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2023 HSR&D/QUERI National Conference Abstract

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1156 — Autonomy in Work Location Decision and Burnout in Behavioral Health Providers: Lessons Learned from COVID-19

Lead/Presenter: H. Myra Kim,  COIN - Ann Arbor
All Authors: Kim HM (Consulting for Statistics, Computing, and Analytics Research, University of Michigan, Ann Arbor, Michigan), Van T (Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan) Evans RR (Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan) Burgess J (Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan) Zivin K (Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan; Department of Psychiatry, Michigan Medicine, Ann Arbor)

Objectives:
Teleworking may protect employees from illness and promote productivity. Working from home can provide more flexibility, but consistent data on whether telework increases or decreases stress or job productivity remain absent. In addition, being able to choose one’s work-location such as being able to telework can be an important factor in satisfaction with work or burnout from work. During COVID, teleworking has become more widespread, and in many cases necessary, which allows an opportunity to evaluate an association between autonomy in work-location decision (WLD) and burnout.

Methods:
We used 2020 VA Annual All Employee Survey (AES) data, which included an additional COVID module allowing us to measure the level of autonomy in the work-location decision. Based on responses related to frequency of teleworking and reasons for not teleworking both pre-COVID-19 and during COVID, we generated six groups representing potentially differing levels of autonomy in WLD, with three groups in “higher” autonomy groups and three in “lower” autonomy groups. We included only behavioral health providers (BHPs) at 129 Veterans Health Administration medical care facilities. We hypothesized that the BHPs in the three lower autonomy groups are more likely to experience burnout than those in the three higher autonomy groups. We stratified the analyses by occupation types (psychiatrists, psychologists, or social workers) to evaluate how the relationship between level of autonomy in WLD and burnout may differ by occupation types. We used logistic regression with provider-level dichotomized burnout as dependent variable and WLD groups as the primary independent variable, adjusting for provider demographic variables and with GEE to account for potential within facility correlation.

Results:
The 2020 AES provided data for 18,293 BHPs. Psychologists had the highest proportion of providers reporting burnout (40.1%, 1801/4,494), followed by psychiatrists (35.6%, 703/1,976) and social workers (31.0%, 3421/11,051). The three lower autonomy groups had a higher unadjusted proportion of providers with burnout (33.4%, 35.2%, 36.4%) whereas the three higher autonomy groups had lower burnout (26.9%, 29.7%, 32.4%). After adjusting for covariates, the least autonomous decision group where providers teleworked during COVID-19 but did not have approval for telework pre-COVID-19 showed 1.35 (p = .004), 1.46 (p = .09), and 1.73 ( < .001) times higher odds of burnout among social workers, psychiatrists, and psychologist, respectively, compared to the highest autonomous decision group where providers chose not to telework during COVID-19, and chose not to, could not, or were not approved to telework pre-COVID-19.

Implications:
Lack of autonomy in WLD appears to have positive associations with burnout across different types of occupation in BHPs.

Impacts:
Providing greater autonomy in WLD might represents one approach to reducing BHP burnout.