Changes in VA Psychiatrists' Attitudes About Work Environment and Turnover During Mental Health Service Enhancement
Changes in VA Psychiatrists' Attitudes About Work Environment and Turnover During Mental Health Service Enhancement
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DOI：
10.1176/appi.ps.201200337
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发表时间：
2013-06-01
影响因子：
3.8
通讯作者：
Penfold, Robert B.
中科院分区：
文献类型：
--
作者：
Mohr, David C.;Bauer, Mark S.;Penfold, Robert B.
目的：退伍军人健康管理局（VHA）进行了重大的组织变革，作为加强精神卫生服务的综合战略计划的一部分。组织变革可能会产生压力，降低员工士气，即使这种变革对患者和组织有益。该研究考察了精神科医生的工作满意度和工作环境感知是否在转型期间发生了变化。还审查了设施一级的周转率。方法：对2004年至2010年（不包括2005年）对139家机构进行的年度组织调查的7218名精神科医生的数据进行分析。在一个多层次模型中，调查评分对个人和设施层面的特征进行了回归。将这些措施的调整平均得分与Tukey事后检验进行比较，以确定各年之间的显著差异。结果：在战略改革的初步行动后，大多数措施的满意度有所提高，并在2006年趋于稳定。离职率和离职意向在此期间也保持一致。随着时间的推移，薪酬满意度、成就管理、技能发展、工作场所文明以及对高级管理层的满意度都呈现出正线性趋势。结论：VHA心理健康服务的广泛重组与精神科医生工作场所满意度的提高有关，并且这种提高可以持续一段时间。在目前全国医疗保健改革快速转型的大环境下，VHA的经验可以为更广泛的国家进程和组织战略提供信息，以提高和保持医疗保健工作人员的士气。
Objective: The Veterans Health Administration (VHA) has undergone significant organizational transformation as part of a comprehensive strategic plan to enhance mental health services. Organizational change can create stress and decrease employee morale, even if the change is beneficial for patients and the organization. The study examined whether psychiatrists' work satisfaction and work environment perceptions changed during a period of transformation. Facility-level turnover rate was also examined. Methods: Data were analyzed from 7,218 psychiatrists who responded to an annual organizational survey between 2004 and 2010 (excluding 2005) conducted with 139 facilities. Survey ratings were regressed on individual and facility-level characteristics in a multilevel model. Adjusted mean scores for the measures were compared with Tukey post hoc tests to identify significant differences by year. Results: Most satisfaction ratings on measures improved after the initial actions for strategic reform and stabilized in 2006. Turnover rates and intention to leave were also consistent during this time. Positive linear trends over time were observed for pay satisfaction, management for achievement, skill development, workplace civility, and satisfaction with senior management. Conclusions: Extensive reorganization of VHA mental health services was associated with improvements in psychiatrists' workplace satisfaction, and these increases were sustained over time. In the current climate of rapid transformation under health care reform nationally, the VHA experience may inform the broader national process and organizational strategies to improve and maintain the morale of the health care workforce.