Resilience
The fourth factor, Resilience, originates from the untested category of Motivation. This factor provides insight into how stress affects the individual's ability to engage in patient-centered care. This factor has three questions, which have a Cronbach’s Alpha of .755 and a sample size of 558.
Interestingly, two of these three questions originate from the Figley Burnout Index1. This insight is significant because they were tested when Figley (1995) introduced them into the literature. The fact they loaded together when only one other burnout question, not part of the index, did is not trivial. This may suggest that these questions tap into something precisely related to burnout. The remaining question is a new question with a higher value than either of the Figley questions, suggesting a strong contributing question item among established questions.
Collaboration Requires Effort. How Much More Can I Give?
The capacity to collaborate draws from the ability to self-regulate effort. If provider self-care is competing with patient care, then both lose. These questions provide a look into how much personal effort is required to function at work.
- 14. I have thoughts that I am not succeeding at achieving my life goals.
- 15. I have thoughts that I am a failure at work.
- 16. The stress at work affects my mental health.
Priority for Shared Autonomy
This section examines the internal value structures that facilitate an individual's participation in collaborative leadership. The individual's values regarding the merits of IPC and their capacity to work with others within a flat power structure are foundational in interprofessional collaboration. Among these values is the likelihood of personal growth and goal-seeking (Strype et al., 2014)2. In addition, the peer-to-peer aspect of interprofessional collaboration is essential to creating the most value for patient outcomes.
Additionally, the perceived personal value of collaboration may be linked to each profession's evaluation of the utility of collaboration (Strype et al., 2014)2. The effort here is to evaluate the degree to which an individual is ready to release individual autonomy in professional practice in favor of shared autonomy with peers. This section is necessary as it directly addresses the internal value structure related to IPC. The degree to which that value structure aligns with IPC indicates how individuals prioritize the rest of their clinical practice. This indication is especially helpful in determining if that individual is only doing as instructed or internalizing IPC benefits.
Motivation
The Resilience factor grew from an untested category called Motivation. This category grew from the literature. It examined the positive and negative motivations supporting or inhibiting patient care. While the literature did support this category, the factor analysis changed how the category of Motivation was viewed. Instead, elements of the category were validated together.
Understanding Burnout
The concept of self-regulation provides a positive motivation for a reward and a negative motivation to avoid pain; however, a third form of Motivation exists; no motivation. While burnout affects professional achievement motivation (Lyndon, 2016)3, it does not follow the same self-regulation pattern described above.
It is assumed that healthcare professionals have some baseline work-related stress. While some stress can be useful, too much can cause burnout. It is worth noting that burnout is prevalent in healthcare professionals (Lyndon, 2016)3. Furthermore, burnout has been observed in professionals at each career stage in healthcare (Bridgeman et al., 2018)4. Unfortunately, the knowledge regarding the fallout of burnout and successful interventions is comparatively underdeveloped (Lyndon, 2016)3.
A review of burnout symptoms identified five categories: physical, emotional, behavioral, work-related, and interpersonal (Kahill, 1988). Additionally, there are three phases of burnout: Emotional Exhaustion, Depersonalization, and Personal Accomplishment (Maslach, 1982; Maslach & Jackson, 1981)4,5. Since the lack of personal accomplishment is the last phase, it signals that the progression of burnout has been underway for a while.
Measuring Burnout
Asking respondents to rate their stress directly does not document how often that stress reaches a given threshold. For example, significant stress may be endured if it is brief, while moderate to significant stress may contribute to the erosion of relationships and burnout if the stress level is more frequent or constant. Therefore, examining their related symptoms is necessary to determine an individual's burnout progression (Maslach, 1982)4.
Clinicians, who are at risk of burning out, are consumed with work to the brink of being discouraged, emotionally exhausted, fatigued, have a diminished feeling of personal accomplishment, are unable to meet the job requirements, and are incapable of participating with others (Lyndon, 2016; Maslach & Jackson, 1981)3,6. Often there is a significant volume of interaction with patients (Maslach & Jackson, 1981)5, which may develop into pessimistic disinterest in work and see patients as objects (Lyndon, 2016)3.
Selecting Questions
The relationship between burnout and patient safety is expressed as a motivational deficiency and hampered mental function (Welp et al., 2015). Therefore, it is not surprising that healthcare professionals who are ineffective on the job have lost their ability to contribute (Lyndon, 2016)3. However, an emerging call for interdisciplinary collaboration comes from the literature to effectively combat clinician burnout (Chang & Cato, 2020; Martinussen et al., 2012)6,7.
Integrating interdisciplinary partners may improve healthcare professionals' personal and professional well-being and patient outcomes (Chang & Cato, 2020)5. While Maslach's burnout inventory is well known across many industries for measuring burnout, the questions below were not taken from the Maslach inventory as those questions were not specific enough for this context. However, the Figley inventory of burnout questions had a few questions that fit the context better.
14. I have thoughts that I am not succeeding at achieving my life goals. (Personal Accomplishment)
15. I have thoughts that I am a failure at work. (Personal Accomplishment)
16. The stress at work affects my mental health. (Emotional Exhaustion)
Understanding the Results
Notice that two questions represent the Personal Accomplishment phase of the burnout process and none represent the Depersonalization phase. Great care was taken to ensure that questions representing each phase of the burnout process were offered in the initial development of the research survey. The fact that these three questions made it through the EFA and CFA process may suggest that the first and last phases are more important than the middle phase or simply more definitive. These questions collectively indicate how much stress a person is carrying and offer a meaningful assessment of their progress toward burnout.
Using the Results
Burnout can be reversed however it takes more effort to reverse the further it progresses. Many toxic work environments "Turn and Burn" their employees by pushing them beyond sustainable effort and hiring new employees because it is easier than offering restorative care. The measurement offered from this factor is an indicator to evaluate at-risk employees and the efficacy of restorative efforts.
Naming the Factor
While the research into creating this factor was grounded in the literature related to burnout, there was some discussion about the effects of encapsulating that term. While burnout is a known result of unsustainable working conditions, it is not the force we sought to emphasize. The opposite side is growth-minded, even in the presence of adversity. Healthy work environments promote Resiliency among its employees.
Footnote:
1 Figley, C. R. (1995). Compassion fatigue: Toward a new understanding of the costs of caring. In Secondary traumatic stress: Self-care issues for clinicians, researchers, and educators (pp. 3–28). The Sidran Press.
2Strype, J., Gundhus, H. I., Egge, M., & Ødegård, A. (2014). Perceptions of interprofessional collaboration. Professions and professionalism, 4(3). https://doi.org/10.7577/pp.806
3Lyndon, A. (2016). Burnout among health professionals and its effect on patient safety: Annual perspective 2015. Agency for Healthcare Research and Quality, February, 1–8.
4Bridgeman, P. J., Bridgeman, M. B., & Barone, J. (2018). Burnout syndrome among healthcare professionals. The Bulletin of the American Society of Hospital Pharmacists, 75(3), 147–152. https://doi.org/10.2146/ajhp170460
5Maslach, C. (1982). Burnout: The cost of caring. Malor Books.
6Chang, B. P., & Cato, K. (2020). Tackling Burnout With Team Science: Nursing and Physician Collaborations on Improving Psychological Well-Being Among Emergency Clinicians. Journal of Emergency Nursing, 46(5), 557–559. https://doi.org/10.1016/j.jen.2020.05.009
7Martinussen, M., Adolfsen, F., Lauritzen, C., & Richardsen, A. M. (2012). Improving interprofessional collaboration in a community setting: Relationships with burnout, engagement and service quality. Journal of Interprofessional Care, 26(3), 219–225. https://doi.org/10.3109/13561820.2011.647125