Misalignment of Values Associated With Radiology Staff Burnout

DESCRIPTION OF THE PROBLEM

Organizations within health care are now challenged to address burnout of all their health care workers [1], including in their radiology departments. Studies demonstrating widespread radiologist burnout and linking multiple adverse outcomes to physician burnout have established radiologist burnout as an issue to be addressed by radiology leaders [2]. Radiology, however, is a team sport, and successfully addressing burnout in a radiology practice also necessitates practice leaders addressing burnout of other health care workers in the radiology team. Reduced productivity and job performance from burned-out health care professionals within organizations negatively impacts patient care and organizational margin [1].

Recent studies using validated tools suggest that alignment of personal values and organizational values may be associated with physician burnout [3]. Within the organizational psychology literature, the examination of shared values or value congruence has shown that alignment between one’s personal values and those of the organization resulted in positive work attitudes and organizational outcomes [4].

WHAT WAS DONE

The aim of our study was to evaluate the prevalence of burnout and professional fulfillment of radiology staff in an academic center and to specifically investigate the relationship among personal and organizational values alignment, burnout, and professional fulfillment. The study was approved by the institutional review board at our institution and exempt from ongoing evaluation. The study was HIPAA compliant, and no patient records were accessed.

Study Population

The study population consisted of 833 staff in the Division of Diagnostic Imaging at our institution. These included 635 clinical staff (those involved directly with clinical patient care) and 198 nonclinical staff.

Data Collection

A confidential survey was prepared and structured using Qualtrics. XM (Qualtrics, Provo, Utah) The staff was electronically mailed a web link to this confidential institutional review board–approved survey on April 27, 2021. The staff received by email a description of the study and a voluntary option to participate in the study. By participating in the study, the staff chose to provide consent. The survey was closed May 30, 2021. Demographic data were confidentially imported from and linked to institutional Human Resource records using Peoplesoft (Pleasanton, California).

Reference Standards

Professional Fulfillment and Burnout.

The validated Stanford Professional Fulfillment Index (PFI) was used to assess both professional fulfillment and burnout in staff [5]. For nonclinical staff, three of the questions in the PFI were modified. This was primarily because of the lack of direct patient contact and lack of involvement with direct patient care. These three questions have been previously used and validated in nonclinical health care professionals [6]. See the e-only Appendix 1 for scale questions.

Personal–Organizational Values Alignment.

Personal–organization values alignment was assessed with the three-item Stanford Values Alignment scale to measure the extent to which the staff’s personal values aligned with the values of their institution [3]. Items were scored on a 5-point Likert scale with options ranging from not at all true (0) to completely true (4). Aggregate scores were determined by summing the 0 to 4 score for each of the individual items to yield a total score ranging from 0 to 12, with higher scores indicating greater alignment. This instrument has been previously used by multiple health care organizations within the United States.

Statistical Analysis

The differences in expected and observed frequencies of categorical variables were assessed by χ² tests. Mean differences between groups on continuous variables were assessed by independent samples t tests for two-group comparisons and by analysis of variance (F test) for multiple group comparisons. The associations between continuous variables were assessed by Pearson correlations. P < .05 was considered statistically significant for all two-sided tests.

OUTCOMES AND LIMITATIONS

The overall response rate was 25% for clinical staff (157 of 635) and 45% for nonclinical staff (90 of 198). The variation of burnout and professional fulfillment for radiology staff by demographics is summarized in Table 1. The majority of the radiology staff were White women, with an average age of 44 years.

Table 1.

Demographic variation of burnout and professional fulfillment of radiology staff

Variable	Staff, n (%)	Burnout, n (%)	P Value	Fulfilled, n (%)	P Value
Sex			>.999		.887
Female	175 (71)	70 (40)		69 (39)
Male	73 (29)	29 (40)		30 (41)
Race and Ethnicity			.479		.037
White	80 (32)	36 (46)		32 (54)
Black	59 (24)	23 (42)		23 (43)
Asian	55 (22)	21 (36)		19 (35)
Hispanic	52 (21)	18 (34)		25 (31)
Managerial level			.133		.507
Individual contributors	185 (80)	79 (43)		21 (45)
Managers	47 (20)	14 (30)		72 (39)

The overall burnout rate of all staff was 40%, and the overall professional fulfillment rate of all staff was 40% (Cronbach’s α = 0.887). Burnout rates were slightly higher for clinical staff than nonclinical staff (43% versus 34%), although the difference was not statistically significant. Clinical staff were slightly less professionally fulfilled than nonclinical staff (38% versus 44%), but the difference did not reach statistical significance. Our study findings corroborate previous work that burnout is prevalent across health care roles [7]. Given the similarity on overall burnout and professional fulfillment rates, clinical and nonclinical staff are reported together as “staff” for the remainder of the analyses. There was a statistically significant inverse correlation between professional fulfillment and burnout among staff (r = −0.57; P < .001).

Burnout rates were similar across sexes (40% female, 40% male) and race/ethnicity (46% White, 42% Black, 36% Asian, 34% Hispanic). Burnout rates differed by managerial level (43% nonmanagers, 30% managers), although this difference was not statistically significant. Professional fulfillment rates were similar across sexes (41% male, 39% female) and managerial levels (45% managers, 39% nonmanagers), but differed by race and ethnicity (54% Asian, 43% Hispanic, 35% Black, 31% White).

The variation of personal–organizational values alignment by demographics is summarized in Table 2. Personal–organizational value alignment scores of staff demonstrated an inverse correlation with burnout (r = −0.45; P < .001) and a positive correlation with professional fulfillment (r = 0.50; P < .001). That is, higher personal-organizational values alignment scores are related to lower burnout scores and higher PFI scores; staff whose personal values align more strongly with organizational values reported less burnout and more professional fulfillment. Mean alignment scores were similar across sexes (mean = 7.29 female, mean = 7.23 male) and race and ethnicity (mean = 7.53 Black, mean = 7.38 Hispanic, mean = 7.14 Asian, and mean = 7.13 White) but differed by managerial level (mean = 8.71 manager, mean = 6.82 nonmanagers).

Table 2.

Demographic variation of personal–organizational alignment of radiology staff

Variable	Alignment		Test	Value	P Value
	Mean	SD
Sex			t test	t = 0.12	.903
Female	7.29	3.30
Male	7.23	3.34
Race/Ethnicity			F test	F = 0.21	.890
Black	7.53	3.25
Hispanic	7.38	3.45
Asian	7.14	3.70
White	7.13	2.97
Managerial level			t test	t = 4.00	<.001
Individual contributor	6.82	3.36
Manager	8.71	2.75

To help reduce burnout of radiology staff, our findings suggest academic organizations should focus at the system level, beyond individual resiliency, considering organizational culture and enactment of values [8]. Possible organizational interventions include allocation of available resources, structural changes in the environment, changes in workload, and structural staffing changes [8].

Study limitations included a response rate of 30%. Study was conducted at a single-institution tertiary-care oncology center; the results may not be generalizable to all types of radiology practices. Responses were prone to voluntary selection-type bias. Nonresponse bias may have occurred in the most severely burned-out individuals; because of higher workload and/or time constraints, they may have been less inclined to participate.