Study Measures
The Maslach Burnout Inventory
(MBI) Human Services Survey for Medical Personnel is a 22-item
self-reported survey instrument developed to assess the 3 dimensions of
burnout using a multidimensional model.1 Whereas
previous measures of burnout focused only on the exhaustion
dimension,16 the MBI incorporates the central
construct of exhaustion and extends measurement to depersonalization and
reduced personal accomplishment constructs to articulate
interrelationships.17 The MBI is widely used in
burnout research and considered the standard tool for
measurement.18 MBI items are scored by a 7-point
frequency scale from “never” to “daily.”
The MBI was not developed as a clinical diagnostic tool, and therefore
does not distinguish between burned-out and not burned-out individuals.
However, studies have attempted to validate MBI cutoff scores that
reflect both a binary distinction of burnout, and also low, moderate,
and high levels of emotional exhaustion, depersonalization, and reduced
personal accomplishment. The MBI Manual (4th edition; 2016) removed
cut-off scores due to lack of diagnostic validity.17This study reported burnout levels only to compare with previous studies
administering the MBI to participants within oncology
settings.4,5 Therefore, high level burnout was defined
when respondents had 1 of 3 criteria: raw sum score of ≥27 in the
emotional exhaustion dimension, ≥10 in the depersonalization dimension,
or ≥15 in the reduced personal accomplishment
dimension.11,12,19,20
Workplace factors were measured with the National Aeronautics and Space
Administration Task Load Index (NASA-TLX),21 which
measures 5 aspects of subjective job demand: mental demand, physical
demand, temporal demand, effort, and frustration. NASA-TLX scores ranged
from 0 to 10; higher scores reflected higher perceived workload. The
NASA-TLX has been previously used in healthcare
research.14,22
A screener question from the Second Victim Experience and Support Tool
(SVEST) was used to assess PSE involvement. The SVEST is a 29-item
survey instrument designed to provide healthcare organizations
information on PSE involvement support resources most preferred by
clinicians.23 SVEST responses are recorded with
5-point Likert-scale agreement items ranging from “strongly disagree”
to “strongly agree”.
Participants could also include open-response comments via the item,
“Please use this space to include any comments about how we can improve
patient safety or the work experience for the St. Jude patient care
staff.” These comments were analyzed post-hoc, in response to results
demonstrating associations among the NASA-TLX job demand, frustration,
and burnout prevalence. Two authors (TD & JDB) reviewed comments
independently to identify broad concepts related to potential sources of
frustration. Final concept terminology was developed by consensus, and
content analysis methods identified relevant comments. Content analysis
disagreements were resolved through consensus.