BACKGROUND: Physicians and nurses face high levels of burnout. The role of care teams may be protective against burnout and provide a potential target for future interventions. OBJECTIVE: To explore levels of burnout among physicians and nurses and differences in burnout between physicians and nurses, to understand physician and nurse perspectives of their healthcare teams, and to explore the association of the role of care teams and burnout. DESIGN: A mixed methods study in two school of medicine affiliated teaching hospitals in an urban medical center in Baltimore, Maryland. PARTICIPANTS: Participants included 724 physicians and 971 nurses providing direct clinical care to patients. MAIN MEASURES AND APPROACH: Measures included survey participant characteristics, a single-item burnout measure, and survey questions on care teams and provision of clinical care. Thematic analysis was used to analyze qualitative survey responses from physicians and nurses. KEY RESULTS: Forty-three percent of physicians and nurses screened positive for burnout. Physicians reported more isolation at work than nurses (p<0.001), and nurses reported their care teams worked efficiently together more than physicians did (p<0.001). Team efficiency was associated with decreased likelihood of burnout (p<0.01), and isolation at work was associated with increased likelihood of burnout (p<0.001). Free-text responses revealed themes related to care teams, including emphasis on team functioning, team membership, and care coordination and follow-up. Respondents provided recommendations about optimizing care teams including creating consistent care teams, expanding interdisciplinary team members, and increasing clinical support staffing. CONCLUSIONS: More team efficiency and less isolation at work were associated with decreased likelihood of burnout. Free-text responses emphasized viewpoints on care teams, suggesting that better understanding care teams may provide insight into physician and nurse burnout.
“Where You Feel Like a Family Instead of Co-Workers”: A Mixed Methods Study on Care Teams and Burnout
The physician burnout discourse emphasises organisational challenges and personal well-being as primary points of intervention. However, these foci have minimally impacted this worsening public health crisis by failing to address the primary sources of harm: oppression. Organised medicine's whiteness, developed and sustained since the nineteenth century, has moulded training and clinical practice, favouring those who embody its oppressive ideals while punishing those who do not. Here, we reframe physician burnout as the trauma resulting from the forced assimilation into whiteness and the white supremacy culture embedded in medical training's hidden curriculum. We argue that 'ungaslighting' the physician burnout discourse requires exposing the history giving rise to medicine's whiteness and related white supremacy culture, rejecting discourses obscuring their harm, and using bold and radical frameworks to reimagine and transform medical training and practice into a reflective, healing process.
White Supremacy Culture and the Assimilation Trauma of Medical Training: Ungaslighting the Physician Burnout Discourse
[This is an excerpt.] The diversity of the health workforce is critical for health equity. It has implications for access, quality, health equity, and job opportunities in low-income communities. This evidence review focuses specifically on racial/ethnic population groups that have been historically identified as underrepresented in healthcare professions that require higher education. [To read more, click View Resource.]
This resource is found in our Actionable Strategies for Health Organizations: Promoting Diversity, Equity, & Inclusion.
Who Enters the Health Workforce? An Examination of Racial and Ethnic Diversity
This study examined whether and how listening in the internal communication context may influence the quality of employee-organization relationships. This study proposed employee psychological need satisfaction as the potential underlying mechanism that mediates the relationship between internal listening and employee relational outcomes. An online survey was conducted with 443 employees across various industries in the United States. The key findings of this study showed that employee perceptions of internal organizational listening were positively associated with employees’ perceived relationships with their organization. In addition, employee psychological need satisfaction positively mediated the effects of both organizational and supervisory listening on the quality of employee-organization relationships. This study advances the theorizing of listening from an internal communication perspective and contributes to the growing body of knowledge in relationship management.
This resource is found in our Actionable Strategies for Health Organizations: Empowering Worker & Learner Voice (Worker & Learner Engagement).
Why does listening matter inside the organization? The impact of internal listening on employee-organization relationships
OBJECTIVE: This study examined the association between workplace exposure and prescription drug misuse in nurses. BACKGROUND: Studies have found RNs and other health providers have higher rates of prescription misuse than the general population and have suggested that workplace exposures along with excessive job demands create circumstances fostering misuse. METHODS: Survey data from 1170 RNs on workplace exposures (availability, frequency of administration, knowledge of substances, and workplace controls) were described by workplace, position, and specialty. Exposures were then related to prescription drug misuse using logistic regression. RESULTS: Each workplace exposure was associated with past year prescription drug misuse. An index combining all exposures was significantly related to misuse (P = 0.001), and odds of misuse increased by 38% for each point increase in the exposure index. CONCLUSIONS: Consideration of the health and well-being of nurses at higher odds of exposure to prescription drugs with misuse potential is warranted. Workplace support to help nurses maintain and restore their health should be a priority.
Workplace Exposures and Prescription Drug Misuse Among Nurses
[This is an excerpt.] Workplace violence against nurses happens every day. In 2022, the rate of assaults in U.S. hospitals increased by 23%. A recent study of RNs found a significant proportion of nurses who cared for patients with COVID-19 experienced more physical violence and verbal abuse, and had more difficulty in reporting the incidents to management. These statistics attest to the magnitude of this serious problem that nurses face every day. Our Presenter is Lynda Enos RN, MS, COHN-S, CPE. Lynda is an occupational health nurse and certified professional ergonomist with over 30 years of work and consulting experience in industrial and health care ergonomics and safety with over 200 companies nationwide. She holds an undergraduate degree in nursing and a graduate degree in human factors/ergonomics from the University of Idaho. In 2017, she completed a 2-year project for the Oregon Association for Hospitals and Health Systems (OAHHS) that included providing assistance to 5 hospitals in Oregon to evaluate and facilitate development of comprehensive workplace violence prevention (WPV) programs. As a result of this project Lynda developed a comprehensive toolkit for prevention violence in healthcare “Oregon Workplace Safety Initiative Workplace Violence in Healthcare: A Toolkit for Prevention and Management” that was published in December 2017 and extensively updated in March 2020. Lynda has since worked with several state hospital associations to conduct WPV prevention workshops that are based on the Oregon WPV toolkit and are offered to hospitals and other healthcare entities throughout a state either in-person and via webinar. In 2019, Lynda assisted the Oregon State Stabilization and Crisis Unit (SACU) to further develop their WPV prevention program for 23 group homes for adults and children. She is a subject matter expert for several regulatory and research entities including, the American Nurses Association and American National Standards Institute and International Standards Organization, and the Joint Commission. [To view, click View Resource.]
This resource is found in our Actionable Strategies for Professional Associations: Spotlights: Professional Associations Operational Strategies (Ensuring Physical & Mental Health).
Workplace Violence against Nurses: What You Can Do
Highlights
• Burnout impacts 50-55% of emergency department nurses; nurse burnout cultural impacts in this setting are under-explored.
• This ethnography revealed an explanatory model of nurse burnout impacts, “The Pathway of Burnout”.
• Cultural clash was identified between pervasive nurse burnout culture and a culture of patient safety.
“You Have to Ask Yourself When You've Had Enough”: An Ethnography of Multi-Level Nurse Burnout Cultural Impacts in the Emergency Department
[This is an excerpt.] Member Boards showed their support for the new Standards for Continuing Certification (Standards) following their approval by the American Board of Medical Specialties (ABMS) Board of Directors during its October meeting, with many issuing statements explaining the new Standards, their implications for board certified physicians, and how changes made or those underway are already in alignment with the new Standards. Some boards had already started making substantial changes to their continuing certification programs following the release of the recommendations made by the Continuing Board Certification: Vision for the Future Commission, which met through 2018 to provide strategic guidance to the ABMS Board of Directors and Member Boards. A few of them predate the recommendations. These programmatic changes reflect the Commission recommendations and the new Standards whose release represents the culmination of three years of development and consultation with myriad stakeholders from across the health care spectrum. As an example, the new Standards reinforce the transition to innovative assessment programs that support and direct physician learning. [To read more, click View Resource.]
This resource is found in our Actionable Strategies for Professional Associations: Spotlights: Professional Associations Operational Strategies (Workloads and Workflows).
ABMS Member Boards Move Toward Alignment with New Standards
BACKGROUND: Academic service-learning nursing partnerships (ASLNPs) integrate instruction, reflection, and scholarship with tailored service through enriched learning experiences that teach civic responsibility and strengthen communities, while meeting academic nursing outcomes. Objective: This scoping review aimed to identify, appraise, and synthesize evidence of community focused ASLNPs that promote primary health care throughout the Americas region. METHODS: A systematic search of PubMed, CINAHL, Scopus, Google Scholar, and LILACS English-language databases was performed in accordance with PRISMA guidelines. Full-text articles published since 2010 were reviewed using an inductive thematic approach stemming from the "Advancing Healthcare Transformation: a New Era for Academic Nursing Report" and the Pan American Health Organization "Strategic Directions for Nursing." RESULTS: A total of 51 articles were included with the vast majority 47 (92.1 %) representing North America. Structured, established relationships between an academic nursing institution or program and one or more community serving entities resulted in high levels of effectiveness and innovation across settings. Five themes emerged: (a) sustaining educational standards and processes - improving academic outcomes (25.5 %), (b) strengthening capacity for collaborative practice and interprofessional education (13.7 %), (c) preparing nurses of the future (11.8 %), (d) enhancing community services and outcomes (21.6 %), and (e) conceptualizing or implementing innovative academic nursing partnerships (27.4 %). A synthesis of conceptual frameworks and models revealed six focus areas: communities/populations (26.2 %), nursing (26.2 %), pedagogy (19 %), targeted outreach (14.3 %), interprofessional collaboration (11.9 %), and health determinants (9.5 %). A proliferation in US articles, triggered by nursing policy publications, was confirmed. CONCLUSIONS: ASLNPs serve as mechanisms for nurses and faculty to develop and lead change across a wide variety of community settings and healthcare systems, develop scholarship, as well as for students to apply the knowledge and skills learned. Given the lack of geographically broad evidence, successes and challenges across U.S. partnerships should be viewed cautiously. Nevertheless, ASLNPs can play a critical role towards meeting the goal of universal health access and coverage through partnering with the education sector. Further investigation of grey literature as well as Spanish and Portuguese language literature from Latin American and Caribbean countries is highly recommended.
This resource is found in our Actionable Strategies for Health Organizations: Improving Workload & Workflows (Safe & Appropriate Staffing).
Academic Service-Learning Nursing Partnerships in the Americas: A Scoping Review
[This is an excerpt.] Addressing clinician well-being has reached a new level of urgency during the COVID-19 pandemic. Record numbers of clinicians are experiencing moral distress from critical resource shortages, emotional distress from delivering care to profoundly ill patients while being socially isolated, and role stress from the loss of child care or other supports. These stressors have been compounded by the deaths of Breonna Taylor, George Floyd, and others, heightening awareness of long-standing, unaddressed structural racism that impacts both clinicians and patients.Work culture heavily influences clinician well-being, and changes that improve organizational work culture and create seamless workflows have been successfully implemented to reduce burnout and increase well-being. Similar arguments can and must be made for health care organizations to adopt antiracist practices that result in sustained meaningful change, because for too many clinicians, racism is a defining component of work culture. [To read more, click View Resource.]
A Call to Action: Align Well-being and Antiracism Strategies
Discrimination towards individuals with disabilities is problematic within nursing. There have been calls to increase diversity in nursing and this includes embracing nurses with disabilities. Increasing diversity in nursing requires increasing diversity among nursing students; in this way, nurse educators are gatekeepers to the profession. Clinical education is a crucial element of nursing education, yet there have been very few studies related to the clinical education of nursing students with disabilities. There have been no studies of attitudes of acute care nurse preceptors toward students with disabilities in the United States. This gap is important as the majority of clinical experiences occur in the acute care environment. Utilizing a focused ethnography, semi-structured interviews were conducted with 20 acute care nurses with at least two years’ experience precepting students. While positive feelings about nursing students with disabilities were shared, thoughts and behavioral intentions remained negative. Six themes emerged: safety, barriers, otherness, communicating to meet needs, disclosure, and student versus colleague. Attitudinal barriers are the primary barriers faced by individuals with disabilities in becoming and practicing as nurses. Nurses in practice and education must embrace more inclusive attitudes towards individuals with disabilities.
Acute Care Nurses’ Attitudes Toward Nursing Students with Disabilities: A Focused Ethnography
BACKGROUND: A variety of stressors throughout medical education have contributed to a burnout epidemic at both the undergraduate medical education (UGME) and postgraduate medical education (PGME) levels. In response, UGME and PGME programs have recently begun to explore resilience-based interventions. As these interventions are in their infancy, little is known about their efficacy in promoting trainee resilience. This systematic review aims to synthesize the available research evidence on the efficacy of resilience curricula in UGME and PGME. METHODS: We performed a comprehensive search of the literature using MEDLINE, EMBASE, PsycINFO, Educational Resources Information Centre (ERIC), and Education Source from their inception to June 2020. Studies reporting the effect of resilience curricula in UGME and PGME settings were included. A qualitative analysis of the available studies was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Risk of bias was assessed using the ROBINS-I Tool. RESULTS: Twenty-one studies met the inclusion criteria. Thirteen were single-arm studies, 6 quasi-experiments, and 2 RCTs. Thirty-eight percent (8/21; n = 598) were implemented in UGME, while 62 % (13/21, n = 778) were in PGME. There was significant heterogeneity in the duration, delivery, and curricular topics and only two studies implemented the same training model. Similarly, there was considerable variation in curricula outcome measures, with the majority reporting modest improvement in resilience, while three studies reported worsening of resilience upon completion of training. Overall assessment of risk of bias was moderate and only few curricula were previously validated by other research groups. CONCLUSIONS: Findings suggest that resilience curricula may be of benefit to medical trainees. Resilience training is an emerging area of medical education that merits further investigation. Additional research is needed to construct optimal methods to foster resilience in medical education.
This resource is found in our Actionable Strategies for Health Organizations: Ensuring Physical & Mental Health (Stress/Trauma & Resilience).
Addressing the Physician Burnout Epidemic with Resilience Curricula in Medical Education: A Systematic Review
[This is an excerpt.] Demographic and policy trends in the United States have combined to create unprecedented demand for home-based, long-term care services for the elderly, with expected growth for decades to come. Home care workers like home health and personal care aides provide most of the care for the increasing elderly population, many of whom have chronic and complex medical and social needs and prefer to age at home. Despite the critical role of those providing this care,home care workers are undervalued, underpaid, and rarely acknowledged as members of client health care teams. This undervaluation contributes to low job satisfaction and high home care worker turnover and attrition, which may negatively affect clients’ health and employers’ bottom lines. As a result, advocates argue that opportunities for skill and career advancement for homecare workers can improve their job quality, satisfaction, and livelihoods while also contributing to positive downstream outcomes for clients, employers, and even health systems. This report, Advancing the Home Care Workforce: A Review of Program Approaches, Evidence,and the Challenges of Widespread Adoption, was commissioned by the Ralph C. Wilson, Jr.Foundation with an objective to examine program approaches to advance the roles of home care workers with a deeper dive into some of the contextual factors that may impact uptake specifically in in Western New York and Southeast Michigan due to the Foundation’s geographic focus in these two regions. Findings emerged from a literature review and interviews with content experts representing a range of stakeholder groups. [To read more, click View Resource.]
This resource is found in our Actionable Strategies for Health Organizations: Meaningful Rewards& Recognition (Career Supports and Development)
Advancing the Home Care Workforce: A Review of Program Approaches, Evidence, and the Challenges of Widespread Adoption
[This is an excerpt.] The field of occupational therapy utilizes a variety of frameworks and models to inform the occupational therapy (OT) process for assessment and goal development, and to provide intervention and guidelines for practitioners. This document applies the Occupational Adaptation (OA) model to address diversity, equity, and inclusion within the field of occupational therapy. The model provides a method to identify areas of need and supports the growth of our students, practitioners, and those in academia. The purpose of this framework is to provide a tool for increasing awareness of the diverse needs of individuals in our professional communities and to provide inclusive occupational therapy practice for all. The occupational adaptational model provides the framework for exploring our own needs as we press for mastery as an occupational therapy practitioner, a student, a fieldwork educator, or a faculty member. This framework guides individuals through understanding their own perspectives as occupational therapy practitioners, fieldwork students, fieldwork educators, or faculty in occupational therapy education. As we press for practice from a perspective of cultural humility, we must recognize the implicit and explicit biases that impact our interactions.The framework also allows understanding the perspective of others and considering the influence of environment and contexts on providing inclusive occupational therapy services. [To read more, click View Resource.]
This resource is found in our Actionable Strategies for Professional Associations: Spotlights: Professional Associations Relational Strategies (Improving Diversity, Equity, & Inclusion).
A Framework for Addressing Diversity, Equity, and Inclusion in Everyday Practice for Occupational Therapy
OBJECTIVE: The objective of this study was to addresses the basic question of whether alternative legislative approaches are effective in encouraging hospitals to increase nurse staffing. METHODS: Using 16 years of nationally representative hospital-level data from the American Hospital Association (AHA) annual survey, we employed a difference-in-difference design to compare changes in productive hours per patient day for registered nurses (RNs), licensed practical/vocational nurses (LPNs), and nursing assistive personnel (NAP) in the state that mandated staffing ratios, states that legislated staffing committees, and states that legislated public reporting, to changes in states that did not implement any nurse staffing legislation before and after the legislation was implemented. We constructed multivariate linear regression models to assess the effects with hospital and year fixed effects, controlling for hospital-level characteristics and state-level factors. RESULTS: Compared with states with no legislation, the state that legislated minimum staffing ratios had an 0.996 (P<0.01) increase in RN hours per patient day and 0.224 (P<0.01) increase in NAP hours after the legislation was implemented, but no statistically significant changes in RN or NAP hours were found in states that legislated a staffing committee or public reporting. The staffing committee approach had a negative effect on LPN hours (difference-in-difference=-0.076, P<0.01), while the public reporting approach had a positive effect on LPN hours (difference-in-difference=0.115, P<0.01). There was no statistically significant effect of staffing mandate on LPN hours. CONCLUSIONS: When we included California in the comparison, our model suggests that neither the staffing committee nor the public reporting approach alone are effective in increasing hospital RN staffing, although the public reporting approach appeared to have a positive effect on LPN staffing. When we excluded California form the model, public reporting also had a positive effect on RN staffing. Future research should examine patient outcomes associated with these policies, as well as potential cost savings for hospitals from reduced nurse turnover rates.
This resource is found in our Actionable Strategies for Health Organizations: Improving Workload & Workflows (Safe & Appropriate Staffing).
Alternative Approaches to Ensuring Adequate Nurse Staffing
OBJECTIVE:The objective of this study was to addresses the basic question of whether alternative legislative approaches are effective in encouraging hospitals to increase nurse staffing. METHODS: Using 16 years of nationally representative hospital-level data from the American Hospital Association (AHA) annual survey, we employed a difference-in-difference design to compare changes in productive hours per patient day for registered nurses (RNs), licensed practical/vocational nurses (LPNs), and nursing assistive personnel (NAP) in the state that mandated staffing ratios, states that legislated staffing committees, and states that legislated public reporting, to changes in states that did not implement any nurse staffing legislation before and after the legislation was implemented. We constructed multivariate linear regression models to assess the effects with hospital and year fixed effects, controlling for hospital-level characteristics and state-level factors. RESULTS: Compared with states with no legislation, the state that legislated minimum staffing ratios had an 0.996 (P<0.01) increase in RN hours per patient day and 0.224 (P<0.01) increase in NAP hours after the legislation was implemented, but no statistically significant changes in RN or NAP hours were found in states that legislated a staffing committee or public reporting. The staffing committee approach had a negative effect on LPN hours (difference-in-difference=−0.076, P<0.01), while the public reporting approach had a positive effect on LPN hours (difference-in-difference=0.115, P<0.01). There was no statistically significant effect of staffing mandate on LPN hours. CONCLUSIONS: When we included California in the comparison, our model suggests that neither the staffing committee nor the public reporting approach alone are effective in increasing hospital RN staffing, although the public reporting approach appeared to have a positive effect on LPN staffing. When we excluded California form the model, public reporting also had a positive effect on RN staffing. Future research should examine patient outcomes associated with these policies, as well as potential cost savings for hospitals from reduced nurse turnover rates.
Alternative Approaches to Ensuring Adequate Nurse Staffing: The Effect of State Legislation on Hospital Nurse Staffing
[This is an excerpt.] The first case of COVID-19 was reported in America in January of 2020. In the ensuing months, COVID-19 has taken the lives of more than 200,000 people in the USA and upended our current model of medical education and practice. In the midst of a pandemic, hospitals across the country report millions of dollars in economic losses, healthcare providers face furloughs, and medical students sit at home delaying their training indefinitely. The novel coronavirus threatens to disrupt every facet of our healthcare system, and work surrounding diversity, equity, and inclusion in medicine is not immune. [To read more, click View Resource.]
This resource is found in our Actionable Strategies for Health Organizations: Promoting Diversity, Equity, & Inclusion.
A Roadmap for Diversity in Medicine During the Age of COVID-19 and George Floyd
IMPORTANCE: Medical trainee burnout is associated with poor quality care and attrition. Medical students in sexual minority groups report fear of discrimination and increased mistreatment, but the association between sexual orientation, burnout, and mistreatment is unknown. OBJECTIVE: To evaluate whether medical student burnout differs by sexual orientation and whether this association is mediated by experiences of mistreatment. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study surveyed US medical students graduating from Association of American Medical Colleges (AAMC)–accredited US allopathic medical schools who responded to the AAMC graduation questionnaire in 2016 and 2017. Statistical analyses were performed from March 15, 2019, to July 2, 2020, and from November 20 to December 9, 2020. MAIN OUTCOMES AND MEASURES: Burnout was measured using the Oldenburg Burnout Inventory for Medical Students, and sexual orientation was categorized as either heterosexual or lesbian, gay, or bisexual (LGB). Logistic regression models were constructed to evaluate the association between sexual orientation and experiencing burnout (defined as being in the top quartile of exhaustion and disengagement burnout dimensions) and to test the mediating association of mistreatment. RESULTS: From 2016 to 2017, 30 651 students completed the AAMC Graduation Questionnaire, and 26 123 responses were analyzed. Most respondents were younger than 30 years (82.9%) and White (60.3%). A total of 13 470 respondents (51.6%) were male, and 5.4% identified as LGB. Compared with heterosexual students, a greater proportion of LGB students reported experiencing mistreatment in all categories, including humiliation (27.0% LGB students vs 20.7% heterosexual students; P < .001), mistreatment not specific to identity (17.0% vs 10.3%; P < .001), and mistreatment specific to gender (27.3% vs 17.9%; P < .001), race/ethnicity (11.9% vs 8.6%; P < .001), and sexual orientation (23.3% vs 1.0%; P < .001). Being LGB was associated with increased odds of burnout (adjusted odds ratio, 1.63 [95% CI, 1.41-1.89]); this association persisted but was attenuated after adjusting for mistreatment (odds ratio, 1.36 [95% CI, 1.16-1.60]). The odds of burnout increased in a dose-response manner with mistreatment intensity. Lesbian, gay, or bisexual students reporting higher mistreatment specific to sexual orientation had and 8-fold higher predicted probability of burnout compared with heterosexual students (19.8% [95% CI, 8.3%-31.4%] vs 2.3% [95% CI, 0.2%-4.5%]; P < .001). Mediation analysis showed that mistreatment accounts for 31% of the total association of LGB sexual orientation with overall burnout (P < .001). CONCLUSIONS AND RELEVANCE: This study suggests that LGB medical students are more likely than their heterosexual peers to experience burnout, an association that is partly mediated by mistreatment. Further work is needed to ensure that medical schools offer safe and inclusive learning environments for LGB medical students.
Association Between Sexual Orientation, Mistreatment, and Burnout Among US Medical Students
Practicing physicians and administrators both rightfully consider themselves to be highly trained, skilled, and knowledgeable team members. However, relationships between frontline physicians and administrators are severely strained in many health care organizations, and trust is at an all-time low. Physicians may feel that administrators don’t understand, or don’t care, about the challenges they face taking care of patients. They may feel as though they are treated as line production workers with little control over their schedules, support team, and even clinical decision-making. At the same time, administrators may think physicians do not understand the challenges of running a complex organization such as a hospital or health system, including the financial and management challenges that ensure long term sustainability.
This resource is found in our Actionable Strategies for Health Organizations: Empowering Worker & Learner Voice (Worker & Learner Engagement).
Building Bridges Between Practicing Physicians and AdministratorsImprove Physician–Administrator Relationships and Enhance Engagement
BACKGROUND: Workplace burnout among healthcare professionals is a critical public health concern. Few studies have examined organizational and individual factors associated with burnout across healthcare professional groups. OBJECTIVE: The purpose of this study was to examine the association between practice adaptive reserve (PAR) and individual behavioural response to change and burnout among healthcare professionals in primary care. DESIGN: This cross-sectional study used survey data from 154 primary care practices participating in the EvidenceNOW Heart of Virginia Healthcare initiative. PARTICIPANTS: We analysed data from 1279 healthcare professionals in Virginia. Our sample included physicians, advanced practice clinicians, clinical support staff and administrative staff. MAIN MEASURES: We used the PAR instrument to measure organizational capacity for change and the Change Diagnostic Index© (CDI) to measure individual behavioural response, which achieved a 76% response rate. Logistic regression analysis was used to estimate the effects of PAR and CDI on burnout. KEY RESULTS: As organizational capacity for change increased, burnout in healthcare professionals decreased by 51% (OR: 0.49; 95% CI, 0.33, 0.73). As healthcare professionals showed improved response toward change, burnout decreased by 84% (OR: 0.16; 95% CI, 0.11, 0.23). Analysis by healthcare professional type revealed a significant association between high organizational capacity for change, positive response to change and low burnout among administrative staff (OR: 2.92; 95% CI, 1.37, 6.24). Increased hours of work per week was associated with higher odds of burnout (OR: 1.07; 95% CI, 1.05, 1.10) across healthcare professional groups. CONCLUSION: As transformation efforts in primary care continue, it is critical to understand the influence of these initiatives on healthcare professionals' well-being. Efforts to reduce burnout among healthcare professionals are needed at both a system and organizational level. Building organizational capacity for change, supporting providers and staff during major change and consideration of individual workload may reduce levels of burnout.
