12

Burnout and satisfaction survey

literature on comparing team satisfaction and
burnout in relation to NWW in particular.
Aim of the survey
To measure staff burnout and job satisfaction
before and after the implementation of NWW.
Methods
The Maslach Burnout Inventory and the
Hertfordshire Mental Health Team Member
Questionnaire (HMHTMQ) were used to
measure staff burnout and staff satisfaction
and functioning respectively.
The Maslach Burnout Inventory is designed
to measure three components of burnout
syndrome:
G Emotional exhaustion
G Depersonalisation
G Personal accomplishment.
For both emotional accomplishment and
depersonalisation, higher mean scores
correspond to higher degrees of burnout. In
contrast, lower mean scores for personal
accomplishment correspond to higher degrees
of burnout.
The HMHTMQ was developed from a
questionnaire designed by Onyett (2006) who
is a senior development consultant for the
care services. Onyetts questionnaire has been
used for a national survey of community
mental health teams (CMHTs) and is made of
two sets of questions:
G Section B measures the way staff are
integrated in the team, and the way they
feel and work as a part of the team
G Section C measures how satisfied staff feel
in their present job within the team.
The HMHTMQ was distributed to the 33
multidisciplinary CMHT members (including
psychiatrists) at three time points: before
NWW, six months and two years after
implementing NWW in the team.
Introduction
N
ew Ways of Working for psychiatrists
(NWW) was introduced as a mechanism
for using the skills of consultants more
effectively and reducing burnout in the
profession. Among its objectives was to
encourage staff working in multidisciplinary
teams to develop and extend their existing
roles within the team, so as to provide a
better service for people with mental health
problems and to distribute responsibilities for
service users care among the team members,
thereby removing assumed responsibility from
the consultant in every case. (Department of
Health, 2005; Department of Health, 2007).
NWW has faced considerable criticism from
the psychiatric profession and it is unclear
how changing the traditional working style of
psychiatrists impacts on the work of other
members of the multidisciplinary team (MDT).
Although there has already been a published
study on user satisfaction and burnout
questionnaires in community mental health
teams staff (Nelson, 2008; Sorgaard, 2007)
at the time of writing there is not any existing
Community mental health team staff: burnout and
satisfaction before and after the introduction of
New Ways of Working for Psychiatrists
Valerio Falchi et al present the results of a survey of Hertfordshire Mental Health team members, looking at burnout and job
satisfaction following the introduction of New Ways of Working for Psychiatrists
Dr Valerio Falchi
Speciality Trainee in Psychiatry, Edinburgh
House, Community Mental Health, St Albans,
Herts
Dr Hannah Baron
Assistant Psychologist, Portman Clinic,
London
Dr Frances Burnett
Consultant Psychiatrists, Edinburgh House,
Community Mental Health, St Albans, Herts
Abstract
New Ways of Working for psychiatrists (NWW)
was introduced as a mechanism to encourage
staff working in multidisciplinary teams to
develop and extend their existing staffing
roles, so as to provide a better service for
people with mental health problems and to
distribute responsibilities for service users
care among the team members.
The aim of the survey was to measure
staff burnout and job satisfaction before and
after the implementation of NWW. We found
that after two years of the implementation of
NWW there was a significant reduction in the
emotional exhaustion (27.3%) and
depersonalisation (30.2%) subscales, and a
slight improvement in the personal
accomplishment (+8%) subscale of the
Maslach Burnout Inventory. There was also
an improvement (14%) in staff satisfaction as
described in the Hertfordshire Mental Health
Team Member questionnaire.
Changing the role of psychiatrists in this
team appeared to have a positive impact on
the multidisciplinary team functioning as a
whole. At the time of writing, NWW has been
not fully implemented and consultants still
continue to carry much higher caseloads
than other team members, further monitoring
of community mental health team staff
reaction to NWW is recommended.
Key words
Maslach Burnout Inventory, questionnaire,
survey, burnout, job satisfaction, CMHT,
team, consultant, New Ways of Working
Reference
Falchi V, Baron H, Burnett F (2009) Community
mental health team staff burnout and
satisfaction before and after the introduction of
New Ways of Working for Psychiatrists. Mental
Health Nursing 29(6): 12-15.
3 A few times a month
4 Once a week
5 A few times a week
6 Every day
Key points from Table 1
G Emotional exhaustion subscale measures
feelings of being emotionally over extended
and exhausted by ones work. The mean
scores for this component have reduced
from 2.86 to 2.08 (27.3%) after two years
of the implementation of NWW
G Depersonalisation subscale assesses
unfeeling and impersonal response towards
service users. The mean scores for this
component have also reduced, from 1.26
to 0.88 (30.2%) after two years of the
implementation of NWW
G Personal accomplishment subscale
measures competence and successful
achievement in ones work with people.
Scores for this subscale have increased
Data analysis
The results of the Maslach Burnout Inventory
were compared between all three time points
surveyed. The results of the HMHTMQ were
compared between questionnaires distributed
before NWW and two years after NWW.
Descriptive statistical tools such as mean
and percentage have been used to analyse
the data.
Results
Out of 33 staff who received the
questionnaires, 21 returned them at baseline
and at six months. However only 14 returned
them at two years following implementation of
NWW in the team.
Table 1 shows scores of 21 Maslach
Burnout Inventory questionnaires before NWW
and six months after NWW, compared with 14
questionnaires after two years from NWW.
Differences are expressed by percentages (%).
The key for Table 1 is as follows:
0 Never
1 A few times a week
2 Once a month or less
13
Question Pre NWW Six months %change Two years %change Component
later later
1) I feel emotionally drained from my work 3.7 2.7 27% 2.4 35.2% EE
2) I feel used up at the end of the day 4.0 4.0 3.0 3.6 10% EE
3) I feel tired when I get up in the morning and have to face another 3.3 2.8 15% 2.7 18.2% EE
day at work
4) I can easily understand how clients feel about things 4.6 3.8 17% 3.6 21.8% PA
5) I feel I treat some clients as if they were impersonal objects. 0.8 0.9 + 12% 0.5 37.5% DP
6) Working with people all day is a real strain for me 1.6 1.6 0% 0.4 75% EE
7) I deal effectively with the problems of clients 5.2 5.1 2% 5.9 + 13.4% PA
8) I feel burned out from my work 3.2 1.9 40% 1.9 40.7% EE
9) I feel I am positively influencing other peoples lives through my work 4.4 4.5 +3% 4.9 +11.4% PA
10) I have become more callous toward people since I took this job 1.3 0.8 38% 0.9 30.8% DP
11) I worry that this job is hardening me emotionally 1.4 1.4 0% 1 28.6% DP
12) I feel very energetic 3.4 3.9 +15% 4.1 +20.6% PA
13) I feel frustrated by my job 3.2 2.4 25% 2.8 12.5% EE
14) I feel I am working too hard on my job 3.6 3.0 17% 3.2 11.2% EE
15) I dont really care what happens to some clients 0.7 0.5 28% 0.6 14.3% DP
16) Working with people directly puts too much stress on me 1.5 0.9 40% 0.6 60% EE
17) I can easily create a relaxed atmosphere with clients 5.5 4.8 13% 5 9.1% PA
18) I feel exhilarated after working closely with clients 3.2 2.8 12.5% 3.5 +9.4% PA
19) I have accomplished many worthwhile things in this job 3.7 4.1 +11% 5 +35.1% PA
20) I feel like I am at the end of my tether 1.6 1.3 18% 1.1 31.3% EE
21) In my work, I deal with emotional problems very calmly 4.8 4.8 0% 5.5 +14.6% PA
22) I feel clients blame me for some of their problems 2.1 1.2 42% 1.4 33.4% DP
Table 1. Scores of 21 Maslach Burnout Inventory questionnaires before NWW and six months after NWW,
compared with 14 questionnaires after two years from NWW
Pre NWW Six months after Two years after
Emotional exhaustion (EE) 2.86 2.5 (12.6%) 2.08 (27.3%)
Depersonalisation (DP) 1.26 0.96 (24%) 0.88 (30.2%)
Personal accomplishment (PA) 4.35 4.2 (3.5%) 4.68 (+8%)
Table 2: Summary of the Maslach Burnout Inventory results
conclusion is that there were no changes before
and after NWW in this respect.
Current job satisfaction
Table 4 details the responses of how satisfied
the team feel about their present job within the
team. The key for Table 3 is as follows:
1 Very much satisfaction
2 Much satisfaction
3 Some satisfaction
4 Some dissatisfaction
5 Much dissatisfaction
6 Very much dissatisfaction
Interpretation of the Hertfordshire Team
Questionnaire (Section C) results
When interpreting the results, given that there is
a 16% gap in the Likert Scale from one rating to
the others for each question, a meaningful
from 4.35 to 4.68 (+8%) reflecting a
significant increase of personal
accomplishment.
Maslach Burnout Inventory summary
Table 2 shows a summary of the results with
respect to the three subscales of the Maslach
Burnout Inventory, filled by staff before NWW
and six months and two years after NWW.
Table 3 shows scores of 21 HMHTMQs
before NWW, compared with 14 questionnaires
after two years from NWW. Differences are
expressed as percentages (%). The key for
Table 3 is as follows:
1 Strongly agree
2 Slightly agree
3 Neither disagree nor agree
4 Slightly disagree
5 Strongly disagree
Interpretation of the Hertfordshire Team
Questionnaire (Section B) results
When interpreting the results, given that there
is a 20% gap in the Likert Scale from one
rating to the others for each question, a
meaningful improvement is when there is a
shift of 10% or more.
In Cluster A questions, the questions are
framed in a way that a low score will reflect
a negative view or opinion that the staff
member has towards the team. There is a
deterioration of 3% from before NWW to
after two years of NWW the conclusion is
that there were no changes before and after
NWW in this respect.
In Cluster B are grouped all the remaining
questions, where a low score reflects a positive
view or opinion that staff has towards the team.
There is in this respect an improvement of 9% in
the score towards the lower scale. Again, the
14
Burnout and satisfaction survey
Question 1 pre After 2 years
B1 I feel uncertain about how much authority I have 3.3 3.1
B2 I am not certain of where the teams responsibilities begin and end 3.1 3.6
B3 The teams clients/patients are usually satisfied with the help they receive. 2.1 1.9
B4 I seldom know whether I am doing my job well or properly. 3.2 3.8
B5 The team generally gets good results for clients/patients. 1.8 1.9
B6 I know exactly what is expected of me. 2.6 2.2
B7 I know what my responsibilities are. 1.9 1.9
B8 The teams clients/patients are meaningfully involved in writing their care plan. 2.5 2.1
B9 I am clear about who the team is trying to help. 1.8 1.4
B10 I feel the team has a clear purpose to its work with clients/patients. 2.2 1.4
B11 I am not sure who I am accountable to for my work with clients/patients. 3.7 4.3
B12 I am not certain what the teams priorities are. 3.6 3.6
B13 I do not feel the role of the team is clearly defined. 3.2 3.4
B14 I am clear what my work priorities are. 1.8 2
B15 I know exactly what is expected of the team. 2.7 2.1
B16 I feel most of my tasks are clearly defined. 2.5 1.9
B17 Current arrangements for the operational management of the team are effective. 2.6 2.9
B18 The team needs to be better managed outside the team. 3.7 3.1
B19 I am clear who I would turn to for help with complex clinical issues. 1.7 1.6
B20 It is difficult to tell whether the team is doing the correctly job or not. 3.3 3.1
B21 The teams clients are clear as to who is responsible for the co-ordination of their care. 2.7 2.4
Cluster A (B1-4-11-12-13-18-20) average score 3.4 3.5 (+3%)
Cluster B (the remaining) average score 2.3 2.1 (9%)
Table 3: Hertfordshire Mental Health Team Member Questionnaire Section B
reaction to NWW is recommended. Another
survey on staff satisfaction and burnout can
be repeated in a years time. MHN
improvement is when there is a shift of 8% or
more. The questions are framed such that the
lower the score the better the staff satisfaction.
The results in the table showed an
improvement in satisfaction of 14%, which is a
meaningful result.
Discussion and conclusion
Two years after the implementation of NWW,
there is a significant reduction in the emotional
exhaustion (27.3%) and depersonalisation
(30.2%) subscales and a slight improvement
in the personal accomplishment (+8%)
subscale of the Maslach Burnout Inventory.
There is also an improvement (14%) in staff
satisfaction, as described in the HMHTMQ.
Changing the role of the psychiatrists in
this team did appear to have a positive
impact on the multidisciplinary team
functioning as a whole.
In the current survey, there are some
confounding factors to be considered. First of
all, the number of staff that responded to the
survey is significantly less than the previous
survey (14 vs. 21 people). A possible
explanation for fewer responders might be
because although questionnaires are
anonymised, some staff might feel identified
by ticking the profession where they come
from. Second, given the turn-over of staff over
the past two years, respondents may well be
different people.
At the time of writing, NWW has been not
fully implemented and consultants still continue
to carry much higher caseloads than other
team members.
Recommendation
Given that NWW has been not fully
implemented, further monitoring of CMHT staff
15
Question 1 pre After 2 years
C1 Communication and the way information flows around the team. 3.5 2.6
C2 The relationships you have with other people at work 2.2 1.9
C3 The feeling you have about the way you and your efforts are valued 3.4 2.6
C4 The actual job itself 3.0 2.4
C5 The degree to which you feel motivated by your job 2.9 2.3
C6 Current career opportunities 3.9 3.3
C7 The level of job security in your present job 2.8 2.8
C8 The extent to which you may identify with the public image or goals of the team 3.0 2.6
C9 The style of supervision that your supervisors use 2.9 1.9
C10 The way changes and innovations are implemented in the team 3.5 3.4
C11 The kind of work or tasks that you are required to perform 3.2 2.7
C12 The degree to which you feel that you can personally develop or grow in your job 3.4 2.8
C13 The way in which conflicts are resolved within the team 3.0 2.9
C14 The scope your job provides to help you achieve your aspirations and ambitions 3.5 3
C15 The amount of participation which you are given in important decision making 3.3 3.1
C16 The degree to which your job taps the range of skills which you feel you possess 3.3 2.7
C17 The amount of flexibility and freedom you feel you have in your job 2.9 2.5
C18 The psychological feel or climate that dominates the team 3.0 2.6
C19 Your level of salary relative to your experience 3.7 3.5
C20 The design or shape of the teams structure 2.9 3
C21 The amount of work you are given to do whether too much or too little 3.6 3.2
C22 The degree to which you feel extended in your job 3.1 2.6
Average score 3.18 2.74 (14%)
Table 4: Hertfordshire Mental Health Team Member Questionnaire Section C
References
Department of Health (2005) New Ways of Working for
Psychiatrists: Enhancing Effective Person-Centred
Service through New Ways of Working in
Multidisciplinary and Multi-agency context. Final Report
But not the End of the Story. London: TSO.
Department of Health (2007) Mental Health: New Ways of
Working for Everyone. London: TSO.
Nelson T, Johnson, S, Bebbibgton P (2008) Satisfaction
and burnout among staff of crisis resolution, assertive
outreach and community mental health teams: A multi-
centre cross sectional survey. Social Psychiatry and
Psychiatric Epidemiology 44(7): 541-9.
Onyett SR (2006) Community mental health teams: The
need for a local whole systems approach. In: Key
Issues in Mental Health Today. Pavilion/Mental Health
Foundation.
Sorgaart KW, Ryan P, Hill R, Dawson I, OSCAR group (2007)
Sources of stress and burnout in acute psychiatric care:
Inpatients vs. community staff. Social Psychiatry and
Psychiatric Epidemiology 42(10): 794-802.