Influence of meaningful work and moral distress on work engagement in the medical workforce

Abstract

Introduction: The Quadruple Aim reframed healthcare improvement by extending beyond patient outcomes, population health, and cost efficiency to include the well-being of healthcare professionals. Among physicians, moral distress (MD) contributes to burnout and disengagement, whereas meaningful work—experienced as purposeful and socially valuable—is associated with greater engagement. However, the interplay between meaningful work, MD, and engagement remains insufficiently studied. Methods: A cross-sectional survey of Portuguese physicians (n = 68) was conducted using the Work and Meaning Inventory, the Measure of Moral Distress for Healthcare Professionals, and the Utrecht Work Engagement Scale. Statistical analyses included descriptive and inferential. Results: The sample was 60.3% female, mostly mid-career, and predominantly employed in the public sector (66.2%). Physicians reported high meaningful work (M = 40.19, SD = 7.17), moderately high engagement (M = 3.98, SD = 1.22), and relatively low MD (M = 133.37, SD = 78.68). Meaningful work correlated positively with engagement (ρ = .48, p < .01), but neither was significantly associated with MD. Female physicians reported significantly higher MD than males (p = .018). No significant differences emerged by marital status, specialty, practice context, or sector. Conclusions: Findings suggest that meaningful work fosters engagement, whereas MD operates largely independently. In line with the Quadruple Aim, enhancing physician well-being requires dual strategies: fostering meaningful work through autonomy, task significance, and value alignment, while addressing systemic drivers of MD such as ethical conflict and resource constraints.

Introdução: O “Quadruple Aim” redefiniu a prestação de cuidados de saúde, alargando o foco tradicional — centrado nos resultados clínicos, na saúde populacional e na eficiência — para também integrar o bem-estar dos profissionais. Nos médicos, o distress moral (DM) contribui para o burnout e menor envolvimento, enquanto o trabalho com significado está associado a maior envolvimento. Contudo, as relações entre estas variáveis permanecem pouco estudadas. Métodos: Estudo transversal com médicos portugueses (n = 68), utilizando o Work and Meaning Inventory, a Measure of Moral Distress for Healthcare Professionals e a Utrecht Work Engagement Scale. Foi realizada análise estatística descritiva e inferencial. Resultados: A amostra foi maioritariamente feminina (60,3%), em meados da carreira, e no setor público (66,2%). Os participantes reportaram níveis elevados de trabalho com significado (M = 40,19; DP = 7,17), moderadamente elevados de envolvimento (M = 3,98; DP = 1,22) e baixos de DM (M = 133,37; DP = 78,68). O trabalho com significado correlacionou- se positivamente com envolvimento (ρ = 0,48; p < 0,01), mas não com DM. As médicas reportaram níveis significativamente mais elevados de DM do que os homens (p = 0,018). Não se verificaram diferenças significativas segundo estado civil, especialidade, contexto ou setor. Conclusões: O trabalho com significado promove o envolvimento, enquanto o DM atua de forma independente. Em consonância com o “Quadruple Aim”, a promoção do bem-estar médico requer estratégias duais: reforçar o trabalho com significado (autonomia, relevância das tarefas, alinhamento de valores) e reduzir fatores sistémicos de DM (conflitos éticos, escassez de recursos).