Organizational-level Predictors of Burnout in the Primary Care Workforce at the Veterans Health Administration

Abstract

Burnout, an occupational problem associated with workplace stress, is common in health care. Most burnout research focuses on assessing and treating predictors of burnout among individuals, yet many precursors to burnout stem from organizational policies, practices, and work systems. Addressing organizational-level predictors of burnout, rather than emphasizing individual transformation, may alleviate the job demands predictive of burnout, benefiting the workforce – and health systems – at large. This research tested associations between changes in three potential burnout predictors in primary care staff at the Veterans Health Administration (VHA). Using aggregated, annual All Employee Survey data from the VHA, we tested burnout in response to changes in (1) Veteran patient enrollment levels at VHA facilities for primary care team staff members, (2) electronic health record notification volume for primary care providers, and (3) full practice authority for VHA nurse practitioners. All three predictors reflected large-scale, health system-wide changes in workload, type of work, and professional autonomy. We found limited evidence of associations between these predictors and burnout when measured at the VHA facility level; only nurse burnout was associated with changes in patient enrollment. While this research contributes to the limited evidence on organizational-level burnout predictors, these associations may be different when burnout is measured at the individual or team – rather than aggregate – level.