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Author Interview: Luca Morgantini on Burnout among Healthcare Professionals in COVID-19

Dr. Luca Morgantini worked with a diverse group of researchers to survey healthcare professionals across the globe to study the degree of burnout they were experiencing. For their PLOS ONE article, Factors contributing to healthcare professional burnout during the COVID-19 pandemic: A rapid turnaround global survey, they surveyed 2,700 individuals across 60 countries in April 2020 and found that burnout had generally increased compared to pre-pandemic times. I asked Luca on whether there were any surprises he came across during this study, the scientific communities’ response to the crisis and more.

This paper seems outside the scope of your usual work. How did you get involved in this study and why do you believe this research is important?

LM: I decided to document the mental health burden of the COVID-19 pandemic on healthcare workers the moment I saw non-medical parts of our society downplay what was happening in March, when the SARS-CoV-2 virus was starting to spread in Europe and North America. This research is important because we gathered data during the height of the pandemic, providing solid foundations for future healthcare policies while avoiding recall biases.

It was evident from the reports of my Chinese friends and colleagues how serious was this disease, with Wuhan going on lockdown in late January. I observed how the infection slowly spread to the rest of the world hitting Italy, my home country, particularly hard. I completed my medical training in Milan, where my colleagues found themselves working in the red zone without adequate protection or directives from their supervisors. Soon the pandemic reached the United States, where I am currently living. While study is outside my usual scope of work, as a healthcare professional and researcher I felt the need to play my part in the fight against COVID-19.

I note that you originally uploaded the manuscript to MedRxiv as a preprint. At what time in your career did you start thinking about Open Science, and why is it important to you?

LM: I believe that Open Science is essential for a fair and accessible future of science. Paywalls and other accessibility restrictions disproportionally affect early-career investigators or individuals with less economic means. I have been personally impacted by these paywalls, as institutions often cannot offer a subscription to all the countless scientific publishers. I understand there is a delicate balance between accessibility and profit, but I am convinced that other business models are feasible.

My team chose to publish a preprint on MedRxiv and then published our article on PLOS ONE, because one of the purposes of our research is to make all our collected data freely available for other researchers.

You additionally opted to publish your peer review history with your publication. What led you to this decision and how important do you think transparency of the review process is?

LM: We decided to publish the peer review history for two reasons. First, we believe this is a way to recognize the tremendous work done by the Editor and the Reviewers. They significantly contributed to the relevance of our manuscript by providing constructive comments, and we want to acknowledge their role in our publication by making their comments public.

Second, we believe in the importance of a transparent review process. This will allow other researchers investigating this field to understand what the concerns of the reviewers were.

Do you consider this research interdisciplinary? If so, how crucial are structures that support interdisciplinary review to the publication and dissemination of this type of research?

LM: Burnout is a complex phenomenon and an interdisciplinary approach allowed our team to evaluate it from different perspectives. My co-authors have different backgrounds in urology, psychiatry, biostatistics and epidemiology research. The heterogeneity of our team was essential in creating a short but comprehensive questionnaire.

An interdisciplinary team of reviewers is important for the same reasons. Analyzing such complex arguments from different points of view is required to better assess the eventual limitations of each study.

Were you particularly surprised by anything your study uncovered or were the results generally what you expected?

LM: To be honest, we were simply amazed by the number of healthcare professionals that participated in our study. I feel that they appreciated our process because we were as inclusive as possible, considering parts of the healthcare workforce and geographical areas that are often overlooked in healthcare research. From the comments we received, we noticed how they appreciated our effort to study their quality of work and life, and their willingness to make their COVID-19 experiences count.

One of the most surprising results was the selflessness and dedication of healthcare workers: the vast majority is willing to continue working despite the obvious risk. Their main concern is not infecting themselves, but bringing the virus home to friends and loved ones. These results were consistent across all countries, genders, and healthcare professions.

In your Conclusion, you mention a few actions that could potentially mitigate burnout for healthcare professionals. Are there any that you would particularly like to see pursued by institutions and other stakeholders?

LM: It is evident how our society and healthcare systems were not ready to withstand the first wave of a global pandemic. When the Spanish flu infected an estimated half a billion individuals around a century ago, the scientific community was only starting to understand what viruses are and how pandemics evolve. COVID-19 is the first true global pandemic where modern science can play an active and aware role. This is an unprecedented opportunity for researchers to document and understand how to improve the condition of frontline healthcare workers. The manuscript we published represents only one of the hundreds of studies that are being conducted on this topic that all together will contribute to mitigating the negative effects of future pandemics.

In particular, we observed how training was mostly reported to be ineffective and how adequate protective equipment was rarely available. We understood how healthcare workers are more concerned about their families than themselves, and future policies that would assure the safety of their loved ones, such as periodical testing, kindergartens, or short term rentals close to hospitals, would greatly improve their quality of life.

What have you seen from peers and the scientific community as a whole during the COVID-19 pandemic?

LM: Because of the COVID-19 pandemic, the scientific community is performing an extraordinary and unprecedented synergic effort towards improving diagnosis, treatment, and vaccination against SARS-CoV-2. I felt this willingness to help and collaborate while conducting this research, where I received tremendous support from my institution, colleagues, and expert researchers. The lessons learned during these difficult times will greatly help our scientific community and will help build a collaborative and constructive future. I am grateful to be part of this collective scientific effort that is one of the positive lessons to be learnt from this pandemic.

Comments from the Editor

Dr. Michio Murakami, PLOS ONE Academic Editor from the Fukushima Medical University School of Medicine, speaks on the significance of Luca’s work and the need to work through differences to improve our world.

MM: Among the many published COVID-19-related papers, the paper by Morgantini et al. is particularly significant. First, they conducted a rapid survey of 60 countries, highlighting that burnout of healthcare professionals is an important issue around the world. Second, it points out the importance of training and organizational support as a solution to address burnout. Ultimately, the paper points out an issue that is shared globally and presents findings that can lead to solutions.

COVID-19 and the associated social response pose a diverse range of physical and socio-psychological health problems. Some of these issues relate to discrimination, prejudice and social division. Different values and cultural worldviews, depending on the identity and position of individuals and groups, may lead to different opinions and social division. We need to be respectful of our values to individuals and different groups, and increase awareness of the fact that society is built on mutual reciprocity. There are shared goals and a vision of the world we can aspire to, even though our values may differ.

Needless to say, there are many aspects of our health that is supported by healthcare professionals, and none of us want a world in which many healthcare professionals leave their work. This paper by Morgantini et al. provides useful insights on this global issues that should be addressed and encourages further discussion about the vision of the world we aspire to.

I extend my gratitude to both Luca and Michio for providing their thoughtful comments and for their hard work as researchers.

Citation

Morgantini LA, Naha U, Wang H, Francavilla S, Acar Ă–, Flores JM, et al. (2020) Factors contributing to healthcare professional burnout during the COVID-19 pandemic: A rapid turnaround global survey. PLoS ONE 15(9): e0238217. https://doi.org/10.1371/journal.pone.0238217

Discussion
  1. Burnout in healthcare professionals has been noticed to be accentuated in Covidtimes. Altered duty schedules and slots, unexpected clinical loads and disturbed academics/research activity have been some important reasons.

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