Bringing the well being and patient safety research agenda together: why healthy HPs equal safe patients

Health care is changing. Ageing populations, new therapeutic possibilities and rising expectations have made the provision of health care much more complex than in the past. The changing healthcare landscape means a greater burden for the healthcare professionals (HPs) who are expected to deliver the same quality of care with decreasing resources, while patient expectations of care remain stable or increase. Many countries in Europe are responding to this challenge by introducing new ways of delivering healthcare. However, the constant evolution of healthcare models is not resulting in better HPs, as indicated by the increasing phenomenon of burnout among health professionals (Leiter and Harvie, 1996; Rosenberg and Pace, 2006), or in safer care, as indicated by the increasing number of medical errors (Kondro, 2010). Today, there is enough evidence to suggest that expecting health professionals to deliver safe, efficient and patient-centered care, while they are getting more and more burnt-out, is not only ineffective but also costly and dangerous. In order for healthcare systems to be truly patient-centered, safe, and efficient, they need primarily to protect the health and well-being of their workers. Both healthcare professionals and patients are reinforced to view hospitals via a pathogenic lens. However, a saultogenic approach is needed. Interventions need to be bottom-up and system focused. Action research (AR) represents an appropriate methodology to link healthcare/patient input to improving hospital safety. HP AND PATIENT HEALTH ENTWINED One of the biggest risks for both patient safety and decreased quality of care today is health professionals themselves. Healthcare systems across Europe have systematically highlighted the importance of treating patients as whole people, not just as diseases, but health professionals (HPs) seem to be exempt from this holistic view. The European and Global trend is that between one third to half of health professionals are either feeling ill while present at work (i.e., presenteeism), or feel disengaged and demotivated (i.e., burnout) (Shanafelt et al., 2012). Substantial differences in burnout are observed by specialty, with the highest rates among HPs at the front line of care access (family medicine, internal, and emergency medicine). The consequences for HPs are significant and include; broken relationships, problematic alcohol use and suicidal ideation (Shanafelt et al., 2011; Oreskovich et al., 2012). The multi-center ORCAB (2014) project (http://orcab.web. auth.gr/) has recently shown that burntout HPs are at higher risk for medical mistakes. It has also highlighted that violence against HPs is increasing across Europe, especially women (European Foundation for the Improvement of Working and Living Conditions, 2010), and is driven by patient expectations and overburdened HPs. The aforementioned is exacerbated by increased patient expectations. Thus, a vicious cycle is created where inappropriate patient demands fuel feelings of exhaustion and depersonalization among HPs, which results in poor communication, which in turn ramps up already frustrated patient demands (and the cycle spirals downward).