Emotional Exhaustion in Relation to Integrating Care in the Veterans Health Administration

As primary cares transitions to team-based models of care, major organizational and policy changes can result in primary care clinicians (PCCs) and staff suffering from emotional exhaustion (EE). EE is defined as “the sense of feeling overwhelmed and exhausted” and is a major component of “burnout.”

 A recent study published in Medical Care examined EE among workers at the Veterans Health Administration (VA) during the implementation of Patient Aligned Care Team (PACT) and Veterans Assessment and Improvement Laboratory for Patient-Centered Care (VAIL). Researchers surveyed over 500 workers (191 PCCs and 324 staff) from 23 outpatient clinics and five VA Healthcare Systems in Veterans Integrated Service Network 22, which spans from Southern California to Nevada. EE was compared to four frameworks used to evaluate the success of health care innovations:

  • Outer Setting Characteristics – Clinic Workload, Clinic Size, Access to Clinic Services
  • Intervention Characteristics – Early Stage of the VA Medical Home Demonstration (PACT/VAIL)
  • Individual Characteristics and Individual Perceptions –Demographics/Professional Efficacy for PACT Changes, Satisfaction with Teamlet, Team Skills and Processes
  • Inner Setting Characteristics –  Perceptions About the Organization, Participatory Decision-making Communication, Leadership Engagement

The results show that more than 50 percent of PCCs and 40 percent of staff have significant EE. Early stages of medical home transformation correlate with high levels of EE. Perceived efficacy for PACT changes and participatory decision making are individual characteristics that are significantly associated with EE. These characteristics are “potentially susceptible to organizational change.” The researchers suggest that these findings be used as an “organizational checkup” to monitor PCC and staff response to medical home implementation and prevent EE. Providing adequate workforce training and involving PCCs and staff in the transition process are also ways to reduce EE.

The researchers state:

“…these findings have implications for preventing and reducing EE in primary care. We found that efficacy to change is an important variable associated with EE. This suggests that leadership needs to assess the extent to which the individual PCCs and staff are properly “primed” for the ensuing changes. Involving all staff in the developmental stages and encouraging input into decision making is likely to make change transformation more successful...”

View the abstract on PubMed.