Mental health productivity monitoring in the Veterans Health
                        Administration: Challenges and lessons learned.

Kearney, Lisa K.; Smith, Clifford A.; Kivlahan, Daniel R.; Gresen, Robert C.; Moran, Eileen; Schohn, Mary; Trafton, Jodie A.; Zeiss, Antonette M.

doi:10.1037/ser0000173

Cited by 8 publications

(6 citation statements)

References 32 publications

(43 reference statements)

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“…We used two facility‐level variables (staffing ratio and productivity) in sensitivity analyses as possible predictors of the relationship between self‐reported work–environment characteristics and burnout. Further details outlining the purpose—origins and definitions—of these two metrics appear elsewhere 20–22 …”

Section: Methodsmentioning

confidence: 99%

“…This study provided a unique opportunity to take advantage of rich individual‐level data from two large annual national surveys that included BHPs: All Employee Survey (AES) 18 and Mental Health Provider Survey (MHPS) 19 . We supplemented analyses with facility‐level Mental Health Onboard Clinical (MHOC) staffing and productivity data, which identify and track provider productivity across settings, including mental health outpatient 20–23 . Published findings of VHA surveys have tended to use facility‐level data and thus could not address potentially modifiable individual‐level work–environment characteristics associated with burnout.…”

Section: Introductionmentioning

confidence: 99%

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Relationships between work–environment characteristics and behavioral health provider burnout in the Veterans Health Administration

Zivin

Chang

Vân

et al. 2022

Health Services Research

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Objective To identify work–environment characteristics associated with Veterans Health Administration (VHA) behavioral health provider (BHP) burnout among psychiatrists, psychologists, and social workers. Data Sources The 2015–2018 data from Annual All Employee Survey (AES); Mental Health Provider Survey (MHPS); N = 57,397 respondents; facility‐level Mental Health Onboard Clinical (MHOC) staffing and productivity data, N = 140 facilities. Study Design For AES and MHPS separately, we used mixed‐effects logistic regression to predict BHP burnout using surveys from year pairs (2015–2016, 2016–2017, 2017–2018; six models). Within each year‐pair, we used the earlier year of data to train models and tested the model in the later year, with burnout (emotional exhaustion and/or depersonalization) as the outcome for each survey. We used potentially modifiable work–environment characteristics as predictors, controlling for employee demographic characteristics as covariates, and employment facility as random intercepts. Data Collection/Extraction Methods We included work–environment predictors that appeared in all 4 years (11 in AES; 17 in MHPS). Principal Findings In 2015–2018, 31.0%–38.0% of BHPs reported burnout in AES or MHPS. Work characteristics consistently associated with significantly lower burnout were included for AES: reasonable workload; having appropriate resources to perform a job well; supervisors address concerns; given an opportunity to improve skills. For MHPS, characteristics included: reasonable workload; work improves veterans' lives; mental health care provided is well‐coordinated; and three reverse‐coded items: staffing vacancies; daily work that clerical/support staff could complete; and collateral duties reduce availability for patient care. Facility‐level staffing ratios and productivity did not significantly predict individual‐level burnout. Workload represented the strongest predictor of burnout in both surveys. Conclusions This study demonstrated substantial, ongoing impacts that having appropriate resources including staff, workload, and supervisor support had on VHA BHP burnout. VHA may consider investing in approaches to mitigate the impact of BHP burnout on employees and their patients through providing staff supports, managing workload, and goal setting.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Relationships between work–environment characteristics and behavioral health provider burnout in the Veterans Health Administration

Zivin

Chang

Vân

et al. 2022

Health Services Research

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“…The risk of resource investment being considered a waste if no value is added to patient outcomes was apparent [48]. To mitigate this risk, the involvement of stakeholders in target-setting was associated with improved acceptance and compliance towards efficiency targets [90]. Clear target definition and stakeholder collaboration during improvement initiative development were reported as factors for improvement initiative success [50,91].…”

Section: Stakeholder Engagementmentioning

confidence: 99%

Supporting efficiency improvement in public health systems: a rapid evidence synthesis

Walters¹,

Sharma

Malica³

et al. 2022

BMC Health Serv Res

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Background Public health systems internationally are under pressure to meet increasing demand for healthcare in the context of increasing financial resource constraint. There is therefore a need to maximise health outcomes achieved with public healthcare expenditure. This paper aims to establish and synthesize the contemporary evidence base for approaches taken at a system management level to improve efficiency. Methods Rapid Evidence Assessment (REA) methodology was employed. A search strategy was developed and applied (PUBMED, MEDLINE) returning 5,377 unique titles. 172 full-text articles were screened to determine relevance with 82 publications included in the final review. Data regarding country, study design, key findings and approaches to efficiency improvement were extracted and a narrative synthesis produced. Publications covering health systems from developed countries were included. Results Identified study designs included policy reviews, qualitative reviews, mixed methods reviews, systematic reviews, literature reviews, retrospective analyses, scoping reviews, narrative papers, regression analyses and opinion papers. While findings revealed no comprehensive frameworks for system-wide efficiency improvement, a range of specific centrally led improvement approaches were identified. Elements associated with success in current approaches included dedicated central functions to drive system-wide efficiency improvement, managing efficiency in tandem with quality and value, and inclusive stakeholder engagement. Conclusions The requirement for public health systems to improve efficiency is likely to continue to increase. Reactive cost-cutting measures and short-term initiatives aimed only at reducing expenditure are unlikely to deliver sustainable efficiency improvement. By providing dedicated central system-wide efficiency improvement support, public health system management entities can deliver improved financial, health service and stakeholder outcomes.

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“…There is a risk for resource investment to be considered a waste if no value is added to patient outcomes (46) . To mitigate this risk, the involvement of stakeholders in target-setting has been associated with improved acceptance and compliance towards established targets (67) . Clear target definition and stakeholder collaboration during improvement initiative development are factors for improvement initiative success (68,69) .…”

Section: Stakeholder Engagementmentioning

confidence: 99%

Supporting Efficiency Improvement in Public Health Systems: a Rapid Systematic Review of Current Evidence

Walters¹,

Harrison²,

Sharma³

et al. 2020

Preprint

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Rationale, aims and objectives Public health systems are under pressure to meet increasing demand for health care in environments of increasing financial resource constraint. There is therefore a need to maximise health outcomes given limited public healthcare expenditure. This paper aims to establish the extent of literature and approaches to efficiency improvement in public health systems of developed countries. Methods The Rapid Evidence Assessment model was used to address the review question. Two database searches returned a result of 3,526 unique titles, which were individually screened for potential relevance. 144 titles were selected for full review to determine relevance. 73 papers were included in the final review. Results Data on country, study design, key findings and links to efficiency improvement were extracted and synthesized. Synthesis of findings revealed that the literature on this topic is disparate and non-cohesive. A range of isolated approaches were described, and no evidence or consensus on a single best-practice approach to efficiency improvement was identified. Conclusions Combining the factors identified in this review has the potential to inform a framework for supporting efficiency improvement in public health systems. By considering these factors central health system management bodies can support efficiency improvement to deliver both financial and health services benefits.

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Mental health productivity monitoring in the Veterans Health Administration: Challenges and lessons learned.

Cited by 8 publications

References 32 publications

Relationships between work–environment characteristics and behavioral health provider burnout in the Veterans Health Administration

Relationships between work–environment characteristics and behavioral health provider burnout in the Veterans Health Administration

Supporting efficiency improvement in public health systems: a rapid evidence synthesis

Supporting Efficiency Improvement in Public Health Systems: a Rapid Systematic Review of Current Evidence

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