The Association of Team-Specific Workload and Staffing with Odds of Burnout Among VA Primary Care Team Members
The Association of Team-Specific Workload and Staffing with Odds of Burnout Among VA Primary Care Team Members
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DOI：
10.1007/s11606-017-4011-4
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发表时间：
2017-07-01
影响因子：
5.7
通讯作者：
Nelson, Karin M.
中科院分区：
文献类型：
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作者：
Helfrich, Christian D.;Simonetti, Joseph A.;Nelson, Karin M.
与工作相关的职业倦怠在初级保健中很常见，并与较差的患者安全、患者满意度和员工心理健康相关。工作量、人员稳定性和团队完整性可能是职业倦怠的驱动因素。然而，很少有研究在团队层面评估这些关联，更少的研究包括团队成员，而不仅仅是医生。为了研究初级保健提供者(PCP)、护士护理经理、临床助理(MA、LPN)和行政办事员之间的职业倦怠与其团队中的人员和工作量的关系。我们对2014年的调查和行政数据进行了个人层面的横断面分析。退伍军人管理局诊所的初级保健人员对国家调查做出了回应。职业倦怠的测量采用有效的单项调查测量，分为两部分，以指示职业倦怠的存在。自变量为团队人员配置(有一个完整的团队，在多个团队中服务，团队中的人员流动率)的调查指标，以及调查项目(延长工作时间)和行政数据(患者小组能力过剩和小组平均合并症)的工作量。职业倦怠的总体患病率为41%。在调整后的分析中，与职业倦怠最强的关联是拥有一个全员团队(优势比[OR]=0.55，95%CI为0.47-0.65)，团队中有人员流动(OR=1.67，95%CI为1.43-1.94)，以及患者小组能力过剩(OR=1.19，95%CI为1.01-1.40)。与处于相反情况的受访者相比，在全员团队中工作且没有人员流动并在能力范围内照顾小组的受访者的职业倦怠发生率降低了30.1%(28.5%比58.6%)。完整的团队人员配备、团队成员的流动率和小组能力过剩与职业倦怠有很强的累积关联。需要进一步的研究来了解这些因素的改善是否会降低职业倦怠。
Work-related burnout is common in primary care and is associated with worse patient safety, patient satisfaction, and employee mental health. Workload, staffing stability, and team completeness may be drivers of burnout. However, few studies have assessed these associations at the team level, and fewer still include members of the team beyond physicians.To study the associations of burnout among primary care providers (PCPs), nurse care managers, clinical associates (MAs, LPNs), and administrative clerks with the staffing and workload on their teams.We conducted an individual-level cross-sectional analysis of survey and administrative data in 2014.Primary care personnel at VA clinics responding to a national survey.Burnout was measured with a validated single-item survey measure dichotomized to indicate the presence of burnout. The independent variables were survey measures of team staffing (having a fully staffed team, serving on multiple teams, and turnover on the team), and workload both from survey items (working extended hours), and administrative data (patient panel overcapacity and average panel comorbidity).There were 4610 respondents (estimated response rate of 20.9%). The overall prevalence of burnout was 41%. In adjusted analyses, the strongest associations with burnout were having a fully staffed team (odds ratio [OR] = 0.55, 95% CI 0.47-0.65), having turnover on the team (OR = 1.67, 95% CI 1.43-1.94), and having patient panel overcapacity (OR = 1.19, 95% CI 1.01-1.40). The observed burnout prevalence was 30.1% lower (28.5% vs. 58.6%) for respondents working on fully staffed teams with no turnover and caring for a panel within capacity, relative to respondents in the inverse condition.Complete team staffing, turnover among team members, and panel overcapacity had strong, cumulative associations with burnout. Further research is needed to understand whether improvements in these factors would lower burnout.