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Matos RI, Cervero RM, Melton JL, Clemons MA, Sims BW, Ma T. Adaptive Leadership and Burnout in Military Healthcare Workers During a Global Health Pandemic. Mil Med 2024; 189:106-112. [PMID: 39160846 DOI: 10.1093/milmed/usae057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/25/2023] [Accepted: 02/09/2024] [Indexed: 08/21/2024] Open
Abstract
INTRODUCTION Occupational burnout among healthcare workers has continued to climb, impacting workforce well-being, patient safety, and retention of qualified personnel. Burnout in military healthcare workers, who have had the added stress of increased deployments, remains unknown. Although certain leadership styles have been associated with lower rates of burnout, the association between adaptive leadership and burnout in military healthcare has not previously been described. The aim of this study is to examine the role of adaptive leadership in burnout among military healthcare workers following the Coronavirus Disease 2019 (COVID-19) pandemic. MATERIALS AND METHODS A convenience sampling of military healthcare workers employed at a military medical treatment facility between March 2020 and March 2023 was anonymously surveyed using an online link, which included demographics, the Maslach-Burnout Inventory Health Services Survey (MBI-HSS), the Adaptive Leadership with Authority Scale, and the Pandemic Experiences and Perceptions Survey. Data were analyzed for associations. Structural equation modeling (SEM) was performed using MPlus 8.0, which included demographics, all three subscales that contribute to burnout (emotional exhaustion, depersonalization, and personal accomplishment [PA]), adaptive leadership (indicated by a subscale mean), and COVID impact and COVID risk perception. RESULTS Of the 365 participants analyzed, 88.5% had high emotional exhaustion, and 80.4% had high depersonalization. Burnout was significantly associated with adaptive leadership (r = -0.302, P < .001), COVID impact (r = 0.208, P < .001), and COVID risk perception (r = 0.174, P < .001). A total of 93.0% scored high in at least one subscale of the MBI-HSS (i.e., emotional exhaustion ≥27, depersonalization ≥10, or PA ≤33), although 78 (21.8%) met the complete definition of burnout, because of the overwhelmingly high levels of PA (77.8% reported high PA). In the SEM model, burnout was significantly and negatively predicted by adaptive leadership (b = -0.28, SE = 0.05, Standardized b = -0.31, P < .001). Burnout was also significantly and positively predicted by COVID impact (b = 0.25, SE = 0.09, Standardized b = 0.17, P = .028) and health professions' perception of risk (b = 0.15, SE = 0.07, Standardized b = 0.14, P = .008). Together, this model explained 17% of the total variance in health professions' reported burnout. CONCLUSIONS The findings of burnout in this military healthcare worker population were higher than have previously been described in healthcare workers or other military personnel, and the significant associations between adaptive leadership and burnout suggest the protective role of adaptive leadership in healthcare systems to address burnout. Implementing adaptive leadership training or selecting leaders with more adaptive leadership skills may be beneficial in a health care system where employee burnout is prevalent, especially during periods stressed by adaptive problems. This may be especially important in military healthcare when active duty service obligations preclude attrition in the presence of additional stressors such as deployments and Federal Emergency Management Agency responses. Further research is needed to determine whether this intervention is successful at reducing healthcare burnout.
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Affiliation(s)
- Renée I Matos
- Center for Health Professions Education, Uniformed Services University, Bethesda, MD 20814, USA
- Department of Pediatrics, Brooke Army Medical Center, Ft Sam Houston, TX 78314, USA
| | - Ronald M Cervero
- Center for Health Professions Education, Uniformed Services University, Bethesda, MD 20814, USA
| | - John L Melton
- Center for Health Professions Education, Uniformed Services University, Bethesda, MD 20814, USA
| | - Melissa A Clemons
- 59th Medical Wing Science & Technology, JBSA-Lackland, TX 78236, USA
| | - Britt W Sims
- Integrated Behavior Solutions, Inc., San Antonio, TX 78217, USA
| | - TingLan Ma
- Center for Health Professions Education, Uniformed Services University, Bethesda, MD 20814, USA
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Tung J, Nahid M, Rajan M, Bogdewic S, Mancuso CA. Putting Traits Associated with Effective Medical Leadership into Action: Support for a Faculty Development Strategy. J Clin Psychol Med Settings 2024:10.1007/s10880-024-10031-7. [PMID: 39143441 DOI: 10.1007/s10880-024-10031-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2024] [Indexed: 08/16/2024]
Abstract
Leadership development is essential to the well-being of medical organizations, but leadership concepts do not easily translate into skills or actions. The Mayo Leadership Behavior Index© (Leader Index), a validated instrument describing eight leadership traits associated with constituent well-being, can serve as a guide. The authors analyzed narratives from a qualitative study of senior medical leaders describing successful leadership behaviors to see how the tenets of the Leader Index can be applied. Current/emeritus chairs of major academic departments/divisions from a single institution were asked to describe anecdotes of actions used by leaders in actual settings. Narratives from interviews were analyzed for behaviors that map to the eight traits in the Leader Index. Eleven senior leaders volunteered multiple scenarios of effective and ineffective leadership with illustrative examples. The behaviors they identified mapped to all eight traits of the Leader Index, specifically career conversations, empowerment to do the job, encouragement of ideas, treatment with respect and dignity, provision of job performance feedback and coaching, recognition of well-done work, information about organizational changes, and development of talents and skills. These findings provide faculty development experts and psychologists tangible behaviors and actions they can teach to enhance leadership skills.
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Affiliation(s)
- Judy Tung
- Department of Medicine, Weill Cornell Medicine, 505 East 70th Street New York, New York, NY, 10021, USA.
| | - Musarrat Nahid
- Department of Medicine, Weill Cornell Medicine, 505 East 70th Street New York, New York, NY, 10021, USA
| | - Mangala Rajan
- Department of Medicine, Weill Cornell Medicine, 505 East 70th Street New York, New York, NY, 10021, USA
| | - Stephen Bogdewic
- Department of Family Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Carol A Mancuso
- Department of Medicine, Hospital for Special Surgery, New York, NY, USA
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Ashmore JA, Waddimba AC, Douglas ME, Coombes SV, Shanafelt TD, DiMaio JM. The Mayo Leadership Impact Index Adapted for Matrix Leadership Structures: Initial Validity Evidence. J Healthc Leadersh 2024; 16:315-327. [PMID: 39161696 PMCID: PMC11330859 DOI: 10.2147/jhl.s465170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 07/06/2024] [Indexed: 08/21/2024] Open
Abstract
Importance Physician burnout has reached crisis levels. Supportive leadership is one of the strongest drivers of physician well-being, and monitoring supervisor support is key to developing well-being focused leadership skills. Existing measures of leader support were designed within "direct report" supervision structures limiting their applicability to matrixed leadership reporting structures where direct reports are not the predominant norm. Antecedently, no measure of leadership support is validated specifically for implementation in matrixed leadership structures. Objective Adapt and validate the Mayo Leadership Impact Index (MLII) for settings with matrixed leadership structures. Design A psychometric validation study utilizing classical test theory and item response theory. Setting A tripartite hospital system in the southwestern US. Participants Physician-respondents to a 2023 cross-sectional survey. Main Outcomes and Measures After pilot testing, the adapted MLII was examined using a unidimensional graded response model and confirmatory factor analyses. Convergent validity was investigated via correlations with professional fulfillment, perceived autonomy support, self-valuation, and peer connectedness/respect. Divergent validity was tested via correlations with burnout. Results Of the three candidate revisions of the MLII, the 9-item adaptation was selected for its superior validity/reliability indices. Standardized Cronbach's and Ordinal alpha coefficients were 0.958 and 0.973, respectively. CFA loadings exceeded 0.70 (p < 0.001), and coefficients of variation (R2) exceeded 0.60 for all items. GRM slope parameters indicated "high" to "very high" item discrimination. Items 2, 5, and 8 were the most informative. Positive correlations of the adapted MLII with professional fulfillment, perceived autonomy support, and peer connectedness/respect were observed, supporting convergent validity. Negative correlation with overall burnout supports divergent validity. Conclusions and Relevance The findings provide evidence of the adapted MLII's validity, reliability, and appropriateness for implementation within matrixed leadership settings. Prior to this study, no leadership support measure had been validated for use among the growing number of healthcare systems with matrixed leadership reporting structures.
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Affiliation(s)
- Jamile A Ashmore
- Office of Professionalism and Well-Being, Baylor Scott & White-The Heart Hospital, Plano, TX, USA
- College of Medicine, Texas A&M University, Dallas, TX, USA
| | - Anthony C Waddimba
- College of Medicine, Texas A&M University, Dallas, TX, USA
- Division of Surgical Research, Department of Surgery, Baylor University Medical Center, Dallas, TX, USA
- Research Development & Analytics Core, Baylor Scott and White Research Institute, Dallas, TX, USA
| | - Megan E Douglas
- Trauma Research Consortium, Baylor Scott and White Research Institute, Dallas, TX, USA
| | | | - Tait D Shanafelt
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - J Michael DiMaio
- College of Medicine, Texas A&M University, Dallas, TX, USA
- Research Development & Analytics Core, Baylor Scott and White Research Institute, Dallas, TX, USA
- Division of Cardiothoracic Surgery, Baylor Scott & White-The Heart Hospital, Plano, TX, USA
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Dyrbye LN, Satele D, West CP. A Pragmatic Approach to Assessing Supervisor Leadership Capability to Support Healthcare Worker Well-Being. J Healthc Manag 2024; 69:280-295. [PMID: 38976788 DOI: 10.1097/jhm-d-23-00137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
GOAL We sought to build upon previous studies that have demonstrated how healthcare workers' ratings of their immediate supervisor's leadership capabilities relate to their well-being and job satisfaction. METHODS In 2022, we analyzed cross-sectional data from 1,780 physicians and 39,896 allied health professionals (collected in 2017) and 729 residents (collected in 2019), as well as longitudinal data from 1,632 physicians (collected from 2015 to 2017), to identify a psychometrically strong, broadly applicable, actionable, and low-burden approach to assessing supervisor leadership capability to support healthcare worker well-being. PRINCIPAL FINDINGS The magnitude of association between our 1-, 2-, 3-, and 9-item leadership indexes and burnout, and between our 1-, 2-, 3-, and 9-item leadership indexes and satisfaction with the organization were similar to each other in the cross-sectional and longitudinal cohorts and across diverse groups of healthcare workers, including physicians, residents, and allied health professionals. The likelihood ratio for a high leadership score increased with an increasing score for each leadership measure. The area under the receiver operating characteristic curve for the 1-, 2-, and 3-item measures for a high leadership score was 0.9349, 0.9672, and 0.9819, respectively. PRACTICAL APPLICATIONS A single item assessing perceptions of leadership capability efficiently provides useful information about leadership qualities of healthcare workers' immediate supervisors. The inclusion of this item in healthcare worker surveys may be useful for evaluating interventions and galvanizing organizational action to support healthcare worker well-being.
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Affiliation(s)
| | - Daniel Satele
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Colin P West
- Department of Medicine, Mayo Clinic, Rochester, Minnesota
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Walker SJ, Ey S, Hedlund S. A Model for Providing Psychological Support to Healthcare Leaders and Teams in Times of Crisis. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2024:10.1007/s40596-024-01965-z. [PMID: 38632218 DOI: 10.1007/s40596-024-01965-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 04/02/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVE Pre-pandemic, the healthcare workforce was already at risk for higher burnout than the general population and, in some roles (e.g., physicians, nurses), at higher risk for clinical distress and suicide. Studies of healthcare workforce well-being during and after past pandemics reflect that distress can persist after a pandemic subsides, if adequate support within the workplace is not forthcoming and accessible. The current report presents the rationale for and development of a wellness consult service to provide support to leaders and teams in an academic medical center during the COVID-19 pandemic and now as teams work to recover and rebuild after years of significant pandemic and other stressors. METHODS Healthcare workers who participated in supportive Listening Sessions or Interactive Workshops facilitated by the wellness consult service were invited to complete an anonymous post-session survey. RESULTS Between March 2020 and November 2022, 185 leaders and teams participated in 342 supportive Listening Sessions and Interactive Workshops. Of the respondents to the post-session survey (N = 701), 89% rated the intervention as "good to excellent" and 84% were likely or very likely to recommend this service. Leaders rated the experience more highly than non-leaders (F (1,307) = 13.99, p < 0.001) and were more likely to report feeling emotionally supported (F (1,304) = 19.836, p < 0.001). CONCLUSIONS Supporting leader and team well-being may be critical to post-pandemic recovery of the healthcare workforce. The current report presents a feasible, theory-driven model for doing so, which was rated as highly satisfactory by participants.
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Affiliation(s)
- Sara J Walker
- Oregon Health and Science University, Portland, OR, USA.
| | - Sydney Ey
- Oregon Health and Science University, Portland, OR, USA
| | - Susan Hedlund
- Oregon Health and Science University, Portland, OR, USA
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Hu JS, Pangaro LN, Gloria Andrada BM, Ceasar RC, Phillips JL. Physician Leadership and Burnout: The Need for Agency; a Qualitative Study of an Academic Institution. J Healthc Leadersh 2024; 16:121-130. [PMID: 38449510 PMCID: PMC10914963 DOI: 10.2147/jhl.s419203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/18/2024] [Indexed: 03/08/2024] Open
Abstract
Purpose Organizational approaches to physician burnout are limited. Training physician leaders to influence the organizational environment is a growing area of study. This study explored perceived physician leadership behaviors in response to burnout from the viewpoint of faculty physicians not in formal leadership positions. Understanding physician leadership behaviors from the viewpoint of those faculty being led can inform organizational strategy and leadership training to address physician burnout. Subjects and Methods Interview requests were sent to 70 randomly identified faculty physicians from a roster containing all 1145 physician faculty that excluded the Pediatric Department, at an academic health care institution in Southern California. The first ten respondents were asked to participate in a 30-to-40-minute semi-structured virtual interview via Zoom. The interviewees were asked two questions pertaining to burnout and their perception of how leadership responded. The two questions were "What has leadership done to address burnout?" and "If you had five minutes to advise your leaders on burnout, what would you say?" The recorded interviews were transcribed, redacted, and then sent to two reviewers. Thematic analysis through iterative coding was completed, and categories were constructed that aligned with the two interview questions. Results Overall, five themes were identified. These themes were organized according to the interview questions and broadly categorized as physician leadership behaviors observed that corresponded to the interview question of what leadership had done to address burnout and physician leadership behaviors desired corresponding to the second interview question of what advice should be given. Leadership behaviors observed in the context of burnout included three themes; referral to individual wellness programs, increased number of meetings and events, and a lack of agency in addressing wellness issues. The two themes of leadership behaviors desired were the obtainment of more resources and the granting of greater appreciation and recognition for work done through enhanced communication. Conclusion This small study of faculty physician perceptions of leadership behaviors identified several themes that had been identified in previous studies of leadership and burnout; need for relationship building through communication, need for resources to address work issues, and referral to wellness programs. However, the identification of a lack of agency in addressing factors in the wellness environment has not been identified in the previous burnout and physician leadership literature. Further study into the causes of this perceived lack of agency should be explored. Understanding the root causes of physician leaders' lack of agency can further inform physician leadership education as an organizational approach to burnout.
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Affiliation(s)
- James S Hu
- Department of Medicine – MD, EdD, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Louis N Pangaro
- Department of Medicine – MD, F. Edward Hébert School of Medicine of the Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | | - Rachel C Ceasar
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Jennifer L Phillips
- USC Rossier School of Education – DLS, University of Southern California, Los Angeles, CA, USA
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Couser GP, Stevens AM, Arndt HD, Nation JL, Breitinger SA, Lafferty DS, Sawchuk CN. Improving Supervisor Confidence in Responding to Distressed Health Care Employees. Jt Comm J Qual Patient Saf 2024; 50:209-218. [PMID: 38071188 DOI: 10.1016/j.jcjq.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 03/01/2024]
Abstract
BACKGROUND Professional distress and burnout are increasingly common among health professionals. This trend prompted stakeholders at a large multicenter health care system to survey supervisors for improvement opportunities. The stakeholders learned that workplace leaders lacked tools and direction for appropriately responding to distressed employees. The authors implemented a supervisor training video on providing resources to improve employee mental health. METHODS Using the DMAIC (Define, Measure, Analyze, Improve, and Control) methodology, the authors conducted key stakeholder interviews to identify strengths, weaknesses, opportunities, and threats. Next, an e-mail survey was administered to a representative sample of supervisors that asked about degree of confidence in responding appropriately to distressed employees, with the response options "very confident," "somewhat confident," and "not at all confident." After identifying factors contributing to low supervisor confidence, the research team developed and disseminated a six-minute, on-demand video to train supervisors to respond appropriately to employees during a mental health crisis. The same group of supervisors were surveyed using the same survey after exposure to the video, and responses were collected from those who had viewed the video but had not answered the preintervention survey. RESULTS The proportion of supervisors who responded "not at all confident" in the survey decreased from 7.1% (15/210) of responses to 0.8% (1/123), while the proportion of supervisors who chose "somewhat confident" increased significantly, from 62.9% (132/210) to 69.1% (85/123) (p = 0.03). Of the 28 supervisors who had not participated in the presurvey and viewed the video, none indicated that they were "not at all confident." The percentage of supervisors who felt distress "sometimes" or more frequently from navigating and supporting employee emotional concerns decreased nonsignificantly from 41.9% (88/210) to 37.4% (46/123) (p = 0.87). CONCLUSION Simple, on-demand supervisor training videos can improve the confidence of supervisors to respond appropriately to distressed employees, which may indirectly contribute to improved employee mental health.
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Schwatka NV, Burden M, Dyrbye LN. An Organizational Leadership Development Approach to Support Health Worker Mental Health. Am J Public Health 2024; 114:142-147. [PMID: 38354347 PMCID: PMC10916722 DOI: 10.2105/ajph.2023.307407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 02/16/2024]
Affiliation(s)
- Natalie V Schwatka
- Natalie V. Schwatka is with the Center for Health, Work & Environment, Department of Environmental & Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora. Marisha Burden is with the Division of Hospital Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora. Liselotte N. Dyrbye is the senior associate dean of faculty and chief well-being officer, professor of medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora
| | - Marisha Burden
- Natalie V. Schwatka is with the Center for Health, Work & Environment, Department of Environmental & Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora. Marisha Burden is with the Division of Hospital Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora. Liselotte N. Dyrbye is the senior associate dean of faculty and chief well-being officer, professor of medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora
| | - Liselotte N Dyrbye
- Natalie V. Schwatka is with the Center for Health, Work & Environment, Department of Environmental & Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora. Marisha Burden is with the Division of Hospital Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora. Liselotte N. Dyrbye is the senior associate dean of faculty and chief well-being officer, professor of medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora
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Guastello AD, Brunson JC, Sambuco N, Dale LP, Tracy NA, Allen BR, Mathews CA. Predictors of professional burnout and fulfilment in a longitudinal analysis on nurses and healthcare workers in the COVID-19 pandemic. J Clin Nurs 2024; 33:288-303. [PMID: 35949164 PMCID: PMC9538120 DOI: 10.1111/jocn.16463] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 05/14/2022] [Accepted: 06/27/2022] [Indexed: 01/22/2023]
Abstract
AIMS AND OBJECTIVES (1) To investigate the vulnerability of nurses to experiencing professional burnout and low fulfilment across 5 months of the COVID-19 pandemic. (2) To identify modifiable variables in hospital leadership and individual vulnerabilities that may mitigate these effects. BACKGROUND Nurses were at increased risk for burnout and low fulfilment prior to the COVID-19 pandemic. Hospital leadership factors such as organisational structure and open communication and consideration of employee opinions are known to have positive impacts on work attitudes. Personal risk factors for burnout include symptoms of depression and anxiety. METHODS Healthcare workers (n = 406 at baseline, n = 234 longitudinal), including doctors (n = 102), nurses (n = 94), technicians (n = 90) and non-clinical administrative staff (n = 120), completed 5 online questionnaires, once per month, for 5 months. Participants completed self-report questionnaires on professional fulfilment and burnout, perceptions of healthcare leadership, and symptoms of anxiety and depression. Participants were recruited from various healthcare settings in the southeastern United States. The STROBE checklist was used to report the present study. RESULTS Both at baseline and across the 5 months, nurses working during the COVID-19 pandemic reported increased burnout and decreased fulfilment relative to doctors. For all participants, burnout remained largely steady and fulfilment decreased slightly. The strongest predictors of both burnout and fulfilment were organisational structure and depressive symptoms. Leadership consideration and anxiety symptoms had smaller, yet significant, relationships to burnout and fulfilment in longitudinal analyses. CONCLUSIONS Burnout and reduced fulfilment remain a problem for healthcare workers, especially nurses. Leadership styles and employee symptoms of depression and anxiety are appropriate targets for intervention. RELEVANCE TO CLINICAL PRACTICE Leadership wishing to reduce burnout and increase fulfilment among employees should increase levels of organisational support and consideration and expand supports to employees seeking treatment for depression and anxiety.
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Affiliation(s)
- Andrea D. Guastello
- Department of PsychiatryCollege of Medicine, University of FloridaGainesvilleFloridaUSA
- Univeristy of Florida, Evelyn F. and William L. McKnight Brain InstituteGainesvilleFloridaUSA
- UF Center for OCD, Anxiety, and Related DisordersUniversity of FloridaGainesvilleFloridaUSA
| | - Jason Cory Brunson
- Laboratory for Systems MedicineCollege of Medicine, University of FloridaGainesvilleFloridaUSA
| | - Nicola Sambuco
- Univeristy of Florida, Evelyn F. and William L. McKnight Brain InstituteGainesvilleFloridaUSA
- UF Center for OCD, Anxiety, and Related DisordersUniversity of FloridaGainesvilleFloridaUSA
- Department of Clinical and Health PsychologyCollege of Public Health and Health Professions, University of FloridaGainesvilleFloridaUSA
| | - Lourdes P. Dale
- Department of PsychiatryCollege of Medicine‐Jacksonville, University of FloridaJacksonvilleFloridaUSA
| | - Natasha A. Tracy
- Department of PsychiatryCollege of Medicine, University of FloridaGainesvilleFloridaUSA
- Univeristy of Florida, Evelyn F. and William L. McKnight Brain InstituteGainesvilleFloridaUSA
- UF Center for OCD, Anxiety, and Related DisordersUniversity of FloridaGainesvilleFloridaUSA
| | - Brandon R. Allen
- Department of Emergency MedicineCollege of Medicine, University of FloridaGainesvilleFloridaUSA
| | - Carol A. Mathews
- Department of PsychiatryCollege of Medicine, University of FloridaGainesvilleFloridaUSA
- Univeristy of Florida, Evelyn F. and William L. McKnight Brain InstituteGainesvilleFloridaUSA
- UF Center for OCD, Anxiety, and Related DisordersUniversity of FloridaGainesvilleFloridaUSA
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Becker A, Sullivan EE, Leykum LK, Brown R, Linzer M, Poplau S, Sinsky C. Burnout Among Hospitalists During the Early COVID-19 Pandemic: a National Mixed Methods Survey Study. J Gen Intern Med 2023; 38:3581-3588. [PMID: 37507550 PMCID: PMC10713906 DOI: 10.1007/s11606-023-08309-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/28/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND : Hospitalist physician stress was exacerbated by the pandemic, yet there have been no large scale studies of contributing factors. OBJECTIVE Assess remediable components of burnout in hospitalists. PARTICIPANTS, STUDY DESIGN AND MEASURES In this Coping with COVID study, we focused on assessment of stress factors among 1022 hospital-based clinicians surveyed between April to December 2020. We assessed variables previously associated with burnout (anxiety/depression due to COVID-19, work overload, fear of exposure or transmission, mission/purpose, childcare stress and feeling valued) on 4 point Likert scales, with results dichotomized with the top two categories meaning "present"; burnout was assessed with the Mini Z single item measure (top 3 choices = burnout). Quantitative analyses utilized multilevel logistic regression; qualitative analysis used inductive and deductive methods. These data informed a conceptual model. KEY RESULTS Of 58,408 HCWs (median response rate 32%), 1022 were hospital-based clinicians (906 (89%) physicians; 449 (44%) female; 469 (46%) White); 46% of these hospital-based clinicians reported burnout. Work overload was associated with almost 5 times the odds of burnout (OR 4.9, 95% CIs 3.67, 6.85, p < 0.001), and those with anxiety or depression had 4 times the odds of burnout (OR 4.2, CIs 3.21, 7.12, p < 0.001), while those feeling valued had half the burnout odds (OR 0.43, CIs 0.31, 0.61, p < 0.001). Regression models estimated 42% of burnout variance was explained by these variables. In open-ended comments, leadership support was helpful, with "great leadership" represented by transparency, regular updates, and opportunities to ask questions. CONCLUSIONS In this national study of hospital medicine, 2 variables were significantly related to burnout (workload and mental health) while two variables (feeling valued and leadership) were likely mitigators. These variables merit further investigation as means of reducing burnout in hospital medicine.
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Affiliation(s)
| | - Erin E Sullivan
- Sawyer Business School, Suffolk University, Boston, MA, USA
- Harvard Medical School Center for Primary Care, Boston, MA, USA
| | - Luci K Leykum
- The University of Texas at Austin, Dell Medical School, Austin, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Roger Brown
- University of Wisconsin School of Nursing, Madison, WI, USA
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Dyrbye LN. Taking Action Against Burnout: Organizations Moving Forward with Impact. Jt Comm J Qual Patient Saf 2023; 49:507-510. [PMID: 37596169 DOI: 10.1016/j.jcjq.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
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Snyder RL, Barnes LEA, White KA, Cochran RL. Burnout and staff turnover among certified nursing assistants working in acute care hospitals during the COVID-19 pandemic. PLoS One 2023; 18:e0290880. [PMID: 37647316 PMCID: PMC10468035 DOI: 10.1371/journal.pone.0290880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/17/2023] [Indexed: 09/01/2023] Open
Abstract
INTRODUCTION Healthcare worker burnout is a growing problem in the United States which affects healthcare workers themselves, as well as the healthcare system as a whole. The goal of this qualitative assessment was to understand factors that may lead to healthcare worker burnout and turnover through focus groups with Certified Nursing Assistants who worked in acute care hospitals during the COVID-19 pandemic. METHODS Eight focus group discussions lasting approximately 30 minutes each were held remotely from October 2022-January 2023 with current and former Certified Nursing Assistants who worked during the COVID-19 pandemic in acute care hospitals. Participants were recruited through various sources such as social media and outreach through professional organizations. The focus groups utilized open-ended prompts including topics such as challenges experienced during the pandemic, what could have improved their experiences working during the pandemic, and motivations for continuing or leaving their career in healthcare. The focus groups were coded using an immersion-crystallization technique and summarized using NVivo and Microsoft Excel. Participant demographic information was summarized overall and by current work status. RESULTS The focus groups included 58 Certified Nursing Assistants; 33 (57%) were current Certified Nursing Assistants and 25 (43%) were Certified Nursing Assistants who no longer work in healthcare. Throughout the focus groups, five convergent themes emerged, including staffing challenges, respect and recognition for Certified Nursing Assistants, the physical and mental toll of the job, facility leadership support, and pay and incentives. CONCLUSIONS Focus group discussions with Certified Nursing Assistants identified factors at individual and organizational levels that might contribute to burnout and staff turnover in healthcare settings. Suggestions from participants on improving their experiences included ensuring staff know they are valued, being included in conversations with leadership, and improving access to mental health resources.
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Affiliation(s)
- Rachel L. Snyder
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Laura E. A. Barnes
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Katelyn A. White
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ronda L. Cochran
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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13
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Dwan D, Dialani V. Burnout Among Breast Radiologists: How Can We Restore Fulfillment? JOURNAL OF BREAST IMAGING 2023; 5:467-472. [PMID: 38416898 DOI: 10.1093/jbi/wbad014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Indexed: 03/01/2024]
Abstract
Physician burnout is increasing in prevalence and has negative implications for the quality of patient care and the health and wellbeing of physicians. Surveys before the COVID-19 pandemic showed high rates of burnout among breast radiologists, and the COVID-19 pandemic has further increased stress. This article summarizes strategies to combat burnout, including improving individual resilience by increasing mindfulness about handling stress, making goals, and noting personal accomplishments. However, more effective change is likely to occur when there is change at both a personal and an organizational level, which includes identifying the stakeholders in a workplace and determining what changes must occur to increase joy and decrease rates of burnout. Despite the increasing rates of burnout, breast radiologists report high rates of personal career satisfaction. Self-reflection and positive steps to increase joy at work are important in maintaining career fulfillment in these challenging times.
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Affiliation(s)
- Dennis Dwan
- Beth Israel Deaconess Medical Center, Department of Radiology, Boston, MA, USA
| | - Vandana Dialani
- Beth Israel Deaconess Medical Center, Department of Radiology, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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14
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Hu JS, Phillips J, Wee CP, Pangaro LN. Physician Burnout-Evidence That Leadership Behaviors Make a Difference: A Cross-Sectional Survey of an Academic Medical Center. Mil Med 2023; 188:e1580-e1587. [PMID: 36260483 DOI: 10.1093/milmed/usac312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/08/2022] [Accepted: 09/27/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION High rates of physician burnout are well documented in the USA. Identifying beneficial leadership behaviors as an organizational approach to mitigating burnout can lead to improved wellness in the physicians that they lead; however, few studies have examined which leadership behaviors are beneficial and which may be detrimental. MATERIALS AND METHODS This survey study of academic medical center physicians and their physician leaders assessed the correlation between burnout and leadership behaviors. Data were analyzed for the strength of correlation between scores for leadership behaviors and self-reported physician burnout with analysis of variance by sex, time from training, specialty, and age. RESULTS Of 1,145 physicians surveyed, 305 returned surveys. Among the respondents, 45% were female, 25% were 56 years or older, and 57% self-identified as practitioners of medicine or medicine subspecialties. Two transformational leadership categories of behaviors (idealized influence behaviors and individualized consideration) and one transactional leadership behavior category (contingent reward) correlated favorably with all domains of burnout (P < .0001). Conversely, two transactional leadership categories of burnout (management by exception passive and laissez-faire) correlated unfavorably with all burnout domains. CONCLUSIONS Organizational interventions are needed to improve burnout in physicians. Adopting favorable leadership behaviors while avoiding unfavorable leadership behaviors can improve burnout in those physicians being led. These findings could inform the conceptual basis of future physician leadership training programs as transactional leadership behaviors also have an impact on physician wellness.
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Affiliation(s)
- James S Hu
- Department of Medicine, University of Southern California/Norris Comprehensive Cancer Center, Los Angeels, CA 90033, USA
| | - Jennifer Phillips
- University of Southern California, Rossier School of Education, Los Angeles, CA 90089, USA
| | - Choo Phei Wee
- Department of Population and Public Health Sciences, Southern California Clinical and Translational Science Institute, University of Southern California/Keck School of Medicine, Los Angeles, CA 90089, USA
| | - Louis N Pangaro
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA
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15
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Boyd NM, Larson S. Building community at work: An exploratory study in healthcare system management. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:2276-2299. [PMID: 36930613 DOI: 10.1002/jcop.23027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/25/2023] [Accepted: 03/03/2023] [Indexed: 06/14/2023]
Abstract
Recent scholarship has demonstrated that experiences in the community (i.e., a sense of community [SOC] and a SOC responsibility) can enhance employee psychological and behavioral outcomes. Recent evidence also shows that the experiences of the community are better able to predict employee outcomes compared to long-regarded management and public management constructs. However, very little empirical evidence exists on antecedent conditions that help build community experiences at work. To evaluate this gap, we conducted interviews with executive leaders, and focus groups with administrative leaders, across four major facilities in a large nonprofit healthcare system that is headquartered in Pennsylvania, United States. The study confirmed the propositions of the Community Experience Model, and explored organizational conditions that appear to build community experiences. The findings help frame factors that scholars can empirically test in future studies, and assist executives, human resource professionals, and managers throughout an organization, in building community at work.
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Affiliation(s)
- Neil M Boyd
- Management & Organizations Department, Freeman College of Management, Bucknell University, Lewisburg, Pennsylvania, USA
| | - Sharon Larson
- Thomas Jefferson University College of Population Health, Philadelphia, Pennsylvania, USA
- Main Line Health Center for Population Health Research, Lankenau Institute for Medical Research, Philadelphia, Pennsylvania, USA
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16
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Peccoralo LA, Pietrzak RH, Tong M, Kaplan S, Feingold JH, Feder A, Chan C, Verity J, Charney D, Ripp J. A Longitudinal Cohort Study of Factors Impacting Healthcare Worker Burnout in New York City During the COVID-19 Pandemic. J Occup Environ Med 2023; 65:362-369. [PMID: 36727906 PMCID: PMC10171104 DOI: 10.1097/jom.0000000000002790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study aimed to longitudinally examine the prevalence and correlates of burnout in frontline healthcare workers (FHCWs) during COVID-19 in New York City. METHODS A prospective cohort study of 786 FHCWs at Mount Sinai Hospital was conducted during the initial COVID surge in April to May 2020 (T1) and November 2020 to January 2021 (T2) to assess factors impacting burnout. RESULTS Burnout increased from 38.9% to 44.8% ( P = 0.002); 222 FHCWs (28.3%) had persistent burnout, 82 (10.5%) had early burnout, and 129 (16.5%) had delayed burnout. Relative to FHCWs with no burnout ( n = 350; 44.7%), those with persistent burnout reported more prepandemic burnout (relative risk [RR], 6.67), less value by supervisors (RR, 1.79), and lower optimism (RR, 0.82), whereas FHCWs with delayed burnout reported more prepandemic burnout (RR, 1.75) and caring for patients who died (RR, 3.12). CONCLUSION FHCW burnout may be mitigated through increasing their sense of value, support, and optimism; treating mental health symptoms; and counseling regarding workplace distress.
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17
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Friedson AI, Humphreys A, LeCraw F, Pelletreau B, Vierra P, Mroz TA. Comparison of Health Care Worker Satisfaction Before vs After Implementation of a Communication and Optimal Resolution Program in Acute Care Hospitals. JAMA Netw Open 2023; 6:e232302. [PMID: 36892843 PMCID: PMC9999242 DOI: 10.1001/jamanetworkopen.2023.2302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Abstract
This case-control study investigates the association between a communication and optimal resolution program to address unexpected adverse patient outcomes and measures of health care worker satisfaction.
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Affiliation(s)
| | | | - Florence LeCraw
- Northside Healthcare System, Atlanta, Georgia
- Andrew Young School of Policy Studies, Georgia State University, Atlanta
| | | | | | - Thomas A. Mroz
- Andrew Young School of Policy Studies, Georgia State University, Atlanta
- Federal Reserve Bank of Atlanta, Atlanta, Georgia
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18
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Ali A, Hamid TA, Naveed RT, Siddique I, Ryu HB, Han H. Preparing for the “black swan”: Reducing employee burnout in the hospitality sector through ethical leadership. Front Psychol 2022; 13:1009785. [PMID: 36312154 PMCID: PMC9597687 DOI: 10.3389/fpsyg.2022.1009785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/28/2022] [Indexed: 11/17/2022] Open
Abstract
Hospitality is at a crossroads. While the growth and developmental indicators in this sector show economic potential, the rising employee burnout rate is a serious challenge to hospitality management. Literature suggests that an ethical leader can reduce employee burnout significantly. Although hospitality employees face a higher risk of burnout than other service segments, shockingly, past leadership studies did not focus on how ethical leaders in a hospitality organization may reduce the risk of burnout. Therefore, we conducted this research to explore ethical leadership-burnout relationships in the hospitality sector with the mediating effects of subjective wellbeing and employee resilience. A questionnaire was provided to employees in different hotel organizations (n = 346). Structural equation modeling was employed for hypothesis testing. The statistical evidence supported the theoretical assumptions that ethical leadership negatively predicts employee burnout, and subjective wellbeing and resilience mediate this relationship. The outcomes of this study suggest different theoretical and social implications. For example, the findings indicate the effectiveness of ethical leadership in reducing employee burnout in the hospitality sector. Several other implications have been discussed in detail.
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Affiliation(s)
- Anis Ali
- Department of Management, College of Business Administration, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Tasawar Abdul Hamid
- OUS Royal Academy of Economics and Technology in Switzerland, Zurich, Switzerland
| | - Rana Tahir Naveed
- Division of Management and Administrative Sciences, University of Education (UE) Business School, University of Education, Lahore, Pakistan
| | - Irfan Siddique
- Faculty of Management Studies, University of Central Punjab, Lahore, Pakistan
| | - Hyungseo Bobby Ryu
- Food Franchise Department, College of Health Sciences, Kyungnam University, Changwon, South Korea
- *Correspondence: Hyungseo Bobby Ryu
| | - Heesup Han
- College of Hospitality and Tourism Management, Sejong University, Seoul, South Korea
- Heesup Han
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19
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Shanafelt T, Trockel M, Wang H, Mayer T, Athey L. Assessing Professional Fulfillment and Burnout Among CEOs and Other Healthcare Administrative Leaders in the United States. J Healthc Manag 2022; 67:317-338. [PMID: 35984407 PMCID: PMC9447437 DOI: 10.1097/jhm-d-22-00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
GOAL The objective of this study was to evaluate the prevalence of burnout and professional fulfillment among healthcare administrative leaders and examine the association between burnout and professional fulfillment and personal and professional characteristics. METHODS Between June 7 and June 30, 2021, we performed a national survey of CEOs and other senior operational leaders to evaluate their personal work experience. Burnout and professional fulfillment-as well as a sleep-related impairment and self-valuation-were assessed using standardized instruments. PRINCIPLE FINDINGS Of the 5,994 members of the American College of Healthcare Executives who were sent an invitation to participate, 1,269 (21.2%), including 279 CEOs, submitted usable responses. The mean overall burnout score was 2.71 (range: 0-10), and 33% of participants had burnout scores that fell in the high range (unfavorable). Mean professional fulfillment score was 7.29 (range: 0-10), with 56.6% scoring in the high range (favorable). Burnout and professional fulfillment scores varied by role. On multivariable analysis, sleep-related impairment (OR for each 1-point increase = 1.29, 95% CI [1.19-1.41]; p < .001) and self-valuation (OR for each 1-point increase = 0.63, 95% CI [0.57-0.68]; p < .001) were independently associated with burnout after adjusting for all other variables. APPLICATIONS TO PRACTICE Results of this study suggest that healthcare leaders had lower burnout and professional fulfillment scores than clinicians. Nonetheless, one third of healthcare leaders had burnout scores that fell in the high range. At the individual level, improved sleep health and self-valuation appear to reduce risk of burnout and promote professional fulfillment.
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Affiliation(s)
| | | | | | | | - Leslie Athey
- American College of Healthcare Executives, Chicago, Illinois
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20
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Chan MK, Volk A, Patro N, Lee W, Sonnenberg LK, Dath D, Meschino DDC. Creating space for leadership education in undergraduate medical education in Canada. CANADIAN MEDICAL EDUCATION JOURNAL 2022; 13:36-48. [PMID: 36091741 PMCID: PMC9441118 DOI: 10.36834/cmej.73216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The need for effective leadership by physicians is clear, yet the design/delivery of curricula, and assessment of leadership competencies, in Undergraduate Medical Education (UGME) continues to need work. In reappraising their UGME assessment strategies, the Medical Council of Canada (MCC) invited position papers across diverse lenses, including the CanMEDS Intrinsic Roles. This article is foundational work derived from the report on leadership assessment to the MCC. Using Kern's Model of Curriculum development as a guide, we reviewed the landscape of Canadian UGME leadership education through an environmental scan of the published and grey literature, Canadian leadership frameworks and resources, and consultation with learner and faculty leadership. Leadership education across programs was highly variable and learners were often unaware of available opportunities. In response, we have suggested processes for curricular development, including strategies for key content, teaching and assessment, and program evaluation considerations. Leadership education cannot remain another checkbox on a list of UGME experiences. Such training necessitates focused attention and investment to foster ongoing identity formation toward becoming a good doctor.
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Affiliation(s)
- Ming-Ka Chan
- Office of Leadership Education, Rady Faculty of Health Sciences, University of Manitoba, Manitoba, Canada
| | - Auriele Volk
- Faculty of Medicine & Dentistry, University of Alberta, Alberta, Canada
| | - Nivedh Patro
- Department of Family Medicine, Michael G. DeGroote School of Medicine, McMaster University, Ontario, Canada
| | - Wonjae Lee
- Michael G. DeGroote School of Medicine, McMaster University, Ontario, Canada
| | - Lyn K Sonnenberg
- Office of Educational Innovation & Academic Technologies, Faculty of Medicine & Dentistry, University of Alberta, Alberta, Canada
- Neurodevelopmental Pediatrics, Glenrose Rehabilitation Hospital, Alberta, Canada
| | - Deepak Dath
- Department of Surgery, McMaster University, Ontario, Canada
| | - Diane de Camps Meschino
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
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21
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Khoo E, Saeed SG, Chiu HY, Quach V, Janal M, Stewart K. Stress and anxiety in orthodontic residents during the coronavirus disease 2019 pandemic. Am J Orthod Dentofacial Orthop 2022; 162:e35-e43. [PMID: 35589506 PMCID: PMC9058028 DOI: 10.1016/j.ajodo.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 04/04/2022] [Accepted: 04/04/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The coronavirus disease 2019 pandemic has had far-reaching effects on health care providers and health professional students; however, little is known about the factors related to stress and anxiety levels, specifically among orthodontic residents during this time. METHODS A 2-part questionnaire, which included modified stress and anxiety inventories, was disseminated electronically to U.S. orthodontic residents between June and July 2020. Descriptive and comparative statistics were used to analyze the data. RESULTS Overall, 261 participants responded (56% female), representing a response rate of 26.8%. Significant gender differences were found in 18 stress items, with female respondents expressing more stress than their male counterparts. Only 1 stress item (ie, fear of being unable to catch up if behind) varied as a function of the difference on the basis of respondents' stage in the program. First-year residents reported more stress in relation to this than more senior residents. Responses to all anxiety items but 1 item varied by gender, with females reporting higher scores. Residents in the middle stages of their program responded with higher anxiety scores with significant differences on 3 anxiety items. CONCLUSIONS Although financial responsibilities and travel plans were the most stressful and anxiety-inducing items for orthodontic residents during the early aspect of the coronavirus disease 2019 pandemic, multiple items contributed to their stress and anxiety. In addition, both gender and stage of progress in a residency program impacted the level of stress and anxiety reported by respondents.
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Affiliation(s)
- Edmund Khoo
- Department of Orthodontics and Oral Facial Genetics, Indiana University School of Dentistry, Indianapolis, Ind,Eastman Institute of Oral Health, University of Rochester, Rochester, NY,Address correspondence to: Edmund Khoo, 301 E 22nd St, Apt 9M, New York, NY 10010
| | - Sophia G. Saeed
- School of Dental Medicine, University of Connecticut, Farmington, Conn
| | - Hong-Yan Chiu
- Department of Orthodontics, College of Dentistry, New York University, New York, NY
| | - Vicky Quach
- College of Dentistry, New York University, New York, NY
| | - Malvin Janal
- Department of Epidemiology and Health Promotion, College of Dentistry, New York University, New York, NY
| | - Kelton Stewart
- Department of Orthodontics and Oral Facial Genetics, Indiana University School of Dentistry, Indianapolis, Ind
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22
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Mete M, Goldman C, Shanafelt T, Marchalik D. Impact of leadership behaviour on physician well-being, burnout, professional fulfilment and intent to leave: a multicentre cross-sectional survey study. BMJ Open 2022; 12:e057554. [PMID: 36691255 PMCID: PMC9171269 DOI: 10.1136/bmjopen-2021-057554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 04/28/2022] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE To examine how perceived leadership behaviours affect burnout, professional fulfilment and intent to leave the organisation among physicians. DESIGN Anonymous cross-sectional survey study from November 2016 to October 2018. SETTING 12 036 attending and resident physicians at 11 healthcare organisations participating in the Physician Wellness Academic Consortium (PWAC) were surveyed to assess burnout and professional fulfilment and their drivers. PARTICIPANTS A sample of 5416 attending physicians with complete data on gender, specialty, leadership, burnout and professional fulfilment. MAIN OUTCOMES AND MEASURES The leadership behaviour of each physician's supervisor was assessed using the Mayo Clinic Participatory Management Leadership Index and categorised in tertiles. Multivariable logistic regression analyses examined the effect of leadership behaviour rating of each physician's supervisor on burnout, professional fulfilment and intent to leave controlling for gender and specialty. RESULTS The response rate was 45% across 11 institutions. Half of the respondents were female. Professional fulfilment increased with increasing tertiles of leadership behaviour rating (19%, 34%, 47%, p<0.001). The odds of professional fulfilment were 5.8 times higher (OR=5.8, 95% CI: 5.1 to 6.59) for physicians in the top tertile compared with those in the lowest tertile. Physicians in the top tertile were also 48% less likely to be burned out (OR=0.52, 95% CI: 0.45 to 0.61) and reported 66% lower intent to leave (OR=0.34, 95% CI: 0.26 to 0.44). Individuals who rated their supervisor's leadership in upper tertiles relative to lower tertiles exhibited lower levels of burnout (18% vs 35% vs 47%, p<0.001), and intent to leave (16% vs 24% vs 50% p<0.001). CONCLUSION Perceived leadership behaviours have a strong relationship with burnout, professional fulfilment and intent to leave among physicians. Organisations should consider leadership development as a potential vehicle to improve physician wellness and prevent costly physician departures.
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Affiliation(s)
- Mihriye Mete
- Department of Behavioral Health Research, MedStar Health Research Institute, Hyattsville, Maryland, USA
- Department of Psychiatry, Georgetown University Medical Center, Washington, District of Columbia, USA
- MedStar Health Center for Wellbeing, Washington, District of Columbia, USA
| | - Charlotte Goldman
- Department of Urology, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Tait Shanafelt
- Department of Medicine, Stanford University, Stanford, California, USA
| | - Daniel Marchalik
- MedStar Health Center for Wellbeing, Washington, District of Columbia, USA
- Department of Urology, Georgetown University School of Medicine, Washington, District of Columbia, USA
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Zeidan S, Prentice C, Nguyen M. Securing jobs with individual trait and organisational support? INTERNATIONAL JOURNAL OF ORGANIZATIONAL ANALYSIS 2022. [DOI: 10.1108/ijoa-12-2021-3076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
In view of the COVID-19 pandemic’s impact on organisations and employees, this study aims to investigate a reverse relationship between role conflict, burnout and job insecurity, and proposed emotional intelligence (EI) and organisational support as individual and organisational factors, respectively, that may moderate this chain relationship. Drawing on conservation of resources (COR) theory, this paper proposes that organisational support as an organisational factor and EI as an individual ability may aid in minimising the perception of the depletion of resources and play a moderating role in conflict–burnout–job insecurity relationships.
Design/methodology/approach
This study was undertaken in Australia with a focus on those who were employed and worked during the COVID-19 pandemic. The survey was conducted online using the Qualtrics platform as it offers user-friendly features for respondents. In total, 723 usable responses were generated for data analysis. Structural equation modelling was performed to test the hypotheses of this study.
Findings
The results show that role conflict was significantly related to burnout, which in turn led to job insecurity. EI and organisational support reduced the impact of burnout on job insecurity.
Originality/value
Theoretically, this research deepens an understanding of COR and role theory and contributes to mental health research and organisational studies. COR depicts individuals’ reservation of resources for desired or expected outcomes. This study approached from a depletion of resources perspective and revealed the consequences for both individuals and organisations. This study also expands role theory and includes job and family-derived roles to deepen the role conflict during the pandemic. Whilst most research taps into the job performance and behaviour domain to understand the impact of role conflict, this study proposed a novel concept of a mediation relationship between role conflict, burnout and job insecurity in line with the status quo of the pandemic. Consequently, this study contributes to job attitude research by approaching the antecedents from a combination of organisational, individual and situational factors because role conflict is reflected as a clash of job demands, family obligations and responsibilities, and the pandemic situation.
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Workplace Cognitive Failure among Nurses during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910394. [PMID: 34639695 PMCID: PMC8508323 DOI: 10.3390/ijerph181910394] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 12/20/2022]
Abstract
Numerous studies provide evidence of the physical and emotional strain experienced by nurses during the COVID-19 pandemic. However, little is known regarding the impact of this occupational strain on nurses’ cognitive function at work. The aim of this study was to identify factors associated with workplace cognitive failure in a sample of U.S. nurses during the COVID-19 pandemic. An online questionnaire was administered in May 2020 to Michigan nurses statewide via three nursing organizations (n = 695 respondents). Path analysis was conducted to test the parallel effects of frequency of contact with COVID patients and personal protective equipment (PPE) supply on workplace cognitive failure scores. Mediation effects of stress, sleep quality, secondary trauma, and work-related exhaustion were examined for each exposure. Results revealed significant indirect effects of all mediators except sleep quality of contact with COVID patients (cumulative indirect effect = 1.30, z = 6.33, p < 0.001) and PPE (cumulative indirect effect = −2.10, z = −5.22, p < 0.001) on cognitive failure. However, 58% of the PPE effect was direct. To reduce the risk of cognitive failure, healthcare organizations need to provide nurses with protective equipment and work environments that allow nurses to strengthen their resilience to extreme working conditions.
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Home Is Where the Heart Is, but What About That Other Place You Spend Your Time? Anesth Analg 2021; 133:860-862. [PMID: 34524985 DOI: 10.1213/ane.0000000000005542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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26
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Dyrbye LN, Major-Elechi B, Hays JT, Fraser CH, Buskirk SJ, West CP. Physicians' Ratings of their Supervisor's Leadership Behaviors and Their Subsequent Burnout and Satisfaction: A Longitudinal Study. Mayo Clin Proc 2021; 96:2598-2605. [PMID: 34538425 DOI: 10.1016/j.mayocp.2021.01.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 01/20/2021] [Accepted: 01/25/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the relationships between immediate supervisors' leadership qualities and the subsequent levels and changes in burnout and satisfaction of supervised physicians 2 years later. PARTICIPANTS AND METHODS In 2015 and 2017 physicians were asked to complete surveys that included the 9-item Mayo Clinic Leadership Score (range, 9 to 45) assessing their supervisor, an item about satisfaction with the organization, and two items from the Maslach Burnout Inventory. Individual participants' responses to the surveys were linked. RESULTS Among the 3698 physicians invited to complete both the 2015 and 2017 survey, 1795 (48.5%) responded. The mean composite baseline leadership score was 38.1 (SD, 8.4). Lower mean baseline leadership scores were reported by physicians who had burnout (mean [SD], 36.0 [9.7] vs 39.1 [7.3]; P<.001) 2 years later in comparison to those who did not have burnout 2 years later. In multivariable analysis, higher baseline leadership score of supervisors was independently associated with lower odds of physicians having burnout 2 years later (for each 1-point increase, odds ratio, 0.98; 95% CI, 0.96 to 0.99; P=.002) after adjusting for burnout at baseline, age, gender, length of service, and specialty. Baseline composite leadership score of supervisors was also independently associated with physicians' satisfaction with the organization 2 years later (odds ratio, 1.05; 95% CI, 1.03 to 1.07; P<.0001). CONCLUSION Physicians' ratings of their immediate supervisors' leadership qualities were associated with their subsequent levels and changes in burnout and satisfaction 2 years later. Additional studies are needed to determine the effect of sharing such scores with immediate supervisors and providing additional leadership training to those with low scores, and if doing so ultimately reduces burnout and improves satisfaction of the supervised physicians.
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Affiliation(s)
| | | | - J Taylor Hays
- Department of Mayo Clinic Leadership and Workforce Development, Rochester, MN
| | | | | | - Colin P West
- Mayo Clinic Program on Physician Well-Being, Rochester, MN
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Sonnenberg LK, Do V, Maniate J, Chan MK, Kvern B, Prevost B, Busari J. Deconstructing the ABC’s of leadership for successful curriculum development and implementation in residency education. Leadersh Health Serv (Bradf Engl) 2021. [DOI: 10.1108/lhs-03-2021-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Leadership decisions occur frequently throughout the day, yet as clinicians, who balance multiple roles and responsibilities, the authors seldom label them explicitly. This translates to missed opportunities to foster the requisite skill sets junior trainees to require in their current and future contexts. While there is clear evidence for a purposeful leadership curriculum, developing, implementing and assessing these competencies remains challenging. The purpose of this paper is to provide educators with a curricular approach to incorporate leadership opportunities in their own teaching and supervisory practices.
Design/methodology/approach
A dyadic “teaching and assessment” strategy may overcome leadership curricular challenges. The authors propose a new framework that breaks down leadership opportunities into their requisite learning settings. Like fine wine and cheese, these learning experiences are paired with assessment strategies to provide further formative and summative feedback, all in the context of educational theories and frameworks.
Findings
In this paper, the authors recommend six unique learning environments for educators to consider, captured in the abbreviation ABC’S3 for administrative, bedside, classroom, simulation, self-awareness and summarization, all of which lend themselves to leadership development opportunities for resident physicians. The authors provide tested examples and pair these teaching options with a variety of assessment strategies to choose from.
Practical implications
Three practical implications are put forth in this paper, namely, leadership competencies are needed for everyone, not just for those with leadership titles or positions; multiple learning settings (and all aspects of work) can be harnessed to provide diverse leadership opportunities; and advancement beyond Miller’s knows is needed to create opportunities to hone practical leadership competencies in the shows how and does levels.
Originality/value
This paper uniquely pairs learning opportunities with assessment strategies across diverse practical settings and environments. These techniques and opportunities will serve to stimulate ideas and kick-start dialogue about incorporating a practical leadership curriculum within clinical training programs.
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Dyrbye LN, Major-Elechi B, Thapa P, Hays JT, Fraser CH, Buskirk SJ, West CP. Characterization of Nonphysician Health Care Workers' Burnout and Subsequent Changes in Work Effort. JAMA Netw Open 2021; 4:e2121435. [PMID: 34415312 PMCID: PMC8379653 DOI: 10.1001/jamanetworkopen.2021.21435] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
IMPORTANCE Burnout is a pervasive, unrelenting problem among health care workers (HCWs), with detrimental impact to patients. Data on the impact of burnout on workforce staffing are limited and could help build a financial case for action to address system-level contributors to burnout. OBJECTIVE To explore the association of burnout and professional satisfaction with changes in work effort over 24 months in a large cohort of nonphysician HCWs. DESIGN, SETTING, AND PARTICIPANTS This longitudinal cohort study was conducted in Rochester, Minnesota; Scottsdale and Phoenix, Arizona; Jacksonville, Florida; and community-based hospitals and health care facilities in the Midwest among nonphysician HCWs who responded to 2 surveys from 2015 to 2017. Analysis was completed November 25, 2020. EXPOSURES Burnout, as measured by 2 items from the Maslach Burnout Inventory, and professional satisfaction. MAIN OUTCOMES AND MEASURES The main outcome was work effort, as measured in full-time equivalent (FTE) units, recorded in payroll records. RESULTS Data from 26 280 responders (7293 individuals aged 45-54 years [27.8%]; 20 263 [77.1%] women) were analyzed. A total of 8115 individuals (30.9%) had worked for the organization more than 15 years, and 6595 individuals (25.1%) were nurses. After controlling for sex, age, duration of employment, job category, baseline FTE, and baseline burnout, overall burnout (odds ratio [OR], 1.53; 95% CI, 1.38-1.70; P < .001), high emotional exhaustion at baseline (OR, 1.54; 95% CI, 1.39-1.71; P < .001), and high depersonalization at baseline (OR, 1.40; 95% CI, 1.21-1.62; P < .001) were associated with an HCW reducing their FTE over the following 24 months. Conversely, satisfaction with the organization at baseline was associated with lower likelihood of reduced FTE (OR, 0.73; 95% CI, 0.65-0.83; P < .001). Findings were similar when emotional exhaustion (OR per 1-point increase, 1.12; 95% CI, 1.10-1.16; P < .001), depersonalization (OR per 1-point increase, 1.10; 95% CI, 1.06-1.14; P < .001) and satisfaction with the organization (OR per 1-point increase, 0.83; 95% CI, 0.79-0.88; P < .001) were modeled as continuous measures. Nurses represented the largest group (1026 of 1997 nurses [51.4%]) reducing their FTE over the 24 months. CONCLUSIONS AND RELEVANCE This cohort study found that burnout and professional satisfaction of HCWs were associated with subsequent changes in work effort over the following 24 months. These findings highlight the importance of addressing factors contributing to high stress among all HCWs as a workforce retention and cost reduction strategy.
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Affiliation(s)
- Liselotte N. Dyrbye
- Mayo Clinic Program on Physician Well-Being, Mayo Clinic, Rochester, Minnesota
| | | | - Prabin Thapa
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - J. Taylor Hays
- Mayo Clinic Leadership and Workforce Development, Mayo Clinic, Rochester, Minnesota
| | | | - Steven J. Buskirk
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Colin P. West
- Mayo Clinic Program on Physician Well-Being, Mayo Clinic, Rochester, Minnesota
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Parikh JR, Bender CE. How Radiology Leaders Can Address Burnout. J Am Coll Radiol 2021; 18:679-684. [PMID: 33958083 DOI: 10.1016/j.jacr.2020.12.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/08/2020] [Accepted: 12/02/2020] [Indexed: 12/23/2022]
Abstract
The 2018 Annual Workforce Survey conducted by the ACR Commission on Human Resources demonstrated that, although the majority of radiology practice leaders acknowledge radiologist burnout as a significant problem, only about one in five leaders responded that their practices were either extremely or very effective at addressing physician burnout. Moving forward, leaders will be increasingly held accountable and expected to describe to their teams their reasons for not addressing burnout. In this article, common misperceptions that may contribute to radiology practice leaders not addressing burnout are described, followed by outlining practical skills that leaders should develop to effectively address burnout.
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Affiliation(s)
- Jay R Parikh
- Professor of Radiology, Division Wellness Lead, Division of Diagnostic Imaging, The University MD Anderson Cancer Center, Houston, Texas.
| | - Claire E Bender
- Professor, Department of Radiology, Mayo Clinic, Rochester, Minnesota
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Gautham KS, West CP. The Role of Leaders in Promoting Health Professional Wellness and Improving the Culture of Safety: Does a Positive Approach Matter? Jt Comm J Qual Patient Saf 2021; 47:399-400. [PMID: 34120874 DOI: 10.1016/j.jcjq.2021.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Shanafelt T, Trockel M, Rodriguez A, Logan D. Wellness-Centered Leadership: Equipping Health Care Leaders to Cultivate Physician Well-Being and Professional Fulfillment. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:641-651. [PMID: 33394666 PMCID: PMC8078125 DOI: 10.1097/acm.0000000000003907] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
These are challenging times for physicians. Extensive changes in the practice environment have altered the nature of physicians' interactions with patients and their role in the health care delivery system. Many physicians feel as if they are "cogs in the wheel" of austere corporations that care more about productivity and finances than compassion or quality. They often do not see how the strategy and plan of their organization align with the values of the profession. Despite their expertise, they frequently do not feel they have a voice or input in the operational plan of their work unit, department, or organization. At their core, the authors believe all of these factors represent leadership issues. Many models of leadership have been proposed, and there are a number of effective philosophies and approaches. Here, the authors propose a new integrative model of Wellness-Centered Leadership (WCL). WCL includes core skills and qualities from the foremost leadership philosophies along with evidence on the relationship between leadership and physician well-being and distills them into a single framework designed to cultivate leadership behaviors that promote engagement and professional fulfillment. The 3 elements of WCL are: care about people always, cultivate individual and team relationships, and inspire change. A summary of the mindset, behaviors, and outcomes of the elements of the WCL model is presented, and the application of the elements for physician leaders is discussed. The authors believe that learning and developing the skills that advance these elements should be the aspiration of all health care leaders and a foundational focus of leadership development programs. If cultivated, the authors believe that WCL will empower individual and team performance to address the current problems faced by health care organizations as well as the iterative innovation needed to address challenges that may arise in the decades to come.
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Affiliation(s)
- Tait Shanafelt
- T. Shanafelt is chief wellness officer, Jeanie and Stewart Ritchie Professor of Medicine, and associate dean, Stanford School of Medicine, Stanford, California; ORCID: http://orcid.org/0000-0002-7106-5202
| | - Mickey Trockel
- M. Trockel is clinical associate professor, Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Stanford, California
| | - Ashleigh Rodriguez
- A. Rodriguez is currently a consultant, CMA Wellness Services, California Medical Association, Sacramento, California. At the time of writing, she was a graduate student, USC Marshall School of Business, Los Angeles, California
| | - Dave Logan
- D. Logan is chief executive officer, CMA Wellness Services, California Medical Association, Sacramento, and senior lecturer, Department of Management and Organization, University of Southern California, Los Angeles, California
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Armenta-Hernández O, Maldonado-Macías A, Camacho-Alamilla MDR, Serrano-Rosa MÁ, Baez-Lopez YA, Balderrama-Armendariz CO. The Relationship Between the Burnout Syndrome Dimensions and Body Mass Index as a Moderator Variable on Obese Managers in the Mexican Maquiladora Industry. Front Psychol 2021; 12:540426. [PMID: 33613371 PMCID: PMC7889810 DOI: 10.3389/fpsyg.2021.540426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 01/11/2021] [Indexed: 12/27/2022] Open
Abstract
Burnout syndrome (BS) and obesity are two growing conditions that affect employees' health and company productivity. Recently, several studies have pointed to a possible relationship between both phenomena. However, such a relationship has not been clearly defined. This research analyzes the relationship between BS dimensions and body mass index (BMI), the latter being treated as a moderator variable among obese senior and middle managers in the Mexican maquiladora industry through a structural equation model. A total of 361 senior and middle managers (124 of them classified as obese under the World Health Organization's criteria) completed both the Maslach Burnout Inventory-General Survey [with emotional exhaustion (EE), cynicism, and professional efficacy (PE) as subscale dimensions] and a sociodemographic questionnaire (which included BMI). The results showed a statistically significant relationship between EE and PE (P < 0.001; β = -0.320), with BMI acting as a moderator variable. The results showed that when BMI increases as a moderator variable, the strength of the relationship between EE and PE also changes. For example, although PE had a negative value of 0.14 before the moderator effect, the value increased up to 0.32 when the BMI was factored into the relationship. Therefore, maquiladora industries are being advised to increase their investments on the identification and prevention of employees' EE and obesity. Such interventions would promote a better quality of life and could prevent economic losses resulting from poor employee performance.
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Affiliation(s)
- Oziely Armenta-Hernández
- Electric and Computing Engineering Department, Universidad Autónoma de Ciudad Juárez (Autonomous University of Ciudad Juarez), Ciudad Juarez, Mexico
| | - Aidé Maldonado-Macías
- Industrial Engineering and Manufacturing, Universidad Autonoma de Ciudad Juárez (Autonomous University of Ciudad Juarez, Ciudad Juarez, Mexico
| | - María del Rocío Camacho-Alamilla
- Industrial Engineering and Manufacturing, Universidad Autonoma de Ciudad Juárez (Autonomous University of Ciudad Juarez, Ciudad Juarez, Mexico
| | | | - Yolanda Angélica Baez-Lopez
- Facultad de Arquitectura, Ingeniería y Diseño, Universidad Autónoma de Baja California (Autonomous University of Baja California), Baja California, Mexico
| | - Cesar Omar Balderrama-Armendariz
- Department of Industrial Design, Universidad Autónoma de Ciudad Juárez (Autonomous University of Ciudad Juarez), Ciudad Juarez, Mexico
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Cavanaugh KJ, Lee HY, Daum D, Chang S, Izzo JG, Kowalski A, Holladay CL. An Examination of Burnout Predictors: Understanding the Influence of Job Attitudes and Environment. Healthcare (Basel) 2020; 8:healthcare8040502. [PMID: 33233620 PMCID: PMC7711622 DOI: 10.3390/healthcare8040502] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/04/2020] [Accepted: 11/17/2020] [Indexed: 11/16/2022] Open
Abstract
Burnout amongst healthcare employees is considered an epidemic; prior research indicates a host of associated negative consequences, though more research is needed to understand the predictors of burnout across healthcare employees. All employees in a cancer-focused academic healthcare institution were invited to participate in a bi-annual online confidential employee survey. A 72% response rate yielded 9979 complete responses. Participants completed demographic items, a validated single-item measure of burnout, and items measuring eight employee job attitudes toward their jobs and organization (agility, development, alignment, leadership, trust, resources, safety, and teamwork). Department-level characteristics, turnover, and vacancy were calculated for group level analyses. A univariate F test revealed differences in burnout level by department type (F (3, 9827) = 54.35, p < 0.05) and post hoc Scheffe's tests showed employees in clinical departments reported more burnout than other departments. Hierarchical multiple regression revealed that employee demographic and job-related variables (including department type) explained 8% of the variance of burnout (F (19, 7880) = 37.95, p < 0.001), and employee job attitudes explained an additional 27% of the variance of burnout (F (8, 7872) = 393.18, p < 0.001). Relative weights analysis at the group level showed that, of the constructs measured, alignment is the strongest predictor of burnout, followed by trust and leadership. The relationships are inverse in nature, such that more alignment is related to less burnout. Turnover and vacancy rates did not predict group level burnout. The results reported here provide evidence supporting a shift in the focus of research and practice from detection to prevention of employee burnout and from individual-focused interventions to organization-wide interventions to prevent burnout.
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Affiliation(s)
- Katelyn J. Cavanaugh
- Leadership Institute, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Hwa Young Lee
- Cancer Prevention Training Program, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | | | - Shine Chang
- Epidemiology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Julie G. Izzo
- Human Resources Administration, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Alicia Kowalski
- Anesthesiology & Peri-Operative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Courtney L. Holladay
- Leadership Institute, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
- Correspondence: ; Tel.: +1-713-745-6450
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Egener B. From Clinician to Organizational Wellness. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1627. [PMID: 33109962 DOI: 10.1097/acm.0000000000003669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Barry Egener
- Professional wellness lead, Asante Health System, Medford, Oregon;
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Chesak SS, Perlman AI, Gill PR, Bhagra A. Strategies for Resiliency of Medical Staff During COVID-19. Mayo Clin Proc 2020; 95:S56-S59. [PMID: 32948261 PMCID: PMC7430298 DOI: 10.1016/j.mayocp.2020.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/02/2020] [Indexed: 11/17/2022]
Affiliation(s)
| | - Adam I Perlman
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL
| | | | - Anjali Bhagra
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN.
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Lehto RH, Heeter C, Forman J, Shanafelt T, Kamal A, Miller P, Paletta M. Hospice Employees' Perceptions of Their Work Environment: A Focus Group Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176147. [PMID: 32847036 PMCID: PMC7503310 DOI: 10.3390/ijerph17176147] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/13/2020] [Accepted: 08/17/2020] [Indexed: 11/16/2022]
Abstract
Burnout in healthcare professionals can lead to adverse effects on physical and mental health, lower quality of care, and workforce shortages as employees leave the profession. Hospice professionals are thought to be at particularly high risk for burnout. The purpose of the study was to evaluate workplace perceptions of interdisciplinary hospice care workers who provide care to patients at end of life. Six focus groups and one semi-structured interview were conducted with mixed group of social workers, managers, nurses, hospice aides, chaplains, support staff, and a physician (n = 19). Findings from the groups depicted both rewards and challenges of hospice caregiving. Benefits included intrinsic satisfaction from the work, receiving positive patient and family feedback, and teamwork. Challenges reflected issues with workload, technology issues, administrative demands, travel-related problems, communication and interruptions, difficulties with taking time off from work and maintaining work-life integration, and coping with witnessing grief/loss. Hospice workers glean satisfaction from making meaningful differences in the lives of patients with terminal illness and their family members. It is an expected part of the job that certain patients and situations are particularly distressing; team support and targeted grief support is available for those times. Participants indicated that workload and administrative demands rather than dealing with death and dying were the biggest contributors to burnout. Participants reported episodic symptoms of burnout followed by deliberate steps to alleviate these symptoms. Notably, for all except one of the participants, burnout was cyclical. Symptoms would begin, they would take steps to deal with it (e.g., taking a mental health day), and they recovered. At an organizational level, a multipronged approach that includes both personal and occupational strategies is needed to support professional caregivers and help mitigate the stressors associated with hospice work.
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Affiliation(s)
- Rebecca H. Lehto
- College of Nursing, Michigan State University, East Lansing, MI 48824, USA
- Correspondence:
| | - Carrie Heeter
- Department of Media and Information, Communication Arts & Sciences, Michigan State University, East Lansing, MI 48824;
| | - Jeffrey Forman
- Former Medical Director of Development, Karmanos Cancer Institute, Detroit, MI 48201, USA;
| | - Tait Shanafelt
- Department of Medicine, Stanford University, Stanford, CA 94304, USA;
| | - Arif Kamal
- Department of Medicine, Duke Cancer Institute, Duke University, Durham, NC 27710, USA;
| | - Patrick Miller
- Hospice of Michigan, 2366 Oak Valley Drive, Ann Arbor, MI 48103, USA; (P.M.); (M.P.)
| | - Michael Paletta
- Hospice of Michigan, 2366 Oak Valley Drive, Ann Arbor, MI 48103, USA; (P.M.); (M.P.)
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