http://informahealthcare.com/jmh ISSN: 0963-8237 (print), 1360-0567 (electronic) J Ment Health, 2014; 23(3): 120–124 ! 2014 Shadowfax Publishing and Informa UK Limited. DOI: 10.3109/09638237.2013.869576

ORIGINAL ARTICLE

Value motivations predict burnout and intentions to leave among mental health professionals Jasmin Jambrak1, Frank P. Deane2, and Virginia Williams1 School of Psychology and 2School of Psychology and Illawarra Institute for Mental Health, University of Wollongong, Wollongong, New South Wales, Australia

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Abstract

Keywords

Background: Values guide and potentially motivate people in their lives. Aligning personal values with organisational values has the potential to improve job satisfaction, reduce burnout and lower Intentions To Leave (ITL). Aims: To determine whether changes in Value Motivation (VM) predict burnout and ITL following training. Method: Participants were staff from a Mental Health (MH) organisation in Australia. They participated in the Collaborative Recovery Training Programme (CRTP) and completed pre- and post-measures of values, general health, burnout and ITL. Results: Increasingly holding work values due to guilt and shame predicted higher burnout after training. Increases in intrinsically held values predicted less ITL after training. Conclusions: Attending to and clarifying VM’s has the potential to decrease burnout and ITL. Training programmes should focus on understanding the importance of values in reducing burnout and turnover rates among MH professionals.

Burnout, extrinsic, intention to leave, intrinsic, mental health, value motivation

Introduction Values provide people with a life direction, are ordered by relative importance, and are important drivers of behaviour (Schwartz, 1992). Several models propose that values are important in the formation and development of attitudes (context-specific preferences) and subsequent behaviours (e.g. Homer & Kahle, 1988). It has been found that attitudes mediate the relationship between values and behaviour (Homer & Kahle, 1988). People are most highly motivated to adopt a desired behaviour when it aligns with their values (Sheldon & Kasser, 1998). Self-determination Theory (SDT) suggests that motivation is the key for purposeful strivings (Deci & Ryan, 1985). According to SDT, motivation can be understood in terms of the degree to which it is experienced as autonomous (the motive for acting comes from within the individual), or controlled (the motive for acting is imposed by an external source). Autonomously motivating behaviours feel wholly self regulated as the individual adopts it because of pleasure and importance. Most other behaviours humans engage in are externally motivated (Ryan & Deci, 2000). A Self-Determination continuum explains that some of these ‘‘imposed’’ behaviours are done entirely for external reward or avoidance of punishment (more extrinsic motivation); and others are done because they are important to the individual Correspondence: Professor Frank P. Deane, School of Psychology and Illawarra Institute for Mental Health, Building 22, University of Wollongong, Northfields Ave, Gwynneville, NSW 2500, Australia. Tel: (02) 4221 4523. Fax: (02) 4221 4454. E-mail: [email protected]

History Received 21 June 2013 Accepted 4 October 2013 Published online 16 January 2014

and fit with their values (more intrinsic motivation). The motivation for these latter behaviours is described as ‘‘integrated’’, and goals related to these behaviours are ‘‘self-concordant’’ (Koestner et al., 2008). A premise of the current research is that values not only sit beneath self-concordant goals but are also something we can look at as a way of creating autonomy in otherwise controlled environments. Therefore, the proposed study suggests that values are a source of motivation for staff to change their practice, which we refer to as Value Motivation (VM). Helping people connect imposed behaviours to values-based motivations could potentially assist behaviour change in Mental Health (MH) organisations. Training programmes in organisational settings have the potential to create these pathways between imposed behaviours and deeply held values of MH workers. The current study assesses values in the context of a training programme that aims to improve MH worker transfer of recovery-oriented practices into routine care. It is important for MH workers to understand that recovery involves a person living a satisfying, hopeful and contributing life despite their mental illness (Anthony, 1993). Previous research has shown that such recovery attitudes can be enhanced over the course of training programmes (Crowe et al., 2006); but it is unclear whether values underneath attitudes are also affected. Despite increases in recovery attitudes, transfer of associated skills to clinical practice is limited (Uppal et al., 2010). Another strategy for preparing the workforce for change is to clarify individual

Value motivations in mental health staff

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DOI: 10.3109/09638237.2013.869576

values in the context of the organisation’s stated values. Aligning values with new work skills and practices has the potential to improve intrinsic ‘‘ownership’’ and motivation of new ways of working, and increase desired work outcomes. Higher intrinsic motivation has been associated with increased productivity and well-being (e.g. Deci & Ryan, 2000; Fernet et al., 2004). A more extrinsic work value orientation is associated with less satisfaction, dedication and vitality while on the job (Vansteenkiste et al., 2007). A 2-d workshop that used values interventions to reduce burnout in MH workers found a strong negative relationship between living consistently with work and personal values and burnout (b ¼ 0.54, p50.001; Vilardaga et al., 2011). Burnout is recognised as a chronic problem in MH organisations where staff turnover rates are typically high (Razza, 1993). The more burnout counsellors’ experience, the more likely they are to leave their job (Knudsen et al., 2006). Associations between Intentions To Leave (ITL) and values have found that intrinsic work motivations, and having important life values met in a job were associated with lower ITL (r ¼ 0.29, p50.01, Janssen et al., 1999; r ¼ 0.33, p50.01, George & Jones, 1996). If a job is not fulfilling important goals or values then this can lead to dissatisfaction and ITL (George & Jones, 1996). Thus, workrelated values are likely to be important for understanding ITL. The current study aims to evaluate the types of motivations behind personal work values and the extent to which these are associated with burnout and ITL among staff in a MH organisation. In Australia, recovery currently underpins MH policy and service delivery initiatives (Australian Health Ministers, 2009–2014). In an effort to improve motivation to implement new recovery skills among MH workers, the Collaborative Recovery Model (CRM) training programme includes valuesclarification (Oades et al., 2005). Reconnecting MH workers with their core values (e.g. wanting to help people) links the new recovery orientation to internal motivation (Lyons et al., 2006). This study aims to test whether people’s values shift to become more intrinsically held after participation in training that has an explicit values focus. Second, it assesses whether shifts in VM’s are related to better general health, and lower burnout and ITL. It was hypothesised that intrinsic VM’s will increase and extrinsic VM’s will decrease from pre-to-post training. Second, increases in intrinsic VM’s and decreases in extrinsic VM’s will predict positive changes in outcome variables (burnout, ITL, general health).

Method Participants Participants were 65 staff from a large community managed MH service in Australia. Most of the sample was female (69.1%). Majority of participants were aged between 18 and 30 years (37.9%), followed by 41–50 years (28.8%), 31–40 years (22.3%), and 51–60 years (10.5%). The mean number of years in the MH profession was 4.07 years (SD ¼ 3.52). The most commonly endorsed professional affiliation was ‘‘Other’’ (39.7%), (frequently noted as ‘‘support worker’’),

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followed by welfare worker (37.9%), social worker (13.8%), psychologist (5.2%), and nurse (3.4%). Measures Collaborative recovery model-values questionnaire (CRM-VQ) The CRM-VQ is an adaptation of the Personal Strivings questionnaire (Sheldon & Kasser, 1995). The modification involves extrinsic and intrinsic motivations applied to personal work values instead of goals. The four VM items of the CRM-VQ used were: ‘‘I would put this value into play: (a) ‘because somebody else wants me to value it, or because I’ll get something from somebody if I value it’ [VM_Other], (b) ‘because I would feel ashamed, guilty, or anxious if I didn’t. I feel like I ought to value this’ [VM_Guilt], (c) ‘because I really believe it is an important value to have. I endorse it freely and wholeheartedly’ [VM_Free], and (d) ‘because of the fun and enjoyment this value brings me.’’ My primary reason for ‘‘living’’ this value is simply my interest in the experience itself’ [VM_Fun]. Extrinsic motivations are measured using (a) and (b) and intrinsic motivations are measured using (c) and (d). Items were rated on a 5-point Likert scale from 1 (not at all for this reason) to 5 (entirely for this reason). There is no published reliability or validity data for this revised questionnaire but, reliability for combined extrinsic and intrinsic items in the original questionnaire was a ¼ 0.60 (Sheldon & Kasser, 1998). The Maslach Burnout Inventory (MBI) The MBI (Maslach et al., 1996) is a measure of burnout containing 22 items. This questionnaire has three subscales, each with high reliability (exhaustion, a ¼ 0.91; depersonalisation, a ¼ 0.69; and personal accomplishment, a ¼ 0.75; Vilardaga et al., 2011). Participants rated their responses on a 7-point Likert scale from 0 (never) to 6 (every day). General health questionnaire–12 (GHQ) This 12-item scale has three subscales measuring general health and the absence of ill health (Goldberg, 1978). Participants answered questions such as, ‘‘Have you been feeling unhappy or depressed?’’ All questions were answered using a 4-point Likert scale. Internal consistency has been reported as a ¼ 0.85 (Vansteenkiste et al., 2005). Intention To Leave (ITL) Employees responded to five items designed to assess their ITL the organisation (Wayne et al., 1997). An example item included ‘‘As soon as I can find a better job, I’ll leave my organization’’. Employees responded on a 5-point Likert scale from 1 (strongly disagree) to 5 (strongly agree). High reliability has been reported (a ¼ 0.89; Wayne et al., 1997). Procedure Trainers from the research team conducted training sessions for staff from 16 worksites over a 4-month period. Training occurred over two consecutive days with data collected

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immediately prior to training starting on Day 1 and again at the end of training on Day 2 (T1 n ¼ 65, T2 n ¼ 64). The 2-d workshops provided training in recovery concepts and skills, and a values component (Oades et al., 2005). The values clarification process started with a discussion of ‘‘what values are’’ and a structured values clarification card-sorting task (Ciarrochi & Bailey, 2008). Participants then completed the CRM values tool known as the ‘‘Camera’’ (for more detail see, Oades & Crowe, 2008). The participants worked in pairs to elicit and clarify values for their partners and themselves.

Results

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Data analysis strategy Some research suggests that combining extrinsic and intrinsic items is not reliable due to items not correlating consistently (e.g. Sheldon & Elliot, 1998). In the current study, only VM_Others and VM_Guilt were significantly related at T1 (r ¼ 0.34, p50.01) and T2 (r ¼ 0.69, p50.01). In addition, Cronbach as for the combined items were low for intrinsic (a ¼ 0.14) and extrinsic items at T1 (a ¼ 0.50). Therefore, the value items were treated separately to test hypotheses 1 and 2. Residual Gain Scores (RGS, Beutler & Hamblin, 1986) were used in the test of hypothesis 2. RGS rescales an individual’s score relative to typical gains made by others at the same level. Pre-post changes in VM’s Paired t-tests were conducted to test the hypothesis that there would be increases in intrinsic VM’s and decreases in extrinsic VM’s after the training. There were no significant changes in extrinsic or intrinsic VM’s from T1 to T2 as seen in Table 1. Comparison of intrinsic and extrinsic VM’s Repeated measures analysis of variance (ANOVA) tests were carried out to examine the difference between extrinsic and intrinsic pairs at T1 and T2. Intrinsic VM’s were significantly higher than extrinsic VM’s at both T1 [F(2.80, 181.83) ¼ 180.91, p50.01] and T2 [F(2.30, 149.3) ¼ 169.73, p50.01] as indicated in Table 1. Relationship between residual VM’s and outcome variables

(r ¼ 0.23, p50.05). ITL T2 significantly correlated with Residual Free (r ¼ 0.33, p50.01). There were no significant correlations between Residual VM’s and general health. Predicting burnout and ITL Only those predictors that correlated significantly with outcome variables were used in the regression analyses. Two hierarchical stepwise regressions were conducted and included: (i) Res_Others, Res_Free and Res_Guilt as predictors of Burnout T2 over and above Burnout T1; (ii) Res_Free as a predictor of ITL T2 over and above ITL T1. For the first regression, an a priori justification for separately entering the VM residual items into the stepwise regression was based on the significant correlation between Res_Others and Res_Guilt (r ¼ 0.64, p50.01). Therefore, uncorrelated VM residual items were entered into Step 1 with Burnout T1, and Res_Guilt entered at Step 2. This was to allow clarification of any independent contribution of Res_Guilt to Burnout T2. Other variables such as age, years in the job, and gender did not significantly correlate with the dependent variables so these were not entered into the regressions. The first regression indicated that the increase in extrinsic work values over time explained 3% of the variance in burnout at T2 over and above a person’s burnout at T1 (R2 ¼ 0.78, F(1,58) ¼ 6.63, p ¼ 0.013). Increasingly holding work values because of guilt and shame predicts more burnout at T2 (see Table 2). The second regression indicated that the increase in intrinsic work values over time explained 10% of the variance in ITL at T2 over and above a person’s ITL at T1 (R2 ¼ 0.34, F(1,61) ¼ 9.21, p ¼ 0.004). Increasingly holding work values freely and wholeheartedly predicts less ITL at T2 (see Table 3). The shifts in holding a work value freely, and for somebody else, did not significantly predict changes in burnout at T2 over and above burnout at T1 (p40.05).

Discussion The study found no significant changes in VM’s following training. One reason for the lack of significant change may have been ceiling effects for intrinsic VM’s. Participants had significantly higher intrinsic VM’s than extrinsic VM’s, Table 2. Stepwise regression analysis summary for residual VM predicting burnout at T2.

Burnout T2 significantly correlated with Residual Guilt (r ¼ 0.33, p50.01), Others (r ¼ 0.24, p50.05), and Free

Burnout T2 Step

Table 1. Means (M), standard deviations (SD) and paired t-tests for VM items at T1 and T2. T1 Value motivation 1. 2. 3. 4.

VM_Others VM_Guilt VM_Free VM_Fun

M 1.43 1.58a 4.33b 3.61c

2

T2 SD

a

0.81 0.90 0.77 1.12

M

SD a

1.45 1.51a 4.24b 3.69c

0.83 0.89 1.14 1.14

t (df) 1.16 0.61 0.65 0.52

(64) (64) (65) (63)

p 0.87 0.55 0.52 0.60

All p values for paired t-tests are non-significant (p40.05). Means within columns differ from each other at p50.01, with the exception of those that share a letter.

a,b,c

1

Predictor

b

SE– b



R2

DR2

Burnout T1 Res_Othersa Res_Freec Burnout T1 Res_Othersa Res_Freec Res_Guiltb

0.85 2.13 1.30 0.83 0.35 1.53 2.92

0.07 0.95 0.94 0.07 1.14 0.90 1.13

0.82** 0.15* 0.09 0.80 0.03 1.11 0.20*

0.75

0.75**

0.78

0.03**

b ¼ unstandardised regression coefficient; SE ¼ standard error; ¼ standardised regression coefficient; R2 ¼ at each step; DR2 ¼ change in R2 at each step. F for entire model ¼ 50.30, p50.001. a Res_Others ¼ Residual gain score of VM others T1 to T2. b Res_Guilt ¼ Residual gain score of VM guilt T1 to T2. c Res_Free ¼ Residual gain score of VM free T1 to T2. *p50.05, **p50.01.

Value motivations in mental health staff

DOI: 10.3109/09638237.2013.869576

Table 3. Stepwise regression analysis summary for residual VM predicting intention to leave at T2. Intention to leave T2 Step 1 2

Predictor

B

Intention to leave T1 0.44 Intention to leave T1 0.42 Res_Freea 1.46

SE– b 0.10 0.09 0.48



R2

DR2

0.50** 0.24 0.24** 0.47** 0.34 0.10** 0.32**

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b ¼ unstandardised regression coefficient; SE ¼ standard error; ¼ standardised regression coefficient; R2 ¼ at each step; DR2 ¼ change in R2 at each step. F for entire model ¼ 15.81, p50.001. a Res_Free ¼ residual gain score of VM free T1 to T2. **p50.01.

a finding consistent with prior research suggesting that people in helping professions are aware of the values that bring them into MH work (e.g. benevolence – the preservation and enhancement of the welfare of people; Schwartz, 1992). While no consistent group changes in VM’s from T1 to T2 were measured, the shifts individuals made toward clarifying their intrinsic or extrinsic VM’s affected subsequent burnout and ITL. Shifts toward holding work values due to guilt and shame predicted higher burnout. It is possible that when a person’s motivations for work values are driven by guilt and shame there is greater conflict between more intrinsically held personal values and their daily work life. Such conflict may increase burnout. This explanation is consistent with findings that burnout in counsellors increased due to a disconnection between their values and day-to-day actions (Vilardaga et al., 2011). Further, burnout has been found to have negative effects on therapeutic relationships and job commitment (Maslach et al., 2001). Although in the present study change in extrinsic VM’s predicted only a small amount of burnout, further refinement of values workplace interventions may lead to stronger effects in the future. Shifts towards holding work values freely and wholeheartedly predicted less ITL. The extent to which individuals are enabled to work in line with their values is likely to influence the meaning and satisfaction they experience in their job and organisation, and impact on whether they wish to stay in the role (George & Jones, 1996). The current study suggests that changes in VM’s could lead to decreased ITL. Turnover in MH organisations has been described as producing ‘‘chaos’’ in services (Vilardaga et al., 2011, p. 323). Clarifying intrinsic work VM’s through values interventions has the potential to reduce ITL and possibly turnover. Study limitations include potential sample bias, since individuals agreeing to participate may have been more intrinsically motivated than those who declined. This is consistent with research suggesting that participants who volunteer for research value benevolence compared to nonvolunteers (Harth et al., 1992). Unfortunately, we did not have data on those who declined in our sample. Secondly, other important work site predictors of burnout such as organisational climate, job control or social support, were not measured in this study and the effects of these could not be controlled in the regressions (Maslach et al., 2001). The main limitation of the study was that there was only a 2-d period for changes to occur on all variables, but particularly VM’s. This could in part explain the small effect

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of VM change on burnout. Despite this short time span, there were sufficient individual shifts in VM’s to significantly predict burnout and ITL. This is important since it raises tantalising questions about whether more sustained strategies, perhaps delivered through peer coaching or supervision, could have more substantial effects on VM’s and subsequent effects on burnout and ITL. Our findings have important implications for future research. There is a need to further clarify the relationships between personal and work values as well as their intrinsic and extrinsic motivations. Are there particular value domains that are more likely to come into conflict in the work place (e.g. achievement and social justice values) and what interventions are needed to reconcile such conflicts? Exit interviews may provide a novel opportunity to explore potential conflicts in values among those leaving an organisation. Training programmes or professional development planning could facilitate clarification of how a person’s current position in their workplace fits with their personal work values. A number of authors have highlighted how difficult it is to make structural work-site changes in MH organisations (e.g. Vilardaga et al., 2011). Values-based approaches could provide a feasible alternative to reduce burnout and ITL.

Declaration of interest The participating MH organisation provided funding to the research team for training in the Collaborative Recovery Model (CRM). The authors declare no conflicts of interests. The authors alone are responsible for the content and writing of this article.

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Value motivations predict burnout and intentions to leave among mental health professionals.

Values guide and potentially motivate people in their lives. Aligning personal values with organisational values has the potential to improve job sati...
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