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

dc.contributor.author Freeman, Toby
dc.contributor.author Baum, Fran
dc.contributor.author Labonte, Ronald
dc.contributor.author Javanparast, Sara
dc.contributor.author Lawless, Angela Patricia
dc.date.accessioned 2019-02-06T00:45:00Z
dc.date.available 2019-02-06T00:45:00Z
dc.date.issued 2017-02-17
dc.description.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. en_US
dc.identifier.citation Freeman, T., Baum, F., Labonté, R., Javanparast, S., & Lawless, A. (2017). Primary health care reform, dilemmatic space and risk of burnout among health workers. Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine, 22(3), 277–297. https://doi.org/10.1177/1363459317693404 en
dc.identifier.doi https://doi.org/10.1177/1363459317693404 en
dc.identifier.issn 1363-4593
dc.identifier.uri http://hdl.handle.net/2328/38908
dc.language.iso en
dc.publisher Sage Journals en
dc.relation http://purl.org/au-research/grants/nhmrc/535041 en
dc.relation http://purl.org/au-research/grants/nhmrc/1078046 en
dc.relation.grantnumber NHMRC/535041 en
dc.relation.grantnumber NHMRC/1078046 en
dc.rights © The Author(s) 2017 en
dc.rights.holder The Author(s) en
dc.subject burnout en
dc.subject health care reform, en
dc.subject health promotion, en
dc.subject primary health care en
dc.title Primary health care reform, dilemmatic space and risk of burnout among health workers en
dc.type Article en
local.contributor.authorOrcidLookup Freeman, Toby: https://orcid.org/0000-0002-2787-8580 en_US
local.contributor.authorOrcidLookup Baum, Fran: https://orcid.org/0000-0002-2294-1368 en_US
local.contributor.authorOrcidLookup Javanparast, Sara: https://orcid.org/0000-0002-0388-5524 en_US
local.contributor.authorOrcidLookup Lawless, Angela Patricia: https://orcid.org/0000-0003-0718-8088 en_US
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