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Healthcare workers' capacity for change key in fighting COVID-19 related burnout

Work environments and job demands have a significant effect on the health and wellbeing of frontline care workers.

Jeff Lagasse, Associate Editor

Even prior to the pandemic, burnout among healthcare professionals was a pervasive public health concern, with some studies reporting burnout in more than 50% of clinicians. During the COVID-19 pandemic, healthcare professionals are required to work even longer hours in high-stress situations. Understanding causes of burnout and factors that can protect against it can help improve quality of life for the healthcare workforce and quality of care for patients.

New research by faculty at George Mason University's College of Health and Human Services found that healthcare professionals with a greater personal ability to respond to change experienced lower rates of burnout when their work environments offered strong communication, teamwork and leadership support. The study looked at both individual response to change and organizational capacity for change and how these factors affect burnout among healthcare professionals.

Dr. Debora Goldberg led the study published in the Journal of General Internal Medicine. Goldberg is an expert in primary care practice transformation, patient experience and care for the underserved, with her current and upcoming research focused on workplace health and wellbeing.


Work environments and job demands have a significant effect on the health and wellbeing of frontline care workers, which may also affect the health of patients, findings showed. With the COVID-19 pandemic ratcheting things up several notches, it's more important than ever to be aware of the effects these hardships can have.

Goldberg and colleagues surveyed 1,279 individuals in 154 primary care practices in Virginia. They measured the practices' capacity for change, individuals' change readiness, hours worked per week, and burnout. Participants were part of the Agency for Healthcare Research and Quality Heart of Virginia Healthcare (HVH) collaborative, which supported these practices with transformation and implementation of evidence-based cardiovascular care as they made major changes in operations and employee roles.

Burnout was measured with a single question on whether the healthcare professionals were experiencing burnout, a measure previously validated and used in workplace studies. Individual change readiness was measured with the Change Diagnostic Index (CDI), which was developed by Dr. Victoria Grady in Mason's School of Business. Typically, the CDI is used in organizations that are planning for large change initiatives, and this is the first time it has been applied in primary care. 

The CDI measures individual attitudes toward organizational change in the areas of anxiety, frustration, delayed development, rejection of the environment, refusal to participate, withdrawal and overall attitude. These individual attitudes can be indicators of larger organizational issues with morale, productivity, motivation, conflict, absenteeism, turnover and overall organizational issues. 

The capacity of practices to change was measured by the practice adaptive reserve (PAR) instrument, which asks about an organization's communication, teamwork, relationship trust, leadership, work environment, adoption of innovations and learning systems.

Consistent with their earlier work, the researchers found that providers were more likely to report burnout (25.5%) than other professionals (19.9% of clinical support staff and 17.5% of administrative staff).

Among all types of healthcare professionals (providers, clinical support staff and administrative staff), both practice and individual factors were related to levels of burnout. Lower levels of burnout were reported among those who had higher scores for individual response to change and among practices that had higher organizational capacity for change. 

As the change capacity of the practice increased, burnout in healthcare professionals decreased. As healthcare professionals had more positive responses to change, burnout decreased.

Higher levels of burnout were reported among those who worked more hours per week, were part of a larger practice (more than 10 clinicians) or were part of a single specialty practice.


In a paper published in March, Dr. James Adams of Northwestern University's Feinberg School of Medicine and Dr. Ron Walls of Harvard Medical School write that the combination of stress and possible exposure puts healthcare professionals, from physicians to nurses and specialists, at greater risk of contracting COVID-19 and potentially spreading it to others.

It's the classic rock-and-a-hard-place scenario – healthcare workers and caregivers are desperately needed during the global response to the outbreak, but represent one of the most vulnerable populations in terms of contracting the highly virulent disease.

Championing the caregiver experience

This special collection, which will be updated throughout the month, looks at what's being done to ease the burden on providers impacted by COVID-19.

Twitter: @JELagasse
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