Burnout in practice: A qualitative study of the impact of organizational factors on burnout and patient care among VA mental health providers

Organizational causes of burnout among mental health providers (MHPs) are extensively documented in the literature. Additionally, several studies have established a relationship between higher burnout rates and poorer patient care. However, it remains unclear whether worse patient care results from organizational causes of burnout, MHP burnout itself, or a combination of both. Therefore, an in-depth qualitative exploration of MHPs' experiences with organizational causes of burnout and their perceptions of how these causes may affect patient care was conducted. Fifty-four MHPs (i.e., social workers, psychologists and psychiatrists) across nine Veteran Health Administration (VA) medical centers participated in semi-structured interviews. Content analysis was used to analyze the data. Findings revealed a complex relationship between organizational factors and individual behaviors influenced by burnout, and their potential impact on patient care. MHPs' acknowledged that their burnout could impact the quality of care provided to Veterans. The behaviors associated with burnout, such as disengagement, lack of empathy, distraction, lack of preparedness, and procrastination, may inadvertently compromise the therapeutic alliance and the overall efficacy of treatment. Findings also indicated that MHP experienced moral distress from the dissonance between the desire to provide high-quality care and the reality of institutional constraints. Additionally, MHP burnout impacted Veterans' trust and engagement with the VA mental health care system. Therefore, addressing burnout requires a multifaceted approach including organizational reforms, support and resources for MHPs, and dedicated support for MHPs to deliver high quality care. Our findings emphasize the critical need for organizational-level interventions that prioritize clinical care over bureaucratic demands.