Primary health care reform, dilemmatic space and risk of burnout among health workers

Toby Freeman, Fran Baum, Ronald Labonté, Sara Javanparast, Angela Lawless

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Health system changes may increase primary health care workers’ dilemmatic space, created when reforms contravene professional values. Dilemmatic space may be a risk factor for burnout. This study partnered with six Australian primary health care services (in South Australia: four state government–managed services including one Aboriginal health team and one non-government organisation and in Northern Territory: one Aboriginal community–controlled service) during a period of change and examined workers’ dilemmatic space and incidence of burnout. Dilemmatic space and burnout were assessed in a survey of 130 staff across the six services (58% response rate). Additionally, 63 interviews were conducted with practitioners, managers, regional executives and health department staff. Dilemmatic space occurred across all services and was associated with higher rates of self-reported burnout. Three conditions associated with dilemmatic space were (1) conditions inherent in comprehensive primary health care, (2) stemming from service provision for Aboriginal and Torres Strait Islander peoples and (3) changes wrought by reorientation to selective primary health care in South Australia. Responses to dilemmatic space included ignoring directives or doing work ‘under the radar’, undertaking alternative work congruent with primary health care values outside of hours, or leaving the organisation. The findings show that comprehensive primary health care was contested and political. Future health reform processes would benefit from considering alignment of changes with staff values to reduce negative effects of the reform and safeguard worker wellbeing.

Original languageEnglish
Pages (from-to)277-297
Number of pages21
JournalHealth: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine
Volume22
Issue number3
Early online date2017
DOIs
Publication statusPublished - 1 May 2018

Keywords

  • burnout
  • health care reform
  • health promotion
  • primary health care

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