Risk managers are among the healthcare professionals affected by the stress of responding to the COVID-19 pandemic. They are at risk of burnout from social distancing, increased workloads, and financial concerns.

  • More than 70% of survey respondents qualified as burned out.
  • Workplace resources often are not targeted to nonclinical employees.
  • Assistance programs for risk managers should not be time-limited.

Burnout and severe stress brought on by the pandemic may affect risk managers and patient safety professionals more than commonly known. Most attention related to stress is focused on frontline clinicians, but the effect on risk managers appears to be substantial.

Researchers in California used an online survey including the Oldenburg Burnout Inventory (OLBI), along with this question: “Since the start of the COVID-19 pandemic, what work- or non-work-related issues have been causing you the most stress?”1

The results indicated burnout and pandemic-related stress might be very common among those working in healthcare risk management and patient safety, says study author Alan J. Card, PhD, MPH, DFASHRM, assistant professor in the department of pediatrics at UC San Diego School of Medicine.

More than 70% of respondents qualified as burned out, Card says. The most prominent causes were the effects of social distancing, changing duties and workload, real and potential effects of the virus (such as the fear of infection for self or others), and financial concerns (both personal and organizational).

Respondents also reported stress from guidance that was constantly changing and sometimes untrustworthy, and feeling abused by persons in power.

Risk Managers as Third Victim

Card previously co-authored a paper on how risk managers can become a “third victim” of adverse events, following the concept that clinicians are sometimes the “second victim” because they suffer from the stress of being part of a patient’s bad outcome.2

“The idea is that the effects extend beyond the clinicians who are directly involved and to the risk managers, patient safety folks, quality improvement professionals — anyone who is involved with investigating those incidents and coming up with solutions and pushing for those to be implemented,” he says.

Card’s latest research expands on that idea and specifically addresses the effects on risk managers from COVID-19.

“One of the biggest findings was the impact of social distancing. That includes everything from working from home, especially when you have kids in the house, which was very difficult for people,” Card says. “People also were worried about their parents or their adult children being isolated all the time. The workplace impact from social distancing also was important, just the inability to drop in on someone for a chat and get a more direct answer to a question.”

Risk managers also reported stress from the inability to blow off steam after dealing with COVID-19 issues at work. For instance, several noted frustration with the inability to go shopping. Others mentioned being unable to go to the gym or church, which they had depended on for de-stressing.

“Without being able to do these things that relieved stress, they were just stuck stewing with it at home,” Card says.

Contact Tracing Stressful

The next biggest stressor was changing work duties, Card says. The survey revealed many risk managers were tasked with contact tracing and notification, which proved to be stressful because no one was happy to hear from them.

When contacting patients, even those who had received the best care still wanted to vent. Risk managers ended up hearing everyone’s woes about COVID-19.

“They had to do the emotional labor of listening to someone vent about something they had no control over. That was a heavy burden for some risk managers,” Card says.

At the same time, risk managers had to address their usual responsibilities, and some reported an uptick in safety incidents during the pandemic. But they found that there was less organizational energy to address the ordinary risk management work.

Risk managers also had to cover for others who were away from work, either because of exposure to the virus or layoffs.

“On top of that, they were worried about getting the virus at work and taking it home to their families. More people expressed concern about giving the virus to their families than getting it themselves,” Card says. “Financial concerns were another important theme because risk managers knew the financial problems of the hospital would trickle down. One had already been laid off, others feared being laid off, and many were working in organizations that had had layoffs and they were covering for those people.”

Some risk managers held on to their jobs but became the only breadwinner in the family because a spouse was laid off. That created additional stress and fear of losing work, leaving the family with no income.

Stress Can Affect Performance

The stress imposed by COVID-19 almost certainly affected risk managers’ performance, Card says. Research from many industries confirms burnout leads to reduced work performance. That is significant because a risk manager’s work performance is critical to the safety and financial health of their organization.

“The potential for burnout to impair the risk management mission is pretty significant, especially if we are looking at burnout in the range of 70%,” Card says. “This was a small study and the people who completed the survey may have been more likely to self-select because they were burned out. But the fact that we managed to find 70% who were burned out suggests that this is still probably fairly high across the population of risk managers.”1

Card notes there is little research regarding the effects of burnout and other factors on risk managers because their work is outward-focused, addressing risks facing patients and employees. When he researched the effects of stress on risk managers before COVID-19, he found many were reluctant to complain or accept help. The risk managers felt attention regarding stress and burnout should go to the frontline clinicians, patients, and family.2

“Often, they would insist they are not the ones who need help, but they see these adverse events and the difficult experiences of their doctors, nurses, and patients. They are involved in that experience, and it takes a toll,” Card says. “The culture of risk management isn’t one that supports them in acknowledging that and feeling like they have a right to take action to reduce that burden.”

Risk managers could benefit simply from knowing they are not alone in experiencing stress and burnout, Card says. The research also suggests assigning contact tracing and notification to risk managers, on top of their usual duties, might not have been the best choice. Hospital administrators could learn from that experience the next time such tasks must be assigned.

“Risk managers could advocate to their management that they should hire temporary workers to do that. It’s not something that requires expertise, and it’s not something that necessarily benefits from the skills and experience of a risk manager,” he says.

More Resources Needed

Hospitals have made progress in providing resources to address burnout in clinicians, Card notes, but nonclinical healthcare employees have mostly been left out. Putting those kinds of resources in place for risk managers and other nonclinical employees is vitally important.

To understand the effects of stress, it is worth considering the difference between the experience of risk managers and safety professionals vs. clinicians. Most clinicians are not seeing major adverse events often, Card explains, whereas risk managers are involved with each one at the organization.

A doctor or nurse may experience one terrible adverse event over many years, or they may go their entire careers without experiencing one, he notes. But the risk manager or patient safety professional investigates them every day.

“They’re exposed to that stress on a chronic level in ways that a physician may not be,” Card says. “It’s important when we implement programs to support their psychological well-being to note that they are not time-limited in the way that employee assistance programs are. They might give you four sessions with a therapist, but that is not going to cut it when your whole career is digging into those psychologically harmful events.”


  1. Card AJ. Burnout and sources of stress among healthcare risk managers and patient safety personnel during the COVID-19 pandemic: A pilot study. Disaster Med Public Health Prep 2021;1-9.
  2. Holden J, Card AJ. Patient safety professionals as the third victims of adverse events. J Patient Saf Risk Manag 2019;24:166-175.


  • Alan J. Card, PhD, MPH, DFASHRM, Assistant Professor, Department of Pediatrics, University of California, San Diego School of Medicine. Email: alcard@health.ucsd.edu.