Burnout, employee engagement, and changing organizational contexts in VA primary care during the early COVID-19 pandemic
Abstract Background The COVID-19 pandemic involved a rapid change to the working conditions of all healthcare workers (HCW), including those in primary care. Organizational responses to the pandemic, including a shift to virtual care, changes in staffing, and reassignments to testing-related work, m...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-11-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12913-023-10270-8 |
| _version_ | 1797415642819723264 |
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| author | Eric A. Apaydin Danielle E. Rose Michael R. McClean David C. Mohr Elizabeth M. Yano Paul G. Shekelle Karin M. Nelson Rong Guo Caroline K. Yoo Susan E. Stockdale |
| author_facet | Eric A. Apaydin Danielle E. Rose Michael R. McClean David C. Mohr Elizabeth M. Yano Paul G. Shekelle Karin M. Nelson Rong Guo Caroline K. Yoo Susan E. Stockdale |
| author_sort | Eric A. Apaydin |
| collection | DOAJ |
| description | Abstract Background The COVID-19 pandemic involved a rapid change to the working conditions of all healthcare workers (HCW), including those in primary care. Organizational responses to the pandemic, including a shift to virtual care, changes in staffing, and reassignments to testing-related work, may have shifted more burden to these HCWs, increasing their burnout and turnover intent, despite their engagement to their organization. Our objectives were (1) to examine changes in burnout and intent to leave rates in VA primary care from 2017–2020 (before and during the pandemic), and (2) to analyze how individual protective factors and organizational context affected burnout and turnover intent among VA primary care HCWs during the early months of the pandemic. Methods We analyzed individual- and healthcare system-level data from 19,894 primary care HCWs in 139 healthcare systems in 2020. We modeled potential relationships between individual-level burnout and turnover intent as outcomes, and individual-level employee engagement, perceptions of workload, leadership, and workgroups. At healthcare system-level, we assessed prior-year levels of burnout and turnover intent, COVID-19 burden (number of tests and deaths), and the extent of virtual care use as potential determinants. We conducted multivariable analyses using logistic regression with standard errors clustered by healthcare system controlled for individual-level demographics and healthcare system complexity. Results In 2020, 37% of primary care HCWs reported burnout, and 31% reported turnover intent. Highly engaged employees were less burned out (OR = 0.57; 95% CI 0.52–0.63) and had lower turnover intent (OR = 0.62; 95% CI 0.57–0.68). Pre-pandemic healthcare system-level burnout was a major predictor of individual-level pandemic burnout (p = 0.014). Perceptions of reasonable workload, trustworthy leadership, and strong workgroups were also related to lower burnout and turnover intent (p < 0.05 for all). COVID-19 burden, virtual care use, and prior year turnover were not associated with either outcome. Conclusions Employee engagement was associated with a lower likelihood of primary care HCW burnout and turnover intent during the pandemic, suggesting it may have a protective effect during stressful times. COVID-19 burden and virtual care use were not related to either outcome. Future research should focus on understanding the relationship between engagement and burnout and improving well-being in primary care. |
| first_indexed | 2024-03-09T05:52:36Z |
| format | Article |
| id | doaj.art-c32c520d37ec4aea86c6b7e1e24bd901 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-03-09T05:52:36Z |
| publishDate | 2023-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-c32c520d37ec4aea86c6b7e1e24bd9012023-12-03T12:16:38ZengBMCBMC Health Services Research1472-69632023-11-0123111210.1186/s12913-023-10270-8Burnout, employee engagement, and changing organizational contexts in VA primary care during the early COVID-19 pandemicEric A. Apaydin0Danielle E. Rose1Michael R. McClean2David C. Mohr3Elizabeth M. Yano4Paul G. Shekelle5Karin M. Nelson6Rong Guo7Caroline K. Yoo8Susan E. Stockdale9Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare SystemCenter for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare SystemCenter for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare SystemNational Center for Organization Development, Veterans Health AdministrationCenter for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare SystemCenter for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare SystemSeattle-Denver Center of Innovation, VA Puget Sound Health Care SystemCenter for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare SystemCenter for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare SystemCenter for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare SystemAbstract Background The COVID-19 pandemic involved a rapid change to the working conditions of all healthcare workers (HCW), including those in primary care. Organizational responses to the pandemic, including a shift to virtual care, changes in staffing, and reassignments to testing-related work, may have shifted more burden to these HCWs, increasing their burnout and turnover intent, despite their engagement to their organization. Our objectives were (1) to examine changes in burnout and intent to leave rates in VA primary care from 2017–2020 (before and during the pandemic), and (2) to analyze how individual protective factors and organizational context affected burnout and turnover intent among VA primary care HCWs during the early months of the pandemic. Methods We analyzed individual- and healthcare system-level data from 19,894 primary care HCWs in 139 healthcare systems in 2020. We modeled potential relationships between individual-level burnout and turnover intent as outcomes, and individual-level employee engagement, perceptions of workload, leadership, and workgroups. At healthcare system-level, we assessed prior-year levels of burnout and turnover intent, COVID-19 burden (number of tests and deaths), and the extent of virtual care use as potential determinants. We conducted multivariable analyses using logistic regression with standard errors clustered by healthcare system controlled for individual-level demographics and healthcare system complexity. Results In 2020, 37% of primary care HCWs reported burnout, and 31% reported turnover intent. Highly engaged employees were less burned out (OR = 0.57; 95% CI 0.52–0.63) and had lower turnover intent (OR = 0.62; 95% CI 0.57–0.68). Pre-pandemic healthcare system-level burnout was a major predictor of individual-level pandemic burnout (p = 0.014). Perceptions of reasonable workload, trustworthy leadership, and strong workgroups were also related to lower burnout and turnover intent (p < 0.05 for all). COVID-19 burden, virtual care use, and prior year turnover were not associated with either outcome. Conclusions Employee engagement was associated with a lower likelihood of primary care HCW burnout and turnover intent during the pandemic, suggesting it may have a protective effect during stressful times. COVID-19 burden and virtual care use were not related to either outcome. Future research should focus on understanding the relationship between engagement and burnout and improving well-being in primary care.https://doi.org/10.1186/s12913-023-10270-8BurnoutPrimary careHealthcare workforceEmployee engagementCOVID-19Virtual care |
| spellingShingle | Eric A. Apaydin Danielle E. Rose Michael R. McClean David C. Mohr Elizabeth M. Yano Paul G. Shekelle Karin M. Nelson Rong Guo Caroline K. Yoo Susan E. Stockdale Burnout, employee engagement, and changing organizational contexts in VA primary care during the early COVID-19 pandemic BMC Health Services Research Burnout Primary care Healthcare workforce Employee engagement COVID-19 Virtual care |
| title | Burnout, employee engagement, and changing organizational contexts in VA primary care during the early COVID-19 pandemic |
| title_full | Burnout, employee engagement, and changing organizational contexts in VA primary care during the early COVID-19 pandemic |
| title_fullStr | Burnout, employee engagement, and changing organizational contexts in VA primary care during the early COVID-19 pandemic |
| title_full_unstemmed | Burnout, employee engagement, and changing organizational contexts in VA primary care during the early COVID-19 pandemic |
| title_short | Burnout, employee engagement, and changing organizational contexts in VA primary care during the early COVID-19 pandemic |
| title_sort | burnout employee engagement and changing organizational contexts in va primary care during the early covid 19 pandemic |
| topic | Burnout Primary care Healthcare workforce Employee engagement COVID-19 Virtual care |
| url | https://doi.org/10.1186/s12913-023-10270-8 |
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