Changes in VA Psychiatrists' Attitudes About Work Environment and Turnover During Mental Health Service Enhancement

Objective: The Veterans Health Administration (VHA) has undergone significant organizational transformation as part of a comprehensive strategic plan to enhance mental health services. Organizational change can create stress and decrease employee morale, even if the change is beneficial for patients and the organization. The study examined whether psychiatrists' work satisfaction and work environment perceptions changed during a period of transformation. Facility-level turnover rate was also examined. Methods: Data were analyzed from 7,218 psychiatrists who responded to an annual organizational survey between 2004 and 2010 (excluding 2005) conducted with 139 facilities. Survey ratings were regressed on individual and facility-level characteristics in a multilevel model. Adjusted mean scores for the measures were compared with Tukey post hoc tests to identify significant differences by year. Results: Most satisfaction ratings on measures improved after the initial actions for strategic reform and stabilized in 2006. Turnover rates and intention to leave were also consistent during this time. Positive linear trends over time were observed for pay satisfaction, management for achievement, skill development, workplace civility, and satisfaction with senior management. Conclusions: Extensive reorganization of VHA mental health services was associated with improvements in psychiatrists' workplace satisfaction, and these increases were sustained over time. In the current climate of rapid transformation under health care reform nationally, the VHA experience may inform the broader national process and organizational strategies to improve and maintain the morale of the health care workforce.