Caring for the caregiver: predictors and consequences of VA mental health provider burnout

背景：精神健康提供者(MHP)对VHA来说是“关键任务”，他们报告了第二个 职业倦怠程度最高，仅次于初级保健医生。MHP耗竭可能与负性系统有关- 级别因素(组织氛围、工作组看法和监督行为)、提供商体验 (敬业度、满意度和离职率)和患者结果(获得、连续性、护理体验)。 VHA尚未进行系统的设施级研究，以确定MHP的预测因素和后果 精疲力竭。这项研究将讨论HSR&D的优先事项，重点是医疗保健系统的变化、 与退伍军人护理质量和改善员工相关的组织和提供者因素 订婚。目标：这项实施前的研究旨在通过以下方式描述MHP职业倦怠的变化 设施随着时间的推移，确定工作场所的特征和高性能设施的做法，可以 翻译为可能在有改进空间的设施中实施。目标1：检查设施- VHA MHP职业倦怠的水平预测因子和后果；目标2：了解VHA MHP领导力和 一线提供者对设施中防止或加剧职业倦怠的因素的看法 不同程度的工作倦怠；和目标3：确定对环境敏感的战略，使设施成功 减少VHA MHP的消耗。方法：采用顺序解释性混合方法研究，分两个阶段进行 设计时先进行定量数据收集和分析，然后再进行定性数据收集和分析 随后，我们将评估影响MHP职业倦怠的因素及其对患者的影响 结果。我们将编制工作场所条件、年度人员编制和生产率的年度调查数据。 2014财年至2018财年之间的数据，以评估相同和随后一年的提供者和患者结果 反映提供者和患者的体验。全体员工调查(AES)是一项年度组织普查 对工作场所的看法和满意度。精神卫生提供者调查(MHPS)是一项年度调查，旨在 评估MHP对获得精神卫生保健的机会和质量以及工作满意度的看法。心理上的 健康门诊临床方法跟踪MHP住院患者和门诊患者的临床时间和生产力。我们 将使用以下战略分析来检查MHP工作满意度和患者体验指标 改进和学习(SAIL)心理健康领域，VHA的质量监控系统。设施 使用基于患者风险、专科医生数量、体量、 以及教学和研究水平，包括心理健康项目的特点。通过链接这些数据 我们将量化职业倦怠的预测因素以及职业倦怠对患者结局的影响。我们会 与精神卫生机构领导层和一线MHPS进行访谈，有意使用 设施级别的MHP烧毁。我们将创建一个联合展示，以解释以下方面的定量和定性调查结果 根据设施背景和任何用于以下方面的策略，预测与倦怠相关的因素和患者结果 地址耗尽。我们将把我们的发现提交给由运营合作伙伴、退伍军人管理局临床医生、 管理员、政策领导者和专家。小组将选择与上下文相关的最佳实践进行分享 解决MHP烧毁问题的设施，并建议潜在的干预措施。最后，我们将重新启用设施 参加了目标2，并组织了重点小组，分享反馈报告中提出的结果。我们会 广泛传播调查结果，这将支持制定可行的政策和方法，以 解决MHP耗尽问题。对退伍军人健康的预期影响和下一步行动：这项研究将 协助未来与VHA合作伙伴一起开发和测试干预措施，以改善MHP工作倦怠和 员工敬业度。减少MHP职业倦怠可以改善护理质量、等待时间和收入损失 由于员工自然减员。我们的发现可能对VHA、其提供者和患者具有临床和经济价值。 我们的工作将有助于VHA护理的广泛改进，并将为护理提供产生新的见解。

Background: Mental health providers (MHPs), who are "mission critical" for the VHA, report the second highest level of burnout after primary care physicians. MHP burnout may be associated with negative system- level factors (organizational climate, workgroup perceptions, and supervisory behaviors), provider experiences (engagement, satisfaction, and turnover) and patient outcomes (access to, continuity of, experience of care). VHA has yet to conduct a systematic facility-level study identifying predictors and consequences of MHP burnout. This study will address HSR&D priorities focused on health care systems change, the impact of organizational and provider factors associated with quality of care for Veterans, and improving employee engagement. Objectives: This pre-implementation study aims to characterize variation in MHP burnout by facility over time, identifying workplace characteristics and practices of high performing facilities that can be translated for potential implementation at facilities with room for improvement. Aim 1: to examine facility- level predictors and consequences of VHA MHP burnout; Aim 2: to understand VHA MHP leadership and front-line provider perspectives regarding factors that protect against or exacerbate burnout in facilities with differing levels of burnout; and Aim 3: to identify context-sensitive strategies for facilities to successfully reduce VHA MHP burnout. Methods: Using a sequential explanatory mixed methods study, a two-phase design with quantitative data collection and analysis followed by qualitative data collection and analysis, and subsequent integration, we will evaluate factors that influence MHP burnout and their effects on patient outcomes. We will compile annual survey data on workplace conditions and annual staffing and productivity data between FY2014 and FY2018 to assess same and subsequent year provider and patient outcomes reflecting provider and patient experiences. The All Employee Survey (AES) is an annual organizational census of workplace perceptions and satisfaction. The Mental Health Provider Survey (MHPS) is an annual survey to assess MHP perceptions about access to and quality of mental health care, and job satisfaction. The Mental Health Outpatient Clinical method tracks MHP inpatient and outpatient clinical hours and productivity. We will examine MHP job satisfaction and patient experience metrics using the Strategic Analytics for Improvement and Learning (SAIL) Mental Health domain, the VHA's quality monitoring system. Facility complexity level is measured using a five level indicator based on patient risk, number of specialists, volume, and level of teaching and research, including mental health program characteristics. By linking these data sources, we will quantify predictors of burnout and the impact of burnout on patient outcomes. We will conduct interviews with mental health facility leadership and front-line MHPs, intentionally sampled using facility-level MHP burnout. We will create a joint display to interpret quantitative and qualitative findings on predictors and patient outcomes associated with burnout in light of facility context and any strategies used to address burnout. We will present our findings to an expert panel of operational partners, VA clinicians, administrators, policy leaders, and experts. The panel will select context-sensitive best practices to share with facilities to address MHP burnout and recommend potential interventions. Finally, we will reengage facilities that participated in Aim 2 and conduct focus groups and share results presented in feedback reports. We will broadly disseminate findings, which will support the development of actionable policies and approaches to addressing MHP burnout. Anticipated impacts on Veterans' health and next steps: This study will assist in future developing and testing interventions with VHA partners to improve MHP burnout and employee engagement. Decreased MHP burnout could improve quality of care, wait times, and lost revenues due to staff attrition. Our findings could be of clinical and financial value to VHA, its providers, and patients. Our work will contribute to broad VHA care improvements, and will generate new insights for care delivery.