The Impact of Burnout on Patient-Centered Care: A Comparative Effectiveness Trial in Mental Health
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Burnout
- Sponsor
- Indiana University
- Enrollment
- 679
- Locations
- 2
- Primary Endpoint
- Maslach Burnout Inventory (MBI): Emotional Exhaustion
- Status
- Completed
- Last Updated
- 9 years ago
Overview
Brief Summary
Healthcare providers play an important role in helping patients be actively involved in treatment and recover from mental illness. But mental health clinicians, like other healthcare providers, are at risk for experiencing burnout-feeling emotionally drained from their work, having cynical thoughts toward patients and others, and feeling little accomplishment in their work. Burnout can lead to problems for the clinician including poor overall health, depression, and lower job satisfaction. Burnout also can impact how clinicians perform on the job; for example, people with high levels of burnout take more time off, show lower commitment to their job, and are more likely to quit or be fired. There is some evidence that burnout can affect the quality of care for patients, but very little rigorous research has tested this assumption. The purpose of our study is threefold. First, we will investigate how patients perceive burnout in clinicians and whether (and/or how) burnout impacts the care they receive. Next, we will test an intervention to reduce clinician burnout called Burnout Reduction: Enhanced Awareness, Tools, Handouts, and Education (BREATHE). BREATHE brings together tools that mental health clinicians are already familiar with, including relaxation and mindfulness exercises, setting boundaries, using social supports, and changing negative thought patterns and replacing them with more helpful ways of thinking. We have found this intervention effective in reducing burnout in other organizations, but have yet to study whether it also can improve patient outcomes. Clinicians (approximately 200) who participate will receive either the BREATHE intervention or training in motivational interviewing, which could also improve patient involvement in treatment and patient outcomes, but is unlikely to significantly reduce clinician burnout. We will also recruit up to 600 adult patients served by participating clinicians. We will survey clinicians and interview patients over a 12-month period after the intervention to determine how the intervention impacts clinician burnout and patient perceptions of care (relationship with the clinician, degree of autonomy in decision making), patient involvement in care, and outcomes (confidence in managing mental health, symptoms, functioning, and hope). Finally, this study will use a statistical procedure called Structural Equation Modeling to test a theoretical model of the relationship between burnout and patient outcomes. Findings from this study will show whether reducing clinician burnout can improve patient outcomes and the quality of care that patients receive. Our intervention will have the potential to be easily implemented in a variety of settings where burnout is a problem. Knowing how clinician burnout impacts patient outcomes, and whether improving burnout can improve patient care, can help improve the healthcare system.
Investigators
Michelle Salyers
Professor, Department of Psychology
Indiana University
Eligibility Criteria
Inclusion Criteria
- •A staff member with client contact at either Four County Counseling or Places for People.
- •Randomly chosen client from the participating staff lists. Must be 18 years old or older.
Exclusion Criteria
- •Clients younger than 18 years old.
Outcomes
Primary Outcomes
Maslach Burnout Inventory (MBI): Emotional Exhaustion
Time Frame: Measured with staff at baseline, 3 months, 6 months, and 12 months
Burnout was assessed with the Maslach Burnout Inventory (MBI), a widely-used measure of three components of burnout: emotional exhaustion, depersonalization, and personal accomplishment. The survey contains 22 statements of job-related feelings and staff were asked to read each statement and decide if they ever felt that way about their job. The item scores were averaged. Scale: 0 (Never), 1 (A few times a year or less), 2 (Once a month or less), 3 (A few times a month), 4 (Once a week), 5 (A few times a week), 6 (Every Day). Maslach C, Jackson, S. E., Leiter, M. P. Maslach Burnout Inventory Manual. 3 ed. Palo Alto, California: Consulting Psychologists Press; 1996.
Maslach Burnout Inventory (MBI): Depersonalization
Time Frame: Measured with staff at baseline, 3 months, 6 months, and 12 months
Burnout was assessed with the Maslach Burnout Inventory (MBI), a widely-used measure of three components of burnout: emotional exhaustion, depersonalization, and personal accomplishment. The survey contains 22 statements of job-related feelings and staff were ased to read each statement and decide if they ever felt that way about their job. The item scores were averaged. Scale: 0 (Never), 1 (A few times a year or less), 2 (Once a month or less), 3 (A few times a month), 4 (Once a week), 5 (A few times a week), 6 (Every Day). Maslach C, Jackson, S. E., Leiter, M. P. Maslach Burnout Inventory Manual. 3 ed. Palo Alto, California: Consulting Psychologists Press; 1996.
Maslach Burnout Inventory (MBI): Personal Accomplishment
Time Frame: Measured with staff at baseline, 3 months, 6 months, and 12 months
Burnout was assessed with the Maslach Burnout Inventory (MBI), a widely-used measure of three components of burnout: emotional exhaustion, depersonalization, and personal accomplishment. The survey contains 22 statements of job-related feelings and staff were ased to read each statement and decide if they ever felt that way about their job. The item scores were averaged. Scale: 0 (Never), 1 (A few times a year or less), 2 (Once a month or less), 3 (A few times a month), 4 (Once a week), 5 (A few times a week), 6 (Every Day). Maslach C, Jackson, S. E., Leiter, M. P. Maslach Burnout Inventory Manual. 3 ed. Palo Alto, California: Consulting Psychologists Press; 1996.
Secondary Outcomes
- Turnover Intentions-Considered Leaving(Measured with staff at baseline, 3 months, 6 months, and 12 months)
- Turnover Intentions-Likely to Leave(Measured with staff at baseline, 3 months, 6 months, and 12 months)
- Work Interference With Home Life(Measured with staff at baseline, 3 months, 6 months, and 12 months)
- Home Life Interference With Work(Measured with staff at baseline, 3 months, 6 months, and 12 months)
- Job Satisfaction(Measured with staff at baseline, 3 months, 6 months, and 12 months)
- Emotional Labor Scale: Surface Acting(Measured with staff at baseline, 3 months, 6 months, and 12 months)
- Emotional Labor Scale: Deep Acting(Measured with staff at baseline, 3 months, 6 months, and 12 months)
- Importance: Reduce Work-Related Stress(Measured with staff at baseline, 3 months, 6 months, and 12 months)
- Confidence: Reduce Work-Related Stress(Measured with staff at baseline, 3 months, 6 months, and 12 months)
- Emotional Labor Scale: Genuine Emotions(Measured with staff at baseline, 3 months, 6 months, and 12 months)
- Importance: Client Interaction(Measured with staff at baseline, 3 months, 6 months, and 12 months)
- Confidence: Client Interaction(Measured with staff at baseline, 3 months, 6 months, and 12 months)
- Quality of Care: Person Centered Care(Measured with staff at baseline, 3 months, 6 months, and 12 months)
- Quality of Care: Discordant Care(Measured with staff at baseline, 3 months, 6 months, and 12 months)
- Quality of Care-Total(Measured with staff at baseline, 3 months, 6 months, and 12 months)
- Perceptions of Supervisory Support(Measured with staff at baseline, 3 months, 6 months, and 12 months)
- Staff Turnover(Measured with staff at 12 months)
- Medication Adherence Rating Scale (MARS) - Medication Adherence - 4-item(Measured with clients at baseline, 6 months, and 12 months)
- Adult State Hope Scale(Measured with clients at baseline, 6 months, and 12 months)
- Medication Adherence Rating Scale (MARS) - Medication Attitudes - 10-item(Measured with clients at baseline, 6 months, and 12 months)
- Working Alliance Inventory (WAI) - Tasks Subscale(Measured with clients at baseline, 6 months, and 12 months)
- Working Alliance Inventory (WAI) - Goals Subscale(Measured with clients at baseline, 6 months, and 12 months)
- Working Alliance Inventory (WAI) - Bonds Subscale(Measured with clients at baseline, 6 months, and 12 months)
- Health-Care Climate Questionnaire(Measured with clients at baseline, 6 months, and 12 months)
- Working Alliance Inventory (WAI)(Measured with clients at baseline, 6 months, and 12 months)
- Short-Form Health Survey (SF-12)-Mental Health Functioning(Measured with clients at baseline, 6 months, and 12 months)
- Generalized Anxiety Disorder (GAD-7)(Measured with clients at baseline, 6 months, and 12 months)
- Patient Engagement-Missed Appointments(Measured with clients at baseline, 6 months, and 12 months)
- Quality of Care-Inattentive Care(Measured with clients at baseline, 6 months, and 12 months)
- Patient Activation Measure-Mental Health (PAM-MH)-0 to 100 Scale(Measured with clients at baseline, 6 months, and 12 months)
- Short-Form Health Survey (SF-12)-Physical Health Functioning(Measured with clients at baseline, 6 months, and 12 months)
- Client Satisfaction Questionnaire(Measured with clients at baseline, 6 months, and 12 months)
- Quality of Care-Person Centered Care(Measured with clients at baseline, 6 months, and 12 months)
- Quality of Care-Negative Interactions(Measured with clients at baseline, 6 months, and 12 months)
- Quality of Care Total(Measured with clients at baseline, 6 months, and 12 months)
- Patient Health Questionnaire 9-item (PHQ-9)(Measured with clients at baseline, 6 months, and 12 months)