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Burnout and satisfaction survey

literature on comparing team satisfaction and

burnout in relation to NWW in particular.

Aim of the surveyTo measure staff burnout and job satisfaction

before and after the implementation of NWW.

MethodsThe 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:

Emotional exhaustion

Depersonalisation

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:

Section B measures the way staff are

integrated in the team, and the way they

feel and work as a part of the team

Section C measures how satisfied staff feel

in their present job within the team.

The HMHTMQ was distributed to the 33

multidisciplinary CMHT members (includingpsychiatrists) at three time points: before

NWW, six months and two years after

implementing NWW in the team.

Introduction

New 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 burnoutquestionnaires 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 ofNew Ways of Working for PsychiatristsValerio 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, EdinburghHouse, 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 theemotional 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 beennot 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 Nursing29(6): 12-15.

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3 A few times a month

4 Once a week

5 A few times a week

6 Every day

Key points from Table 1

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

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

Personal accomplishment subscalemeasures competence and successful

achievement in ones work with people.

Scores for this subscale have increased

Data analysisThe 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.

ResultsOut 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

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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) resultsWhen 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 summaryTable 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 agree3 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 positiveview 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 1.4B11 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 I t 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

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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 conclusionTwo 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 inthis 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.

RecommendationGiven 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 3.4C11 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 3.2C22 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 Epidemiology44(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 Epidemiology42(10): 794-802.