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IIR 17-262 – HSR Study

IIR 17-262
Caring for the caregiver: predictors and consequences of VA mental health provider burnout
Kara Zivin, PhD MS MA
VA Ann Arbor Healthcare System, Ann Arbor, MI
Ann Arbor, MI
Funding Period: December 2019 - September 2024


Background: Mental health providers (MHPs), who are "mission critical" for the VHA, report the second highest level of burnout after primary care physicians. MHP burnout may be associated with negative system- level factors (organizational climate, workgroup perceptions, and supervisory behaviors), provider experiences (engagement, satisfaction, and turnover) and patient outcomes (access to, continuity of, experience of care). VHA has yet to conduct a systematic facility-level study identifying predictors and consequences of MHP burnout. This study will address HSR&D priorities focused on health care systems change, the impact of organizational and provider factors associated with quality of care for Veterans, and improving employee engagement. Objectives: This pre-implementation study aims to characterize variation in MHP burnout by facility over time, identifying workplace characteristics and practices of high performing facilities that can be translated for potential implementation at facilities with room for improvement. Aim 1: to examine facility- level predictors and consequences of VHA MHP burnout; Aim 2: to understand VHA MHP leadership and front-line provider perspectives regarding factors that protect against or exacerbate burnout in facilities with differing levels of burnout; and Aim 3: to identify context-sensitive strategies for facilities to successfully reduce VHA MHP burnout. Methods: Using a sequential explanatory mixed methods study, a two-phase design with quantitative data collection and analysis followed by qualitative data collection and analysis, and subsequent integration, we will evaluate factors that influence MHP burnout and their effects on patient outcomes. We will compile annual survey data on workplace conditions and annual staffing and productivity data between FY2014 and FY2018 to assess same and subsequent year provider and patient outcomes reflecting provider and patient experiences. The All Employee Survey (AES) is an annual organizational census of workplace perceptions and satisfaction. The Mental Health Provider Survey (MHPS) is an annual survey to assess MHP perceptions about access to and quality of mental health care, and job satisfaction. The Mental Health Outpatient Clinical method tracks MHP inpatient and outpatient clinical hours and productivity. We will examine MHP job satisfaction and patient experience metrics using the Strategic Analytics for Improvement and Learning (SAIL) Mental Health domain, the VHA's quality monitoring system. Facility complexity level is measured using a five level indicator based on patient risk, number of specialists, volume, and level of teaching and research, including mental health program characteristics. By linking these data sources, we will quantify predictors of burnout and the impact of burnout on patient outcomes. We will conduct interviews with mental health facility leadership and front-line MHPs, intentionally sampled using facility-level MHP burnout. We will create a joint display to interpret quantitative and qualitative findings on predictors and patient outcomes associated with burnout in light of facility context and any strategies used to address burnout. We will present our findings to an expert panel of operational partners, VA clinicians, administrators, policy leaders, and experts. The panel will select context-sensitive best practices to share with facilities to address MHP burnout and recommend potential interventions. Finally, we will reengage facilities that participated in Aim 2 and conduct focus groups and share results presented in feedback reports. We will broadly disseminate findings, which will support the development of actionable policies and approaches to addressing MHP burnout. Anticipated impacts on Veterans' health and next steps: This study will assist in future developing and testing interventions with VHA partners to improve MHP burnout and employee engagement. Decreased MHP burnout could improve quality of care, wait times, and lost revenues due to staff attrition. Our findings could be of clinical and financial value to VHA, its providers, and patients. Our work will contribute to broad VHA care improvements, and will generate new insights for care delivery.

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Journal Articles

  1. Zivin K, Van T, Osatuke K, Boden M, Pfeiffer PN, Sripada RK, Abraham KM, Burgess J, Kim HM. Behavioral Health Provider Burnout and Mental Health Care in the Veterans Health Administration. Journal of general internal medicine. 2023 Aug 1; 38(10):2254-2261. [view]
  2. Zivin K, Kononowech J, Boden M, Abraham K, Harrod M, Sripada RK, Kales HC, Garcia HA, Pfeiffer P. Correction: Predictors and Consequences of Veterans Affairs Mental Health Provider Burnout: Protocol for a Mixed Methods Study. JMIR research protocols. 2021 Jan 12; 10(1):e26934. [view]
  3. Abraham KM, Chang MM, Van T, Resnick SG, Zivin K. Employment After Vocational Rehabilitation Predicts Decreased Health Care Utilization in Veterans With Mental Health Diagnoses. Military medicine. 2021 Aug 28; 186(9-10):850-857. [view]
  4. Admon LK, Zivin K, Kozhimannil KB. Perinatal insurance coverage and behavioural health-related maternal mortality. International review of psychiatry (Abingdon, England). 2021 Sep 1; 33(6):553-556. [view]
  5. Zivin K, Kononowech J, Boden M, Abraham K, Harrod M, Sripada RK, Kales HC, Garcia HA, Pfeiffer P. Predictors and Consequences of Veterans Affairs Mental Health Provider Burnout: Protocol for a Mixed Methods Study. JMIR research protocols. 2020 Dec 21; 9(12):e18345. [view]
  6. Haffajee RL, Faherty LJ, Zivin K. Pregnant Women with Substance Use Disorders - The Harm Associated with Punitive Approaches. The New England journal of medicine. 2021 Jun 24; 384(25):2364-2367. [view]
  7. Zivin K, Chang MM, Van T, Osatuke K, Boden M, Sripada RK, Abraham KM, Pfeiffer PN, Kim HM. Relationships between work-environment characteristics and behavioral health provider burnout in the Veterans Health Administration. Health services research. 2022 Jun 1; 57 Suppl 1(Suppl 1):83-94. [view]
  8. Burgess J, Kim HM, Porath BR, Van T, Osatuke K, Boden M, Sripada RK, Wong ES, Zivin K. The Importance of Autonomy and Performance Goals in Perceived Workload Among Behavioral Health Providers. Psychiatric services (Washington, D.C.). 2024 Mar 27; appips20230406. [view]
  9. Tam J, Warner KE, Zivin K, Taylor GMJ, Meza R. The Potential Impact of Widespread Cessation Treatment for Smokers With Depression. American journal of preventive medicine. 2021 Nov 1; 61(5):674-682. [view]
  10. Medicaid Outcomes Distributed Research Network (MODRN) , Donohue JM, Jarlenski MP, Kim JY, Tang L, Ahrens K, Allen L, Austin A, Barnes AJ, Burns M, Chang CH, Clark S, Cole E, Crane D, Cunningham P, Idala D, Junker S, Lanier P, Mauk R, McDuffie MJ, Mohamoud S, Pauly N, Sheets L, Talbert J, Zivin K, Gordon AJ, Kennedy S. Use of Medications for Treatment of Opioid Use Disorder Among US Medicaid Enrollees in 11 States, 2014-2018. JAMA. 2021 Jul 13; 326(2):154-164. [view]
  11. Smith C, Boden M, Trafton J. Veterans Health Administration Outpatient Psychiatry Staffing Model: Longitudinal Analysis on Mental Health Performance. Journal of general internal medicine. 2023 Jul 1; 38(Suppl 3):814-820. [view]

DRA: Mental, Cognitive and Behavioral Disorders, Health Systems
DRE: TRL - Applied/Translational, Data Science
Keywords: Best Practices
MeSH Terms: None at this time.

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