Working in values-discrepant environments inhibits clinicians ability to provide compassion and reduces wellbeing: a cross-sectional study

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)O_ST_ABSWhat is already known on this topicC_ST_ABSO_LICompassion predicts better patient outcomes and clinician quality of life C_LIO_LIBoth personal and perceived organisational values predict variability in clinicians ability to show compassion and burnout C_LIO_LIPsychological tension associated with possibility of having to behave inconsistently with ones own values, attitudes, and believes may result in unhelpful defence mechanisms associated with a range of negative outcomes C_LI What this paper addsO_LIWorking 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 C_LIO_LIPsychological 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 C_LIO_LIThe 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 C_LIO_LIOrganisational 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 C_LI