Burnout and Health Care Workforce Turnover
Burnout and Health Care Workforce Turnover
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DOI：
10.1370/afm.2338
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发表时间：
2019-01-01
影响因子：
4.4
通讯作者：
Grumbach, Kevin
中科院分区：
文献类型：
--
作者：
Willard-Grace, Rachel;Knox, Margae;Grumbach, Kevin
目的初级保健临床医生和工作人员的职业倦怠水平高得惊人，人们普遍认为职业倦怠和员工敬业度的缺乏导致了劳动力的高流动率。然而，支持这一论断的研究证据很少。方法采用2013年和2014年收集的旧金山2个卫生系统740名初级保健临床医生和工作人员的倦怠和员工敬业度调查数据，与2016年的就业花名册数据相匹配，进行了一项纵向队列研究。结果：倦怠、低敬业度和人员流失率较高，53%的临床医生和工作人员报告倦怠，只有32%的临床医生和35%的工作人员报告高敬业度，30%的临床医生和41%的工作人员在2至3年后不再在同一系统的初级保健工作。职业倦怠预测临床医生离职（校正优势比= 1.57;95% CI, 1.02-2.40）；低敬业度也有很强的趋势，即低敬业度预测临床医生的离职（高敬业度的调整优势比= 0.58;95% CI, 0.33-1.04）。这两项指标都无法显著预测员工流动率。结论：在初级保健中，高倦怠率和高流动率是一个引人注目的问题。我们的研究结果提供了证据，证明职业倦怠会导致初级保健临床医生的离职，而不是员工的离职。虽然减少临床医生的职业倦怠可能有助于降低离职率，但关注初级保健员工离职的卫生保健组织和政策制定者需要了解离职的多因素原因，以便为临床医生和员工制定有效的保留策略。
PURPOSE Levels of burnout among primary care clinicians and staff are alarmingly high, and there is widespread belief that burnout and lack of employee engagement contribute to high turnover of the workforce. Scant research evidence exists to support this assertion, however.METHODS We conducted a longitudinal cohort study using survey data on burnout and employee engagement collected in 2013 and 2014 from 740 primary care clinicians and staff in 2 San Francisco health systems, matched to employment roster data from 2016.RESULTS Prevalence of burnout, low engagement, and turnover were high, with 53% of both clinicians and staff reporting burnout, only 32% of clinicians and 35% of staff reporting high engagement, and 30% of clinicians and 41% of staff no longer working in primary care in the same system 2 to 3 years later. Burnout predicted clinician turnover (adjusted odds ratio = 1.57; 95% CI, 1.02-2.40); there was also a strong trend whereby low engagement predicted clinician turnover (adjusted odds ratio with high engagement = 0.58; 95% CI, 0.33-1.04). Neither measure significantly predicted turnover for staff.CONCLUSIONS High rates of burnout and turnover in primary care are compelling problems. Our findings provide evidence that burnout contributes to turnover among primary care clinicians, but not among staff. Although reducing clinician burnout may help to decrease rates of turnover, health care organizations and policymakers concerned about employee turnover in primary care need to understand the multifactorial causes of turnover to develop effective retention strategies for clinicians and staff.