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Articles   |    
Changes in VA Psychiatrists’ Attitudes About Work Environment and Turnover During Mental Health Service Enhancement
David C. Mohr, Ph.D.; Mark S. Bauer, M.D.; Robert B. Penfold, Ph.D.
Psychiatric Services 2013; doi: 10.1176/appi.ps.201200337
View Author and Article Information

Dr. Mohr and Dr. Bauer are affiliated with the Center for Organization, Leadership, and Management Research, Veterans Affairs Boston Healthcare System, 150 South Huntington Ave., 152M, Boston, MA 02130 (e-mail: david.mohr2@va.gov). Dr. Mohr is also with the School of Public Health, Boston University. Dr. Bauer is also a professor of psychiatry at Harvard Medical School, Boston. Dr. Penfold is with the Group Health Research Institute and with the Department of Health Services Research, Univeristy of Washington, Seattle.

Copyright © 2013 by the American Psychiatric Association

Abstract

Objective  The Veterans Health Administration (VHA) has undergone significant organizational transformation as part of a comprehensive strategic plan to enhance mental health services. Organizational change can create stress and decrease employee morale, even if the change is beneficial for patients and the organization. The study examined whether psychiatrists’ work satisfaction and work environment perceptions changed during a period of transformation. Facility-level turnover rate was also examined.

Methods  Data were analyzed from 7,218 psychiatrists who responded to an annual organizational survey between 2004 and 2010 (excluding 2005) conducted with 139 facilities. Survey ratings were regressed on individual and facility-level characteristics in a multilevel model. Adjusted mean scores for the measures were compared with Tukey post hoc tests to identify significant differences by year.

Results  Most satisfaction ratings on measures improved after the initial actions for strategic reform and stabilized in 2006. Turnover rates and intention to leave were also consistent during this time. Positive linear trends over time were observed for pay satisfaction, management for achievement, skill development, workplace civility, and satisfaction with senior management.

Conclusions  Extensive reorganization of VHA mental health services was associated with improvements in psychiatrists’ workplace satisfaction, and these increases were sustained over time. In the current climate of rapid transformation under health care reform nationally, the VHA experience may inform the broader national process and organizational strategies to improve and maintain the morale of the health care workforce.

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Figure 1 Job satisfaction categories with significant upward trend among Veterans Health Administration psychiatrists, 2004–2010a

aThe All Employee Survey was not conducted in 2005. Possible scores range from 1 to 5, with higher scores indicating more positive evaluations of the workplace.

Figure 2 Job satisfaction categories without significant upward trend among Veterans Health Administration psychiatrists, 2004–2010a

aThe All Employee Survey was not conducted in 2005. Possible scores range from 1 to 5, with higher scores indicating more positive evaluations of the workplace, with the exception of intention to leave, where higher scores indicate a negative evaluation.

Anchor for Jump
Table 1Characteristics of 7,218 psychiatrists who completed the All Employee Survey from 2004 to 2010a
Table Footer Note

a Excludes 2005, when the survey was not conducted

Anchor for Jump
Table 2Ratings from Veterans Affairs psychiatrists on All Employee Survey measures, 2004–2010a
Table Footer Note

a The survey was not conducted in 2005. Adjusted values are reported at the national level and account for individual and organizational characteristics. Possible scores range from 1 to 5, with higher scores indicating more positive evaluations of the workplace, with the exception of intention to leave, where higher scores indicate a negative evaluation.

Table Footer Note

b,c Values within the same row that share a superscript are statistically different from one another (year to year) with Tukey-Kramer post hoc adjustment.

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