Highlights of VA’s Research Agenda to Address Clinician Burnout
January 4, 2023
Takeaway: A new research agenda focused on VA clinician burnout identifies priority areas of study and is organized into a framework that addresses issues and actions at the national level, the VISN level, the level of individual VA medical centers (VAMCs), and the clinician level to:
- Enhance the efficiency of clinical practice
- Promote a culture of wellness
- Ensure institutional support for professional well-being
With clinician burnout reaching crisis levels at health systems across the country, multidisciplinary experts and stakeholders from within and outside VA—including VHA’s Task Force to Reduce Employee Burnout and Optimize Organizational Thriving (REBOOT), VA’s Health Services Research and Development (HSR&D) researchers, and AcademyHealth, a national organization that focuses on health services research and policy—collaborated to review evidence on burnout and generate research questions that address gaps in the existing evidence regarding the drivers of burnout and how best to prevent, mitigate, and eliminate clinician burnout. The resulting research agenda identifies research priorities within five domains that require attention:
- Context of policy: Addressing the context of national and local policy for reducing/eliminating burnout;
- Culture of wellness: Interventions that improve a culture of wellness among clinicians and others;
- Efficiency of practice: Assessments and interventions to improve efficiency of practice;
- Institutional support: Strategies for activating institutional support of professional well-being; and
- Improved research: Broadly, improving research on clinician burnout, retention, wellness, and related factors and approaches to increase its real-world impacts on VA clinicians and the VA health system at large.
According to VHA’s 2021 All Employee Survey (AES), approximately 25 percent of respondents reported one symptom of burnout on a weekly basis, 20 percent reported two symptoms of burnout per week, and 5 percent reported three symptoms per week.
Key recommendations from the research agenda
- Prioritize research on interventions that address burnout at the organizational or system levels. The biggest gap in the existing evidence base on clinician burnout is not its drivers or causes, but how to effectively address them across teams, divisions, and whole systems.
- Capitalize on variation among VAMCs to study the comparative effectiveness and costs of interventions that address burnout, specifically which approaches work for whom and under what circumstances. Also, seize the opportunity to learn from “positive deviants,” identifying VAMCs with low rates of clinician burnout, and leveraging their approaches to consider effective adaptations in other organizational contexts and/or at the system level.
- Leverage VA’s ability to conduct large, controlled studies across sites and/or clinician types, particularly for “whole system interventions” with varying components (e.g., staffing levels, support for participation in shared governance, leadership availability and responsiveness, etc.). Findings should be widely disseminated and implemented across diverse VA sites to share learnings with health systems nationally and globally.
- Focus on the particular experiences of burnout among staff from racial and ethnic minority groups and other minority populations, and on the effectiveness of burnout interventions on these groups. This is a salient gap in the evidence.
- Study aspects of the role of effective VA leadership (from senior leaders to supervisors of frontline staff) in addressing burnout, including trust in leadership, strategies for leadership training and support, and approaches for leaders to create and sustain a welcoming and supportive culture.
The importance of burnout to the VA is reflected in the REBOOT initiative, a national multi-pronged program that seeks to address burnout in all VA employees. While REBOOT was able to develop interventions based on existing evidence and clinical consensus, many questions remain about the most effective and sustainable approaches, as well as the distributional impacts of any changes made. Substantial investments in health services research are needed to continue to guide VA’s actions, evaluations, and commitment to reduce clinician and other employee burnout. This research agenda will help HSR&D and VA researchers to prioritize needed areas of study related to clinician burnout.
View the full VA Clinician Burnout Research Agenda here.