamwork are the most relevant criteria for understanding and preventing burnout. Prevention strategies should therefore be structured around these major axes, addressing each identified risk factor:

• Emotional management and psychological support: Intense emotional exposure and ethical pressure require targeted actions. This includes emotional management training, the establishment of listening spaces, support groups, stress management workshops, and psychological support systems. Allowing caregivers to talk about their suffering is crucial.
• Optimization of workload and schedules: Faced with workload overload and staff shortages, it is essential to rethink staff and schedule management. Rotations should be stabilized, and rest periods can be increased. It is imperative to have adequate care and administrative staff to reduce the administrative burden on caregivers. A more efficient organization of work and concerted rest periods reduces the work/family imbalance.
• Improved interpersonal relations and management: The deterioration of relations within hospital teams is a major risk factor. Management training (conflict resolution, participatory management) is recommended. Caregivers also benefit from learning caring communication techniques to better interact with each other and with patients. "Team-building" approaches are very effective in preventing turnover and improving job satisfaction. Tutoring of novices and communication promoted at all levels are also essential. The establishment of a professional code of mutual respect, allowing individuals to express their opinions and feelings, is a lever against the risks associated with social relations. Improving relations between nurses and doctors is fundamental to team morale and staff retention.
• Information flow and clarity of roles: The proper flow of information within a cohesive work collective is essential to reduce uncertainty regarding treatments, decrease burnout, and improve influence at work and perceived recognition. Clear objectives with measurable criteria, clinical and administrative collection systems, a clear division of labor, and effective communication are key characteristics for team cohesion. Nurses' access to information and resources promotes their collaboration and reduces stress.
• Skills development and autonomy: To prevent risks associated with a lack of skills development, healthcare personnel should be able to regularly attend continuing education courses. Improving autonomy and participation in decision-making can increase job satisfaction and reduce burnout.
• Job security and institutional social support: Faced with job insecurity and socio-economic difficulties (low wages, commuting problems), it is important to develop health policies that are more oriented towards social support and solidarity, and less on competitiveness and performance.
• Work/life balance: The difficulty of balancing professional life and the demands of private life is a major factor in psychosocial risks. Management support to enable employees to play their different professional and family roles is crucial. Promoting regular sports and leisure activities is also an effective means of preventing burnout.

Holicare: A digital solution for the detection and management of psychosocial risks

Faced with the complexity of detecting and preventing psychosocial risks, innovative solutions are emerging. Holicare is a digital tool designed to help quickly detect burnout and manage it effectively.

This solution offers:

• A quick test to assess caregivers' mental health.
• Clinically proven results, obtained in minutes.
• Access to a personalized and rapidly deployable program for the prevention of psychosocial risks within the hospital.

Holicare addresses the imperative of focusing on various aspects of healthcare professionals' daily lives (workload, emotions, human relationships, organization) to identify which aspect to prioritize in the event of suspected risk to mental health. Such a solution illustrates the ability to mobilize technological tools to support the well-being of healthcare human capital.

Conclusion

Psychosocial risks among healthcare workers are a major, multifactorial challenge, the scale of which in France is worrying. Professional burnout, stress and violence, fueled by high work intensity, intense emotional demands, a lack of autonomy, sometimes strained social relationships, conflicts of values and job insecurity, have devastating consequences on the mental and physical health of healthcare workers. This suffering does not remain confined to the individual sphere; it has a direct impact on the quality and safety of care provided to patients, leading to errors, absenteeism and high staff turnover.

Studies confirm that factors such as imbalance between effort and reward and quality of teamwork are the most powerful determinants of burnout, alongside conflicts between work and family life. Nurses and nursing assistants, as well as women and caregivers at the beginning or end of their careers, appear particularly vulnerable.

To reverse this trend, a genuine prevention policy is imperative within hospitals. This implies a global and integrated approach, acting on several levers: adapted management of workload and schedules, training in emotional management and benevolent communication, strengthening social support and teamwork, improving autonomy, clarity of roles and job security, and active support for work-life balance. The circulation of information within teams is essential to reduce uncertainty and improve recognition.

Ultimately, the well-being of healthcare professionals should be considered an index and indicator of the quality and safety of care. Investing in the prevention of psychosocial risks means protecting those who protect us, while ensuring a more efficient and humane healthcare system. Tools like Holicare can contribute to this by facilitating the detection and personalized management of risks. Team solidarity, efficient work organization, and concerted rest periods are essential for a sustainable world where care is both high-quality and respectful of human capital.

Sources

https://www.relyens.eu/fr/newsroom/blog/prevenir-rps-hopital

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