David A. Hurtado, ScD, Oregon Institute of Occupational Health Sciences, OHSU; Steele Valenzuela, MSc, Department of Family Medicine, OHSU; Wendy McGinnis, MSc, Division of General Internal Medicine and Geriatrics, OHSU. Samuel A. Greenspan, MPH, Oregon Institute of Occupational Health Sciences, OHSU; Teresa Everson, MD, Department of Family Medicine, OHSU; Abigail Lenhart, MD, Division of General Internal Medicine and Geriatrics, OHSU.
Our presentation is about a supervisor-led practice created at a primary care clinic that contributed to lowering and sustaining lower burnout levels. Our study applied quantitative and qualitative methods to understand and estimate the impact of the check-ins as a supervisor-led tactic to reduce burnout in primary care clinics.
Burnout is a consequence of chronic work stressors, affecting at least a third of the healthcare workforce. Burnout is a significant occupational health and safety problem because it increases the risk for adverse outcomes in workers (e.g., occupational injuries, stress-related diseases) and healthcare organizations (e.g., turnover, sick leave, and worse quality of care). While burnout is an industry-wide problem with many upstream drivers (e.g., intensification of care, reimbursement policies that increase work pace, demanding electronic health records), systemic transformations require might take time and need a longer timeframe and concerted stakeholder action. Meanwhile, healthcare organizations remain in need of swift and local solutions to this pervasive problem. Direct supervisors can address more immediate, everyday organizational factors that increase the risk of worker burnout. In this sense, supervisors can alter procedures and environments or call for new resources to reduce stressors for their staff. Our presentation is about a supervisor-led practice created at a primary care clinic that contributed to lowering and sustaining lower burnout levels. The practice titled “Well-being check-ins” consisted of monthly one-on-one frequent, confidential encounters between clinic staff and their respective supervisor to identify, address and monitor problems that affected performance and well-being with collaborative solutions. Our study applied quantitative and qualitative methods to understand and estimate the impact of the check-ins as a supervisor-led tactic to reduce burnout in primary care clinics.
We will present findings from two data sources: 1) a repeated cross-sectional survey conducted in 2017 (n=329), 2018 (n=294), and 2019 (n=284) among ten primary care clinics of a large academic health center in the Pacific Northwest, and 2) follow-up interviews conducted in 2020 and 2021 with clinic supervisors (n=4) and staff with different roles (n=6) to investigate the extent to which the check-ins contributed to sustained burnout reductions at the clinic in which these were implemented. The survey was administered among all employees, including faculty clinicians (e.g., MDs) and staff (e.g., front-of-office specialists). The response rates for each year were above 50%. The survey measured burnout with a single item from the Mini-Z screening questionnaire, a widely used and validated instrument in academic medicine. The interviews were designed to deepen on the rationale, process, experiences, and impact of the check-ins.
Survey findings from 2017 indicate an overall burnout prevalence of 32% across ten primary care clinics. The 2018 survey showed an increased burnout prevalence of 43% across the clinics; however, at one clinic (n=37), burnout was reduced from 42% in 2017 to 24%. This reduction was more noticeable among clinical faculty who reduced burnout prevalence from 35% to 7%, whereas burnout for staff changed from 46% to 35%. Interviews with the clinic employees revealed that during that period, the supervisors initiated the check-ins. Follow-up interviews revealed that the practice manager started the check-ins upon their appointment to gather information about well-being issues, demonstrate commitment to workers’ well-being, and increase trust in leadership. Interviews with the clinic supervisors noted that the check-ins consisted of brief one-on-one meetings (15-30 min) between supervisors and employees, which occurred every 4-6 weeks. The check-ins were separate from performance reviews and were intended to gather information affecting each worker’s work or life matters. Supervisors were meant to listen to worker’s input, acknowledge the problems, and improve workflow issues. Interviews with employees indicated that the check-ins were a useful encounter to provide feedback regarding work processes and update supervisors’ situations that may affect performance. Examples of organizational changes sparked by the check-ins are supervisors are changes to procedures (e.g., how to schedule vaccination clinics, facilitating remote work for workers with long commutes), changes to environments (e.g., workstations upgrades, ergonomic assessments), and increased resources (e.g., redeployed staff for specific operations). However, staff mentioned that they needed to trust and feel safe as a prerequisite to disclose any information. After the encounter, the supervisors would send a follow-up email with the following steps or plans of action. The 2019 survey showed that burnout prevalence increased at this clinic but remained low for faculty (14%), whereas clinic staff burnout levels returned to baseline (48%). The overall burnout prevalence across other clinics was 32% for faculty and 40% for staff.
In a context with high rates of burnout, both survey and interview data suggest that the check-ins contributed to reduced levels of burnout at a primary care clinic. However, the benefits appeared to be concentrated among faculty clinicians for whom burnout levels remained low after the check-ins were implemented. Whereas the check-ins may have contributed to reducing staff burnout, the benefits were short-termed. Potential mechanisms that explain this effect include increased trust between leaders and staff demonstrated in their willingness to listen, act upon, and follow-through based on workers’ feedback. Still, the long-term success of the check-ins is contingent on levels of supervisor support and trust to leaders, guarantees of psychological safety for staff to disclose information, and transformative organizational changes.
Although a specific evaluative design is needed, we believe that the check-ins could be a swift and practical strategy to address work stressors in primary care clinics. As a next step, we will be conducting a cluster randomized controlled trial to test the internal validity, reproducibility and sustainability, of the check-ins to reduce burnout in healthcare settings.