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Burnout among behavioral health care providers and employees is associated with poor patient and provider outcomes. Leadership style has generally been identified as a means of reducing burnout, yet it is unclear whether some leadership styles are more effective than others at mitigating burnout. Additionally, behavioral health care is provided in a variety of contexts and a leadership style employed in one context may not be effective in another. The purpose of this paper was to review the literature on leadership style and burnout in behavioral health care contexts to identify the different leadership styles and contexts in which the relationship between the two constructs was studied. Studies were categorized based on the leadership style, study design, research methods, and study context. Findings of this review provide insights into potential approaches to prevent employee burnout and its attending costs, as well as ways to improve future research in this critical area.

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Background Caesarean section (C-sections) is a medically critical and often life-saving procedure for prevention of childbirth complications. However, there are reports of its overuse, especially in women covered by private insurance as compared to public insurance. This study evaluates the difference in C-Section rates among nulliparous women in Florida hospitals across insurance groups and quantifies the contribution of maternal and hospital factors in explaining the difference in rates. Methods We used Florida’s inpatient data provided by the Florida Agency for HealthCare Administration (FLAHCA) and focused on low-risk births that occurred between January 1, 2010, and September 30, 2015. A Fairlie decomposition method was performed on cross-sectional data to decompose the difference in C-Section rates between insurance groups into the proportion explained versus unexplained by the differences in observable maternal and hospital factors. Results Of the 386,612 NTSV low-risk births, 72,984 were delivered via C-Section (18.87%). Higher prevalence of C-section at maternal level was associated with diabetes, hypertension, and the expectant mother being over 35 years old. Higher prevalence of C-section at the hospital level was associated with lower occupancy rate, presence of neonatal ICU (NICU) unit and higher obstetrics care level in the hospital. Private insurance coverage in expectant mothers is associated with C-section rates that were 4.4 percentage points higher as compared to that of public insurance. Just over 33.7% of the 4.4 percentage point difference in C-section rates between the two insurance groups can be accounted for by maternal and hospital factors. Conclusions The study identifies that the prevalence of C-sections in expectant mothers covered by private insurance is higher compared to mothers covered by public insurance. Although, majority of the difference in C-Section rates across insurance groups remains unexplained (around 66.3%), the main contributor that explains the other 33.7% is advancing maternal age and socioeconomic status of the expectant mother. Further investigation to explore additional factors that explain the difference needs to be done if United States wants to target specific policies to lower overall C-Section rate.

PurposeThe purpose of this study was to examine the organizational context that may support learning and change readiness climates that previous research has found to be conducive to implementing evidence-based interventions.Design/methodology/approachAn exploratory, mixed method evaluation that included 15 rheumatology clinics throughout the United States was performed. Quantitative data were collected using a web-based survey completed by 135 clinic members. Qualitative data were collected via semi-structured interviews with 88 clinic members.FindingsIn general, clinics reported strong, positive learning and change readiness climates. More complex organizations (e.g. multispecialty, academic medical centers) with rational/hierarchical cultures and members with longer tenure were associated with less supportive learning and change readiness climates. The authors’ findings highlight opportunities for organizational leaders and evidence-based intervention sponsors to focus their attention and allocate resources to settings that may be most susceptible to implementation challenges.Originality/valueFirst, the authors address a deficit in previous research by describing both the level and strength of the learning and change readiness climates for implementing an evidence-based shared decision-making aid (SDMA) and examine how these vary as a function of the organizational context. Second, the study examines a broader set of factors to assess the organizational context (e.g. organizational culture, organizational structure, ownership) than previous research, which may be especially salient for shaping the climate in smaller specialty clinics like those we study. Third, the authors utilize a mixed methods analysis to provide greater insights into questions of how and why organizational factors such as size and structure may influence the learning and change readiness climate.