Australian Occupational Therapy Journal (2013) 60, 395–403
doi: 10.1111/1440-1630.12074
Research Article
Enhancing retention of occupational therapists working in mental health: Relationships between wellbeing at work and turnover intention Justin Newton Scanlan,1 Pamela Meredith2 and Anne A. Poulsen2 1 Discipline of Occupational Therapy, Faculty of Health Sciences, The University of Sydney and Mental Health Services, Sydney and South Western Sydney Local Health Districts, Sydney, New South Wales, and 2School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
Background/aim: Occupational therapists working in mental health who experience burnout, low work engagement or poor job satisfaction are at risk of poor wellbeing at work and may be more likely to leave their jobs. The aim of this project was to explore factors associated with wellbeing at work and turnover intention in a sample of occupational therapists working in mental health. Methods: One hundred and three occupational therapists working in mental health in Queensland completed a survey exploring work/life balance, effort invested in work, rewards received from work, wellbeing at work (job satisfaction, burnout and work engagement) and turnover intention. Analyses were conducted to explore relationships between work/life balance, effort, reward, wellbeing at work and turnover intention. Results: All measures of wellbeing at work were significantly associated with turnover intention. A large proportion (33%) of the variance in turnover intention was predicted by job satisfaction. Perceptions of both work/life balance and effort invested in work, as well as perceived rewards in terms of recognition, prestige and personal satisfaction were significantly associated with work-related wellbeing scores. Conclusions and significance of the study: Results from this study deepen the understanding of factors associated with wellbeing at work and turnover intention for occupational therapists in mental health. This knowledge
Justin Newton Scanlan PhD, MHM, BOccThy; Lecturer. Pamela Meredith PhD, BA (Hons), BSc, BOccThy; Senior Lecturer. Anne A. Poulsen PhD, BOccThy (Hons); Senior Research Officer. Correspondence: Justin Newton Scanlan, Room J120, C43J, Faculty of Health Sciences, The University of Sydney, PO Box 170, Lidcombe, NSW 1825, Australia. Email: justin. [email protected] Accepted for publication 23 June 2013. © 2013 Occupational Therapy Australia
will support the development of interventions aimed at reducing turnover intention and enhancing retention of occupational therapists in the mental health workforce. KEY WORDS burnout, job satisfaction, psychiatry, work engagement, workforce.
Introduction Ultimately, every service user and manager wants the same thing: for staff to be productive and committed to the organisation and to the provision of quality services. This is especially true in health services, where employees are the organisation’s most valuable resource. Unlike some other industries where employee satisfaction and wellbeing may not be directly linked with efficiency or quality (Courtney, Whelan, Majoor, Ibrahim & Day, 2006), maintaining employee wellbeing is critical in health services. Health service employees who are burnt out (i.e., physically and emotionally depleted due to chronic occupational stress; Demerouti, Bakker, Vardakou & Kantas, 2003), or dissatisfied, are more likely to make errors and less likely to be responsive to individual consumer needs (Aiken et al., 2012). In extreme circumstances, burnt out employees may even act malevolently (Neveu, 2008). In addition, staff turnover can be seen as having adverse and costly outcomes for health services. In terms of monetary costs, health services must expend resources to advertise, screen, interview, appoint, induct and train replacement employees (Jones, 2004; O’BrienPallas et al., 2006). There are also costs in terms of client care, with loss of organisational knowledge, compromised long-term continuity of care and, potentially, interruption of the implementation of evidence-based practices (O’Brien-Pallas et al.; Woltmann et al., 2008). Finally, where staff turnover causes extended vacancies, there is cost to the wellbeing of other staff (O’Brien-Pal-
396 las et al.). When there are vacancies within a team, other staff members often carry additional workloads. This can lead to increased stress, dissatisfaction, and further staff turnover, which can have an enduring effect on the stability of teams. The risk of burnout and poor retention in occupational therapy is an issue for the entire profession (Balogun, Titiloye, Balogun, Oyeyemi & Katz, 2002; Gupta, Paterson, Lysaght & von Zweck, 2012; Painter, Akroyd, Elliot & Adams, 2003). Occupational therapists in mental health settings have been identified as particularly susceptible to burnout (Painter et al.). Some aspects of working in mental health settings (e.g., working with distressed individuals, perceived lack of consumer progress) and high workloads can contribute to burnout for these practitioners (Bassett & Lloyd, 2001; Painter et al.). In addition to burnout, two other aspects of wellbeing at work are job satisfaction and work engagement. Job satisfaction is defined as a global sense of satisfaction with one’s work (Nagy, 2002) and has been reported to be the most significant predictor of lower turnover intention in other employee populations (Lambert, Hogan & Barton, 2001). Work engagement is often considered the theoretical opposite of burnout: while burnout is defined in negative terms, work engagement is seen when employees are motivated, enthusiastic and energised by their work (Schaufeli & Bakker, 2004). Work engagement can be seen as “health at work” rather than simply the absence of “sickness at work” (burnout). Examining these interdependent constructs has potential to provide greater understanding of wellbeing at work from a salutogenic (health-related) perspective that moves beyond a unidirectional focus on poor health. Given the importance occupational therapists place on meaningful engagement and a holistic view of health, it is surprising that work engagement has been largely overlooked in previous research into wellbeing at work for occupational therapists. A focus on these three key elements of wellbeing at work (high levels of job satisfaction, low levels of burnout and high levels of work engagement) may provide new insights to enhance retention of occupational therapists. Although burnout and factors associated with job satisfaction for occupational therapists have been explored in previous studies (Balogun et al., 2002; Gupta et al., 2012; Hayes, Bull, Hargreaves & Shakespeare, 2008; Moore, Cruickshank & Haas, 2006; Painter et al., 2003; Scanlan, Still, Stewart & Croaker, 2010), the relationships between wellbeing at work and turnover intention have received little attention. As mental health practice is considered especially emotionally demanding (Sørgaard, Ryan, Hill, Dawson, & the OSCAR group, 2007), occupational therapists in these settings represent one population that may be at particular risk for poor wellbeing at work. A wide range of factors contribute to wellbeing at work. These can be conceptualised as factors directly © 2013 Occupational Therapy Australia
J. N. SCANLAN ET AL.
related to the job itself, such as perceived benefits and rewards, and person-related factors, such as appraisals of external non-work demands. Each of these will be discussed below in relation to theoretical models. According to the model of Effort-Reward Imbalance (Siegrist, 2002), employees who perceive that they invest a high degree of effort in their work, but receive little in return, are more likely to experience poorer wellbeing at work than those with better perceived balance between effort and reward (Kouvonen et al., 2006). Perceptions of effort and reward are useful measures of job-related factors that may contribute to, or diminish, wellbeing at work. One person-related factor that may influence wellbeing at work is an individual’s satisfaction with their work/life balance. Work/life balance is the degree to which employees consider that they can achieve a satisfying mix of work and non-work activities (Bauld, Brough & Timms, 2009). Stressors in either work or non-work domains may contribute to conflict between job-related and personal commitments and this in turn can impact perceptions of work/life balance and wellbeing. Not surprisingly, work/life balance has been associated with both job and family satisfaction (Brough, O’Driscoll & Kalliath, 2005). The present study was established to explore factors associated with wellbeing at work, and the associations between wellbeing at work and turnover intention, in a group of occupational therapists in working mental health. The study is guided by three research questions: 1. Are demographic variables related to differences in measures of wellbeing at work (job satisfaction, burnout and work engagement) or turnover intention? 2. What are the relationships between job-related factors (effort and reward), person-related factors (work/life balance) and wellbeing at work? 3. How much of the variance in turnover intention is explained by measures of wellbeing at work? A detailed understanding of how different elements of wellbeing at work are associated with lower turnover intention will provide better opportunities to address retention issues for occupational therapists in mental health. This is a critical issue for the profession, both now and into the future.
Method The study was approved by the University of Queensland’s Behavioural and Social Sciences Ethics Research Committee.
Participants During 2010, all occupational therapists registered in Queensland (N = 2349) were invited to complete a survey exploring factors related to work and wellbeing. A total of 951 usable surveys were returned (overall response rate 40.5%). This article focuses on data pro-
397
TURNOVER INTENTION AND WELLBEING AT WORK
vided by 103 respondents who identified mental health as their primary clinical area. Data regarding the practice areas for the overall sample were not available, so a specific response rate for occupational therapists in mental health practice could not be determined. Demographics for the sample are summarised in Table 1.
TABLE 1: Selected demographic characteristics of the sample, N = 103 Domain
Category
n
%
Gender
Female Male Missing 45 years Missing 25 years Full-time Part-time Other Missing Team/group practice Sole practitioner Other Public sector Private sector Other Metropolitan Regional/Rural/Remote No Yes Missing Single/never married Married Partner/cohabiting Divorced/separated Widowed Missing No Yes Missing
doi: 10.1111/1440-1630.12074
Research Article
Enhancing retention of occupational therapists working in mental health: Relationships between wellbeing at work and turnover intention Justin Newton Scanlan,1 Pamela Meredith2 and Anne A. Poulsen2 1 Discipline of Occupational Therapy, Faculty of Health Sciences, The University of Sydney and Mental Health Services, Sydney and South Western Sydney Local Health Districts, Sydney, New South Wales, and 2School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
Background/aim: Occupational therapists working in mental health who experience burnout, low work engagement or poor job satisfaction are at risk of poor wellbeing at work and may be more likely to leave their jobs. The aim of this project was to explore factors associated with wellbeing at work and turnover intention in a sample of occupational therapists working in mental health. Methods: One hundred and three occupational therapists working in mental health in Queensland completed a survey exploring work/life balance, effort invested in work, rewards received from work, wellbeing at work (job satisfaction, burnout and work engagement) and turnover intention. Analyses were conducted to explore relationships between work/life balance, effort, reward, wellbeing at work and turnover intention. Results: All measures of wellbeing at work were significantly associated with turnover intention. A large proportion (33%) of the variance in turnover intention was predicted by job satisfaction. Perceptions of both work/life balance and effort invested in work, as well as perceived rewards in terms of recognition, prestige and personal satisfaction were significantly associated with work-related wellbeing scores. Conclusions and significance of the study: Results from this study deepen the understanding of factors associated with wellbeing at work and turnover intention for occupational therapists in mental health. This knowledge
Justin Newton Scanlan PhD, MHM, BOccThy; Lecturer. Pamela Meredith PhD, BA (Hons), BSc, BOccThy; Senior Lecturer. Anne A. Poulsen PhD, BOccThy (Hons); Senior Research Officer. Correspondence: Justin Newton Scanlan, Room J120, C43J, Faculty of Health Sciences, The University of Sydney, PO Box 170, Lidcombe, NSW 1825, Australia. Email: justin. [email protected] Accepted for publication 23 June 2013. © 2013 Occupational Therapy Australia
will support the development of interventions aimed at reducing turnover intention and enhancing retention of occupational therapists in the mental health workforce. KEY WORDS burnout, job satisfaction, psychiatry, work engagement, workforce.
Introduction Ultimately, every service user and manager wants the same thing: for staff to be productive and committed to the organisation and to the provision of quality services. This is especially true in health services, where employees are the organisation’s most valuable resource. Unlike some other industries where employee satisfaction and wellbeing may not be directly linked with efficiency or quality (Courtney, Whelan, Majoor, Ibrahim & Day, 2006), maintaining employee wellbeing is critical in health services. Health service employees who are burnt out (i.e., physically and emotionally depleted due to chronic occupational stress; Demerouti, Bakker, Vardakou & Kantas, 2003), or dissatisfied, are more likely to make errors and less likely to be responsive to individual consumer needs (Aiken et al., 2012). In extreme circumstances, burnt out employees may even act malevolently (Neveu, 2008). In addition, staff turnover can be seen as having adverse and costly outcomes for health services. In terms of monetary costs, health services must expend resources to advertise, screen, interview, appoint, induct and train replacement employees (Jones, 2004; O’BrienPallas et al., 2006). There are also costs in terms of client care, with loss of organisational knowledge, compromised long-term continuity of care and, potentially, interruption of the implementation of evidence-based practices (O’Brien-Pallas et al.; Woltmann et al., 2008). Finally, where staff turnover causes extended vacancies, there is cost to the wellbeing of other staff (O’Brien-Pal-
396 las et al.). When there are vacancies within a team, other staff members often carry additional workloads. This can lead to increased stress, dissatisfaction, and further staff turnover, which can have an enduring effect on the stability of teams. The risk of burnout and poor retention in occupational therapy is an issue for the entire profession (Balogun, Titiloye, Balogun, Oyeyemi & Katz, 2002; Gupta, Paterson, Lysaght & von Zweck, 2012; Painter, Akroyd, Elliot & Adams, 2003). Occupational therapists in mental health settings have been identified as particularly susceptible to burnout (Painter et al.). Some aspects of working in mental health settings (e.g., working with distressed individuals, perceived lack of consumer progress) and high workloads can contribute to burnout for these practitioners (Bassett & Lloyd, 2001; Painter et al.). In addition to burnout, two other aspects of wellbeing at work are job satisfaction and work engagement. Job satisfaction is defined as a global sense of satisfaction with one’s work (Nagy, 2002) and has been reported to be the most significant predictor of lower turnover intention in other employee populations (Lambert, Hogan & Barton, 2001). Work engagement is often considered the theoretical opposite of burnout: while burnout is defined in negative terms, work engagement is seen when employees are motivated, enthusiastic and energised by their work (Schaufeli & Bakker, 2004). Work engagement can be seen as “health at work” rather than simply the absence of “sickness at work” (burnout). Examining these interdependent constructs has potential to provide greater understanding of wellbeing at work from a salutogenic (health-related) perspective that moves beyond a unidirectional focus on poor health. Given the importance occupational therapists place on meaningful engagement and a holistic view of health, it is surprising that work engagement has been largely overlooked in previous research into wellbeing at work for occupational therapists. A focus on these three key elements of wellbeing at work (high levels of job satisfaction, low levels of burnout and high levels of work engagement) may provide new insights to enhance retention of occupational therapists. Although burnout and factors associated with job satisfaction for occupational therapists have been explored in previous studies (Balogun et al., 2002; Gupta et al., 2012; Hayes, Bull, Hargreaves & Shakespeare, 2008; Moore, Cruickshank & Haas, 2006; Painter et al., 2003; Scanlan, Still, Stewart & Croaker, 2010), the relationships between wellbeing at work and turnover intention have received little attention. As mental health practice is considered especially emotionally demanding (Sørgaard, Ryan, Hill, Dawson, & the OSCAR group, 2007), occupational therapists in these settings represent one population that may be at particular risk for poor wellbeing at work. A wide range of factors contribute to wellbeing at work. These can be conceptualised as factors directly © 2013 Occupational Therapy Australia
J. N. SCANLAN ET AL.
related to the job itself, such as perceived benefits and rewards, and person-related factors, such as appraisals of external non-work demands. Each of these will be discussed below in relation to theoretical models. According to the model of Effort-Reward Imbalance (Siegrist, 2002), employees who perceive that they invest a high degree of effort in their work, but receive little in return, are more likely to experience poorer wellbeing at work than those with better perceived balance between effort and reward (Kouvonen et al., 2006). Perceptions of effort and reward are useful measures of job-related factors that may contribute to, or diminish, wellbeing at work. One person-related factor that may influence wellbeing at work is an individual’s satisfaction with their work/life balance. Work/life balance is the degree to which employees consider that they can achieve a satisfying mix of work and non-work activities (Bauld, Brough & Timms, 2009). Stressors in either work or non-work domains may contribute to conflict between job-related and personal commitments and this in turn can impact perceptions of work/life balance and wellbeing. Not surprisingly, work/life balance has been associated with both job and family satisfaction (Brough, O’Driscoll & Kalliath, 2005). The present study was established to explore factors associated with wellbeing at work, and the associations between wellbeing at work and turnover intention, in a group of occupational therapists in working mental health. The study is guided by three research questions: 1. Are demographic variables related to differences in measures of wellbeing at work (job satisfaction, burnout and work engagement) or turnover intention? 2. What are the relationships between job-related factors (effort and reward), person-related factors (work/life balance) and wellbeing at work? 3. How much of the variance in turnover intention is explained by measures of wellbeing at work? A detailed understanding of how different elements of wellbeing at work are associated with lower turnover intention will provide better opportunities to address retention issues for occupational therapists in mental health. This is a critical issue for the profession, both now and into the future.
Method The study was approved by the University of Queensland’s Behavioural and Social Sciences Ethics Research Committee.
Participants During 2010, all occupational therapists registered in Queensland (N = 2349) were invited to complete a survey exploring factors related to work and wellbeing. A total of 951 usable surveys were returned (overall response rate 40.5%). This article focuses on data pro-
397
TURNOVER INTENTION AND WELLBEING AT WORK
vided by 103 respondents who identified mental health as their primary clinical area. Data regarding the practice areas for the overall sample were not available, so a specific response rate for occupational therapists in mental health practice could not be determined. Demographics for the sample are summarised in Table 1.
TABLE 1: Selected demographic characteristics of the sample, N = 103 Domain
Category
n
%
Gender
Female Male Missing 45 years Missing 25 years Full-time Part-time Other Missing Team/group practice Sole practitioner Other Public sector Private sector Other Metropolitan Regional/Rural/Remote No Yes Missing Single/never married Married Partner/cohabiting Divorced/separated Widowed Missing No Yes Missing
