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Emotional Exhaustion in Primary Care During Early Implementation of the VA’s Medical Home Transformation

Patient-aligned Care Team (PACT)

Meredith, Lisa S., PhD*,†; Schmidt Hackbarth, Nicole, MA, MPhil*,‡; Darling, Jill, MSHS; Rodriguez, Hector P., PhD, MPH§; Stockdale, Susan E., PhD; Cordasco, Kristina M., MD, MPH, MSHS†,∥; Yano, Elizabeth M., PhD, MSPH†,∥; Rubenstein, Lisa V., MD, MSPH*,†,¶

doi: 10.1097/MLR.0000000000000303
Original Articles

Objective: Transformation of primary care to new patient-centered models requires major changes in healthcare organizations, including interprofessional expectations and organizational policies. Emotional exhaustion (EE) among workers can accompany major organizational change, threatening its success. Yet little guidance exists about the magnitude of associations with EE during primary care transformation. We assessed EE during the initial phase of national primary care transformation in the Veterans Health Administration.

Research Design: Cross-sectional online surveys of primary care clinicians (PCCs) and staff in 23 primary care clinics within 5 healthcare systems in 1 veterans administration administrative region. We used descriptive, bivariate, and multivariable analyses adjusted for clinic membership and weighted for nonresponse.

Participants: 515 veterans administration employees (191 PCCs and 324 other primary care staff).

Measures: Outcome is the EE subscale of the Maslach Burnout Inventory. Predictors include clinic characteristics (from administrative data) and self-reported efficacy for change, experiences with transformation, and perspectives about the organization.

Results: The overall response rate was 64% (515/811). In total, 53% of PCCs and 43% of staff had high EE. PCCs (vs. other primary care staff), female (vs. male), and non-Latino (vs. Latino) respondents reported higher EE. Respondents reporting higher efficacy for change and participatory decision making had lower EE scores, adjusting for sex and race.

Conclusions: Recognition by healthcare organizations of the potential for clinician and staff EE during primary care transformation is critical. Methods for reducing EE by increasing clinician and staff change efficacy and opportunities to participate in decision making should be considered, with attention to PCCs, and women.

*RAND Corporation, Santa Monica

VA HSR&D Center for the Study of Healthcare Implementation, Innovation, and Policy, Sepulveda

Pardee RAND Graduate School, Santa Monica

§School of Health Policy and Management, University of California, Berkeley

Department of Health Policy and Management, UCLA, Fielding School of Public Health

UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA

Funding for the PACT Demonstration Laboratory initiative, which includes VAIL, is provided to Drs L.V.R., E.Y., and Altman from the VA Office of Patient Care Services. Dr E.Y. effort was contributed through a VA HSR&D Senior Research Career Scientist award (Project #05-195).

The authors declare no conflict of interest.

Reprints: Lisa S. Meredith, PhD, RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138. E-mail:

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