The Impact of Burnout on Patient-Centered Care: A Comparative Effectiveness Trial in Mental Health

NCT02146326 | Completed Results

• 1 other identifier: IH-1304-6597
• Study Type: interventional
• Target: 679
• Locations: 1 country
• Sites: 2

Brief Summary

Healthcare providers play an important role in helping patients be actively involved in treatment and recover from mental illness. But mental health clinicians, like other healthcare providers, are at risk for experiencing burnout-feeling emotionally drained from their work, having cynical thoughts toward patients and others, and feeling little accomplishment in their work. Burnout can lead to problems for the clinician including poor overall health, depression, and lower job satisfaction. Burnout also can impact how clinicians perform on the job; for example, people with high levels of burnout take more time off, show lower commitment to their job, and are more likely to quit or be fired. There is some evidence that burnout can affect the quality of care for patients, but very little rigorous research has tested this assumption. The purpose of our study is threefold. First, we will investigate how patients perceive burnout in clinicians and whether (and/or how) burnout impacts the care they receive. Next, we will test an intervention to reduce clinician burnout called Burnout Reduction: Enhanced Awareness, Tools, Handouts, and Education (BREATHE). BREATHE brings together tools that mental health clinicians are already familiar with, including relaxation and mindfulness exercises, setting boundaries, using social supports, and changing negative thought patterns and replacing them with more helpful ways of thinking. We have found this intervention effective in reducing burnout in other organizations, but have yet to study whether it also can improve patient outcomes. Clinicians (approximately 200) who participate will receive either the BREATHE intervention or training in motivational interviewing, which could also improve patient involvement in treatment and patient outcomes, but is unlikely to significantly reduce clinician burnout. We will also recruit up to 600 adult patients served by participating clinicians. We will survey clinicians and interview patients over a 12-month period after the intervention to determine how the intervention impacts clinician burnout and patient perceptions of care (relationship with the clinician, degree of autonomy in decision making), patient involvement in care, and outcomes (confidence in managing mental health, symptoms, functioning, and hope). Finally, this study will use a statistical procedure called Structural Equation Modeling to test a theoretical model of the relationship between burnout and patient outcomes. Findings from this study will show whether reducing clinician burnout can improve patient outcomes and the quality of care that patients receive. Our intervention will have the potential to be easily implemented in a variety of settings where burnout is a problem. Knowing how clinician burnout impacts patient outcomes, and whether improving burnout can improve patient care, can help improve the healthcare system.

Conditions

Burnout; Quality of Care

Outcome Measures

Primary Outcomes (3)

• Maslach Burnout Inventory (MBI): Emotional Exhaustion

  Burnout was assessed with the Maslach Burnout Inventory (MBI), a widely-used measure of three components of burnout: emotional exhaustion, depersonalization, and personal accomplishment. The survey contains 22 statements of job-related feelings and staff were asked to read each statement and decide if they ever felt that way about their job. The item scores were averaged. Scale: 0 (Never), 1 (A few times a year or less), 2 (Once a month or less), 3 (A few times a month), 4 (Once a week), 5 (A few times a week), 6 (Every Day). Maslach C, Jackson, S. E., Leiter, M. P. Maslach Burnout Inventory Manual. 3 ed. Palo Alto, California: Consulting Psychologists Press; 1996.

  Measured with staff at baseline, 3 months, 6 months, and 12 months

• Maslach Burnout Inventory (MBI): Depersonalization

  Burnout was assessed with the Maslach Burnout Inventory (MBI), a widely-used measure of three components of burnout: emotional exhaustion, depersonalization, and personal accomplishment. The survey contains 22 statements of job-related feelings and staff were ased to read each statement and decide if they ever felt that way about their job. The item scores were averaged. Scale: 0 (Never), 1 (A few times a year or less), 2 (Once a month or less), 3 (A few times a month), 4 (Once a week), 5 (A few times a week), 6 (Every Day). Maslach C, Jackson, S. E., Leiter, M. P. Maslach Burnout Inventory Manual. 3 ed. Palo Alto, California: Consulting Psychologists Press; 1996.

  Measured with staff at baseline, 3 months, 6 months, and 12 months

• Maslach Burnout Inventory (MBI): Personal Accomplishment

  Burnout was assessed with the Maslach Burnout Inventory (MBI), a widely-used measure of three components of burnout: emotional exhaustion, depersonalization, and personal accomplishment. The survey contains 22 statements of job-related feelings and staff were ased to read each statement and decide if they ever felt that way about their job. The item scores were averaged. Scale: 0 (Never), 1 (A few times a year or less), 2 (Once a month or less), 3 (A few times a month), 4 (Once a week), 5 (A few times a week), 6 (Every Day). Maslach C, Jackson, S. E., Leiter, M. P. Maslach Burnout Inventory Manual. 3 ed. Palo Alto, California: Consulting Psychologists Press; 1996.

  Measured with staff at baseline, 3 months, 6 months, and 12 months

Secondary Outcomes (36)

• Job Satisfaction

  Measured with staff at baseline, 3 months, 6 months, and 12 months

• Turnover Intentions-Considered Leaving

  Measured with staff at baseline, 3 months, 6 months, and 12 months

• Turnover Intentions-Likely to Leave

  Measured with staff at baseline, 3 months, 6 months, and 12 months

• Work Interference With Home Life

  Measured with staff at baseline, 3 months, 6 months, and 12 months

• Home Life Interference With Work

  Measured with staff at baseline, 3 months, 6 months, and 12 months

Study Arms (4)

Motivational Interviewing-Mental Health Staff

ACTIVE COMPARATOR

Behavioral: Motivational Interviewing (MI)

BREATHE-Mental Health Staff

ACTIVE COMPARATOR

Behavioral: Burnout Reduction: Enhanced Awareness, Tools, Handouts, and Education (BREATHE)

Motivational Interviewing-Clients

ACTIVE COMPARATOR

Behavioral: Motivational Interviewing (MI)

BREATHE-Clients

ACTIVE COMPARATOR

Behavioral: Burnout Reduction: Enhanced Awareness, Tools, Handouts, and Education (BREATHE)

Interventions

Motivational Interviewing (MI) BEHAVIORAL

MI is a common counseling technique. It was offered as an 8-9 hour workshop across 3 sessions to mental health agency staff who were randomly assigned to MI. Each session occurred approximately one month apart.

Motivational Interviewing-Clients; Motivational Interviewing-Mental Health Staff

Burnout Reduction: Enhanced Awareness, Tools, Handouts, and Education (BREATHE) BEHAVIORAL

BREATHE is a program developed to attempt to improve or prevent the symptoms of burnout. It was offered as an 8-9 hour workshop across 3 sessions to mental health agency staff who were randomly assigned to BREATHE. Each session occurred approximately one month apart.

BREATHE-Clients; BREATHE-Mental Health Staff

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• A staff member with client contact at either Four County Counseling or Places for People.
• Randomly chosen client from the participating staff lists. Must be 18 years old or older.

You may not qualify if:

• Clients younger than 18 years old.

Sponsors & Collaborators

• Indiana University: lead
• Four County Counseling Center: collaborator
• Places for People: collaborator
• Patient-Centered Outcomes Research Institute: collaborator

Study Sites (2)

Four County Counseling Center

Logansport, Indiana, 46947, United States

Location

Places for People

St Louis, Missouri, 63108, United States

Location

MeSH Terms

Conditions

Burnout, Psychological

Interventions

Motivational Interviewing; Educational Status

Condition Hierarchy (Ancestors)

Stress, Psychological; Behavioral Symptoms; Behavior

Intervention Hierarchy (Ancestors)

Directive Counseling; Counseling; Mental Health Services; Behavioral Disciplines and Activities; Health Services; Health Care Facilities Workforce and Services; Socioeconomic Factors; Population Characteristics

Limitations and Caveats

Absence of treatment as usual condition, high staff turnover, and difficulty linking patients with specific clinicians with whom they had meaningful contact

Results Point of Contact

• Title: Michelle Salyers, PhD / Professor, Department of Psychology
• Organization: Indiana University

mpsalyer@iupui.edu

317-274-2904

Study Officials

• Michelle P Salyers, PhD

  Indiana University School of Medicine

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: Yes

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor, Department of Psychology

Study Record Dates

• First Submitted: May 21, 2014
• First Posted: May 23, 2014
• Study Start: December 1, 2013
• Primary Completion: April 1, 2016
• Study Completion: June 1, 2016
• Last Updated: April 14, 2017
• Results First Posted: April 14, 2017

Record last verified: 2017-04

Data Sharing

• IPD Sharing: Will not share

Locations

US (2)