Burgess Jennifer, Kim Hyungjin Myra, Porath Brittany R, Van Tony, Osatuke Katerine, Boden Matthew, Sripada Rebecca K, Wong Edwin S, Zivin Kara
Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Health Care System, Ann Arbor (Burgess, Kim, Porath, Van, Sripada, Zivin); Departments of Biostatistics (Kim) and Psychiatry (Sripada, Zivin), University of Michigan, Ann Arbor; Veterans Health Administration, National Center for Organization Development, Cincinnati (Osatuke); Program Evaluation and Resource Center and VA Office of Mental Health Operations, VA Palo Alto Health Care System, Palo Alto, California (Boden); Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, and Department of Health Systems and Population Health, Magnuson Health Sciences Center, University of Washington School of Public Health, Seattle (Wong).
Psychiatr Serv. 2024 Aug 1;75(8):748-755. doi: 10.1176/appi.ps.20230406. Epub 2024 Mar 27.
The authors sought to assess workplace characteristics associated with perceived reasonable workload among behavioral health care providers in the Veterans Health Administration.
The authors evaluated perceived reasonable workload and workplace characteristics from the 2019 All Employee Survey (AES; N=14,824) and 2019 Mental Health Provider Survey (MHPS; N=10,490) and facility-level staffing ratios from Mental Health Onboard Clinical Dashboard data. Nine AES and 15 MHPS workplace predictors of perceived reasonable workload, 11 AES and six MHPS demographic predictors, and facility-level staffing ratios were included in mixed-effects logistic regression models.
In total, 8,874 (59.9%) AES respondents and 5,915 (56.4%) MHPS respondents reported having a reasonable workload. The characteristics most strongly associated with perceived reasonable workload were having attainable performance goals (average marginal effect [AME]=0.10) in the AES and ability to schedule patients as frequently as indicated (AME=0.09) in the MHPS. Other AES characteristics significantly associated with reasonable workload included having appropriate resources, support for personal life, skill building, performance recognition, concerns being addressed, and no supervisor favoritism. MHPS characteristics included not having collateral duties that reduce care time, staffing levels not affecting care, support staff taking over some responsibilities, having spirit of teamwork, primary care-mental health integration, participation in performance discussions, well-coordinated mental health care, effective veteran programs, working at the top of licensure, and feeling involved in improving access. Facility-level staffing ratios were not significantly associated with perceived reasonable workload.
Leadership may consider focusing resources on initiatives that support behavioral health providers' autonomy to schedule patients as clinically indicated and develop attainable performance goals.
作者试图评估退伍军人健康管理局中与行为健康护理提供者所感知的合理工作量相关的工作场所特征。
作者从2019年全员工调查（AES；N = 14,824）和2019年心理健康提供者调查（MHPS；N = 10,490）中评估了所感知的合理工作量和工作场所特征，并从心理健康入职临床仪表盘数据中获取了机构层面的人员配备比率。混合效应逻辑回归模型纳入了9个AES和15个MHPS中与所感知的合理工作量相关的工作场所预测因素、11个AES和6个MHPS的人口统计学预测因素以及机构层面的人员配备比率。
总计，8874名（59.9%）AES受访者和5915名（56.4%）MHPS受访者报告工作量合理。与所感知的合理工作量最密切相关的特征在AES中是有可实现的绩效目标（平均边际效应[AME]=0.10），在MHPS中是能够按指示的频率安排患者就诊（AME = 0.09）。与合理工作量显著相关的其他AES特征包括拥有适当资源、对个人生活的支持、技能培养、绩效认可、问题得到解决以及不存在主管偏袒。MHPS特征包括没有减少护理时间的附带职责、人员配备水平不影响护理、支持人员承担一些职责、有团队合作精神、初级保健与心理健康整合、参与绩效讨论、心理健康护理协调良好、有效的退伍军人项目、在执照允许的最高水平工作以及感觉参与改善就医机会。机构层面的人员配备比率与所感知的合理工作量没有显著关联。
领导层可考虑将资源集中于支持行为健康提供者根据临床指示自主安排患者就诊并制定可实现绩效目标的举措上。
