Using a Single Item to Measure Burnout in Primary Care Staff: A Psychometric Evaluation

Abstract

BACKGROUND: Burnout affects nearly half of all U.S. nurses and physicians, and has been linked to poor outcomes such as worse patient safety. The most common measure of burnout is the well-validated Maslach Burnout Inventory (MBI). However, the MBI is proprietary and carries licensing fees, posing challenges to routine or repeated assessment. OBJECTIVE: To compare a non-proprietary, single-item burnout measure to a single item from the MBI Emotional Exhaustion (MBI:EE) subscale that has been validated as a standalone burnout measure. DESIGN: Cross-sectional online survey. PARTICIPANTS: A sample of primary care providers (PCPs), registered nurses, clinical associates (e.g., licensed practical nurses (LPNs), medical technicians), and administrative clerks in the Veterans Health Administration surveyed in 2012. MAIN METHODS: We compared a validated one-item version of the MBI:EE and a non-proprietary single-item burnout measure used in the Physician Work Life Study. We calculated kappa statistics, sensitivity and specificity, positive predictive (PPV) and negative predictive values (NPV), and area under the receiver operator curve (AUC). We conducted analyses stratified by occupation to determine the stability of the correlation between the two measures. KEY RESULTS: We analyzed responses from 5,404 participants, including 1,769 providers and 1,380 registered nurses. The prevalence of burnout was 36.7 % as measured on the single MBI:EE item and 38.5 % as measured on the non-proprietary single-item measure. Relative to the MBI:EE, the non-proprietary single-item measure had a correlation of 0.79, sensitivity of 83.2 %, specificity of 87.4 %, and AUC of 0.93 (se=0.004). Results were similar when stratified by respondent occupation. CONCLUSIONS: A non-proprietary single-item measure served as a reliable substitute for the MBI:EE across occupations. Because it is non-proprietary and easy to interpret, it has logistical advantages over the one-item MBI.

Task Delegation and Burnout Trade-offs Among Primary Care Providers and Nurses in Veterans Affairs Patient Aligned Care Teams (VA PACTs)

“…However, this single-item measure has been used previously 38 and shows strong correlation with the emotional exhaustion subscale of the Maslach Burnout Inventory. 33 Second, as a crosssectional survey, we cannot make conclusions regarding causation, only association. With subsequent surveys of VA PCPs and staff, we may be able to study how changes in task delegation affect burnout over time.…”

“…This question has been validated previously against the Emotional Exhaustion Subscale of the Maslach Burnout Inven- tory. 26,33,35 Consistent with previous analyses, a score Ն3 was considered burnout. …”

“…33,34 The specific question is, "Overall, based on your definition of burnout, how would you rate your level of burnout?" Responses were scored on a 5-category ordinal scale: 1 ϭ "I enjoy my work.…”

Work–Life Balance, Burnout, and Satisfaction of Early Career Pediatricians

“…Many previous investigations of burnout have used multi-item scales; however, some have suggested that single-item burnout assessments are a valid and reliable substitute for multiquestion surveys. 46,47 The item used in our study was adapted from this previous work 36 and pilot tested with young pediatricians. Third, although previous research has identified that early career physicians are most likely to have dissatisfaction with overall career choice and the highest frequency of work-home conflicts, our study is limited to early career pediatricians; therefore, the generalizability of the 7 by guest on May 12, 2018 http://pediatrics.aappublications.org/ Downloaded from findings to other specialties or career stages remains unclear.…”

Predictors of burnout among physicians and advanced-practice clinicians in central New York

“…[24,25] The Physician Work Life Study (PWLS), [26] Minimizing Error and Maximizing Outcome (MEMO) study, [27] and Mississippi Workforce Study (MWS) [28] also used the same measure. It has been validated against (the emotional exhaustion subscale of) the "gold standard" Maslach Burnout Inventory (MBI) among 307 Texas medical school graduates, [29] 740 Australian oncology care providers, [30] 5,404 primary care providers/staff at Veterans Affairs hospitals, [31] and our study sample. [32] The item poses the question: "Overall, how would you rate your level of burnout?"…”