Working in values-discrepant environments inhibits clinicians’ ability to provide compassion and reduces wellbeing: a cross-sectional study
Bibliographic record
Abstract
Abstract Objectives: to describe the association between personal and organisational value discrepancies and compassion ability, burnout, job satisfaction, absenteeism, and consideration of early retirement among healthcare professionals. Design: online cross-sectional survey. Setting: primary, secondary, and tertiary care. Participants: 1025 current practising clinicians (doctors, nurses, and allied health professionals) in Aotearoa/New Zealand. Main outcome measures: The Sinclair Compassion Questionnaire – Healthcare Provider Ability and Competence Self-Assessment, The Maslach Burnout Inventory - Human Services Survey abbreviated 2-Question Summative Score, 10-item Warr-Cook-Wall Job Satisfaction questionnaire, measures of absenteeism and consideration of early retirement. Results: Perceived discrepancies between personal and organisational values predicted lower compassion ability ( B =-0.006, 95% CI [-0.01, -0.00], P<0.001, f2=0.05) but not competence (p=0.24), lower job satisfaction ( B =-0.20, 95% CI [-0.23, -0.17], P<0.001, f2=0.14), higher burnout ( B =0.02, 95% CI [0.01, 0.03], P<0.001, f2=0.06), absenteeism ( B =0.004, 95% CI [0.00, 0.01], P=0.01 f2=0.01), and greater consideration of early retirement ( B =0.02, 95% CI [0.00, 0.03], P=0.04, f2=0.004). Conclusions: Working in value-discrepant environments predicts a range of poorer outcomes among healthcare professionals, including the ability to be compassionate. Scalable organisational and systems level interventions that address operational processes and practices that lead to the experience of value discrepancies are recommended to improve clinician performance and wellbeing outcomes. Study registration: the study was pre-registered on AsPredicted (Registration number 75407) What is already known on this topic Compassion predicts better patient outcomes and clinician quality of life Both personal and perceived organisational values predict variability in clinicians’ ability to show compassion and burnout Psychological tension associated with possibility of having to behave inconsistently with one’s own values, attitudes, and believes may result in unhelpful defence mechanisms associated with a range of negative outcomes What this paper adds Working in value-discrepant environments is associated with a lower ability to show compassion, lower job satisfaction, and higher burnout, absenteeism, and intention to retire early, even when overall competency is not affected Psychological tension and a low expectancy of positive outcomes seem likely to contribute to the link between being situated in value-discrepant environments and negative professional outcomes The findings of this study are non-consistent with the notion of compassion fatigue as reflecting the cost of caring that arises from exposure to repeated suffering. It seems more likely that not being able to practice compassionately due to conflicting personal-organisational values ultimately results in poorer professional wellbeing Organisational and fiscal level interventions that address operational processes and practices that lead to perceived value discrepancies are recommended and should be more effective for scalable improvement of health professional performance and wellbeing outcomes
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.009 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".