Only One Burnout Estimator Is Consistently Associated with Health Care Providers’ Perceptions of Job Demand and Resource Problems

Abstract

Five "high" burnout estimators are in common use. Each is based on a different subset of the three aspects of "Burnout Syndrome", so each gives a different estimate of the "high" burnout prevalence in a population. Managers often don't know these prevalences are incomparable. Managers also have little specific information on how their institution's burnout measure is associated with their employees' perceptions of problems in job demands and resources in their work environment, as regularly queried in organizational health surveys. In the current study, we demonstrated the differences in the prevalences of "high" burnout obtained using each of five "high" burnout estimators. We also evaluated and compared the five burnout estimators' associations with employee-perceived problems in each of 31 areas of job demands and resources in human-systems functioning. We measured these associations by how much more the aspects of burnout queried in the estimator were reported by those who perceived a problem than by those who did not (the positive likelihood ratio, LR+). We examined five types of physicians (6599), nurse practitioners (2158) and physician assistants (786). We found that four of the "high" burnout estimators showed few associations with employee perceptions of problems in job demands or resources, but one estimator-the trivariate joint occurrence of "high" (i.e. frequent) emotional exhaustion, "high" depersonalization and "low" sense of personal accomplishment (measured by well-validated single-item surrogates for the three Maslach Burnout Inventory subscales)-was clinically significantly associated with 97% (30) of the problems in job demands and resources studied, in at least one of the health provider groups. Our results challenge the current preference for "high" emotional exhaustion dominated "high" burnout estimators.

Examining burnout profiles in relation to health and well‐being in the Veterans Health Administration employee population

“…Burnout was measured within the AES using three items from a widely used and validated measure of employee burnout, the Maslach Burnout Inventory‐Human Service Survey (MBI‐HSS; Maslach et al, ). The MBI‐HSS items reflect employee self‐ratings on the three dimensions of burnout (depersonalization, emotional exhaustion, and personal accomplishment) and were chosen based on the literature and in consultation with the authors of the MBI (Beckstrand et al, ). The item “I worry that this job is hardening me emotionally” (MBI‐HSS: DP Item 11) represents depersonalization; this item was chosen instead of another well‐validated depersonalization item (“I've become callous toward people since I took this job”) because the former item lacked face validity across the wide range of employees in VHA (Beckstrand et al, ); the well‐validated single item “I feel burned out from my work” (Item 8) represents emotional exhaustion and is a surrogate for the MBI‐HSS: EE subscale score (West et al, ; West, Dyrbye, Satele, Sloan, & Shanafelt, ; West, Dyrbye, Sloan, & Shanafelt, ); and the item “I have accomplished many worthwhile things in this job” (MBI‐HSS: PA Item 19) represents personal accomplishment.…”

“…The item “I worry that this job is hardening me emotionally” (MBI‐HSS: DP Item 11) represents depersonalization; this item was chosen instead of another well‐validated depersonalization item (“I've become callous toward people since I took this job”) because the former item lacked face validity across the wide range of employees in VHA (Beckstrand et al, ); the well‐validated single item “I feel burned out from my work” (Item 8) represents emotional exhaustion and is a surrogate for the MBI‐HSS: EE subscale score (West et al, ; West, Dyrbye, Satele, Sloan, & Shanafelt, ; West, Dyrbye, Sloan, & Shanafelt, ); and the item “I have accomplished many worthwhile things in this job” (MBI‐HSS: PA Item 19) represents personal accomplishment. This item was chosen based on validity studies by Beckstrand et al () because no previously used well‐validated surrogate items for this dimension could be found in the literature. An earlier study using the full MBI demonstrated that these single items were psychometrically appropriate for representing these dimensions, that is, the item scores are adequate short measures of full MBI scale scores (Hernandez, Luthanen, Ramsel, & Osatuke, ).…”

“…In the past 2 or 3 years, a growing number of studies on burnout in VHA employees have been published; these studies have focused primarily on burnout and its prevention or treatment in different types of mental health providers (Garcia et al, ; Garcia et al, ; Park, Chang, Mueller, Resnick, & Eisen, ; Rollins et al, ), burnout in primary care providers within the context of implementing new patient‐centered care models (Dolan et al, ; Locatelli & LaVela, ; Meredith et al, ; Nelson et al, ; Simonetti et al, ), and research, which we build upon here, defining and illustrating the usefulness of burnout profiles in examining correlates and the implications of burnout across the system (Beckstrand, Yanchus, & Osatuke, ; Luthanen, Beckstrand, Yanchus, & Osatuke, ; Yanchus, Beckstrand, & Osatuke, ).…”

“…Research utilizing a unique configurational approach has documented eight distinctive burnout profiles in employees based on the three dimensions of burnout (depersonalization, emotional exhaustion, and personal accomplishment) in VHA (Beckstrand et al, ; Yanchus et al, ). Compared with alternative estimators of high burnout, Beckstrand et al () found only the trivariate joint occurrence of “high” emotional exhaustion, high depersonalization, and “low” sense of personal accomplishment (“Burned Out” profile) to be consistently associated with health care providers' perceptions of job demands and resource problems. Specifically, this estimator was clinically‐significantly associated with 97% (30) of 31 problems studied in select provider groups whereas other commonly used estimators (high emotional exhaustion alone and high emotional exhaustion or high depersonalization) were not consistently associated with job demands and resource problems.…”

“…It may also reveal vulnerabilities within an occupational group. For example, Beckstrand et al () noted that primary care physicians appeared vulnerable to an increase in high burnout prevalence (from 13.4% to as high as 33%) if the 19.6% jointly high on emotional exhaustion and depersonalization (“Burning Up” profile) were to lose those factors in their work environment sustaining their high sense of personal accomplishment leading to the trivariate joint occurrence of high emotional exhaustion, high depersonalization, and low sense of personal accomplishment (Burned Out profile). Examining these potential vulnerabilities by occupational group may provide targets for future organizational interventions.…”