Research Snapshot: Organizational conditions that influence work engagement and burnout

What you need to know

There is growing concern for clinician burnout in healthcare settings. However, there is limited research on interventions to improve burnout and work engagement in mental health and rehabilitation settings. High levels of burnout can lead to reduced physical and emotional well-being, lack of engagement at work, reduced commitment to organizational goals and values, and staff turnover.

In this study, the researchers identified three main organizational themes related to enhancing work engagement and/or mitigating burnout: (1) a work culture that prioritizes person-centered care over productivity and other performance metrics, (2) robust management skills and practices to overcome bureaucracy and (3) opportunities for employee professional development and self-care.  

What is this research about?

There has been a lack of attention focusing on reducing or preventing mental health clinician burnout, and the literature points to the need for organizational-level interventions to mitigate burnout. To overcome the challenges of burnout at the organizational level, it is important to understand what is driving clinician burnout.

The purpose of this study was to develop an understanding of organizational drivers associated with burnout from the perspectives of mental health staff. The study’s long-term goal is to mitigate clinician burnout and its associated effects by identifying interventions that target key drivers of burnout at the organization level.

What did the researchers do?

The researchers conducted a one-time, 30-minute, semi-structured interview with 40 participants to understand their views of organizational conditions impacting burnout and work engagement. This study was part of a larger randomized control trial to reduce burnout for mental health staff at three Department of Veterans Health Affairs (VHA) facilities and two non-VHA social service agencies. The majority of participants were mental health clinicians and managers who were White (77.5%), female (67.5%) and held a Master’s degree or higher (75.0%). Each interview consisted of open-ended questions on factors associated with the following:

The questions were designed to capture the participants’ descriptions of their own experiences while looking at in-depth issues related to burnout at local and organizational levels.

What did the researchers find?

From the interviews, the researchers summarized their findings into three main organizational contexts related to enhancing work engagement and/or mitigating burnout:   

  1. Work culture that prioritizes person-centered care over productivity and other performance metrics.

    In the first theme, the researchers found that organizational culture was driven by high workload from productivity and documentation requirements, and these factors led to burnout and a decrease in client care. Furthermore, the participants felt that understaffing, including delays in filling vacant positions or not filling vacancies at all, impacted their ability to provide all aspects of care that clients needed. Also, participants reported that a lot of these pressures might not have come from management, but from health system level policies and budget constraints, which further led to difficulties managing rapid and sometimes conflicting policy changes.

  2. Robust management skills and practices to overcome bureaucracy.

    In the second theme, several sub-themes were identified as follows:

    1. Communication and leader accessibility. The researchers identified that poor communication, at multiple levels, affected participants’ burnout. Participants felt comfortable voicing concerns or asking questions of upper management, but found inadequate communication regarding expectations and policy changes. Managers themselves were also impacted by poor communication. Some participants liked that their supervisors had regular contact with staff and appreciated upper level managers who had “open door” policies, such as having monthly lunch with staff, which connected them to the organization.
    2. Streamlining processes to maximize efficiency. The researchers noted the main contributor to inefficient work systems was bureaucratic requirements around documentation. There was a need for better coordination between departments to make processes flow better.
    3. Empowering managers with good leadership skills. The researchers identified several key leadership skills that were helpful in promoting work engagement. Managers who were most helpful supported employee autonomy, held employees accountable, accepted and acted upon feedback, and built trusting, supportive relationships with their staff. Burnout occurred when managers elicited feedback through huddles or other forums but the feedback was not acted upon, often due to a lack of authority by staff or managers. Furthermore, the researchers discovered that managers who were overcommitted or had a high workload were inattentive.
  3. Opportunities for employee professional development and self-care.

    In the third theme, the researchers discovered that time was needed for training and professional development, including mentoring, continuing education or retreats. Participants wanted management to prioritize time dedicated to self-care, especially practicing mindfulness, relaxation, prioritizing tasks for minimal disruptions and preserving time for lunch. They also wanted management to focus on efforts to help separate work and personal life by giving participants vacation and time away from work to re-energize and focus. Overall, some participants noted that managers could proactively encourage self-care, but others acknowledged the struggle to take time off and meet high productivity demands.

Limitations of the research

The researchers noted several limitations. Firstly, this study used a limited number of organizations that were located in the Midwestern United States. Secondly, the sample included more Veterans Affairs mental health staff than staff from other settings. Lastly, the sample size was derived from participants from a larger intervention study and potentially excluded those individuals who were struggling the most with burnout.

How can you use this research?

The researchers suggest that this research should inform several possible targets of intervention as well as the development of initiatives at the health system, organizational and program levels. Furthermore, the findings could guide the field toward more effective ways to reduce burnout and improve work engagement.

About the researchers

Angela L. Rollins,1,2,3 Johanne Eliacin,1,2,3 Alissa L. Russ-Jara,1,4 Maria Monroe-Devita,5 Sally Wasmuth,1,3,6 Mindy E. Flanagan,1 Gary A. Morse,7 Michael Leiter,8 Michelle P. Salyers2

  1. VA HSR&D Center for Health Information and Communication, Veterans Health Indiana, Indianapolis, IN, United States
  2. Department of Psychology, ACT Center of Indiana, IUPUI, Indianapolis, IN, United States
  3. Regenstrief Institute, Inc., Indianapolis, IN, United States
  4. Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN, United States
  5. Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States
  6. Department of Occupational Therapy, Indiana University School of Health & Human Sciences, Indianapolis, IN, United States
  7. Research and Development, Places for People, St. Louis, MO, United States
  8. Department of Psychology, Acadia University, Wolfville, NS, Canada

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