Primary health care reform, dilemmatic space and risk of burnout among health workers
Primary health care reform, dilemmatic space and risk of burnout among health workers
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DOI：
10.1177/1363459317693404
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发表时间：
2018-05-01
期刊：
影响因子：
2.1
通讯作者：
Lawless, Angela
中科院分区：
文献类型：
--
作者：
Freeman, Toby;Baum, Fran;Lawless, Angela
卫生系统的变化可能会增加初级卫生保健工作者的两难空间，当改革违背专业价值观时。两难的空间可能是倦怠的一个危险因素。这项研究与六个澳大利亚初级卫生保健服务（在南澳：四个州政府管理的服务，包括一个土著卫生小组和一个非政府组织，并在北领地：一个土著社区控制的服务）在一段时间的变化，并检查工人的困境空间和倦怠的发生率。在对六个部门的130名工作人员进行的一项调查中评估了困境空间和职业倦怠（58%的答复率）。此外，还对从业人员、管理人员、区域行政人员和卫生部门工作人员进行了63次访谈。两难空间发生在所有的服务，并与较高的自我报告的倦怠率。与两难空间相关的三个条件是：（1）综合初级卫生保健中固有的条件;（2）为土著和托雷斯海峡岛民提供的服务;（3）南澳选择性初级卫生保健的重新定位所带来的变化。对两难空间的反应包括无视指令或在雷达下工作，在工作时间之外从事与初级卫生保健价值观一致的替代工作，或离开组织。调查结果表明，全面的初级卫生保健是有争议的和政治性的。未来的卫生改革进程将受益于考虑使改革与工作人员的价值观保持一致，以减少改革的负面影响，保障工人的福祉。
Health system changes may increase primary health care workers' dilemmatic space, created when reforms contravene professional values. Dilemmatic space may be a risk factor for burnout. This study partnered with six Australian primary health care services (in South Australia: four state government-managed services including one Aboriginal health team and one non-government organisation and in Northern Territory: one Aboriginal community-controlled service) during a period of change and examined workers' dilemmatic space and incidence of burnout. Dilemmatic space and burnout were assessed in a survey of 130 staff across the six services (58% response rate). Additionally, 63 interviews were conducted with practitioners, managers, regional executives and health department staff. Dilemmatic space occurred across all services and was associated with higher rates of self-reported burnout. Three conditions associated with dilemmatic space were (1) conditions inherent in comprehensive primary health care, (2) stemming from service provision for Aboriginal and Torres Strait Islander peoples and (3) changes wrought by reorientation to selective primary health care in South Australia. Responses to dilemmatic space included ignoring directives or doing work under the radar', undertaking alternative work congruent with primary health care values outside of hours, or leaving the organisation. The findings show that comprehensive primary health care was contested and political. Future health reform processes would benefit from considering alignment of changes with staff values to reduce negative effects of the reform and safeguard worker wellbeing.