Physician Burnout and Patient Safety Culture in Internal Medicine Departments: A Mixed-Methods Investigation Using an Investigator-Developed Questionnaire and Healthcare Provider Interviews

BackgroundPhysician burnout is increasingly recognized as an important factor influencing healthcare quality, physician well-being, and patient safety culture in hospital settings.Internal medicine physicians may be particularly vulnerable to burnout due to high workload, extended duty hours, and complex clinical responsibilities.Using a mixed-methods approach, this study aimed to assess study-specific burnout classifications and perceived patient safety culture and to examine their association, while qualitatively exploring physicians' workplace experiences and perceived factors related to burnout and patient safety culture. MethodsThis cross-sectional mixed-methods study included 120 physicians working in the internal medicine department of a tertiary care hospital.Burnout and patient safety culture were assessed using an investigator-developed Physician Burnout and Patient Safety Culture Questionnaire, developed based on a review of published literature and domains commonly assessed by established instruments.Semi-structured interviews were conducted with a purposively selected subsample of 20 participants to explore their workplace experiences in greater depth.Quantitative data were analyzed using descriptive and inferential statistics, while qualitative data were analyzed using thematic analysis. ResultsA total of 120 physicians were included in the quantitative component, with 20 participants purposively selected for qualitative interviews.Overall, 86 (71.7%) participants were classified as having moderate or high burnout according to the study-specific scoring criteria, while high emotional exhaustion and depersonalization were each reported in 38 (31.7%) participants.A significant association was observed between study-specific burnout classification and perceived patient safety culture, with positive safety culture perceptions decreasing from 24 (70.6%)among participants with low burnout to 10 (25.0%) among those with high burnout (p < 0.001).Excessive workload, long duty hours, and poor work-life balance were frequently reported contributors to burnout, while 62 (51.7%) participants perceived an increased risk of medical errors.Qualitative findings further highlighted workload stress, staffing shortages, communication challenges, and fear of blame as important factors related to burnout and patient safety culture. ConclusionA substantial proportion of physicians were classified as having moderate or high burnout according to the study-specific scoring criteria, and higher burnout classifications were associated with less favorable perceptions of patient safety culture.Given the cross-sectional design and study-specific nature of the scoring system, these findings should not be interpreted as evidence of causality or as population prevalence estimates.Organizational strategies addressing workload, staffing, communication, and workplace culture may help support physician well-being and patient safety.