Estimates of Clinicians and Staff Burnout 10 The item originated from a study of burnout in HMOs 11 and has subsequently been included in several major studies. The self-defined burnout measure is one of the ten survey questions on the “Mini-Z” work experience instrument developed by Linzer and colleagues. 9 MBI instruments require a license fee to administer. The 16-item General MBI survey uses the terms cynicism and personal accomplishment while the 22-item Health Services Personnel survey uses the analogous terms depersonalization and professional efficacy, with results consistent across survey versions. It is composed of three dimensions: emotional exhaustion, cynicism (or depersonalization), and personal accomplishment (or professional efficacy). The MBI, considered an industry standard, has been fielded across large samples of diverse occupations in multiple countries. Two common measures are the Maslach Burnout Inventory (MBI) and a five-choice, single item based on self-defined burnout. Within this context of heightened attention to clinician and staff well-being, greater understanding of the instruments used to measure burnout is essential. 6 The American Board of Family Medicine added work experience questions to its 2016 recertification registration to better understand and track burnout, 7 and CEOs of leading healthcare organizations have issued a call to action that argues for regular measurement of physician well-being. 5 The Society for General Internal Medicine made burnout a theme of its 2017 Annual Meeting. 4 The American Medical Association’s “STEPS Forward” modules offer guidance on practice transformation and clinician and trainee well-being. Several burnout-related initiatives aim to support the “quadruple aim” of a sustainable clinician and staff work experience in addition to improved patient experience, quality, and lower costs. A burntout workforce may adversely affect clinical quality, patient experience, and costs of care. High levels of burnout are concerning not only for clinician and staff well-being. The National Academy of Medicine 1 and Agency for Healthcare Quality and Research 2, 3 have spotlighted concerning levels of burnout among clinicians and healthcare staff, particularly in primary care. ![]() However, the self-defined burnout and MBI measures are not interchangeable. The self-defined burnout measure has a low response burden, is free to administer, and yields similar associations across two burnout predictors from prior studies. Compared to the MBI, the self-defined burnout measure misses half of high-burnout clinicians and more than 40% of high-burnout staff. Point estimates of burnout notably differ between the self-defined and MBI measures. Team culture and atmosphere were significantly associated with both self-defined burnout and the MBI, confirming concurrent validity. Area under the receiver operator curve was 0.82 for clinicians and 0.81 for staff. The self-defined measure’s sensitivity to correctly identify MBI-assessed burnout was 50.4% for clinicians and 58.6% for staff specificity was 94.7% for clinicians and 92.3% for staff. In contrast, 29% of clinicians (95% CI: 25–33%) and 31% of staff (95% CI: 28–35%) reported “definitely burning out” or more severe symptoms on the self-defined burnout measure. Similar to other nationally representative burnout estimates, 52% of clinicians (95% CI: 47–57%) and 46% of staff (95% CI: 42–50%) reported high MBI emotional exhaustion or high MBI cynicism. (J Am Board Fam Med 27(2):229–38, 2014) and a standard question about workplace atmosphere as reported by Rassolian et al. Concurrent validity was assessed using a validated, 7-item team culture scale as reported by Willard-Grace et al. The MBI measure, calculated from a high score on either the emotional exhaustion or cynicism subscale, and a single-item measure of self-defined burnout. Participantsįour hundred forty-four primary care clinicians and 606 staff from three San Francisco Aarea healthcare systems. DesignĬross-sectional survey (November 2016–January 2017). To identify the sensitivity, specificity, and concurrent validity of the self-defined burnout measure compared to the more established MBI measure. Relatively little is known about how the measures compare. ![]() Two common burnout assessments are the Maslach Burnout Inventory (MBI) and a single-item, self-defined burnout measure. Clinicians and healthcare staff report high levels of burnout.
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