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Greenberg AL, Cevallos JR, Ojute FM, Davis DL, Greene WR, Lebares CC. The General Surgery Residency Experience: A Multicenter Study of Differences in Wellbeing by Race/Ethnicity. ANNALS OF SURGERY OPEN 2022; 3:e187. [PMID: 37601153 PMCID: PMC10431302 DOI: 10.1097/as9.0000000000000187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/16/2022] [Indexed: 11/26/2022] Open
Abstract
Objectives We explored differences by race/ethnicity in regard to several factors that reflect or impact wellbeing. Background Physician wellbeing has critical ramifications for the US healthcare system, affecting clinical outcomes, patient experience, and healthcare economics. Within surgery, literature examining the association between race/ethnicity and wellbeing has been limited and inconclusive. Methods Residents at 16 academic General Surgery training programs completed an online questionnaire. Racial/ethnic identity, gender identity, post-graduate year (PGY) level, and gap years were self-reported. Differences by race/ethnicity in flourishing (global wellbeing) as well as factors reflecting resilience (mindfulness, personal accomplishment, workplace support, workplace control) and risk (depression, emotional exhaustion, depersonalization, stress, anxiety, workplace demand) were assessed. Results Of 300 respondents (response rate 34%), 179 (60%) were non-male, 123 (41%) were residents of color (ROC), and 53 (18%) were from racial/ethnic groups that are underrepresented in medicine (UIM). Relative to White residents, ROC have significantly lower flourishing and higher anxiety, and these remain significant when adjusting for gender, PGY level, and gap years. Relative to residents overrepresented in medicine (OIM), UIM residents have significantly lower emotional exhaustion and depersonalization after adjusting for gender, PGY level and gap years. Conclusions Disparities in resident wellbeing based on race/ethnicity and UIM/OIM status exist. However, the experience of ROC is not homogeneous. As part of the transformative process to address systemic racism, eliminate disparities in surgical training, and reconceptualize wellbeing as a fundamental asset for optimal surgeon performance, further understanding the specific contributors and detractors of wellbeing among different individuals and groups is critical.
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Affiliation(s)
- Anya L. Greenberg
- From the Department of Surgery, University of California San Francisco, San Francisco, CA
| | - Jenny R. Cevallos
- From the Department of Surgery, University of California San Francisco, San Francisco, CA
| | - Feyisayo M. Ojute
- From the Department of Surgery, University of California San Francisco, San Francisco, CA
| | - Denise L. Davis
- Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Wendy R. Greene
- Department of Surgery, Emory University College of Medicine, Atlanta, GA
| | - Carter C. Lebares
- From the Department of Surgery, University of California San Francisco, San Francisco, CA
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Abstract
OBJECTIVE One potential barrier to optimal healthcare may be provider burnout or occupational-related stress in the workplace. The objective of this study is to conduct a systematic review to identify the predictors of burnout among US. healthcare providers. DESIGN Systematic review using in-depth critical appraisal to assess risk of bias and present the quality of evidence in synthesised results from the prognostic studies. DATA SOURCES We searched 11 databases, registries, existing reviews and contacted experts through 4 October 2021. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included all studies evaluating potential predictors and documenting the presence and absence of associations with burnout assessed as a multidimensional construct. We excluded studies that relied solely on a single continuous subscale of burnout. Data were abstracted from eligible studies and checked for accuracy by a content expert and a methodologist. DATA EXTRACTION AND SYNTHESIS Two reviewers independently screened citations and full-text publications using predetermined eligibility criteria. RESULTS The 141 identified studies evaluated a range of burnout predictors. Findings for demographic characteristics were conflicting or show no association. Workplace factors, such as workload, work/life balance, job autonomy and perceived support from leadership, had stronger associations with risk for burnout. Mental health factors, such as anxiety, and physical health risks may increase the risk, although the direction of these associations is unclear as few prospective studies exist to address this question. Factors such as social support appear to have a protective effect. CONCLUSION We found the most evidence for workplace, mental health and psychosocial factors in predicting burnout but limited evidence for other potential predictors. However, more prospective studies are needed to improve our understanding about how to prevent provider burnout. PROSPERO REGISTRATION NUMBER CRD4202014836.
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Affiliation(s)
| | | | - Joan Chang
- Pardee RAND Graduate School, RAND Corporation, Santa Monica, California, USA
| | - Jody Larkin
- RAND Corporation, Santa Monica, California, USA
| | - Aneesa Motala
- RAND Corporation, Santa Monica, California, USA
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Susanne Hempel
- RAND Corporation, Santa Monica, California, USA
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
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3
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Apaydin EA, Rose DE, Yano EM, Shekelle PG, Stockdale SE, Mohr DC. Gender Differences in the Relationship Between Workplace Civility and Burnout Among VA Primary Care Providers. J Gen Intern Med 2022; 37:632-636. [PMID: 33904049 PMCID: PMC8858347 DOI: 10.1007/s11606-021-06818-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 04/08/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Civility, or politeness, is an important part of the healthcare workplace, and its absence can lead to healthcare provider and staff burnout. Lack of civility is well-documented among mostly female nurses, but is not well-described among the gender-mixed primary care provider (PCP) workforce. Understanding civility and its relationship to burnout among male and female PCPs could help lead to tailored interventions to improve civility and reduce burnout in primary care. OBJECTIVE To analyze gender differences in civility, burnout, and the relationship between civility and burnout among male and female PCPs. DESIGN Multi-level logistic regression analysis of a cross-sectional national survey. PARTICIPANTS A total of 3216 PCP respondents (1946 women and 1270 men) in 135 medical centers from a 2019 national Veterans Health Administration (VA) survey. MAIN MEASURES Outcomes: burnout; predictors: workplace civility and gender; controls: race, ethnicity, VA tenure, and supervisory status. KEY RESULTS Workplace civility was rated higher (p<0.001) among male (mean = 4.07, standard deviation [SD] = 0.36, range 1-5) compared to female (mean = 3.88, SD = 0.33) PCPs. Almost half of the sample reported burnout (47.6%), but this difference was not significant (p = 0.73) between the genders. Higher workplace civility was significantly related to lower burnout among female PCPs (odds ratio [OR] = 0.46, 95% confidence interval [CI] = 0.31 to 0.69), but not among male PCPs (OR = 0.71, 95% CI = 0.42 to 1.22). Interactions between civility and other demographic variables (race, ethnicity, VA tenure, or supervisory status) were not significantly related to burnout. CONCLUSION Female PCPs report lower workplace civility than male PCPs. An inverse relationship between civility and burnout is present for women but not men. More research is needed on this phenomenon. Interventions tailored to gender- and primary care-specific needs should be employed to increase civility and reduce burnout among PCPs.
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Affiliation(s)
- Eric A Apaydin
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. .,RAND Corporation, Santa Monica, CA, USA.
| | - Danielle E Rose
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Elizabeth M Yano
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA.,Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Paul G Shekelle
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Susan E Stockdale
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - David C Mohr
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA, USA.,Department of Health Law, Policy & Management, School of Public Health, Boston University, Boston, MA, USA
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4
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Anderson SH, Moe JS, Abramowicz S. Work-Life Balance for Oral and Maxillofacial Surgeons. Oral Maxillofac Surg Clin North Am 2021; 33:467-473. [PMID: 34364748 DOI: 10.1016/j.coms.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Oral and maxillofacial surgeons experience high levels of stress and work-home conflict, which predispose them to burnout. There is emerging evidence in support of work-life integration to prevent burnout; interventional strategies exist on an individual and organizational level. This article explores the current evidence on promoting work-life integration for improved surgeon satisfaction, performance, and efficiency. Work-life integration initiatives can help promote the recruitment and retention of a diverse surgical workforce in oral and maxillofacial surgery.
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Affiliation(s)
- Sara Hinds Anderson
- Department of Oral and Maxillofacial Surgery, Michigan Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Justine Sherylyn Moe
- Department of Oral and Maxillofacial Surgery, Michigan Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Shelly Abramowicz
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, 1365 Clifton Road, Building B, Suite 2300, Atlanta, GA 30322, USA.
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Nishi M, Yamano M, Matoba S. Prediction of well-being and insight into work-life integration among physicians using machine learning approach. PLoS One 2021; 16:e0254795. [PMID: 34265012 PMCID: PMC8282024 DOI: 10.1371/journal.pone.0254795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 07/03/2021] [Indexed: 11/19/2022] Open
Abstract
There has been increasing interest in examining physician well-being and its predictive factors. However, few studies have revealed the characteristics associated with physician well-being and work-life integration using a machine learning approach. To investigate predictive factors of well-being and obtain insights into work-life integration, the survey was conducted by letter mail in a sample of Japanese physicians. A total of 422 responses were collected from 846 physicians. The mean age was 47.9 years, males constituted 83.3% of the physicians, and 88.6% were considered to be well. The most accurate machine learning model showed a mean area under the curve of 0.72. The mean permutation importance of career satisfaction, work hours per week, existence of family support, gender, and existence of power harassment were 0.057, 0.022, 0.009, 0.01, and 0.006, respectively. Using a machine learning model, physician well-being could be predicted. It seems to be influenced by multiple factors, such as career satisfaction, work hours per week, family support, gender, and power harassment. Career satisfaction has the highest impact, while long work hours have a negative effect on well-being. These findings support the need for organizational interventions to promote physician well-being and improve the quality of medical care.
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Affiliation(s)
- Masahiro Nishi
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Cardiovascular Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Michiyo Yamano
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Primary Care Tasks Associated With Nursing Burnout: A Survey of Registered and Licensed Vocational Nurses in Veterans Health Administration Patient-Centered Medical Homes. J Ambul Care Manage 2021; 44:304-313. [PMID: 34054108 DOI: 10.1097/jac.0000000000000385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Using data from the Veterans Assessment and Improvement Laboratory for Patient-Centered Care (VAIL-PCC) Survey, this study investigated the relationship between registered nurses' (RNs') and licensed vocational nurses' (LVNs') report of responsibility for 14 distinct primary care tasks and burnout, taking into account of practice environment contexts. RNs reported higher levels of burnout than LVNs. The task of "following up on referrals" was associated with significantly higher levels of RN burnout, whereas "responding to prescription requests" was associated with higher levels of LVN burnout. "True collaboration" was associated with significantly lower levels of burnout for both RNs and LVNs.
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Lawrence JA, Davis BA, Corbette T, Hill EV, Williams DR, Reede JY. Racial/Ethnic Differences in Burnout: a Systematic Review. J Racial Ethn Health Disparities 2021; 9:257-269. [PMID: 33428158 PMCID: PMC7799165 DOI: 10.1007/s40615-020-00950-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 10/29/2022]
Abstract
BACKGROUND Awareness of burnout and its implications within the medical field has been growing. However, an understanding of the prevalence and consequences of burnout among underrepresented minority (URM), specifically underrepresented minority in medicine (UiM) populations, is not readily available. OBJECTIVE To examine literature investigating burnout among UiM compared to non-UiM, with particular attention to which measures of burnout are currently being used for which racial/ethnic groups. METHODS The authors identified peer-reviewed articles, published in English through systematic examination using PubMed, PsycINFO, Countway Discovery Medicine, and Web of Science databases. Studies meeting the inclusion criteria were summarized and study quality was assessed. RESULTS Sixteen studies assessing racial/ethnic differences in burnout were eligible for inclusion. Nearly all studies were cross-sectional (n = 15) in design and conducted among populations in North America (n = 15). Most studies examined burnout among medical students or physicians and used the Maslach Burnout Inventory. Differences in burnout among UiM and non-UiM are inconclusive, although several studies have nuanced findings. CONCLUSION Increased focus on burnout measurement, conceptualization, and mitigation among UiM populations may be useful in improving recruitment, retention, and thriving.
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Affiliation(s)
- Jourdyn A Lawrence
- Office for Diversity Inclusion and Community Partnership, Harvard Medical School, Boston, MA, USA. .,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, 677 Huntington Ave, Boston, MA, 02115, USA. .,François-Xavier Bagnoud Center for Health and Human Rights, Harvard University, Boston, MA, USA.
| | - Brigette A Davis
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, 677 Huntington Ave, Boston, MA, 02115, USA.,François-Xavier Bagnoud Center for Health and Human Rights, Harvard University, Boston, MA, USA
| | - Thea Corbette
- Office for Diversity Inclusion and Community Partnership, Harvard Medical School, Boston, MA, USA
| | - Emorcia V Hill
- Office for Diversity Inclusion and Community Partnership, Harvard Medical School, Boston, MA, USA
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, 677 Huntington Ave, Boston, MA, 02115, USA.,African and African American Studies, Harvard University, Cambridge, MA, USA
| | - Joan Y Reede
- Office for Diversity Inclusion and Community Partnership, Harvard Medical School, Boston, MA, USA.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, 677 Huntington Ave, Boston, MA, 02115, USA.,Massachusetts General Hospital, Boston, MA, USA
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8
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Leung LB, Rose D, Rubenstein LV, Guo R, Dresselhaus TR, Stockdale S. Does Mental Health Care Integration Affect Primary Care Clinician Burnout? Results from a Longitudinal Veterans Affairs Survey. J Gen Intern Med 2020; 35:3620-3626. [PMID: 32948952 PMCID: PMC7728981 DOI: 10.1007/s11606-020-06203-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 08/31/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Burnout among primary care clinicians (PCPs) is associated with negative health and productivity consequences. The Veterans Health Administration (VA) embedded mental health specialists and care managers in primary care to manage common psychiatric diseases. While challenging to implement, mental health integration is a team-based care model thought to improve clinician well-being. OBJECTIVE To examine the relationships between PCP-reported burnout (and secondarily, job satisfaction) and mental health integration at provider and clinic levels DESIGN: Analysis of 286 cross-sectional surveys in 2012 (n = 171) and 2013 (n = 115) PARTICIPANTS: 210 PCPs in one VA region MAIN MEASURES: Outcomes were PCP-reported burnout (Maslach Burnout Inventory emotional exhaustion subscale), and secondarily, job satisfaction. Two independent variables represented mental health integration: (1) PCP-specialty communication rating and (2) proportion of clinic patients who saw integrated specialists. Using multilevel regression models, we examined PCP-reported burnout (and job satisfaction) and mental health integration, adjusting for PCP characteristics (e.g., gender), PCP ratings of team functioning (communication, knowledge/skills, satisfaction), and organizational factors. KEY RESULTS On average, PCPs reported high burnout (29, range = 9-54) across all VA healthcare systems. In total, 46% of PCPs reported "very easy" communication with mental health; 9% of primary clinic patients had seen integrated specialists. Burnout was not significantly associated with mental health communication ratings (β coefficient = - 0.96, standard error [SE] = 1.29, p = 0.46), nor with proportion of clinic patients who saw integrated specialists (β = 0.02, SE = 0.11, p = 0.88). No associations were observed with job satisfaction either. Among study participants, PCPs with poor team functioning, as exhibited by low team communication ratings, reported high burnout (β = - 1.28, SE = 0.22, p < 0.001) and low job satisfaction (β = 0.12, SE = 0.02, p < 0.001). CONCLUSIONS As currently implemented, primary care and mental health integration did not appear to impact PCP-reported burnout, nor job satisfaction. More research is needed to explore care model variation among clinics in order to optimize implementation to enhance PCP well-being.
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Affiliation(s)
- Lucinda B Leung
- Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. .,Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
| | - Danielle Rose
- Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Lisa V Rubenstein
- Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.,RAND Corporation, Santa Monica, CA, USA.,Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Rong Guo
- Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Timothy R Dresselhaus
- Primary Care Service, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Medicine, UCSD School of Medicine, San Diego, CA, USA
| | - Susan Stockdale
- Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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9
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Pervaz Iqbal M, Manias E, Mimmo L, Mears S, Jack B, Hay L, Harrison R. Clinicians' experience of providing care: a rapid review. BMC Health Serv Res 2020; 20:952. [PMID: 33059673 PMCID: PMC7559170 DOI: 10.1186/s12913-020-05812-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 10/09/2020] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Health care services internationally are refocussing care delivery towards patient centred, integrated care that utilises effective, efficient and innovative models of care to optimise patient outcomes and system sustainability. Whilst significant efforts have been made to examine and enhance patient experience, to date little has progressed in relation to provider experience. This review aims to explore this knowledge gap by capturing evidence of clinician experience, and how this experience is defined and measured in the context of health system change and innovation. METHODS A rapid review of published and grey literature review was conducted utilising a rapid evidence assessment methodology. Seventy-nine studies retrieved from the literature were included in the review. Fourteen articles were identified from the grey literature search and one article obtained via hand searching. In total, 94 articles were included in the review. This study was commissioned by and co-designed with the New South Wales, Ministry of Health. RESULTS Clinician experience of delivering health care is inconsistently defined in the literature, with identified articles lacking clarity regarding distinctions between experience, engagement and work-related outcomes such as job satisfaction. Clinician experience was commonly explored using qualitative research that focused on experiences of discrete health care activities or events in which a change was occurring. Such research enabled exploration of complex experiences. In these contexts, clinician experience was captured in terms of self-reported information that clinicians provided about the health care activity or event, their perceptions of its value, the lived impacts they experienced, and the specific behaviours they displayed in relation to the activity or event. Moreover, clinician's experience has been identified to have a paucity of measurement tools. CONCLUSION Literature to date has not examined clinician experience in a holistic sense. In order to achieve the goals identified in relation to value-based care, further work is needed to conceptualise clinician experience and understand the nature of measurement tools required to assess this. In health system application, a broader 'clinician pulse' style assessment may be valuable to understand the experience of clinical work on a continuum rather than in the context of episodes of change/care.
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Affiliation(s)
- Maha Pervaz Iqbal
- School of Public Health and Community Medicine, UNSW Medicine, UNSW Sydney, Sydney, 2052 Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Laurel Mimmo
- School of Public Health and Community Medicine, UNSW Medicine, UNSW Sydney, Sydney, 2052 Australia
- Sydney Children’s Hospitals, Network, Sydney, NSW Australia
| | - Stephen Mears
- Hunter New England Medical Library, New Lambton, NSW 2350 Australia
| | - Briony Jack
- Strategic Reform and Planning Branch, NSW Ministry of Health, St Leonards, NSW 2065 Australia
| | - Liz Hay
- Economics and Analysis, Strategic Reform and Planning Branch, NSW Ministry of Health, St Leonards, NSW 2065 Australia
| | - Reema Harrison
- School of Public Health and Community Medicine, UNSW Medicine, UNSW Sydney, Sydney, 2052 Australia
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10
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Osuji TA, Macias M, McMullen C, Haupt E, Mittman B, Mularski RA, Wang SE, Werch H, Nguyen HQ. Clinician Perspectives on Implementing Video Visits in Home-Based Palliative Care. Palliat Med Rep 2020; 1:221-226. [PMID: 34223480 PMCID: PMC8241367 DOI: 10.1089/pmr.2020.0074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Despite the increasing use and acceptance of technology in health care, there is limited evidence on the usefulness and appropriate use of telehealth in home-based palliative care (HBPC). As part of the process evaluation of a pragmatic trial of video visits in HBPC, we assessed clinician experience with video visit implementation. Methods: We assessed clinicians' experiences with and perception of the usefulness and appropriateness of video visits using anonymous surveys and brief qualitative interviews with a subset of survey participants. Qualitative analyses were guided by sociotechnical frameworks that emphasize technology's “value proposition” for its end users as being key to adoption. Results: Clinicians (36 physicians and 48 registered nurses) generally had favorable attitudes toward video visits and telehealth. Respondents felt confident in the skills needed to make their role in video visits successful. Clinicians were neutral on whether video visits were useful for their practice or enhanced the patient–caregiver experience. Clinicians found video visits to be most appropriate for follow-up care (as opposed to start of care). The interviews yielded two themes that complemented the survey findings: (1) factors enhancing the value proposition (positive responses from patients and families and convenience) and (2) factors diminishing the value proposition (issues related to the technology and scheduling). Discussion: Our findings provide insights into clinicians' experiences with implementing remote video physician consultations, facilitated by a nurse in the patient's home in the pre-COVID-19 era. Clinician views about video visits may have shifted with the pandemic, which occurred after our data collection was complete. Clinical Trials Registration No. NCT#03694431.
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Affiliation(s)
- Thearis A. Osuji
- Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, California, USA
| | - Mayra Macias
- Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, California, USA
| | - Carmit McMullen
- Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon, USA
| | - Eric Haupt
- Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, California, USA
| | - Brian Mittman
- Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, California, USA
| | - Richard A. Mularski
- Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon, USA
| | - Susan E. Wang
- Kaiser Permanente Southern California, West Los Angeles Medical Center, Los Angeles, California, USA
| | - Henry Werch
- Kaiser Permanente Northwest, Member-Caregiver, Stakeholder Advisory Committee, Portland, Oregon, USA
| | - Huong Q. Nguyen
- Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, California, USA
- Address correspondence to: Huong Q. Nguyen, PhD, RN, Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Avenue, 2nd Floor, Pasadena, CA 91101, USA
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11
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Garcia LC, Shanafelt TD, West CP, Sinsky CA, Trockel MT, Nedelec L, Maldonado YA, Tutty M, Dyrbye LN, Fassiotto M. Burnout, Depression, Career Satisfaction, and Work-Life Integration by Physician Race/Ethnicity. JAMA Netw Open 2020; 3:e2012762. [PMID: 32766802 PMCID: PMC7414389 DOI: 10.1001/jamanetworkopen.2020.12762] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE Previous research suggests that the prevalence of occupational burnout varies by demographic characteristics, such as sex and age, but the association between physician race/ethnicity and occupational burnout is less well understood. OBJECTIVE To investigate possible differences in occupational burnout, depressive symptoms, career satisfaction, and work-life integration by race/ethnicity in a sample of US physicians. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study, data for this secondary analysis of 4424 physicians were originally collected from a cross-sectional survey of US physicians between October 12, 2017, and March 15, 2018. The dates of analysis were March 8, 2019, to May 21, 2020. Multivariable logistic regression, including statistical adjustment for physician demographic and clinical practice characteristics, was performed to examine the association between physician race/ethnicity and occupational burnout, depressive symptoms, career satisfaction, and work-life integration. EXPOSURES Physician demographic and clinical practice characteristics included race/ethnicity, sex, age, clinical specialty, hours worked per week, primary practice setting, and relationship status. MAIN OUTCOMES AND MEASURES Physicians with a high score on the emotional exhaustion or depersonalization subscale of the Maslach Burnout Inventory were classified as having burnout. Depressive symptoms were measured using the Primary Care Evaluation of Mental Disorders instrument. Physicians who marked "strongly agree" or "agree" in response to the survey items "I would choose to become a physician again" and "My work schedule leaves me enough time for my personal/family life" were considered to be satisfied with their career and work-life integration, respectively. RESULTS Data were available for 4424 physicians (mean [SD] age, 52.46 [12.03] years; 61.5% [2722 of 4424] male). Most physicians (78.7% [3480 of 4424]) were non-Hispanic White. Non-Hispanic Asian, Hispanic/Latinx, and non-Hispanic Black physicians comprised 12.3% (542 of 4424), 6.3% (278 of 4424), and 2.8% (124 of 4424) of the sample, respectively. Burnout was observed in 44.7% (1540 of 3447) of non-Hispanic White physicians, 41.7% (225 of 540) of non-Hispanic Asian physicians, 38.5% (47 of 122) of non-Hispanic Black physicians, and 37.4% (104 of 278) of Hispanic/Latinx physicians. The adjusted odds of burnout were lower in non-Hispanic Asian physicians (odds ratio [OR], 0.77; 95% CI, 0.61-0.96), Hispanic/Latinx physicians (OR, 0.63; 95% CI, 0.47-0.86), and non-Hispanic Black physicians (OR, 0.49; 95% CI, 0.30-0.79) compared with non-Hispanic White physicians. Non-Hispanic Black physicians were more likely to report satisfaction with work-life integration compared with non-Hispanic White physicians (OR, 1.69; 95% CI, 1.05-2.73). No differences in depressive symptoms or career satisfaction were observed by race/ethnicity. CONCLUSIONS AND RELEVANCE Physicians in minority racial/ethnic groups were less likely to report burnout compared with non-Hispanic White physicians. Future research is necessary to confirm these results, investigate factors contributing to increased rates of burnout among non-Hispanic White physicians, and assess factors underlying the observed patterns in measures of physician wellness by race/ethnicity.
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Affiliation(s)
- Luis C. Garcia
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California
| | - Tait D. Shanafelt
- Department of Medicine, Stanford University School of Medicine, Stanford, California
- WellMD Center, Stanford University School of Medicine, Stanford, California
| | - Colin P. West
- Department of Medicine, Mayo Clinic, Rochester, Minnesota
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | | | - Mickey T. Trockel
- Department of Psychiatry, Stanford University School of Medicine, Stanford, California
| | - Laurence Nedelec
- WellMD Center, Stanford University School of Medicine, Stanford, California
| | - Yvonne A. Maldonado
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | | | | | - Magali Fassiotto
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California
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12
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Apaydin EA, Rose D, Meredith LS, McClean M, Dresselhaus T, Stockdale S. Association Between Difficulty with VA Patient-Centered Medical Home Model Components and Provider Emotional Exhaustion and Intent to Remain in Practice. J Gen Intern Med 2020; 35:2069-2075. [PMID: 32291716 PMCID: PMC7352025 DOI: 10.1007/s11606-020-05780-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 03/06/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The patient-centered medical home (PCMH) model is intended to improve primary care, but evidence of its effects on provider well-being is mixed. Investigating the relationships between specific PCMH components and provider burnout and potential attrition may help improve the efficacy of the care model. OBJECTIVE We analyzed provider attitudes toward specific components of PCMH in the Veterans Health Administration (VA) and their relation to emotional exhaustion (EE)-a central component of burnout-and intent to remain in VA primary care. DESIGN Logistic regression analysis of a cross-sectional survey. SUBJECTS 116 providers (physicians; nurse practitioners; physician assistants) in 21 practices between September 2015 and January 2016 in one VA region. MAIN MEASURES Outcomes: burnout as measured with the emotional exhaustion (EE) subscale of the Maslach Burnout Inventory and intent to remain in VA primary care for the next 2 years; predictors: difficulties with components of PCMH, demographic characteristics. KEY RESULTS Forty percent of providers reported high EE (≥ 27 points) and 63% reported an intent to remain in VA primary care for the next 2 years. Providers reporting high difficultly with PCMH elements were more likely to report high EE, for example, coordinating with specialists (odds ratio [OR] 8.32, 95% confidence interval [CI] 3.58-19.33), responding to EHR alerts (OR 6.88; 95% CI 1.93-24.43), and managing unscheduled visits (OR 7.53, 95% CI 2.01-28.23). Providers who reported high EE were also 87% less likely to intend to remain in VA primary care. CONCLUSIONS To reduce EE and turnover in PCMH, primary care providers may need additional support and training to address challenges with specific aspects of the model.
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Affiliation(s)
- Eric A Apaydin
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. (151), Los Angeles, CA, 90073, USA. .,RAND Corporation, Santa Monica, CA, USA.
| | - Danielle Rose
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. (151), Los Angeles, CA, 90073, USA
| | - Lisa S Meredith
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. (151), Los Angeles, CA, 90073, USA.,RAND Corporation, Santa Monica, CA, USA
| | - Michael McClean
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. (151), Los Angeles, CA, 90073, USA
| | - Timothy Dresselhaus
- VA San Diego Healthcare System, San Diego, CA, USA.,School of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Susan Stockdale
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. (151), Los Angeles, CA, 90073, USA.,Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
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13
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Rinne ST, Mohr DC, Swamy L, Blok AC, Wong ES, Charns MP. National Burnout Trends Among Physicians Working in the Department of Veterans Affairs. J Gen Intern Med 2020; 35:1382-1388. [PMID: 32096080 PMCID: PMC7210363 DOI: 10.1007/s11606-019-05582-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 11/25/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Heterogeneity of existing physician burnout studies impairs analyses of longitudinal trends, geographic distribution, and organizational factors impacting physician burnout. The Department of Veterans Affairs (VA) is one of the largest integrated healthcare systems in the USA, offering a unique opportunity to study burnout across VA sites and time. OBJECTIVE To characterize longitudinal burnout trends of VA physicians and assess organizational characteristics and geographic distribution associated with physician burnout. DESIGN Longitudinal study of the VA All Employee Survey during 2013-2017. PARTICIPANTS Self-identified physicians practicing in one of nine clinical service areas at 140 VA sites nationwide. MAIN MEASURES We identified burnout using a validated definition adapted from the Maslach Burnout Inventory and characterized burnout trends for physicians in different clinical service areas. We used clustering analysis to categorize sites based on their burnout rates over time, and compared organizational characteristics and geographic distribution of high, medium, and low burnout categories. KEY RESULTS We identified 40,382 physician responses from 140 VA sites. Mean burnout rates across all physicians ranged from 34.3% in 2013 to a high of 39.0% in 2014. Primary care physicians had the highest burnout. High burnout sites were more likely to be rural and non-teaching, have lower complexity (i.e., offer fewer advanced clinical services), and have fewer unique patients per site. CONCLUSIONS VA physician burnout was lower than previously described in many non-VA studies and was relatively stable over time. These findings may be due to unique characteristics of the VA practice environment. Nonetheless, with over a third of VA physicians reporting burnout, organizational interventions are needed. Primary care physicians and those practicing at small, rural sites have higher rates of burnout and may warrant more focused attention. Our results can guide targeted interventions to promote VA physician well-being and inform efforts to address burnout in diverse clinical settings.
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Affiliation(s)
- Seppo T Rinne
- Center for Healthcare Organization & Implementation Research, VA, Bedford, MA, USA. .,The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA.
| | - David C Mohr
- Center for Healthcare Organization & Implementation Research, VA, Boston, MA, USA.,Department of Health Law, Policy, & Management, Boston University School of Public Health, Boston, MA, USA
| | - Lakshman Swamy
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA
| | - Amanda C Blok
- Center for Healthcare Organization & Implementation Research, VA, Bedford, MA, USA.,College of Nursing and Health Sciences, University of Massachusetts, Boston, MA, USA
| | - Edwin S Wong
- Seattle-Denver Center of Innovation for Veteran-Centered & Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Health Services, University of Washington, Seattle, WA, USA
| | - Martin P Charns
- Center for Healthcare Organization & Implementation Research, VA, Boston, MA, USA.,Department of Health Law, Policy, & Management, Boston University School of Public Health, Boston, MA, USA
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14
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Wong WJ, Mohd Norzi A, Ang SH, Chan CL, Jaafar FSA, Sivasampu S. The effects of enhanced primary healthcare interventions on primary care providers' job satisfaction. BMC Health Serv Res 2020; 20:311. [PMID: 32293446 PMCID: PMC7158075 DOI: 10.1186/s12913-020-05183-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 04/02/2020] [Indexed: 11/18/2022] Open
Abstract
Background In response to the rising burden of cardiovascular risk factors, the Malaysian government has implemented Enhanced Primary Healthcare (EnPHC) interventions in July 2017 at public clinic level to improve management and clinical outcomes of type 2 diabetes and hypertensive patients. Healthcare providers (HCPs) play crucial roles in healthcare service delivery and health system reform can influence HCPs’ job satisfaction. However, studies evaluating HCPs’ job satisfaction following primary care transformation remain scarce in low- and middle-income countries. This study aims to evaluate the effects of EnPHC interventions on HCPs’ job satisfaction. Methods This is a quasi-experimental study conducted in 20 intervention and 20 matched control clinics. We surveyed all HCPs who were directly involved in patient management. A self-administered questionnaire which included six questions on job satisfaction were assessed on a scale of 1–4 at baseline (April and May 2017) and post-intervention phase (March and April 2019). Unadjusted intervention effect was calculated based on absolute differences in mean scores between intervention and control groups after implementation. Difference-in-differences analysis was used in the multivariable linear regression model and adjusted for providers and clinics characteristics to detect changes in job satisfaction following EnPHC interventions. A negative estimate indicates relative decrease in job satisfaction in the intervention group compared with control group. Results A total of 1042 and 1215 HCPs responded at baseline and post-intervention respectively. At post-intervention, the intervention group reported higher level of stress with adjusted differences of − 0.139 (95% CI -0.266,-0.012; p = 0.032). Nurses, being the largest workforce in public clinics were the only group experiencing dissatisfaction at post-intervention. In subgroup analysis, nurses from intervention group experienced increase in work stress following EnPHC interventions with adjusted differences of − 0.223 (95% CI -0.419,-0.026; p = 0.026). Additionally, the same group were less likely to perceive their profession as well-respected at post-intervention (β = − 0.175; 95% CI -0.331,-0.019; p = 0.027). Conclusions Our findings suggest that EnPHC interventions had resulted in some untoward effect on HCPs’ job satisfaction. Job dissatisfaction can have detrimental effects on the organisation and healthcare system. Therefore, provider experience and well-being should be considered before introducing healthcare delivery reforms to avoid overburdening of HCPs.
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Affiliation(s)
- Wen Jun Wong
- Centre for Clinical Outcomes Research, Institute for Clinical Research, National Institutes of Health (NIH), Ministry of Health Malaysia, No. 1, Jalan Setia Murni U13/52, Seksyen U13, Bandar Setia Alam, 40170, Shah Alam, Selangor, Malaysia. .,Centre for Clinical Outcomes Research, Institute for Clinical Research, National Institutes of Health (NIH), Ministry of Health Malaysia, No. 1, Jalan Setia Murni U13/52 Seksyen U13, Bandar Setia Alam, 40170, Shah Alam, Selangor, Malaysia.
| | - Aisyah Mohd Norzi
- Centre for Clinical Outcomes Research, Institute for Clinical Research, National Institutes of Health (NIH), Ministry of Health Malaysia, No. 1, Jalan Setia Murni U13/52, Seksyen U13, Bandar Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| | - Swee Hung Ang
- Centre for Clinical Outcomes Research, Institute for Clinical Research, National Institutes of Health (NIH), Ministry of Health Malaysia, No. 1, Jalan Setia Murni U13/52, Seksyen U13, Bandar Setia Alam, 40170, Shah Alam, Selangor, Malaysia.,Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chee Lee Chan
- Centre for Clinical Outcomes Research, Institute for Clinical Research, National Institutes of Health (NIH), Ministry of Health Malaysia, No. 1, Jalan Setia Murni U13/52, Seksyen U13, Bandar Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| | - Faeiz Syezri Adzmin Jaafar
- Institute for Health Management, National Institutes of Health (NIH), Ministry of Health Malaysia, No. 1, Jalan Setia Murni U13/52, Seksyen U13, Bandar Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| | - Sheamini Sivasampu
- Centre for Clinical Outcomes Research, Institute for Clinical Research, National Institutes of Health (NIH), Ministry of Health Malaysia, No. 1, Jalan Setia Murni U13/52, Seksyen U13, Bandar Setia Alam, 40170, Shah Alam, Selangor, Malaysia
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15
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Elements of the healthy work environment associated with lower primary care nurse burnout. Nurs Outlook 2020; 68:14-25. [DOI: 10.1016/j.outlook.2019.06.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 05/26/2019] [Accepted: 06/21/2019] [Indexed: 11/20/2022]
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16
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Kung A, Cheung T, Knox M, Willard-Grace R, Halpern J, Olayiwola JN, Gottlieb L. Capacity to Address Social Needs Affects Primary Care Clinician Burnout. Ann Fam Med 2019; 17:487-494. [PMID: 31712286 PMCID: PMC6846269 DOI: 10.1370/afm.2470] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 05/10/2019] [Accepted: 05/30/2019] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Primary care clinicians disproportionately report symptoms of burnout, threatening workforce sustainability and quality of care. Recent surveys report that these symptoms are greater when clinicians perceive fewer clinic resources to address patients' social needs. We undertook this study to better understand the relationship between burnout and clinic capacity to address social needs. METHODS We completed semistructured, in-person interviews and brief surveys with 29 primary care clinicians serving low-income populations. Interview and survey topics included burnout and clinic capacity to address social needs. We analyzed interviews using a modified grounded theory approach to qualitative research and used survey responses to contextualize our qualitative findings. RESULTS Four key themes emerged from the interview analyses: (1) burnout can affect how clinicians evaluate their clinic's resources to address social needs, with clinicians reporting high emotional exhaustion perceiving low efficacy even in when such resources are available; (2) unmet social needs affect practice by influencing clinic flow, treatment planning, and clinician emotional wellness; (3) social services embedded in primary care clinics buffer against burnout by increasing efficiency, restoring clinicians' medical roles, and improving morale; and (4) clinicians view clinic-level interventions to address patients' social needs as a necessary but insufficient strategy to address burnout. CONCLUSIONS Primary care clinicians described multiple pathways whereby increased clinic capacity to address patients' social needs mitigates burnout symptoms. These findings may inform burnout prevention strategies that strengthen the capacity to address patients' social needs in primary care clinical settings.
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Affiliation(s)
- Alina Kung
- University of California Berkeley-UCSF Joint Medical Program, Berkeley, California
| | | | - Margae Knox
- University of California San Francisco, Center for Excellence in Primary Care, San Francisco, California
| | - Rachel Willard-Grace
- University of California San Francisco, Center for Excellence in Primary Care, San Francisco, California
| | - Jodi Halpern
- University of California Berkeley-UCSF Joint Medical Program, Berkeley, California.,University of California Berkeley, School of Public Health, Berkeley, California
| | - J Nwando Olayiwola
- Department of Family Medicine, Ohio State University College of Medicine, Columbus, Ohio
| | - Laura Gottlieb
- University of California San Francisco, Department of Family and Community Medicine, San Francisco, California.,Social Interventions Research and Evaluation Network, San Francisco, California
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17
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Baron AN, Hemler JR, Sweeney SM, Tate Woodson T, Cuthel A, Crabtree BF, Cohen DJ. Effects of Practice Turnover on Primary Care Quality Improvement Implementation. Am J Med Qual 2019; 35:16-22. [PMID: 31030525 PMCID: PMC6819201 DOI: 10.1177/1062860619844001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Primary care practices often engage in quality improvement (QI) in order to stay current and meet quality benchmarks, but the extent to which turnover affects practices' QI ability is not well described. The authors examined qualitative data from practice staff and external facilitators participating in a large-scale QI initiative to understand the relationship between turnover and QI efforts. The examination found turnover can limit practices' ability to engage in QI activities in various ways. When a staff member leaves, remaining staff often absorb additional responsibilities, and QI momentum slows as new staff are trained or existing staff are reengaged. Turnover alters staff dynamics and can create barriers to constructive working relationships and team building. When key practice members leave, they can take with them institutional memory about QI purpose, processes, and long-term vision. Understanding how turnover affects QI may help practices, and those helping them with QI, manage the disruptive effects of turnover.
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18
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Abstract
BACKGROUND New models of patient-centered primary care such as the patient-centered medical home (PCMH) depend on high levels of interdisciplinary primary care team functioning to achieve improved outcomes. A few studies have qualitatively assessed barriers and facilitators to optimal team functioning; however, we know of no prior study that assesses PCMH team functioning in relationship to patient health outcomes. PURPOSE The aim of the study was to assess the relationships between primary care team functioning, patients' use of acute care, and mortality. METHODOLOGY/APPROACH Retrospective longitudinal cohort analysis of patient outcomes measured at two time points (2012 and 2013) after PCMH implementation began in Veterans Health Administration practices. Multilevel models examined practice-level measures of team functioning in relationship to patient outcomes (all-cause and ambulatory care-sensitive condition-related hospitalizations, emergency department visits, and mortality). We controlled for practice-level factors likely to affect team functioning, including leadership support, provider and staff burnout, and staffing sufficiency, as well as for individual patient characteristics. We also tested the model among a subgroup of vulnerable patients (homeless, mentally ill, or with dementia). RESULTS In adjusted analyses, higher team functioning was associated with lower mortality (OR = 0.92, p = .04) among all patients and with fewer all-cause admissions (incidence rate ratio [IRR] = 0.90, p < 0.01), ambulatory care-sensitive condition-related admissions (IRR = 0.91, p = .04), and emergency department visits (IRR = 0.91, p = .03) in the vulnerable patient subgroup. CONCLUSION These early findings give support for the importance of team functioning within PCMH models for achieving improved patient outcomes. PRACTICE IMPLICATIONS A focus on team functioning is important especially in the early implementation of team-based primary care models.
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19
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Communication Among Team Members Within the Patient-centered Medical Home and Patient Satisfaction With Providers: The Mediating Role of Patient-Provider Communication. Med Care 2019; 56:491-496. [PMID: 29683867 DOI: 10.1097/mlr.0000000000000914] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The Patient-centered Medical Home (PCMH) uses team-based care to improve patient outcomes, including satisfaction. The quality of patients' communication with their primary care providers (PCPs) is a key determinant of patient satisfaction. A shift to team-based care could disrupt the therapeutic relationship between patients and their PCPs and reduce patient satisfaction if communication and coordination among primary care team members is poor. Little is known about the relationship between intrateam communication within a PCMH and patient satisfaction with PCPs, and whether patient-provider communication might mediate this relationship. OBJECTIVES To examine the relationship between intrateam communication in a PCMH and patients' satisfaction with assigned PCPs, and whether patient-provider communication mediates this relationship. RESEARCH DESIGN Cross-sectional surveys of Veterans Health Administration PCPs (2011-2012, n=149) matched with their assigned patients' surveys (n=3329). Mediation analyses using a nested data structure, controlling for patient and provider characteristics. MEASURES Patient satisfaction with PCPs, patient-reported patient-provider communication, and PCP-reported intrateam communication within the PCMH. RESULTS Intrateam communication and patient-provider communication were independently associated with patients' satisfaction with their PCPs. Patient-provider communication mediated 56% of the association between intrateam communication and patient satisfaction. Better intrateam communication combined with better patient-provider communication predicted high satisfaction (81%), compared with poor intrateam communication and poor patient-provider communication (22%). CONCLUSIONS PCMH environments with better communication among team members are likely to experience better patient-provider communication and high patient satisfaction. PCMH practices with low ratings of patient satisfaction may need to look beyond individual PCPs to communication within and across teams.
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20
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Essary AC, Bernard KS, Coplan B, Dehn R, Forister JG, Smith NE, Valentin VL. Burnout and Job and Career Satisfaction in the Physician Assistant Profession: A Review of the Literature. NAM Perspect 2018. [DOI: 10.31478/201812b] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
| | - Kari S. Bernard
- University of Washington MEDEX Northwest Physician Assistant Training Program
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21
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Velezmoro R. The role of the psychologist in the veterans administration's patient aligned care team and huddle: A review, practical recommendations, and a call to action. Health Psychol Res 2018; 6:7393. [PMID: 30542669 PMCID: PMC6240835 DOI: 10.4081/hpr.2018.7393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 07/31/2018] [Indexed: 12/04/2022] Open
Abstract
The Veterans Administration (VA)’s Patient Aligned Care Team (PACT) model has been a cornerstone of primary care in the VA healthcare system and has indicated the need for an organizational cultural shift towards interdisciplinary care. Most of the focus in PACT has been on the traditional providers of the medical model, with little attention focused on the role of the psychologist. This paper examines how psychologists can assist in the PACT model and, in particular, within the team VA huddle. Literature on the PACT model, mental health in PACT, and the advantages of the huddle are reviewed. Lessons learned within a large VA clinic are also discussed. Psychologists’ ability to be a clinician, teambuilder, and system specialist is discussed and how it benefits the PACT and the huddling process. Practical recommendations are made for how to best assist during the huddle, and how to advocate for both the huddle, and for a broader cultural shift in care.
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Affiliation(s)
- Rodrigo Velezmoro
- C.W. Bill Young VAMC, Bay Pines VA Healthcare System, Bay Pines, FL, USA
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22
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Finkelstein A, Bachner YG, Greenberger C, Brooks R, Tenenbaum A. Correlates of burnout among professionals working with people with intellectual and developmental disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2018; 62:864-874. [PMID: 30141530 DOI: 10.1111/jir.12542] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 04/27/2018] [Accepted: 07/19/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Although burnout has been recognised as an important stress-related problem among staff working with people with intellectual and developmental disabilities (IDD), literature on the subject is limited yet emerging. The aim of this study is twofold: (1) to evaluate the level of burnout within different professions working with IDD; (2) to examine the association between socio-demographic, professional and organisational characteristics and burnout. METHOD One hundred ninety-nine professionals working with people with IDD were enrolled in the study (66% response rate). Participants were recruited from several facilities that provide care for people with IDD of all ages, in the Jerusalem area and in other cities in central Israel. The anonymous questionnaires included valid and reliable measures of burnout, socio-demographic variables, professional variables and organisational variables. RESULTS Participants' mean age was 38.3 years, and most were women. There were no significant differences in burnout levels among the different professionals. Role ambiguity, perceived overload, care-recipient group and job involvement were significant predictors of burnout. The model explained a high percentage (46.8%) of the observed variance. CONCLUSIONS Most of these predictors are organisational measures. These findings demonstrate that organisational variables are more significantly associated with burnout of staff working with people with IDD than the socio-demographic factors or professional characteristics. Identifying and better understanding the specific factors associated with burnout among professionals working with IDD could facilitate unique intervention programs to reduce burnout levels in staff.
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Affiliation(s)
- A Finkelstein
- Department of Nursing, Faculty of Life and Health Sciences, Jerusalem College of Technology, Jerusalem, Israel
| | - Y G Bachner
- Department of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - C Greenberger
- Department of Nursing, Faculty of Life and Health Sciences, Jerusalem College of Technology, Jerusalem, Israel
| | - R Brooks
- Department of Pediatrics, Hadassah Medical Center Mt. Scopus, Jerusalem, Israel
| | - A Tenenbaum
- Department of Pediatrics, Hadassah Medical Center Mt. Scopus, Jerusalem, Israel
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Schult TM, Mohr DC, Osatuke K. Examining burnout profiles in relation to health and well-being in the Veterans Health Administration employee population. Stress Health 2018; 34:490-499. [PMID: 29683254 DOI: 10.1002/smi.2809] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 03/12/2018] [Accepted: 03/19/2018] [Indexed: 11/09/2022]
Abstract
The goals of this paper were twofold: (a) To provide a population overview of burnout profiles by occupation in a large, health care sector employee population and (b) to investigate how burnout profiles relate to self-reported health behaviours, chronic conditions, and absenteeism. Burnout profiles were considered by 5 main occupational groups (physicians, nurses, other clinical, administrative, and wage grade [trade, craft, and labor workers]) in survey respondents (n = 86,257 employees). Logistic regression analyses were conducted to examine how burnout profiles were associated with health controlling for gender, age, race, ethnicity, and occupational group. Employees in the "Frustrated/Burning Up" and "Withdrawing/Burned Out" profiles, respectively, had significantly increased odds of anxiety (OR = 2.17; 99% CI [2.04, 2.31]; OR = 2.21; 99% CI [2.05, 2.38]), depression (OR = 2.06; 99% CI [1.93, 2.20]; OR = 2.20; 99% CI [2.04, 2.38]), sleep disorders (OR = 1.98; 99% CI [1.85, 2.12]; OR = 1.97; 99% CI [1.81, 2.13]), low back disease (OR = 1.60; 99% CI [1.50, 1.71]; OR = 1.58; 99% CI [1.47, 1.70]), physical inactivity (OR = 1.49; 99% CI [1.38, 1.60]; OR = 1.68; 99% CI [1.54, 1.83]), and 5 or more days away from work (OR = 1.74; 99% CI [1.65, 1.85]; OR = 2.15; 99% CI [2.01, 2.30]). Burnout is related to the health of employees. Burnout profiles offer a way to assess patterns of burnout by occupational group and may help customize future interventions.
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Affiliation(s)
- Tamara M Schult
- Veterans Health Administration, Occupational Health, Patient Care Services, Washington, D.C., USA.,School of Public Health, University of Minnesota School, Minneapolis, MN, USA
| | - David C Mohr
- Veterans Health Administration, Occupational Health, Patient Care Services, Washington, D.C., USA
| | - Katerine Osatuke
- Veterans Health Administration, National Center for Organizational Development, Cincinnati, OH, USA.,Department of Psychology, Miami University, Oxford, OH, USA
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Meredith LS, Batorsky B, Cefalu M, Darling JE, Stockdale SE, Yano EM, Rubenstein LV. Long-term impact of evidence-based quality improvement for facilitating medical home implementation on primary care health professional morale. BMC FAMILY PRACTICE 2018; 19:149. [PMID: 30170541 PMCID: PMC6119243 DOI: 10.1186/s12875-018-0824-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 07/18/2018] [Indexed: 11/10/2022]
Abstract
Background Poor morale among primary care providers (PCPs) and staff can undermine the success of patient-centered care models such as the patient-centered medical home that rely on highly coordinated inter-professional care teams. Medical home literature hypothesizes that participation in quality improvement can ease medical home transformation. No studies, however, have assessed the impact of quality improvement participation on morale (e.g., burnout or dissatisfaction) during transformation. The objective of this study is to examine whether primary care practices participating in evidence-based quality improvement (EBQI) during medical home transformation reduced burnout and increased satisfaction over time compared to non-participating practices. Methods We used a longitudinal quasi-experimental design to examine the impact of EBQI (vs. no EBQI), a multi-level, interdisciplinary approach for engaging frontline primary care practices in developing evidence-based improvement innovations and tools for spread on PCP and staff morale following the 2010 national implementation of the medical home model in the Veterans Health Administration. The sample included 356 primary care employees (107 primary care providers and 249 staff) from 23 primary care practices (6 intervention and 17 comparison) within one Veterans Health Administration region. Three intervention practices began EBQI in 2011 (early) and three more began EBQI in 2012 (late). Three waves of surveys were administered across 42 months beginning in November 2011 and ending in January 2016 approximately 2 years 18 months apart. We used repeated measures analysis of the survey data on medical home teams. Main outcome measures were the emotional exhaustion subscale from the Maslach Burnout Inventory, and job satisfaction. Results Six of 26 approved EBQI innovations directly addressed provider and staff morale; all 26 addressed medical home implementation challenges. Survey rates were 63% for baseline and 48% for both follow-up waves. Age was associated with lower burnout among PCPs (p = .039) and male PCPs had higher satisfaction (p = .037). Controlling for practice and PCP/staff characteristics, burnout increased by 5 points for PCPs in comparison practices (p = .024) and decreased by 1.4 points for early and 6.8 points (p = .039) for the late EBQI practices. Conclusions Engaging PCPs and staff in EBQI reduced burnout over time during medical home transformation. Electronic supplementary material The online version of this article (10.1186/s12875-018-0824-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lisa S Meredith
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA. .,VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, Los Angeles, CA, USA.
| | | | - Matthew Cefalu
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA
| | - Jill E Darling
- USC Center for Economic and Social Research, Los Angeles, CA, USA
| | - Susan E Stockdale
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, Los Angeles, CA, USA.,Department of Psychiatry and Biobehavioral Medicine, UCLA School of Medicine, Los Angeles, CA, USA
| | - Elizabeth M Yano
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, Los Angeles, CA, USA.,Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Lisa V Rubenstein
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, Los Angeles, CA, USA.,UCLA Schools of Medicine and Public Health, Los Angeles, CA, USA
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25
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Giannitrapani KF, Leung L, Huynh AK, Stockdale SE, Rose D, Needleman J, Yano EM, Meredith L, Rubenstein LV. Interprofessional training and team function in patient-centred medical home: Findings from a mixed method study of interdisciplinary provider perspectives. J Interprof Care 2018; 32:735-744. [PMID: 30156933 DOI: 10.1080/13561820.2018.1509844] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Transitioning from profession-specific to interprofessional (IP) models of care requires major change. The Veterans Assessment and Improvement Laboratory (VAIL), is an initiative based in the United States that supports and evaluates the Veterans Health Administration's (VAs) transition of its primary care practices to an IP team based patient-centred medical home (PCMH) care model. We postulated that modifiable primary care practice organizational climate factors impact PCMH implementation. VAIL administered a survey to 322 IP team members in primary care practices in one VA administrative region during early implementation of the PCMH and interviewed 79 representative team members. We used convergent mixed methods to study modifiable organizational climate factors in relationship to IP team functioning. We found that leadership support and job satisfaction were significantly positively associated with team functioning. We saw no association between team functioning and either role readiness or team training. Qualitative interview data confirmed survey findings and explained why the association with IP team training might be absent. In conclusion, our findings demonstrate the importance of leadership support and individual job satisfaction in producing highly functioning PCMH teams. Based on qualitative findings, we hypothesize interprofessional training is important, however, inconsistencies in IP training delivery compromise its potential benefit. Future implementation efforts should improve standardization of training process and train team members together. Interprofessional leadership coordination of interprofessional training is warranted.
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Affiliation(s)
- Karleen F Giannitrapani
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, Menlo Park, CA, USA
| | - Lucinda Leung
- Division of General Internal Medicine & Health Services Research, University of California, Los Angeles, Los Angeles, CA, USA.,Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Alexis K Huynh
- Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Susan E Stockdale
- Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Danielle Rose
- Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Jack Needleman
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Elizabeth M Yano
- Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Lisa Meredith
- Pardee RAND Graduate School, RAND Corporationt, Santa Monica, CA, USA
| | - Lisa V Rubenstein
- Division of General Internal Medicine & Health Services Research, University of California, Los Angeles, Los Angeles, CA, USA.,Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA.,RAND Corporation, Santa Monica, CA, USA
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26
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Casalino LP. Technical Assistance for Primary Care Practice Transformation: Free Help to Perform Unpaid Labor? Ann Fam Med 2018; 16:S12-S15. [PMID: 29632220 PMCID: PMC5891308 DOI: 10.1370/afm.2226] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 02/20/2018] [Indexed: 02/06/2023] Open
Affiliation(s)
- Lawrence P Casalino
- Department of Healthcare Policy and Research, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York
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27
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Kim LY, Rose DE, Soban LM, Stockdale SE, Meredith LS, Edwards ST, Helfrich CD, Rubenstein LV. Primary Care Tasks Associated with Provider Burnout: Findings from a Veterans Health Administration Survey. J Gen Intern Med 2018; 33:50-56. [PMID: 28948450 PMCID: PMC5756167 DOI: 10.1007/s11606-017-4188-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 08/30/2017] [Accepted: 09/07/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND The patient-centered medical home (PCMH) is a primary care delivery model predicated on shared responsibility for patient care among members of an interprofessional team. Effective task sharing may reduce burnout among primary care providers (PCPs). However, little is known about the extent to which PCPs share these responsibilities, and which, if any, of the primary care tasks performed independently by the PCPs (vs. shared with the team) are particularly associated with PCP burnout. A better understanding of the relationship between these tasks and their effects on PCP burnout may help guide focused efforts aimed at reducing burnout. OBJECTIVE To investigate (1) the extent to which PCPs share responsibility for 14 discrete primary care tasks with other team members, and (2) which, if any, of the primary care tasks performed by the PCPs (without reliance on team members) are associated with PCP burnout. DESIGN Secondary data analysis of Veterans Health Administration (VHA) survey data from two time periods. PARTICIPANTS 327 providers from 23 VA primary care practices within one VHA regional network. MAIN MEASURES The dependent variable was PCP report of burnout. Independent variables included PCP report of the extent to which they performed 14 discrete primary care tasks without reliance on team members; team functioning; and PCP-, clinic-, and system-level variables. KEY RESULTS In adjusted models, PCP reports of intervening on patient lifestyle factors and educating patients about disease-specific self-care activities, without reliance on their teams, were significantly associated with burnout (intervening on lifestyle: b = 4.11, 95% CI = 0.39, 7.83, p = 0.03; educating patients: b = 3.83, 95% CI = 0.33, 7.32, p = 0.03). CONCLUSIONS Performing behavioral counseling and self-management education tasks without relying on other team members for assistance was associated with PCP burnout. Expanding the roles of nurses and other healthcare professionals to assume responsibility for these tasks may ease PCP burden and reduce burnout.
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Affiliation(s)
- Linda Y Kim
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, Greater Los Angeles (GLA) Healthcare System, Los Angeles, CA, USA.
| | - Danielle E Rose
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, Greater Los Angeles (GLA) Healthcare System, Los Angeles, CA, USA
| | - Lynn M Soban
- Department of Nursing Research, Cedars-Sinai Health System, Los Angeles, CA, USA
| | - Susan E Stockdale
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, Greater Los Angeles (GLA) Healthcare System, Los Angeles, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Lisa S Meredith
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, Greater Los Angeles (GLA) Healthcare System, Los Angeles, CA, USA.,RAND Corporation, Santa Monica, CA, USA
| | - Samuel T Edwards
- Section of General Internal Medicine, VA Portland Health Care System, Portland, OR, USA.,Division of General Internal Medicine and Geriatrics, Oregon Health and Sciences University, Portland, OR, USA.,Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
| | - Christian D Helfrich
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, US Department of Veterans Affairs, Seattle, WA, USA.,Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA
| | - Lisa V Rubenstein
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, Greater Los Angeles (GLA) Healthcare System, Los Angeles, CA, USA.,RAND Corporation, Santa Monica, CA, USA
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28
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Care coordination and provider stress in primary care management of high-risk patients. J Gen Intern Med 2018; 33:65-71. [PMID: 28971306 PMCID: PMC5756166 DOI: 10.1007/s11606-017-4186-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 05/11/2017] [Accepted: 09/06/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Care coordination is a critical component of managing high-risk patients, who tend to have complex and multiple medical and psychosocial problems and are typically at high risk for increased hospitalization and incur high health care expenditures. Primary care models such as the patient-centered medical homes (PCMHs) are designed to improve care coordination and reduce care fragmentation. However, little is known about how the burden of care coordination for high-risk patients influences PCMH team members' stress. OBJECTIVE To evaluate the relationship between provider stress and care coordination time in high-risk patient care and whether availability of help is associated with reduced stress. STUDY DESIGN Multivariable regression analysis of a cross-sectional survey of PCMH primary care providers (PCPs) and nurses. PARTICIPANTS A total of 164 PCPs and 272 nurses in primary care practices at five geographically diverse Veteran Health Administration (VA) medical center health systems. MAIN MEASURES The main outcome variable was provider stress due to high-risk patient care. Independent variables were the reported proportion of high-risk patients in PCP/nurse patient panels, time spent coordinating care for these patients, and provider satisfaction with help received in caring for them. KEY RESULTS The response rate was 44%. Spending more than 8 h per week coordinating care was significantly associated with a 0.21-point increase in reported provider stress compared to spending 8 h or less per week (95% CI: 0.04-0.39; p = 0.015). The magnitude of the association between stress and care coordination time was diminished when provider satisfaction with help received was included in the model. CONCLUSIONS Perceived provider stress from care of high-risk patients may arise from challenges related to coordinating their care. Our findings suggest that the perception of receiving help for high-risk patient care may be valuable in reducing provider stress.
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Cain CL, Taborda-Whitt C, Frazer M, Schellinger S, White KM, Kaasovic J, Nelson B, Chant A. A mixed methods study of emotional exhaustion: Energizing and depleting work within an innovative healthcare team. J Interprof Care 2017. [DOI: 10.1080/13561820.2017.1356809 10.1080/13561820.2017.1356809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Cindy L. Cain
- Health Policy and Management, University of California, Los Angeles, CA, USA
| | | | | | | | - Katie M. White
- Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
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30
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Cain CL, Taborda-Whitt C, Frazer M, Schellinger S, White KM, Kaasovic J, Nelson B, Chant A. A mixed methods study of emotional exhaustion: Energizing and depleting work within an innovative healthcare team. J Interprof Care 2017; 31:714-724. [PMID: 28922038 DOI: 10.1080/13561820.2017.1356809] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This mixed methods study documents emotional exhaustion experiences among care team members during the development of an innovative team approach for caring for adults with serious illness. A mixed methods study design was employed to examine depleting work experiences that may produce emotional exhaustion, and energizing aspects of the work that may increase meaningfulness of work, thus reducing emotional exhaustion. The population studied included team members involved in care for adults with serious illness (n = 18). Team members were surveyed quarterly over an 18-month period using the Maslach Burnout Inventory (MBI). The MBI measures burnout, defined as the inability to continue work because of the interactional toll of the work. Analyses of MBI data show that although overall levels of burnout are low, 89% of team members reported moderate/high levels of emotional exhaustion during at least one survey period. In order to understand the kinds of work experiences that may produce or ameliorate emotional exhaustion, qualitative interviews were also conducted with team members at the end of the 18-month period. Major qualitative findings indicate that disputes within the team, environmental pressures, and standardisation of meaningful work leave team members feeling depleted. Having authentic relationships with patients, working as a team, believing in the care model, and practicing autonomy and creativity help team members to restore their emotional energy. Supports for team members' well-being are critical for continued innovation. We conclude with recommendations for improving team members' well-being.
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Affiliation(s)
- Cindy L Cain
- a Health Policy and Management , University of California , Los Angeles , CA , USA
| | | | | | | | - Katie M White
- d Health Policy and Management , University of Minnesota , Minneapolis , MN , USA
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31
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Spinelli WM, Fernstrom KM, Galos DL, Britt HR. Extending Our Understanding of Burnout and Its Associated Factors. Eval Health Prof 2016; 39:282-98. [DOI: 10.1177/0163278716637900] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Burnout has been identified as an occupational hazard in the helping professions for many years and is often overlooked, as health-care systems strive to improve cost and quality. The Maslach Burnout Inventory (MBI) and the Areas of Worklife Survey (AWS) are tools for assessing burnout prevalence and its associated factors. We describe how we used them in outpatient clinics to assess burnout for multiple job types. Traditional statistical techniques and seemingly unrelated regression were used to describe the sample and evaluate the association between work life domains and burnout. Of 838 eligible participants, 467 (55.7%) were included for analysis. Burnout prevalence varied across three job categories: providers (37.5%), clinical assistants (24.6%), and other staff (28.0%). It was not related to age, gender, or years of tenure but was lower in part-time workers (24.6%) than in full-time workers (33.9%). Analysis of the AWS subscales identified organizational correlates of burnout. Accurately identifying and defining the operative system factors associated with burnout will make it possible to create successful interventions. Using the MBI and the AWS together can highlight the relationship between system work experiences and burnout.
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Affiliation(s)
| | | | - Dylan L. Galos
- Division of Applied Research, Allina Health, Minneapolis, MN, USA
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Heather R. Britt
- Division of Applied Research, Allina Health, Minneapolis, MN, USA
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Role expansion on interprofessional primary care teams: Barriers of role self-efficacy among clinical associates. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2016; 4:321-326. [PMID: 28007226 DOI: 10.1016/j.hjdsi.2016.03.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 03/03/2016] [Accepted: 03/07/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Interprofessional team-based models of primary care that expand the role of clinical associates (CAs) are increasingly adopted in primary care practices. In this study we query team members of a newly implemented patient centered medical home (PCMH) to identify facilitators and barriers of occupational role self-efficacy, a belief of possessing the capacity to execute their new team based role effectively. METHODS 79 key informants, members of primary care teams at six Veterans Health Administration (VA) clinics, were interviewed to assess their experiences with implementing expanded roles for CAs. All sites had implemented Patient Aligned Care Teams, the VA's version of PCMH. RESULTS Three themes that produced the self-efficacy necessary for successful role expansion of CAs were identified: (1) role training (2) time and resources for roles and (3) cross-disciplinary role agreement. Sub-themes emerged around role challenges. Training sub themes included incomplete or limited training, inconsistencies in trainings within a site, and not receiving training with team members. Insufficient resources sub-themes included limited time for expanded tasks, inadequate space, low staffing, and poor task mix. Cross-disciplinary agreement failed to occur specifically when there was insufficient coordination between medicine and nursing leadership about staff roles, poor primary care provider (PCPs) knowledge of the boundaries of staff roles, and lack of synchronicity between staff roles and what PCPs would like staff roles to include. CONCLUSIONS These identified themes have implications for healthcare professionals working in interprofessional teams in a variety of settings and indicate the need for interdisciplinary leadership based solutions. IMPLICATIONS Clarifying the factors that impact self-efficacy for the role expansion of PACT staff can inform strategies for role transformation for enhanced primary care delivery.
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Edwards ST, Rubenstein LV, Meredith LS, Hackbarth NS, Stockdale SE, Cordasco KM, Lanto AB, Roos PJ, Yano EM. Who is responsible for what tasks within primary care: Perceived task allocation among primary care providers and interdisciplinary team members. Healthcare (Basel) 2015; 3:142-9. [DOI: 10.1016/j.hjdsi.2015.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 05/11/2015] [Accepted: 05/12/2015] [Indexed: 10/23/2022] Open
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