A Comparative Effectiveness Trial to Reduce Burnout and Improve Quality of Care
- 58 Downloads
Clinician burnout is presumed to negatively impact healthcare quality; yet scant research has rigorously addressed this hypothesis. Using a mixed-methods, randomized, comparative effectiveness design, we tested two competing approaches to improve care—one addressing clinician burnout and the other addressing how clinicians interact with consumers—with 192 clinicians and 469 consumers at two community mental health centers. Although qualitative reports were promising, we found no comparative effectiveness for either intervention on burnout, patient-centered processes, or other outcomes. Discussion includes identifying ways to strengthen approaches to clinician burnout.
KeywordsBurnout Randomized comparative effectiveness Quality of care Mental health
Research reported in this publication was funded through a Patient-Centered Outcomes Research Institute (PCORI) Award (# IH-1304-6597).
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflicts of interest.
The statements in this publication are solely the responsibility 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.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- Bond, G. R., Witheridge, T. F., Dincin, J., Wasmer, D., Webb, J., & De Graaf-Kaser, R. (1990). Assertive community treatment for frequent users of psychiatric hospitals in a large city: A controlled study. American Journal of Community Psychology, 18(6), 865–891. https://doi.org/10.1007/BF00938068.Google Scholar
- Crabtree, B. F., & Miller, W. L. E. (1999). Doing qualitative research, (2nd ed.). Thousand Oaks: Sage Publications.Google Scholar
- Druss, B. G., Zhao, L., von Esenwein, S. A., Bona, J. R., Fricks, L., Jenkins-Tucker, S., et al. (2010). The health and recovery peer (HARP) program: A peer-led intervention to improve medical self-management for persons with serious mental illness. Schizophrenia Research, 118(1–3), 264–270. https://doi.org/10.1016/j.schres.2010.01.026.Google Scholar
- Enders, C. K. (2010). Applied missing data analysis. New York: Guilford press.Google Scholar
- Hackman, J. R., & Oldham, G. R. (1974). The job diagnostic survey: An instrument for the diagnosis of jobs and the evaluation of job redesign projects. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=eric&AN=ED099580&site=ehost-live.
- Halbesleben, J. R., & Rathert, C. (2008). Linking physician burnout and patient outcomes: Exploring the dyadic relationship between physicians and patients. Health Care Management Review, 33(1), 29–39. https://doi.org/10.1097/01.HMR.0000304493.87898.72.Google Scholar
- Heaney, C. A., Price, R. H., & Rafferty, J. (1995). The caregiver support program: An intervention to increase employee coping resources and enhance mental health. In L. R. Murphy, J. J. Hurrell, S. L. Sauter & G. P. Keita (Eds.), Job stress interventions (pp. 93–108). Washington, DC: American Psychological Association.Google Scholar
- Hesser, H. (2015). Modeling individual differences in randomized experiments using growth models: Recommendations for design, statistical analysis and reporting of results of internet interventions. Internet Interventions, 2(2), 110–120.Google Scholar
- Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x.Google Scholar
- Kroenke, K., Spitzer, R. L., Williams, J. B., Monahan, P. O., & Lowe, B. (2007). Anxiety disorders in primary care: Prevalence, impairment, comorbidity, and detection. Annals of Internal Medicine, 146(5), 317–325. https://doi.org/10.7326/003-4819-146-5-200703060-00004.Google Scholar
- Kroenke, K., Theobald, D., Wu, J., Norton, K., Morrison, G., Carpenter, J., et al. (2010). Effect of telecare management on pain and depression in patients with cancer: A randomized trial. JAMA: The journal of the American Medical Association, 304(2), 163–171. https://doi.org/10.1001/jama.2010.944.Google Scholar
- Laschinger, H. K. S., & Fida, R. (2014). A time-lagged analysis of the effect of authentic leadership on workplace bullying, burnout, and occupational turnover intentions. European Journal of Work and Organizational Psychology, 23(5), 739–753. https://doi.org/10.1080/1359432X.2013.804646.Google Scholar
- Long, C. G., Blackwell, C. C., & Midgley, M. (1990). An evaluation of two systems of in-patient care in a general hospital psychiatric unit II: Measures of staff and patient performance. Journal of Advanced Nursing, 15(12), 1436–1442. https://doi.org/10.1111/j.1365-2648.1990.tb01786.x.Google Scholar
- Luther, L., Fukui, S., Garabrant, J. M., Rollins, A. L., Morse, G., & Salyers, M. P. (2018). Measuring quality of care in community mental health: Validation of concordant clinician and client quality of care scales. Journal of Behavioral Health Services & Research. https://doi.org/10.1007/s11414-018-9601-3 Google Scholar
- Luther, L., Miller, A., Hedrick, H., York, M. M., Firmin, R. L., Morse, G., et al. (2016). Client and provider perspectives on the impact of burnout on quality of care and client outcomes in community mental health. Journal of Behavioral and Social Sciences, 3, 73–85.Google Scholar
- Maslach, C. (1993). Burnout: A multidimensional perspective. In W. B. Schaufeli, C. Maslach & T. Marek (Eds.), Professional burnout: Recent developments in theory and research (pp. 19–32). Washington, DC: Taylor & Francis.Google Scholar
- Maslach, C., Jackson, S. E., & Leiter, M. P. (1996). Maslach burnout inventory manual. Palo Alto: Consulting Psychologists Press.Google Scholar
- McGrew, J. H., Johannesen, J. K., Griss, M. E., Born, D., & Katuin, C. (2005). Performance-based funding of supported employment: A multi-site controlled trial. Journal of Vocational Rehabilitation, 23, 81–99.Google Scholar
- Miller, W. R., & Rollnick, S. (2002). Motivational interviewing: Preparing people for change (2nd ed.). New York: Guilford Press.Google Scholar
- Morse, G., Salyers, M., Rollins, A., Monroe-DeVita, M., & Pfahler, C. (2012). Burnout in mental health services: A review of the problem and its remediation. Administration and Policy in Mental Health and Mental Health Services Research, 39(5), 341–352. https://doi.org/10.1007/s10488-011-0352-1.Google Scholar
- Priebe, S., Fakhoury, W., White, I., Watts, J., Bebbington, P., Billings, J.. & Pan-London Assertive Outreach Study. (2004). Characteristics of teams, staff and patients: associations with outcomes of patients in assertive outreach. British Journal of Psychiatry, 185, 306–311. https://doi.org/10.1192/bjp.185.4.306. G.Google Scholar
- Salyers, M. P., Bonfils, K. A., Luther, L., Firmin, R. L., White, D. A., Adams, E. L., et al. (2017). The relationship between professional burnout and quality and safety in healthcare: A meta-analysis. Journal of General Internal Medicine, 32(4), 475–482. https://doi.org/10.1007/s11606-016-3886-9.Google Scholar
- Salyers, M. P., Fukui, S., Rollins, A. L., Firmin, R., Gearhart, T., Noll, J. P., et al. (2015). Burnout and self-reported quality of care in community mental health. Administration and Policy in Mental Health and Mental Health Services Research, 42(1), 61–69. https://doi.org/10.1007/s10488-014-0544-6.Google Scholar
- Sox, H. C., & Greenfield, S. (2009). Comparative effectiveness research: A report from the Institute of Medicine. Annals of Internal Medicine, 151(3), 203–205. https://doi.org/10.7326/0003-4819-151-3-200908040-00125.Google Scholar
- Spitzer, R. L., Williams, J. B., Kroenke, K., Hornyak, R., & McMurray, J. (2000). Validity and utility of the PRIME-MD patient health questionnaire in assessment of 3000 obstetric-gynecologic patients: The PRIME-MD Patient Health Questionnaire Obstetrics-Gynecology Study. American Journal of Obstetrics & Gynecology, 183(3), 759–769. https://doi.org/10.1067/mob.2000.106580.Google Scholar
- Stalker, C., & Harvey, C. (2002). Professional burnout in social service organizations: A review of theory, research, and prevention. Waterloo: Social Work, Wilfrid Laurier University.Google Scholar
- Thompson, K., Kulkarni, J., & Sergejew, A. A. (2000). Reliability and validity of a new Medication Adherence Rating Scale (MARS) for the psychoses. Schizophrenia Research, 42(3), 241–247.Google Scholar
- Vahey, D. C., Aiken, L. H., Sloane, D. M., Clarke, S. P., & Vargas, D. (2004). Nurse burnout and patient satisfaction. Medical Care, 42(2 Suppl), II57–II66. https://doi.org/10.1097/01.mlr.0000109126.50398.5a.Google Scholar
- Williams, G. C., McGregor, H. A., King, D., Nelson, C. C., & Glasgow, R. E. (2005). Variation in perceived competence, glycemic control, and patient satisfaction: Relationship to autonomy support from physicians. Patient Education & Counseling, 57(1), 39–45. https://doi.org/10.1016/j.pec.2004.04.001.Google Scholar
- Williams, G. C., McGregor, H. A., Sharp, D., Levesque, C., Kouides, R. W., Ryan, R. M., & Deci, E. L. (2006). Testing a self-determination theory intervention for motivating tobacco cessation: Supporting autonomy and competence in a clinical trial. Health Psychology, 25(1), 91–101. https://doi.org/10.1037/0278-6126.96.36.199.Google Scholar
- Williams, J. W. Jr., Barrett, J., Oxman, T., Frank, E., Katon, W., Sullivan, M., et al. (2000). Treatment of dysthymia and minor depression in primary care: A randomized controlled trial in older adults. JAMA: The journal of the American Medical Association, 284(12), 1519–1526. https://doi.org/10.1001/jama.284.12.1519.Google Scholar