Center for Health Professions Education, Uniformed Services University, Bethesda, MD 20814, USA.
Department of Pediatrics, Brooke Army Medical Center, Ft Sam Houston, TX 78314, USA.
Mil Med. 2024 Aug 19;189(Suppl 3):106-112. doi: 10.1093/milmed/usae057.
Occupational burnout among healthcare workers has continued to climb, impacting workforce well-being, patient safety, and retention of qualified personnel. Burnout in military healthcare workers, who have had the added stress of increased deployments, remains unknown. Although certain leadership styles have been associated with lower rates of burnout, the association between adaptive leadership and burnout in military healthcare has not previously been described. The aim of this study is to examine the role of adaptive leadership in burnout among military healthcare workers following the Coronavirus Disease 2019 (COVID-19) pandemic.
A convenience sampling of military healthcare workers employed at a military medical treatment facility between March 2020 and March 2023 was anonymously surveyed using an online link, which included demographics, the Maslach-Burnout Inventory Health Services Survey (MBI-HSS), the Adaptive Leadership with Authority Scale, and the Pandemic Experiences and Perceptions Survey. Data were analyzed for associations. Structural equation modeling (SEM) was performed using MPlus 8.0, which included demographics, all three subscales that contribute to burnout (emotional exhaustion, depersonalization, and personal accomplishment [PA]), adaptive leadership (indicated by a subscale mean), and COVID impact and COVID risk perception.
Of the 365 participants analyzed, 88.5% had high emotional exhaustion, and 80.4% had high depersonalization. Burnout was significantly associated with adaptive leadership (r = -0.302, P < .001), COVID impact (r = 0.208, P < .001), and COVID risk perception (r = 0.174, P < .001). A total of 93.0% scored high in at least one subscale of the MBI-HSS (i.e., emotional exhaustion ≥27, depersonalization ≥10, or PA ≤33), although 78 (21.8%) met the complete definition of burnout, because of the overwhelmingly high levels of PA (77.8% reported high PA). In the SEM model, burnout was significantly and negatively predicted by adaptive leadership (b = -0.28, SE = 0.05, Standardized b = -0.31, P < .001). Burnout was also significantly and positively predicted by COVID impact (b = 0.25, SE = 0.09, Standardized b = 0.17, P = .028) and health professions' perception of risk (b = 0.15, SE = 0.07, Standardized b = 0.14, P = .008). Together, this model explained 17% of the total variance in health professions' reported burnout.
The findings of burnout in this military healthcare worker population were higher than have previously been described in healthcare workers or other military personnel, and the significant associations between adaptive leadership and burnout suggest the protective role of adaptive leadership in healthcare systems to address burnout. Implementing adaptive leadership training or selecting leaders with more adaptive leadership skills may be beneficial in a health care system where employee burnout is prevalent, especially during periods stressed by adaptive problems. This may be especially important in military healthcare when active duty service obligations preclude attrition in the presence of additional stressors such as deployments and Federal Emergency Management Agency responses. Further research is needed to determine whether this intervention is successful at reducing healthcare burnout.
医疗保健工作者的职业倦怠持续攀升，影响劳动力的健康、患者的安全和合格人员的保留。在经历了更多部署压力的情况下，军事医疗保健工作者的倦怠情况仍不清楚。虽然某些领导风格与较低的倦怠率有关，但自适应领导与军事医疗保健中的倦怠之间的关联以前尚未描述过。本研究旨在研究在冠状病毒病 2019 （COVID-19）大流行后，自适应领导在军事医疗保健工作者倦怠中的作用。
对 2020 年 3 月至 2023 年 3 月期间在一家军事医疗设施工作的军事医疗保健工作者进行了便利抽样，通过在线链接匿名进行了调查，该链接包括人口统计学信息、Maslach 倦怠量表健康服务调查（MBI-HSS）、自适应领导与权威量表以及大流行经验和看法调查。分析了数据之间的关联。使用 MPlus 8.0 进行结构方程建模（SEM），其中包括人口统计学信息、导致倦怠的三个子量表（情绪衰竭、去个性化和个人成就感 [PA]）、自适应领导（由子量表平均值表示）以及 COVID 影响和 COVID 风险感知。
在分析的 365 名参与者中，88.5%的人情绪衰竭程度较高，80.4%的人去个性化程度较高。倦怠与自适应领导（r= -0.302，P<0.001）、COVID 影响（r= 0.208，P<0.001）和 COVID 风险感知（r= 0.174，P<0.001）显著相关。共有 93.0%的人在 MBI-HSS 的至少一个子量表中得分较高（即情绪衰竭≥27，去个性化≥10，或 PA≤33），尽管 78 人（21.8%）符合完整的倦怠定义，因为 PA 的水平非常高（77.8%的人报告 PA 较高）。在 SEM 模型中，倦怠与自适应领导呈显著负相关（b= -0.28，SE= 0.05，标准化 b= -0.31，P<0.001）。倦怠也与 COVID 影响（b= 0.25，SE= 0.09，标准化 b= 0.17，P= 0.028）和医疗保健专业人员对风险的感知呈显著正相关（b= 0.15，SE= 0.07，标准化 b= 0.14，P= 0.008）。该模型共解释了医疗保健专业人员报告的倦怠总方差的 17%。
本军事医疗保健工作者人群中的倦怠发现高于以前在医疗保健工作者或其他军事人员中描述的发现，自适应领导与倦怠之间的显著关联表明自适应领导在解决倦怠问题的医疗保健系统中具有保护作用。在员工倦怠普遍存在的医疗保健系统中实施自适应领导培训或选择具有更多自适应领导技能的领导者可能是有益的，尤其是在存在自适应问题的压力下，如部署和联邦紧急事务管理局的响应。需要进一步研究以确定这种干预措施是否能成功降低医疗保健人员的倦怠感。
