OBJECTIVE: To explore the relationship between immediate supervisor leadership behaviors and burnout and professional satisfaction of health care employees. PARTICIPATNS AND METHODS: From October 2 to 20, 2017, we surveyed nonphysician health care employees. The survey included 2 items from the Maslach Burnout Inventory and items on their immediate supervisor leadership behaviors. Logistic regression was performed to evaluate the relationship between the leadership score and the prevalence of burnout and satisfaction after adjusting for age, sex, duration of employment, and job category. Sensitivity analysis was performed using mixed models with a random intercept for work unit to assess the impact of the correlation within work units on burnout and satisfaction with the organization. RESULTS: Of the 57,414 employees surveyed, 39,896 (69.5%) responded and answered the leadership questions. Supervisor scores in each dimension and composite leadership scores correlated with burnout and satisfaction of employees (P<.001 for all). In logistic regression, each 1-point increase in leadership score was associated with a 7% decrease in odds of burnout and an 11% increase in odds of satisfaction (P<.001 for both) of employees. The mean composite leadership score rating of each immediate supervisor correlated with rate of burnout (r=-0.247; P<.001) and the satisfaction with the organization (r=0.416; P<.001) at the work unit level. CONCLUSION: Leadership qualities of immediate supervisors relate to burnout and satisfaction of nonphysician health care employees working in a large organization. Further studies are needed to determine whether strategies to monitor and improve supervisor leadership scores result in reduction in burnout and improved satisfaction among health care employees.
Relationship Between Organizational Leadership and Health Care Employee Burnout and Satisfaction
PURPOSE: The purpose of this study is to review research on hospital-based shared governance (SG), focussing on its core elements. DESIGN/METHODOLOGY/APPROACH: A scoping review was conducted by searching the Medline (Ovid), CINAHL (EBSCO), Medic, ABI/INFORM Collection (ProQuest) and SveMed+ databases using SG and related concepts in hospital settings as search terms (May 1998–February 2019). Only original research articles examining SG were included. The reference lists of the selected articles were reviewed. Data were extracted from the selected articles by charting and then subjected to a thematic analysis. FINDINGS: The review included 13 original research articles that examined SG in hospital settings. The studied organizations had implemented SG in different ways, and many struggled to obtain satisfactory results. SG was executed within individual professions or multiple professions and was typically implemented at both unit- and organization-levels. The thematic analysis revealed six core elements of SG as follows: professionalism, shared decision-making, evidence-based practice, continuous quality improvement, collaboration and empowerment. PRACTICAL IMPLICATIONS: An SG framework for hospital settings was developed based on the core elements of SG, the participants and the organizational levels involved. Hospitals considering SG should prepare for a time-consuming process that requires belief in the core elements of SG. The SG framework can be used as a tool to implement and strengthen SG in organizations. ORIGINALITY/VALUE: The review resumes the tradition of systematically reviewing SG literature, which had not been done in the 21st century. General tendencies of the research scene and research gaps are pointed out.
Research on Hospital-Based Shared Governance: A Scoping Review
Teamwork and communication are paramount to patient safety. Poor communication during handoff is implicated in near misses and adverse events. Exposing nurses to other units’ workflow early in their orientation may also aid in surge staffing. This study showed improvements in teamwork and communication, and a deeper understanding of another units’ workflow.
Shadowing to Improve Teamwork and Communication: A Potential Strategy for Surge Staffing
[This is an excerpt.] The purpose of this paper is to review what is known about the different methods for how third-party payers pay primary care health professionals and, in some cases, intermediary organizations to which health professionals may belong. The paper will not explore how the intermediary organization,whether a small or medium size practice or a large health care organization, compensates the clinicians who are either employed or otherwise affiliated with the organization. Findings from two recent surveys illustrate the crucial difference between the two different approaches to characterizing how primary care clinicians are paid or compensated. The final Center for Studying Health System Change Tracking Physician Survey published in 2009 found that the most common compensation arrangement for physicians was salary—nearly 70 percent (Boukus, Cassil, and O’Malley 2009). In contrast, an analysis of payment methods used for physicians conducted using the Medical Expenditure Panel Survey (MEPS) from 2010 found that that fee-for-service was the dominant method, constituting 93 percent of physician office visits (Zuvekas and Cohen 2010). Our interest are the payment methods payers—public and private—can use to pay physicians directly or to compensate organizations through which clinicians are employed or affiliated. [To read more, click View Resource.]
This resource is found in our Actionable Strategies for Government: Optimizing Workload & Workflows (Advance Team-Based Care)
Strengthening Primary Care Delivery through Payment Reform
OBJECTIVE: A rapid review was conducted to identify the most effective stress reduction techniques for health care providers dealing with patients infected with severe coronavirus (SARS, MERS, and COVID-19). METHODS: PubMed, PsychInfo, Embase, and CINAHL databases were searched to identify relevant studies. Searches were restricted by date (2000 until present). All empirical quantitative and qualitative studies in which relaxation techniques of various types implemented on health care providers caring for patients during severe coronavirus pandemics and articles that consider the implementation of mental health care services considered to be pertinent, such as commentaries, were included. RESULTS: Fourteen studies met the selection criteria, most of which were recommendations. Only one study described a digital intervention, and user satisfaction was measured. In the recommendations, both organizational and individual self-care interventions were suggested. CONCLUSIONS: Further research is necessary to establish tailor-made effective stress reduction interventions for this population, during these challenging and particular times.
Stress Reduction Techniques for Health Care Providers Dealing With Severe Coronavirus Infections (SARS, MERS, and COVID-19): A Rapid Review
[This is an excerpt.] Learn how ChristianaCare built foundational well-being programs to lay the groundwork for a Chief Wellness Officer (CWO) position. [To read more, click View Resource.]
This resource is found in our Actionable Strategies for Health Organizations: Establishing Commitment & Shared Governance (Organizational Infrastructure for Well-Being).
Success Story: Laying the Groundwork for a Chief Wellness Officer at ChristianaCare
BACKGROUND/PURPOSE: To evaluate teamness perceptions of employees and trainees and associations between teamness and employee perceptions of burnout, satisfaction, and decision-making in the context of a clinical setting with interprofessional trainees.
METHODS: Seven Veterans Health Administration (VA)-funded Centers of Excellence in Primary Care Education (CoEPCE) developed interprofessional ambulatory learning environments. Two hundred forty-eight trainees and 260 employees completed the Assessment for Collaborative Environments (ACE-15) scale, a measure of teamness; VA employees also answered survey questions on burnout, job satisfaction, and decision-making. Means, standard deviations, t-tests, analysis of variance (ANOVA) using Levene's test for homogeneity and Pearson's product-moment correlations were performed. Data were collected in each of two years.
RESULTS: For employees, higher teamness was correlated with lower burnout, higher satisfaction, and higher decision-making in both years. In Year 1, employee mean ACE-15 score was 46.86 (SD 7.44) and trainee mean was 50.22 (SD 5.81). In year 2, the employee mean was 47.08 (SD 6.16) and trainee mean was 50.47 (SD 6.16) (p < .01 for both years).
CONCLUSIONS: We found that teamness was significantly higher in trainees than employees in both years, and that the ACE-15 was effective in discriminating between these groups. The ACE-15 is helpful in measuring teamness in a primary care education reform context, and correlates with employee improvements in burnout, satisfaction, and decision-making. This study suggests that, in a context of interprofessional learning, measuring teamness among all care team members can enhance understanding of what influences performance and satisfaction.
This resource is found in our Actionable Strategies for Health Organizations: Improving Workload & Workflows (Optimizing Teams).
Teamness, Burnout, Job Satisfaction and Decision-Making in the VA Centers of Excellence in Primary Care Education
OBJECTIVE: To describe and benchmark physician-perceived electronic health record (EHR) usability as defined by a standardized metric of technology usability and evaluate the association with professional burnout among physicians. PARTICIPANTS AND METHODS: This cross-sectional survey of US physicians from all specialty disciplines was conducted between October 12, 2017, and March 15, 2018, using the American Medical Association Physician Masterfile. Among the 30,456 invited physicians, 5197 (17.1%) completed surveys. A random 25% (n=1250) of respondents in the primary survey received a subsurvey evaluating EHR usability, and 870 (69.6%) completed it. EHR usability was assessed using the System Usability Scale (SUS; range 0-100). SUS scores were normalized to percentile rankings across more than 1300 previous studies from other industries. Burnout was measured using the Maslach Burnout Inventory. RESULTS: Mean ± SD SUS score was 45.9±21.9. A score of 45.9 is in the bottom 9% of scores across previous studies and categorized in the “not acceptable” range or with a grade of F. On multivariate analysis adjusting for age, sex, medical specialty, practice setting, hours worked, and number of nights on call weekly, physician-rated EHR usability was independently associated with the odds of burnout with each 1 point more favorable SUS score associated with a 3% lower odds of burnout (odds ratio, 0.97; 95% CI, 0.97-0.98; P<.001). CONCLUSION: The usability of current EHR systems received a grade of F by physician users when evaluated using a standardized metric of technology usability. A strong dose-response relationship between EHR usability and the odds of burnout was observed.
This resource is found in our Actionable Strategies for Health Organizations: Improving Workload & Workflows (Reducing Administrative Burdens).
The Association Between Perceived Electronic Health Record Usability and Professional Burnout Among US Physicians
We analyze the economic and financial impact of right-to-work (RTW) laws in the US. Using data from collective bargaining agreements, we show that there is a decrease in wages for unionized workers after RTW laws. Firms increase investment and employment but reduce financial leverage. Labor-intensive firms experience higher profits and labor-to-asset ratios. Dividends and executive compensation also increase post-RTW. Our results are consistent with a canonical theory of the firm augmented with an exogenous bargaining power of labor and suggest that RTW laws impact corporate policies by decreasing that bargaining power.
This resource is found in our Actionable Strategies for Government: Empowering Workers & Strengthening Leadership and Governance (Strengthening Protections to Speak Up)
The Economic Impact of Right-to-Work Laws: Evidence from Collective Bargaining Agreements and Corporate Policies
PURPOSE: To examine the potential impact of Health Resources and Services Administration (HRSA) funding (predoctoral [PD] and postdoctoral [PDD] programs) on dentists’ practice location in the United States. METHOD: The authors linked 2011–2015 data from HRSA’s Electronic Handbooks to 2015 data from the American Dental Association Masterfile, dental health professional shortage areas, and rural–urban commuting area codes. They examined the associations between PD and PDD funding and dentists’ practice location between 2004 and 2015 using a difference-in-differences analysis and multiple logistic regressions, adjusting for covariates. RESULTS: From 2004 to 2015, 21.2% (1,588/7,506) of dentists graduated from institutions receiving PD funding and 26.8% (2,014/7,506) graduated from institutions receiving PDD funding. Among dentists graduating from institutions receiving PDD funding, after adjusting for covariates, those graduating between 2011 and 2015 were more likely to practice in a rural area than those graduating between 2004 and 2010 (odds ratio [OR] = 1.98; 95% confidence interval [CI] = 1.04–3.76). The difference-in-differences approach showed that PD and PDD funding significantly increased the odds that a dentist would practice in a rural area (respectively, OR = 2.70; 95% CI = 1.31–5.79/OR = 2.84; 95% CI = 1.40–5.77). CONCLUSIONS: HRSA oral health training program funding had a positive effect on dentists choosing to practice in a rural area. By increasing the number of dentists practicing in rural communities, HRSA is improving access to, and the delivery of, oral health care services to underserved and vulnerable rural populations.
The Impact of Title VII Dental Workforce Programs on Dentists’ Practice Location: A Difference-in-Differences Analysis
The purpose of this study is to examine risk factors in working environment affecting firefighters’ burnout and to verify the moderating effect of compassion fatigue in the relationship between risk factors and burnout. A total of 371 firefighters working in large cities and small towns participated in the survey, and 341 questionnaires were analyzed. The questionnaires used in the study were the Working Environment Inventory, the Maslach Burnout Inventory, and the Compassion Fatigue Self-test for Helpers Scale. The results presented a high correlation between risk factors, burnout, and compassion fatigue. The overall regression model of risk factors in working environment and burnout was significant, and the explanatory power of the independent variable was 0.444. The sub-factors affecting burnout were the lack of challenge, the role ambiguity, the role conflict, and overwork. Next, firefighters’ compassion fatigue was found to significantly control the effects of risk factors on burnout. In other words, as the level of compassion fatigue increased, the influence of risk factors in working environment on burnout increased. The significance of this study is to provide a basis for establishing environmental and psychological interventions which can reduce firefighters’ burnout.
This resource is found in our Actionable Strategies for Public Safety Organizations: Drivers (Operational Breakdown)
The Moderating Effect of Compassion Fatigue in the Relationship Between Firefighters’ Burnout and Risk Factors in Working Environment
The passage of the Occupational Safety and Health Act of 1970 brought unprecedented changes in US workplaces, and the activities of the Occupational Safety and Health Administration (OSHA) have contributed to a significant reduction in work-related deaths, injuries, and illnesses. Despite this, millions of workers are injured annually, and thousands killed.
To reduce the toll, OSHA needs greater resources, a new standard-setting process, increased civil and criminal penalties, full coverage for all workers, and stronger whistleblower protections. Workers should not be injured or made sick by their jobs. To eliminate work injuries and illnesses, we must remake and modernize OSHA and restructure the relationship of employers and workers with the agency and each other.
This includes changing the expectation of what employers must do to protect workers and implementing a requirement that firms have a “duty of care” to protect all people who may be harmed by their activities. Only by making major changes can we ensure that every worker leaves work as healthy as they were when their work shift began.
This resource is found in our Actionable Strategies for Government: Empowering Workers & Strengthening Leadership and Governance (Strengthening Protections to Speak Up).
The Occupational Safety and Health Administration at 50: Protecting Workers in a Changing Economy
The coronavirus disease 2019 (COVID-19) pandemic has become one of the central health crises of a generation. The pandemic has affected people of all nations, continents, races, and socioeconomic groups. The responses required, such as quarantining of entire communities, closing of schools, social isolation, and shelter-in-place orders, have abruptly changed daily life.Health care professionals of all types are caring for patients with this disease. The rapid spread of COVID-19 and the severity of symptoms it can cause in a segment of infected individuals has acutely taxed the limits of health care systems. Although the potential shortage of ventilators and intensive care unit (ICU) beds necessary to care for the surge of critically ill patients has been well described, additional supplies and beds will not be helpful unless there is an adequate workforce.
Understanding and Addressing Sources of Anxiety Among Health Care Professionals During the COVID-19 Pandemic
Police officer suicide rates hit an all-time high in the province of Ontario, Canada, in 2018. Sadly, this statistic is somewhat unsurprising, as research has shown that police officers suffer from higher rates of mental health disorder diagnoses compared to the general public. One key reason for the elevated levels of suicide and other mental health issues among police officers is believed to stem from the stigma associated with seeking help. In an attempt to address these serious issues, Ontario’s police services have begun to create internal peer support programs as a way of supporting their members. The present research explores the experiences of police officers serving as peer-support team members, particularly with regards to the impacts of peer support. In addition, this research also examines the importance of discussing shared experiences regarding a lack of standardized procedures for the administration and implementation of peer support in relation to the Policy Feedback Theory. The Policy Feedback Theory (PFT) posits that, when a policy becomes established and resources are devoted to programs, it helps structure current activity. This study utilized a phenomenological, qualitative approach, with data collection consisting of face-to-face interviews with nine police officers serving on the York Regional Police’s peer-support team. The findings revealed that peer support is more than just a “conversation”; rather, it suggests to contribute to enhancing mental health literacy among police officers, and it significantly contributes to stigma reduction. The findings also revealed that internal policy demonstrated an organizational commitment to mental health and peer-support, and that a provincial standard is necessary to ensure best practices and risk management in the creation and maintenance of peer-support programs.
This resource is found in our Actionable Strategies for Public Safety Organizations: Actionable Strategies (Providing a Continuum of Support)
Utilization and Impact of Peer-Support Programs on Police Officers’ Mental Health
Sponsorship is emerging as a valuable tool for increasing diversity in an organization’s senior ranks. The authors define sponsorship as “a helping relationship in which senior, powerful people use their personal clout to talk up, advocate for, and place a more junior person in a key role.” In this piece, they define a number of specific do’s and don’t’s that apply specifically to the use of sponsorship to help the careers of promising employees from underrepresented groups, and to boost diversity at the executive level.
This resource is found in our Actionable Strategies for Health Organizations: Promoting Diversity, Equity, & Inclusion.
Want More Diverse Senior Leadership? Sponsor Junior Talent.
OBJECTIVE: The authors examined the prevalence of burnout and depressive symptoms among North American psychiatrists, determined demographic and practice characteristics that increase the risk for these symptoms, and assessed the correlation between burnout and depression. METHODS: A total of 2,084 North American psychiatrists participated in an online survey, completed the Oldenburg Burnout Inventory (OLBI) and the Patient Health Questionnaire–9 (PHQ-9), and provided demographic data and practice information. Linear regression analysis was used to determine factors associated with higher burnout and depression scores. RESULTS: Participants’ mean OLBI score was 40.4 (SD=7.9) and mean PHQ-9 score was 5.1 (SD=4.9). A total of 78% (N=1,625) of participants had an OLBI score ≥35, suggestive of high levels of burnout, and 16.1% (N=336) of participants had PHQ-9 scores ≥10, suggesting a diagnosis of major depression. Presence of depressive symptoms, female gender, inability to control one’s schedule, and work setting were significantly associated with higher OLBI scores. Burnout, female gender, resident or early-career stage, and nonacademic setting practice were significantly associated with higher PHQ-9 scores. A total of 98% of psychiatrists who had PHQ-9 scores ≥10 also had OLBI scores >35. Suicidal ideation was not significantly associated with burnout in a partially adjusted linear regression model. CONCLUSIONS: Psychiatrists experience burnout and depression at a substantial rate. This study advances the understanding of factors that increase the risk for burnout and depression among psychiatrists and has implications for the development of targeted interventions to reduce the high rates of burnout and depression among psychiatrists. These findings have significance for future work aimed at workforce retention and improving quality of care for psychiatric patients.
Well-Being, Burnout, and Depression Among North American Psychiatrists: The State of Our Profession
[This is an excerpt.] A.B. 394, the CNA-sponsored safe staffing law, has multiple provisions designed to remedy unsafe staffing in acute-care facilities. California's safe staffing standards are based on individual patient acuity, of which the RN ratios is the minimum. [To read more, click View Resource.]
What Does the California Ratios Law Actually Require?
BACKGROUND: Primary care for a panel of patients is a central component of population health, but the optimal panel size is unclear. PURPOSE: To review evidence about the association of primary care panel size with health care outcomes and provider burnout. DATA SOURCES: English-language searches of multiple databases from inception to October 2019 and Google searches performed in September 2019. STUDY SELECTION: English-language studies of any design, including simulation models, that assessed the association between primary care panel size and safety, efficacy, patient-centeredness, timeliness, efficiency, equity, or provider burnout. DATA EXTRACTION: Independent, dual-reviewer extraction; group consensus rating of certainty of evidence. DATA SYNTHESIS: Sixteen hypothesis-testing studies and 12 simulation modeling studies met inclusion criteria. All but 1 hypothesis-testing study were cross-sectional assessments of association. Three studies each provided low-certainty evidence that increasing panel size was associated with no or modestly adverse effects on patient-centered and effective care. Eight studies provided low-certainty evidence that increasing panel size was associated with variable effects on timely care. No studies assessed the effect of panel size on safety, efficiency, or equity. One study provided very-low-certainty evidence of an association between increased panel size and provider burnout. The 12 simulation studies evaluated 5 models; all used access as the only outcome of care. Five and 2 studies, respectively, provided moderate-certainty evidence that adjusting panel size for case mix and adding clinical conditions to the case mix resulted in better access. LIMITATION: No studies had concurrent comparison groups, and published and unpublished studies may have been missed. CONCLUSION: Evidence is insufficient to make evidence-based recommendations about the optimal primary care panel size for achieving beneficial health outcomes.
This resource is found in our Actionable Strategies for Health Organizations: Improving Workload & Workflows (Safe & Appropriate Staffing).
What is the Optimal Primary Care Panel Size?: A Systematic Review
American states have statutes with whistleblowing protection provisions for employees. These laws may focus on the duty to divulge misconduct, procedures for reporting disclosures, and protection from retaliation. The research question is, “What is the scope, content, and perceived effectiveness of these provisions?” The premise is that they have value, albeit uncertain, in the practice of public administration. To investigate this subject area, documentary and attitudinal data were gathered. This article presents the results of the first comprehensive study of state-level whistleblowing provisions. The importance of this work is evident for two reasons. First, though corruption varies across state lines, overall it is common. Second, given the low visibility and high complexity of organizational activities, detection of abuse rests in large part with the workforce.
This resource is found in our Actionable Strategies for Government: Empowering Workers & Strengthening Leadership and Governance (Strengthening Protections to Speak Up)
Whistleblowing Policies in American States: A Nationwide Analysis
Rates of behavioral health workforce turnover are chronically high, with detrimental effects on the agency and remaining staff, as well as hypothesized negative impacts on client care and outcomes. Turnover also creates challenges for studies investigating the effectiveness and/or implementation of behavioral health interventions. Research examining factors that precede and predict behavioral health staff turnover has become increasingly important, as have studies that include recommendations for preventing and reducing turnover. The current paper systematically reviews the body of research on factors associated with behavioral health staff turnover, synthesizes recommendations made for combating turnover, and identifies gaps in this important area of research.
