r Health Research and Educational Trust
Predicting Changes in Staff Morale and
Burnout at Community Health Centers
Participating in the Health Disparities
Jessica E. Graber, Elbert S. Huang, Melinda L. Drum,
Marshall H. Chin, Amy E. Walters, Loretta Heuer, Hui Tang,
Cynthia T. Schaefer, and Michael T. Quinn
Objective. To identify predictors of changes in staff morale and burnout associated with participation in a quality improvement (QI) initiative at community health centers (HCs).
Data Sources. Surveys of staff at 145 HCs participating in the Health Disparities Collaboratives (HDC) program in 2004.
Data Collection and Study Design. Self-administered questionnaire data collected from 622 HC staff (68 percent response rate) were analyzed to identify predictors of reported change in staff morale and burnout. Predictive categories included outcomes of the QI initiative, levels of HDC integration, institutional support, the use of incentives, and demographic characteristics of respondents and centers.
Principal Findings. Perceived improvements in staff morale and reduced likelihood of staff burnout were associated with receiving personal recognition, career promotion, and skill development opportunities. Similar outcomes were associated with sufﬁcient funding and personnel, fair distribution of work, effective training of new hires, and consistent provider participation.
Conclusions. Having sufﬁcient personnel available to administer the HDC was found to be the strongest predictor of team member satisfaction. However, a number of low-cost, reasonably modiﬁable, organizational and leadership characteristics were also identiﬁed, which may facilitate improvements in staff morale and reduce the likelihood of staff burnout at HCs participating in the HDC.
Key Words. Employee satisfaction, community health centers, quality improvement
The introduction of quality improvement (QI) initiatives can present special challenges for health care settings that have limited personnel and ﬁnancial resources, and high attrition among key staff. In the context of such 1403
HSR: Health Services Research 43:4 (August 2008)
constraints, the difﬁculty of balancing daily clinical demands with additional QI responsibilities can lead to lowered staff morale, burnout, and additional turnover, all of which can further compromise quality of care (Cavanagh 1989; Goodall 1993; Busteed, Barwick, and Grubb 1994). While the concerns regarding lowered staff morale are signiﬁcant, other studies with contradictory ﬁndings show that the introduction of QI initiatives can actually lead to improved job satisfaction (Counte et al. 1992; Calomeni, Solberg, and Conn 1999; St. Pierre 2006) by introducing new employee incentives, such as opportunities for training and professional development (Akerboom and Maes 2006; Gilbody et al. 2006).
Institutional and physician support can affect both staff satisfaction and the overall success of the QI effort (Neuhauser 2002; Gollop et al. 2004), and there is further evidence that organizational factors such as culture, group cohesion, and support can limit the detrimental effects of stressful work demands on staff in acute inpatient care and long-term care settings (Karsh, Booske, and Sainfort 2005; Shermont and Krepcio 2006). However, relatively little is known about the impact of QI initiatives in resource-challenged ambulatory care settings, and the relative inﬂuence of these ancillary factors associated with its implementation, including the use of incentives, levels of QI integration, and institutional support.
The Health Resources and Services Administration’s Bureau of Primary Health Care (BPHC) funds and oversees over 1,000 community health centers (HCs) that provide care for approximately 15 million medically underserved people at 5,000 sites (National Association of Community Health Centers 2006). The mission of the...
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