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Emotional exhaustion in primary care during early implementation of the VA's medical home transformation: Patient-aligned Care Team (PACT).
Med Care. 2015 Mar; 53(3):253-60.MC

Abstract

OBJECTIVE

Transformation of primary care to new patient-centered models requires major changes in healthcare organizations, including interprofessional expectations and organizational policies. Emotional exhaustion (EE) among workers can accompany major organizational change, threatening its success. Yet little guidance exists about the magnitude of associations with EE during primary care transformation. We assessed EE during the initial phase of national primary care transformation in the Veterans Health Administration.

RESEARCH DESIGN

Cross-sectional online surveys of primary care clinicians (PCCs) and staff in 23 primary care clinics within 5 healthcare systems in 1 veterans administration administrative region. We used descriptive, bivariate, and multivariable analyses adjusted for clinic membership and weighted for nonresponse.

PARTICIPANTS

515 veterans administration employees (191 PCCs and 324 other primary care staff).

MEASURES

Outcome is the EE subscale of the Maslach Burnout Inventory. Predictors include clinic characteristics (from administrative data) and self-reported efficacy for change, experiences with transformation, and perspectives about the organization.

RESULTS

The overall response rate was 64% (515/811). In total, 53% of PCCs and 43% of staff had high EE. PCCs (vs. other primary care staff), female (vs. male), and non-Latino (vs. Latino) respondents reported higher EE. Respondents reporting higher efficacy for change and participatory decision making had lower EE scores, adjusting for sex and race.

CONCLUSIONS

Recognition by healthcare organizations of the potential for clinician and staff EE during primary care transformation is critical. Methods for reducing EE by increasing clinician and staff change efficacy and opportunities to participate in decision making should be considered, with attention to PCCs, and women.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Meredith LS
*RAND Corporation, Santa Monica †VA HSR&D Center for the Study of Healthcare Implementation, Innovation, and Policy, Sepulveda ‡Pardee RAND Graduate School, Santa Monica §School of Health Policy and Management, University of California, Berkeley ∥Department of Health Policy and Management, UCLA, Fielding School of Public Health ¶UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA.
Schmidt Hackbarth N
No affiliation info available
Darling J
No affiliation info available
Rodriguez HP
No affiliation info available
Stockdale SE
No affiliation info available
Cordasco KM
No affiliation info available
Yano EM
No affiliation info available
Rubenstein LV
No affiliation info available

MeSH

Continuity of Patient CareCross-Sectional StudiesFemaleHospitals, VeteransHumansMalePatient Care TeamPatient-Centered CarePrimary Health CareQuality of Health CareUnited StatesUnited States Department of Veterans Affairs

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25675403

Citation

Meredith, Lisa S., et al. "Emotional Exhaustion in Primary Care During Early Implementation of the VA's Medical Home Transformation: Patient-aligned Care Team (PACT)." Medical Care, vol. 53, no. 3, 2015, pp. 253-60.
Meredith LS, Schmidt Hackbarth N, Darling J, et al. Emotional exhaustion in primary care during early implementation of the VA's medical home transformation: Patient-aligned Care Team (PACT). Med Care. 2015;53(3):253-60.
Meredith, L. S., Schmidt Hackbarth, N., Darling, J., Rodriguez, H. P., Stockdale, S. E., Cordasco, K. M., Yano, E. M., & Rubenstein, L. V. (2015). Emotional exhaustion in primary care during early implementation of the VA's medical home transformation: Patient-aligned Care Team (PACT). Medical Care, 53(3), 253-60. https://doi.org/10.1097/MLR.0000000000000303
Meredith LS, et al. Emotional Exhaustion in Primary Care During Early Implementation of the VA's Medical Home Transformation: Patient-aligned Care Team (PACT). Med Care. 2015;53(3):253-60. PubMed PMID: 25675403.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Emotional exhaustion in primary care during early implementation of the VA's medical home transformation: Patient-aligned Care Team (PACT). AU - Meredith,Lisa S, AU - Schmidt Hackbarth,Nicole, AU - Darling,Jill, AU - Rodriguez,Hector P, AU - Stockdale,Susan E, AU - Cordasco,Kristina M, AU - Yano,Elizabeth M, AU - Rubenstein,Lisa V, PY - 2015/2/13/entrez PY - 2015/2/13/pubmed PY - 2015/4/18/medline SP - 253 EP - 60 JF - Medical care JO - Med Care VL - 53 IS - 3 N2 - OBJECTIVE: Transformation of primary care to new patient-centered models requires major changes in healthcare organizations, including interprofessional expectations and organizational policies. Emotional exhaustion (EE) among workers can accompany major organizational change, threatening its success. Yet little guidance exists about the magnitude of associations with EE during primary care transformation. We assessed EE during the initial phase of national primary care transformation in the Veterans Health Administration. RESEARCH DESIGN: Cross-sectional online surveys of primary care clinicians (PCCs) and staff in 23 primary care clinics within 5 healthcare systems in 1 veterans administration administrative region. We used descriptive, bivariate, and multivariable analyses adjusted for clinic membership and weighted for nonresponse. PARTICIPANTS: 515 veterans administration employees (191 PCCs and 324 other primary care staff). MEASURES: Outcome is the EE subscale of the Maslach Burnout Inventory. Predictors include clinic characteristics (from administrative data) and self-reported efficacy for change, experiences with transformation, and perspectives about the organization. RESULTS: The overall response rate was 64% (515/811). In total, 53% of PCCs and 43% of staff had high EE. PCCs (vs. other primary care staff), female (vs. male), and non-Latino (vs. Latino) respondents reported higher EE. Respondents reporting higher efficacy for change and participatory decision making had lower EE scores, adjusting for sex and race. CONCLUSIONS: Recognition by healthcare organizations of the potential for clinician and staff EE during primary care transformation is critical. Methods for reducing EE by increasing clinician and staff change efficacy and opportunities to participate in decision making should be considered, with attention to PCCs, and women. SN - 1537-1948 UR - https://www.unboundmedicine.com/medline/citation/25675403/Emotional_exhaustion_in_primary_care_during_early_implementation_of_the_VA's_medical_home_transformation:_Patient_aligned_Care_Team__PACT__ DB - PRIME DP - Unbound Medicine ER -