The impact of burnout on patient-centered care: A comparative effectiveness trial in mental health

Research Type

Consumer/Patient Level Research

Collaborators

  • Michelle Salyers
  • Dawn Shimp
  • Angela Rollins
  • Mike Sliter, PhD
  • Jennifer Garabrant, BSW
  • Nancy Henry, BA
  • Alex Miller, BS

Outside Collaborators

  • Sadaaki Fukui
  • Tim Gearhart
  • Jim Noll
  • Elizabeth Avery
  • C.J. Davis
  • David Yoder
  • Gary Morse
  • Wei Wu

Background

Burnout, characterized by high levels of emotional exhaustion, depersonalization (negative or cynical attitudes about patients), and a diminished sense of personal achievement, is very common among mental healthcare providers. Depending on the sample and methods used, 21-67% of mental health workers report high levels of burnout. Research also indicates that burnout creates or is associated with a number of problems not only for individual mental health workers, but also for their employer organizations, patients, and the mental health system as a whole. Burned out workers often experience physical health problems (e.g., insomnia, headaches, poor overall health), relationship problems, reduced job satisfaction, and increased mental health problems (e.g., depression, anxiety, substance abuse). Burnout may also negatively affect organizational functioning in a number of ways, including excessive time off taken by employees, tardiness, frequent breaks, reduced job commitment, and, in some studies, poor job performance and increased turnover. Although existing empirical data are limited, burnout is widely believed to negatively affect the quality of mental health services and therefore can have a detrimental impact not only on the health of clinical providers, but also the patients they serve.

Objectives

  • Aim 1. Understand the patient experience of clinician burnout. Through focus groups and interviews, we will collect qualitative data on how burnout may impact patients.
  • Aim 2. Test the BREATHE intervention using a randomized, comparative effectiveness design to improve staff burnout and patient-centered processes and outcomes in a community mental health setting. Clinicians will receive either BREATHE or motivational interviewing training -- an active control that also could impact patient-centered processes, engagement, and outcomes. We will follow clinicians and randomly-selected patients for 12 months.
  • Aim 3. Test a conceptual framework linking clinician burnout to patient-centered processes, engagement, and outcomes. Using structural equation modeling on data over time, we will test our conceptual model that hypothesizes burnout will lead to poorer patient-centered processes, which will lead to less engagement in care, and worse treatment outcomes.

Impact

Burnout could impact quality of care in a number of different ways, and we believe that patient-centered care processes may be particularly damaged by staff burnout. Patient-centeredness has been defined as an approach that considers social and psychological factors in delivering care, regards the patient as a unique individual with personal meaning and values, and shares power and responsibility for care in a collaborative relationship between patient and clinician. Systematic reviews show that when patients and clinicians work together to identify problems, set goals, and make decisions, the result for patients is greater satisfaction and trust, reduced emotional burden, and improved biomedical markers, such as blood sugar and blood pressure control. Guided by self-determination theory of human motivation and the Job Demands-Resources model of burnout, we propose to test a conceptual model of how burnout can affect patient-centered care, engagement, and patient outcomes.

This work was supported through a Patient-Centered Outcomes Research Institute (PCORI) Award (# IH-1304-6597). All statements in this report, including its findings and conclusions, are solely those of the authors and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute (PCORI), its Board of Governors or Methodology Committee.