Leadership Behaviors and Burnout in Healthcare: A Mixed-Methods Study in the Veterans Health Administration

"Burnout" is defined as chronic and unmanageable workplace stress. While leadership quality is crucial in the workplace, little research has examined leaders' experiences with burnout. This mixed-methods study focuses on a healthcare setting and examines leaders' experiences of burnout. Our research centered on what burnout looks like for supervisors and senior managers, outcomes associated with leader burnout, and the lived experience of burned-out leaders.

Data are from the Veterans Health Administration. We analyzed quantitative and qualitative data from a 2023 organizational census survey that assessed employees' workforce attitudes and perceptions. The quantitative analysis comprised 18,000 respondents who were supervisors and senior managers in clinical roles. We conducted random effects modeling for each of three survey measures (i.e., perceptions toward leadership, employee engagement, and turnover intention), regressed on burnout (i.e., none, some, high), and supervisory role. The qualitative analysis included thematic content analysis of text comments.

Those classified as experiencing some burnout symptoms (b = -.39, SE = .02) and as experiencing high burnout symptoms (b = -1.07, SE = .03) provided lower ratings of senior leaders than respondents with low burnout symptoms. Respondents with some burnout symptoms (OR = 2.85, 95% CI = 2.85, 3.35) and high burnout symptoms (OR = 11.80; 95% CI = 10.35, 13.46) also reported a greater likelihood of leaving their current position. Senior managers had more engagement when experiencing high burnout compared to supervisors (b = .08). For the qualitative results, supervisors and senior managers experienced burnout similarly, along with the issues related to it. Specifically, they saw their own leaders' poor performance as problematic. Acute areas of concern included micromanagement, an inability or unwillingness to enforce accountability throughout the organization, and failure to listen to staff subject-matter experts in decision-making.

Considering our findings on burnout among clinical workplace leaders and given the impact of leadership behaviors on burnout experience, organizations should make additional investments in educational and practical experiences to improve leadership effectiveness. These investments may be particularly important in clinical settings, given previous findings of associations between providers' burnout and patients' experience of quality of care.