ArticleEuropean journal of anaesthesiology and intensive care2026
Consequences of a toxic workplace environment on psychological safety in anaesthesia and intensive care: A European survey.
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Article in European journal of anaesthesiology and intensive care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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- Research Priorities in Perioperative Nursing Across the Lifespan: An e-Delphi Consensus Study.Nursing reports (Pavia, Italy) · 2026Article
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Authors and funding
12 authors.
Iulia CrisanFrom the University Hospital of Zürich, Zürich, Switzerland (IC), Division of Anaesthesiology, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland (RS, MG), Department of Anaesthesia, McGill University, Montréal, Quebec, Canada (MG), Department of Anesthesia and Peri-operative Care, University of California San Francisco, San Francisco, CA, USA (IA), Division of Anaesthesia, Critical Care and Theatres, Imperial College Healthcare NHS Trust, London, UK (BH), Department of Anaesthesia and Intensive Care, University Hospital Kaspela, Plovdiv, Bulgaria (DB), Department of Anaesthesia, Hippocrates' General Hospital of Thessaloniki, Thessaloniki, Greece (GK), Department of Anaesthesia, Intensive Care Medicine and Pain Therapy, University Hospital Balgrist, Zurich, Switzerland (APM), Department of Anaesthesia, Intensive Care and Pain Medicine, Mater Dei Hospital, Msida, Malta (AMCP), Clinic for Prehospital Services, Acute and Emergency Medicine, Operative Services and Intensive Care, Vestfold Hospital Trust, Tønsberg, Norway (E-MR), Institute for Medical Education, University of Bern, Bern, Switzerland (JB-E), RISE-Health, Centre for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal (JB-E), Department of Surgery, UMons, Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium (SS), and Department of Anaesthesiology, Helora, Mons, Belgium (SS).
Roberta SüdyFrom the University Hospital of Zürich, Zürich, Switzerland (IC), Division of Anaesthesiology, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland (RS, MG), Department of Anaesthesia, McGill University, Montréal, Quebec, Canada (MG), Department of Anesthesia and Peri-operative Care, University of California San Francisco, San Francisco, CA, USA (IA), Division of Anaesthesia, Critical Care and Theatres, Imperial College Healthcare NHS Trust, London, UK (BH), Department of Anaesthesia and Intensive Care, University Hospital Kaspela, Plovdiv, Bulgaria (DB), Department of Anaesthesia, Hippocrates' General Hospital of Thessaloniki, Thessaloniki, Greece (GK), Department of Anaesthesia, Intensive Care Medicine and Pain Therapy, University Hospital Balgrist, Zurich, Switzerland (APM), Department of Anaesthesia, Intensive Care and Pain Medicine, Mater Dei Hospital, Msida, Malta (AMCP), Clinic for Prehospital Services, Acute and Emergency Medicine, Operative Services and Intensive Care, Vestfold Hospital Trust, Tønsberg, Norway (E-MR), Institute for Medical Education, University of Bern, Bern, Switzerland (JB-E), RISE-Health, Centre for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal (JB-E), Department of Surgery, UMons, Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium (SS), and Department of Anaesthesiology, Helora, Mons, Belgium (SS).
Mia GisselbaekFrom the University Hospital of Zürich, Zürich, Switzerland (IC), Division of Anaesthesiology, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland (RS, MG), Department of Anaesthesia, McGill University, Montréal, Quebec, Canada (MG), Department of Anesthesia and Peri-operative Care, University of California San Francisco, San Francisco, CA, USA (IA), Division of Anaesthesia, Critical Care and Theatres, Imperial College Healthcare NHS Trust, London, UK (BH), Department of Anaesthesia and Intensive Care, University Hospital Kaspela, Plovdiv, Bulgaria (DB), Department of Anaesthesia, Hippocrates' General Hospital of Thessaloniki, Thessaloniki, Greece (GK), Department of Anaesthesia, Intensive Care Medicine and Pain Therapy, University Hospital Balgrist, Zurich, Switzerland (APM), Department of Anaesthesia, Intensive Care and Pain Medicine, Mater Dei Hospital, Msida, Malta (AMCP), Clinic for Prehospital Services, Acute and Emergency Medicine, Operative Services and Intensive Care, Vestfold Hospital Trust, Tønsberg, Norway (E-MR), Institute for Medical Education, University of Bern, Bern, Switzerland (JB-E), RISE-Health, Centre for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal (JB-E), Department of Surgery, UMons, Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium (SS), and Department of Anaesthesiology, Helora, Mons, Belgium (SS).
Igor AbramovichFrom the University Hospital of Zürich, Zürich, Switzerland (IC), Division of Anaesthesiology, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland (RS, MG), Department of Anaesthesia, McGill University, Montréal, Quebec, Canada (MG), Department of Anesthesia and Peri-operative Care, University of California San Francisco, San Francisco, CA, USA (IA), Division of Anaesthesia, Critical Care and Theatres, Imperial College Healthcare NHS Trust, London, UK (BH), Department of Anaesthesia and Intensive Care, University Hospital Kaspela, Plovdiv, Bulgaria (DB), Department of Anaesthesia, Hippocrates' General Hospital of Thessaloniki, Thessaloniki, Greece (GK), Department of Anaesthesia, Intensive Care Medicine and Pain Therapy, University Hospital Balgrist, Zurich, Switzerland (APM), Department of Anaesthesia, Intensive Care and Pain Medicine, Mater Dei Hospital, Msida, Malta (AMCP), Clinic for Prehospital Services, Acute and Emergency Medicine, Operative Services and Intensive Care, Vestfold Hospital Trust, Tønsberg, Norway (E-MR), Institute for Medical Education, University of Bern, Bern, Switzerland (JB-E), RISE-Health, Centre for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal (JB-E), Department of Surgery, UMons, Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium (SS), and Department of Anaesthesiology, Helora, Mons, Belgium (SS).
Ben HockenhullFrom the University Hospital of Zürich, Zürich, Switzerland (IC), Division of Anaesthesiology, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland (RS, MG), Department of Anaesthesia, McGill University, Montréal, Quebec, Canada (MG), Department of Anesthesia and Peri-operative Care, University of California San Francisco, San Francisco, CA, USA (IA), Division of Anaesthesia, Critical Care and Theatres, Imperial College Healthcare NHS Trust, London, UK (BH), Department of Anaesthesia and Intensive Care, University Hospital Kaspela, Plovdiv, Bulgaria (DB), Department of Anaesthesia, Hippocrates' General Hospital of Thessaloniki, Thessaloniki, Greece (GK), Department of Anaesthesia, Intensive Care Medicine and Pain Therapy, University Hospital Balgrist, Zurich, Switzerland (APM), Department of Anaesthesia, Intensive Care and Pain Medicine, Mater Dei Hospital, Msida, Malta (AMCP), Clinic for Prehospital Services, Acute and Emergency Medicine, Operative Services and Intensive Care, Vestfold Hospital Trust, Tønsberg, Norway (E-MR), Institute for Medical Education, University of Bern, Bern, Switzerland (JB-E), RISE-Health, Centre for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal (JB-E), Department of Surgery, UMons, Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium (SS), and Department of Anaesthesiology, Helora, Mons, Belgium (SS).
Donika BorisovaFrom the University Hospital of Zürich, Zürich, Switzerland (IC), Division of Anaesthesiology, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland (RS, MG), Department of Anaesthesia, McGill University, Montréal, Quebec, Canada (MG), Department of Anesthesia and Peri-operative Care, University of California San Francisco, San Francisco, CA, USA (IA), Division of Anaesthesia, Critical Care and Theatres, Imperial College Healthcare NHS Trust, London, UK (BH), Department of Anaesthesia and Intensive Care, University Hospital Kaspela, Plovdiv, Bulgaria (DB), Department of Anaesthesia, Hippocrates' General Hospital of Thessaloniki, Thessaloniki, Greece (GK), Department of Anaesthesia, Intensive Care Medicine and Pain Therapy, University Hospital Balgrist, Zurich, Switzerland (APM), Department of Anaesthesia, Intensive Care and Pain Medicine, Mater Dei Hospital, Msida, Malta (AMCP), Clinic for Prehospital Services, Acute and Emergency Medicine, Operative Services and Intensive Care, Vestfold Hospital Trust, Tønsberg, Norway (E-MR), Institute for Medical Education, University of Bern, Bern, Switzerland (JB-E), RISE-Health, Centre for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal (JB-E), Department of Surgery, UMons, Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium (SS), and Department of Anaesthesiology, Helora, Mons, Belgium (SS).
Georgios KarrasFrom the University Hospital of Zürich, Zürich, Switzerland (IC), Division of Anaesthesiology, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland (RS, MG), Department of Anaesthesia, McGill University, Montréal, Quebec, Canada (MG), Department of Anesthesia and Peri-operative Care, University of California San Francisco, San Francisco, CA, USA (IA), Division of Anaesthesia, Critical Care and Theatres, Imperial College Healthcare NHS Trust, London, UK (BH), Department of Anaesthesia and Intensive Care, University Hospital Kaspela, Plovdiv, Bulgaria (DB), Department of Anaesthesia, Hippocrates' General Hospital of Thessaloniki, Thessaloniki, Greece (GK), Department of Anaesthesia, Intensive Care Medicine and Pain Therapy, University Hospital Balgrist, Zurich, Switzerland (APM), Department of Anaesthesia, Intensive Care and Pain Medicine, Mater Dei Hospital, Msida, Malta (AMCP), Clinic for Prehospital Services, Acute and Emergency Medicine, Operative Services and Intensive Care, Vestfold Hospital Trust, Tønsberg, Norway (E-MR), Institute for Medical Education, University of Bern, Bern, Switzerland (JB-E), RISE-Health, Centre for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal (JB-E), Department of Surgery, UMons, Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium (SS), and Department of Anaesthesiology, Helora, Mons, Belgium (SS).
Adrian P MartyFrom the University Hospital of Zürich, Zürich, Switzerland (IC), Division of Anaesthesiology, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland (RS, MG), Department of Anaesthesia, McGill University, Montréal, Quebec, Canada (MG), Department of Anesthesia and Peri-operative Care, University of California San Francisco, San Francisco, CA, USA (IA), Division of Anaesthesia, Critical Care and Theatres, Imperial College Healthcare NHS Trust, London, UK (BH), Department of Anaesthesia and Intensive Care, University Hospital Kaspela, Plovdiv, Bulgaria (DB), Department of Anaesthesia, Hippocrates' General Hospital of Thessaloniki, Thessaloniki, Greece (GK), Department of Anaesthesia, Intensive Care Medicine and Pain Therapy, University Hospital Balgrist, Zurich, Switzerland (APM), Department of Anaesthesia, Intensive Care and Pain Medicine, Mater Dei Hospital, Msida, Malta (AMCP), Clinic for Prehospital Services, Acute and Emergency Medicine, Operative Services and Intensive Care, Vestfold Hospital Trust, Tønsberg, Norway (E-MR), Institute for Medical Education, University of Bern, Bern, Switzerland (JB-E), RISE-Health, Centre for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal (JB-E), Department of Surgery, UMons, Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium (SS), and Department of Anaesthesiology, Helora, Mons, Belgium (SS).
Anne Marie Camilleri PodestaFrom the University Hospital of Zürich, Zürich, Switzerland (IC), Division of Anaesthesiology, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland (RS, MG), Department of Anaesthesia, McGill University, Montréal, Quebec, Canada (MG), Department of Anesthesia and Peri-operative Care, University of California San Francisco, San Francisco, CA, USA (IA), Division of Anaesthesia, Critical Care and Theatres, Imperial College Healthcare NHS Trust, London, UK (BH), Department of Anaesthesia and Intensive Care, University Hospital Kaspela, Plovdiv, Bulgaria (DB), Department of Anaesthesia, Hippocrates' General Hospital of Thessaloniki, Thessaloniki, Greece (GK), Department of Anaesthesia, Intensive Care Medicine and Pain Therapy, University Hospital Balgrist, Zurich, Switzerland (APM), Department of Anaesthesia, Intensive Care and Pain Medicine, Mater Dei Hospital, Msida, Malta (AMCP), Clinic for Prehospital Services, Acute and Emergency Medicine, Operative Services and Intensive Care, Vestfold Hospital Trust, Tønsberg, Norway (E-MR), Institute for Medical Education, University of Bern, Bern, Switzerland (JB-E), RISE-Health, Centre for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal (JB-E), Department of Surgery, UMons, Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium (SS), and Department of Anaesthesiology, Helora, Mons, Belgium (SS).
Else-Marie RingvoldFrom the University Hospital of Zürich, Zürich, Switzerland (IC), Division of Anaesthesiology, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland (RS, MG), Department of Anaesthesia, McGill University, Montréal, Quebec, Canada (MG), Department of Anesthesia and Peri-operative Care, University of California San Francisco, San Francisco, CA, USA (IA), Division of Anaesthesia, Critical Care and Theatres, Imperial College Healthcare NHS Trust, London, UK (BH), Department of Anaesthesia and Intensive Care, University Hospital Kaspela, Plovdiv, Bulgaria (DB), Department of Anaesthesia, Hippocrates' General Hospital of Thessaloniki, Thessaloniki, Greece (GK), Department of Anaesthesia, Intensive Care Medicine and Pain Therapy, University Hospital Balgrist, Zurich, Switzerland (APM), Department of Anaesthesia, Intensive Care and Pain Medicine, Mater Dei Hospital, Msida, Malta (AMCP), Clinic for Prehospital Services, Acute and Emergency Medicine, Operative Services and Intensive Care, Vestfold Hospital Trust, Tønsberg, Norway (E-MR), Institute for Medical Education, University of Bern, Bern, Switzerland (JB-E), RISE-Health, Centre for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal (JB-E), Department of Surgery, UMons, Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium (SS), and Department of Anaesthesiology, Helora, Mons, Belgium (SS).
Joana Berger-EstilitaFrom the University Hospital of Zürich, Zürich, Switzerland (IC), Division of Anaesthesiology, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland (RS, MG), Department of Anaesthesia, McGill University, Montréal, Quebec, Canada (MG), Department of Anesthesia and Peri-operative Care, University of California San Francisco, San Francisco, CA, USA (IA), Division of Anaesthesia, Critical Care and Theatres, Imperial College Healthcare NHS Trust, London, UK (BH), Department of Anaesthesia and Intensive Care, University Hospital Kaspela, Plovdiv, Bulgaria (DB), Department of Anaesthesia, Hippocrates' General Hospital of Thessaloniki, Thessaloniki, Greece (GK), Department of Anaesthesia, Intensive Care Medicine and Pain Therapy, University Hospital Balgrist, Zurich, Switzerland (APM), Department of Anaesthesia, Intensive Care and Pain Medicine, Mater Dei Hospital, Msida, Malta (AMCP), Clinic for Prehospital Services, Acute and Emergency Medicine, Operative Services and Intensive Care, Vestfold Hospital Trust, Tønsberg, Norway (E-MR), Institute for Medical Education, University of Bern, Bern, Switzerland (JB-E), RISE-Health, Centre for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal (JB-E), Department of Surgery, UMons, Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium (SS), and Department of Anaesthesiology, Helora, Mons, Belgium (SS).ORCID https://orcid.org/0000-0002-8695-4264
Sarah SaxenaFrom the University Hospital of Zürich, Zürich, Switzerland (IC), Division of Anaesthesiology, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland (RS, MG), Department of Anaesthesia, McGill University, Montréal, Quebec, Canada (MG), Department of Anesthesia and Peri-operative Care, University of California San Francisco, San Francisco, CA, USA (IA), Division of Anaesthesia, Critical Care and Theatres, Imperial College Healthcare NHS Trust, London, UK (BH), Department of Anaesthesia and Intensive Care, University Hospital Kaspela, Plovdiv, Bulgaria (DB), Department of Anaesthesia, Hippocrates' General Hospital of Thessaloniki, Thessaloniki, Greece (GK), Department of Anaesthesia, Intensive Care Medicine and Pain Therapy, University Hospital Balgrist, Zurich, Switzerland (APM), Department of Anaesthesia, Intensive Care and Pain Medicine, Mater Dei Hospital, Msida, Malta (AMCP), Clinic for Prehospital Services, Acute and Emergency Medicine, Operative Services and Intensive Care, Vestfold Hospital Trust, Tønsberg, Norway (E-MR), Institute for Medical Education, University of Bern, Bern, Switzerland (JB-E), RISE-Health, Centre for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal (JB-E), Department of Surgery, UMons, Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium (SS), and Department of Anaesthesiology, Helora, Mons, Belgium (SS).
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundToxic workplace environments in healthcare, characterised by discrimination, bullying, poor communication, and lack of support, have a negative effect on physicians' well-being and patient safety. Anaesthesiologists and intensivists are at high risk of burnout due to the intensity of their work. However, the prevalence and consequences of a toxic work environment in these specialties across Europe remain unknown.
objectivesThe primary objective of this study was to evaluate psychological safety among European anaesthesiologists and intensivists and its relationship to toxic workplace environments. The secondary objectives were to explore associated sociodemographic and professional factors, perceived support and job satisfaction, the prevalence and consequences of toxic workplace experiences, and the coping strategies used in response to them.
designCross-sectional, multinational survey study.
settingOnline anonymous survey distributed via the European Society of Anaesthesiology and Intensive Care mailing list and social media platforms between April and June 2025.
participantsSome 859 respondents: 491 women (57.2%), 364 men (42.4%) and 2 gender-fluid (0.2%). They were predominantly White European (87.2%). Most participants worked in academic hospitals, mainly in anaesthesia alone (80.6%).
interventionsNone.
main outcome measuresPsychological safety (Edmondson's 7-item scale), support/satisfaction (4-item scale), prevalence and consequences of toxic workplace experiences, and coping strategies.
resultsThe Psychological Safety Scale showed high reliability (
conclusionsToxic workplace environments are prevalent in European anaesthesiology and intensive care, strongly associated with burnout and adverse health outcomes. Organisational reforms targeting leadership, communication, and psychological safety are urgently needed.
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