Final Results of the NC Burnout Survey

(Dentists)
By Dr. Bill Claytor, DDS, MAGD
Associate Director

NC Burnout Survey
September 22 through November 30, 2020

NC Dentists Sent Survey
5,594

NC Dentists Responded to Survey
842

Mind Garden (Burnout Survey Company) Comparison Dataset
6,326 medical personnel

Understanding the Importance of Burnout

Burnout is a severe problem affecting medical personnel and healthcare organizations. New technologies, regulations, electronic health records, and increase market pressures are driving rapid change in the healthcare workplace. These changes to organizations and care delivery models impact how care is delivered and how it is experienced by patients. If the resulting work environment is not a good fit with physicians and other medical personnel, this can lead to staff burnout.

I.   Maslach Burnout Inventory (MBI)

Emotional Exhaustion (EE).  Feeling overwhelmed, stressed, and weary, the job demands feel far greater than one can give. An example item: “I feel emotionally drained from my work.”

Depersonalization (DP).  Lost enthusiasm or an unfeeling, impersonal response towards the recipients of one’s care. The job feels like a burden or a chore. An example item: “I don’t really care what happens to some patients.”

Low Personal Accomplishment (PA).  Feeling low levels of confidence and effectiveness and not have a beneficial impact on people. An example item: “I have accomplished many worthwhile things in this job.”

Burnout has many personal costs, including physical illness, increased feelings of hopelessness, irritability, impatience, poor interpersonal relationships with family/coworkers/patients, and drug abuse. In severe cases, burnout can cause diminished executive functioning, attention, and memory.

Burnout has many organizational costs, including absenteeism, increased turnover, and decreased job performance. These consequences have a direct negative effect on patient safety, satisfaction, and quality of care.

Changing personal behaviors, managing exercise and sleep habits, and adding coping strategies such as yoga and meditation can help individuals develop resilience against burnout, but they do not address the areas of work that are actually causing the stress. Burnout prevention and remediation rely on meaningful organizational change.

Results for MBI

NC dentists experienced higher emotional exhaustion and higher depersonalization, while personal accomplishment remained the same as compared to the 6,326 medical personnel dataset.

Engaged43.5%(Low EE and DP, High PA)
Ineffective9.0%(Low PA)
Overextended26.2%(High EE)
Disengaged2.5%(High DP)
Burnout18.8%(High EE and DP)

II.    Six Areas of Worklife (AWS)

To address burnout, we must understand the work environment or organizational context. The root causes for burnout are organizational problems, and therefore the solution will come from deliberate organizational change. We look at six key areas to assess the fit between employees and the organization. A lack of fit or a mismatch between the employee and the organization can lead to burnout.

Workload:  The amount of work to be done in a given time. A manageable workload provides the opportunity to do what one enjoys, pursue career objectives, and develop professionally. A crisis in workload is not just stretching to meet a new challenge but going beyond human limits. An example item: “I do not have time to do the work that must be done.”

Control: The opportunity to make choices and decisions, to solve problems, and to fulfill job responsibilities. A good match has correspondence between control and accountability. A mismatch occurs when people lack sufficient control to fulfill their responsibilities. An example item: “I have control over how I do my work.”

Reward: Financial and social recognition for contributions on the job. A meaningful reward system acknowledges one’s contributions to work and clearly signals what is of value to the organization. People experience a lack of recognition as devaluing their work and themselves. An example item: “I receive recognition from others for my work.”

Community: The quality of an organization’s social environment and the positive connections between coworkers. People thrive in communities characterized by support, collaboration, and positive feelings. Mismatches occur when the employee does not have a positive connection with others at work. An example item: “Members of my workgroup communicate openly.

Fairness: The extent to which consistent and equitable rules apply to everyone and that resources are allocated per generally understood and consistent procedures. Fairness communicates respect for the organization’s members. A lack of fairness indicates confusion in an organization’s values and its relationships with people. An example item:

‘Resources are allocated fairly here.”

Values: Values are what is most important to the individual and to the organization. When these values are congruent, successes are shared. Mismatches occur when there is a gap between the values of the individual and the values or actions of the organization. An example item: “My values and the organization’s values are alike.”

Results for AWS

(All categories are in decreasing order from left to right)
Mismatch:    Workload > Reward > Community > Fairness > Control > Values
Average Fit:    Community > Workload > Control > Reward > Fairness = Values
Good Fit:   Values > Fairness > Control > Reward > Community > Workload

III.    Pandemic Experiences and Perceptions Survey (PEPS)

This PEPS measures the amount of work disruption, depletion of resources, risk perception, the impact on key areas of work-life, and the perception of leadership during the pandemic.

Recommendations for Managing Healthcare Worker Stress in Pandemics

  • Provide Institutional Support and Training
  • Promote a Culture of Resilience
  • Advocate for Self-care
  • Encourage Mental Health Checkups
  • Train Staff on Essential Information
    • Train staff about the outbreak
    • Share ethical guidelines
    • Prepare staff for new workload
  • Recognize Sources of Stress
    • Stress strict biosecurity measures
    • Increase personal and professional demands
    • Discuss the risk of disease transmission
    • Examine the stigma of treating COVID-19 patients
  • Mitigate Employee Stress During Pandemic
    • Promote regular self-care
    • Limit unhelpful coping strategies
    • Maintain social connections
  • Support Staff Post-Pandemic
    • Seek social support from family/colleagues/community
    • Schedule time off
    • Consider formal treatment if stress > 2 or 3 weeks

Leadership Take-Away Message During A Crisis

  • Verify data before decision-making (as much as possible)
  • Be clear (as much as possible)
  • Give goodwill to others
  • Live fairness and justice
  • Give hope

Results for PEPS

(Averages)

  • Work/Personal Affect: Moderate to Large Effect
  • PPEs: Mostly Adequate
  • Office Support: Somewhat to Mostly Adequate
  • Perceived Personal/Family/Patients/Colleagues Risk: Minor to Moderate
  • Positive Organizational Management Leadership: Fairly Often
  • Positive Immediate Supervisor Leadership: Fairly Often

NC Questions

Results for NC Questions

  1. Do you worry, or are you concerned about needing to take more Dental Service Organizations (DSOs), Preferred Provider Organizations (PPOs), working more hours/days, etc., during this Covid-19 period to help with lost revenue?

21.14%: Most likely to most definitely
43.23%: Definitely not
35.63%: To some degree to neutral

  1. If you received government assistance or loans during Covid-19, do you have concerns about paying it back in a timely fashion?

17.45%: Most likely to most definitely
40.73%: Definitely not
41.82%: To some degree to neutral

  1. Since the outbreak of the Covid-19 pandemic (March 2020), have you considered retiring, cutting back from work, selling, or changing how you plan to practice dentistry in the future (other than following the recommended CDC guidelines)?

29.81%: Most likely to most definitely
42.39%: Definitely not
27.80%: To some degree to neutral

  1. In North Carolina, I feel confident that dentistry will rebound from Covid-19 and be better than ever, including practice growth and productivity.

56.42%: Most likely to most definitely
6.53%: Definitely not
37.05%: To some degree to neutral

  1. Personal Challenges(Top 4):

1 – Anxiety
2 – Decreased quality of sleep, worrying
3 – Financial problems
4 – Weight change (gain or loss) (tie)
4 – Feelings of insecurity or lack of purpose (tie)

  1. Practice Challenges(Top 4):

1 – “Big dip” in hygiene schedule/production from mid- September to mid-November 2020
2 – Planning for the future
3 – PPE/supply maintenance
4 – Financial sustainability