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Published Online: 27 March 2024

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

Jennifer Burgess, M.P.H. [email protected], Hyungjin Myra Kim, Sc.D., Brittany R. Porath, M.P.H., Tony Van, M.A., Katerine Osatuke, Ph.D., Matthew Boden, Ph.D., Rebecca K. Sripada, Ph.D., Edwin S. Wong, Ph.D., M.A., and Kara Zivin, Ph.D., M.S.Authors Info & Affiliations
Publication: Psychiatric Services
Volume 75, Number 8
https://doi.org/10.1176/appi.ps.20230406
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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.

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Supplementary Material

File (appi.ps.20230406.ds001.pdf)

Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services
Psychiatric Services
Volume 75 • Number 8 • August 01, 2024
Pages: 748 - 755
PubMed: 38532686

History

Received: 16 August 2023
Revision received: 29 September 2023
Revision received: 20 November 2023
Accepted: 4 January 2024
Published online: 27 March 2024
Published in print: August 01, 2024

Keywords

  1. Burnout
  2. Workload
  3. Performance
  4. Mental health systems
  5. U.S. Department of Veterans Affairs (VA)
  6. Mental health providers

Authors

Affiliations

Jennifer Burgess, M.P.H. [email protected]
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).
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Hyungjin Myra Kim, Sc.D.
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).
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Brittany R. Porath, M.P.H.
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).
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Tony Van, M.A.
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).
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Katerine Osatuke, Ph.D.
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).
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Matthew Boden, Ph.D.
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).
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Rebecca K. Sripada, Ph.D.
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).
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Edwin S. Wong, Ph.D., M.A.
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).
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Kara Zivin, Ph.D., M.S.
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).
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Notes

Send correspondence to Ms. Burgess ([email protected]).

Competing Interests

The authors report no financial relationships with commercial interests.

Funding Information

This study was funded in part by the VA Health Services Research and Development Service (awards VA IIR 17-262 and VA RCS 21-138).

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