Building a 'capable' healthcare system

Survey methodology

  | September 1, 2018

athenahealth's physician burnout and capability survey was administered to 1,391 practicing physicians in June 2018.

The survey included questions that gauged the levels of internal support that physicians currently receive within their practices in areas linked to capability and to other physician measures such as burnout, engagement, and loyalty.

Physicians who responded to the questions "How often do you feel burned out from your work?” or "How often do you feel you’ve become more callous toward people since you took this job?" with a 4 (once a week), 5 (a few times a week) or 6 (every day) were determined to show signs of burnout, with those responding with a 5 or 6 exclusively deemed to be showing signs of significant burnout.

Respondents were deemed to be highly capable if they gave a response of 5 (agree) or 6 (strongly agree) to the statements “I have the latitude I need to provide high quality care to my patents” and “I have the tools and resources I need to properly care for my patients.”

Physicians were deemed isolated if they responded to the question “How often do you feel a sense of isolation in your professional life?” by choosing “once a week,” “a few times a week,” or “every day.”

Likewise, survey takers who responded with a 5 (a few times a week) or 6 (every day) to the question “How often do you feel a deep sense of fulfillment in your work?” were determined to be fulfilled.

To determine which features of internal support were actually associated with change, the responses to those questions and others were regressed against capability and individual physician measures using a multiple ordinary least-squares regression while controlling for demographic and professional factors of the physicians, including gender, specialty, employment setting, employment status, tenure at current organization, and tenure post-residency.

In order to get interpretable results, survey questions that provided redundant information were merged. This was done by clustering the questions using both the correlation of physician responses and domain knowledge of overlapping question themes. This grouping resulted in the creation of nine factors comprising the average responses to as many as eight individual survey questions; these factors were named:

  1. Leadership and organizational communication
  2. EMR satisfaction, data access, and administrative burden
  3. Team skills and cohesion
  4. Care management and patient safety
  5. Pace of practice (i.e., “feeling rushed")
  6. After-hours work
  7. Referral autonomy
  8. Compensation
  9. Isolation

These factor scores were standardized and scaled to make them directly comparable.

The multiple regression resulted in a regression coefficient value for each factor that tells us how much, on average, capability and the other outcomes of interest would change given that a physician's score for that factor were to increase or decrease by a certain amount. The magnitude of these regression coefficients was used to rank the importance of the factors.

It's important to note that this method proves the association of these internal support factors with the outcome variables of interest, but not that they are causally related.

The survey and analysis were conducted by athenahealth researchers Josh Gray, Dorrie Raymond, Ashley Holmes, Payal Patnaik, and Timothy Helbig.

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Survey methodology