Predictors and Consequences of Veterans Affairs Mental Health Provider Burnout: Protocol for a Mixed Methods Study.

Kristen Abraham,Jennifer Kononowech,Molly Harrod,Helen C Kales,Paul Pfeiffer,Hector A Garcia,Rebecca K Sripada,Kara Zivin,Matthew Boden

doi:10.2196/18345

Abstract

BackgroundIn the Veterans Health Administration (VHA), mental health providers (MHPs) report the second highest level of burnout after primary care physicians. Burnout is defined as increased emotional exhaustion and depersonalization and decreased sense of personal accomplishment at work.ObjectiveThis study aims to characterize variation in MHP burnout by VHA facility over time, identifying workplace characteristics and practices of high-performing facilities.MethodsUsing both qualitative and quantitative methods, 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 as well as productivity data to assess same and subsequent year provider and patient outcomes reflecting provider and patient experiences. We will conduct interviews with mental health leadership at the facility level and with frontline MHPs sampled based on our quantitative findings. We will present our findings to an expert panel of operational partners, Veterans Affairs clinicians, administrators, policy leaders, and experts in burnout. We will reengage with facilities that participated in the earlier qualitative interviews and will hold focus groups that share results based on our quantitative and qualitative work combined with input from our expert panel. We will broadly disseminate these findings to support the development of actionable policies and approaches to addressing MHP burnout.ResultsThis study will assist in developing and testing interventions to improve MHP burnout and employee engagement. Our work will contribute to improvements within VHA and will generate insights for health care delivery, informing efforts to address burnout.ConclusionsThis is the first comprehensive, longitudinal, national, mixed methods study that incorporates different types of MHPs. It will engage MHP leadership and frontline providers in understanding facilitators and barriers to effectively address burnout.International Registered Report Identifier (IRRID)PRR1-10.2196/18345

Highlights

BackgroundClinical provider burnout is a key indicator of how well a health care system functions
We describe the study objectives and methods and discuss its potential for assisting developing and testing interventions with Veterans Health Administration (VHA) partners to improve mental health providers (MHPs) burnout and employee engagement
Our sequential explanatory mixed methods study aims to understand the factors that contribute to MHP burnout and associated patient outcomes, as well as opportunities and challenges that individual facilities experience with trying to address burnout [24]

Summary

Introduction

Clinical provider burnout is a key indicator of how well a health care system functions. Health care providers face a large and increasing number of demands to do more work in less time (work compression) to try to achieve the triple aim of improving the patient experience of care, improving the health of populations, and reducing per capita costs of care [1]. Provider burnout remains a systemic problem associated with reductions in work effort within 24 months [3,4]. A meta-analysis found that greater provider burnout was associated with poorer quality health care and reduced patient safety [11]. In the Veterans Health Administration (VHA), mental health providers (MHPs) report the second highest level of burnout after primary care physicians. Burnout is defined as increased emotional exhaustion and depersonalization and decreased sense of personal accomplishment at work

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Conclusion