The Importance of Autonomy and Performance Goals in Perceived Workload Among Behavioral Health Providers

Jennifer Burgess; Hyungjin Myra Kim; Brittany R Porath; Tony Van; Katerine Osatuke; Matthew Boden; Rebecca K Sripada; Edwin S Wong; Kara Zivin

doi:10.1176/appi.ps.20230406

The Importance of Autonomy and Performance Goals in Perceived Workload Among Behavioral Health Providers

Psychiatr Serv. 2024 Mar 27:appips20230406. doi: 10.1176/appi.ps.20230406. Online ahead of print.

Authors

Jennifer Burgess¹, Hyungjin Myra Kim¹, Brittany R Porath¹, Tony Van¹, Katerine Osatuke¹, Matthew Boden¹, Rebecca K Sripada¹, Edwin S Wong¹, Kara Zivin¹

Affiliation

¹ 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).

PMID: 38532686
DOI: 10.1176/appi.ps.20230406

Abstract

Objective: The authors sought to assess workplace characteristics associated with perceived reasonable workload among behavioral health care providers in the Veterans Health Administration.

Methods: 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.

Results: 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.

Conclusions: Leadership may consider focusing resources on initiatives that support behavioral health providers' autonomy to schedule patients as clinically indicated and develop attainable performance goals.

Keywords: Burnout; Mental health providers; Mental health systems; Performance; U.S. Department of Veterans Affairs (VA); Workload.