Working in values-discrepant environments inhibits clinicians’ ability to provide compassion and reduces wellbeing: a cross-sectional study
Authors: Pavlova Alina , Paine Sarah-Jane , Sinclair Shane , O’Callaghan Anne , Consedine Nathan S 
Published: November 2022

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