Team-Based Care: Caring for the team under payment reform
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Hennepin Healthcare, Minneapolis, MN, USA; 2Hennepin Healthcare Research Institute, Minneapolis, MN, USA; 3Allina Health, United Family Medicine, Saint Paul, MN, USA.
J Gen Intern Med DOI: 10.1007/s11606-019-05452-2 © Society of General Internal Medicine 2019
INTRODUCTION
The epidemic of burnout among clinicians is well documented1. Less is known, however, about stress and burnout among staff2, particularly in safety net settings. As many organizations aim to reduce clinician burnout, and as an era of team-based care brings opportunity for sharing the care among multiple team members, the potential impact on work–life and wellness among other staff members remains to be determined. We examined burnout among all team members using data from a project on impact of payment reform on safety net health care clinicians, staff, and patients. We explored whether certain aspects of teamwork might be associated with lower burnout. The answers to these questions would provide the substrate for future studies to determine mechanisms to reduce burnout among all care team members.
three primary care clinic sites with majority low-income patients. Surveys were collected at two time points 11 months apart (2017 and 2018). We completed double data entry from paper surveys into a REDCap database; a senior research staff corrected inconsistencies. Stata 15.1 was used to summarize survey responses using descriptive and bivariate statistics. Individuals were classified in their predominant role (if a nurse practitioner (NP) and a registered nurse (RN), they were considered an NP; if a physician and a resident, they were considered a resident). To protect confidentiality, groups with four or less individuals were relegated to an “other” category. Burnout, measured as a single item with five choices from not burned out and not stressed to highly burned out, was recoded as a binary variable (burned out, choices 3–5, vs not burned out, choice 1 or 2). Pearson’s correlation coefficients were calculated for a correlation matrix for 6 questions about how clinicians contributed to a collegial environment (r ≥ 0.3 considered clinically meaningful). Institutional Review Boards at Allina Health and Hennepin Healthcare Research Institute approved this study while the University of Minnesota deemed the study exempt from requiring consent.
METHODS
Interviews were conducted with staff and clinicians to design survey questions about awareness of payment reform. The single-item question on burnout, validated against the Maslach Burnout Inventory3, correlates predominantly with the emotional exhaustion component of burnout. Questions on collegial work environment were drawn from Jaen et al.’s work on adaptive reserve4. Clinicians and staff were recruited at clinic-wide meetings. Copies of surveys were left for absent respondents with return envelopes. Denominators included all distributed surveys. Paper surveys were administered at Prior presentations: None Received July 15, 2019 Revised July 15, 2019 Accepted September 27, 2019
RESULTS
We appro
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