Post-Pandemic Primary Care Burnout Drivers: Interplay of Organizational Constraints, Values (Mis)alignment, and Team-Leader Dynamics

Purpose: Burnout has been exacerbated by post-pandemic woes, and research has examined burnout drivers; however, limited attention has been given to how values alignment with leadership, organizational constraints, psychological safety, and supervisor support simultaneously shape burnout outcomes. This study aimed to identify workplace factors most strongly associated with emotional exhaustion, depersonalization, and personal accomplishment to inform leadership strategies for improving clinician well-being. Patients and Methods: Cross-sectional survey of 338 employees across 12 primary care clinics in a healthcare system in Portland, Oregon, from January to August 2023 (response rate: 63.5%). Eligible respondents included clinicians and support staff. Burnout was assessed using the Maslach Burnout Inventory (MBI-HSS). Independent variables included organizational constraints, values alignment with leadership, psychological safety, and two forms of supervisor support (general support and family-supportive supervisor behaviors FSSB). Structural Equation Modeling (SEM) was employed to examine the simultaneous relationships between workplace factors and burnout dimensions, while controlling for demographic and occupational characteristics. Results: Lower values alignment with leaders was the strongest predictor of emotional exhaustion (β = – 0.15, p < 0.001). Organizational constraints were associated with both emotional exhaustion (β = 0.08, p < 0.001) and depersonalization (β = 0.05, p < 0.001). Lower psychological safety was also linked to greater emotional exhaustion (β = – 0.04, p < 0.001). For personal accomplishment, higher values alignment (β = 0.10, p < 0.05) and fewer organizational constraints (β = – 0.03, p < 0.001) were positive predictors. General supervisor support was associated with greater personal accomplishment, while higher FSSB was unexpectedly associated with lower accomplishment (β = – 0.06, p < 0.001). Conclusion: These findings underscore the importance of aligning values with leadership and promoting psychological safety as crucial levers for mitigating emotional exhaustion. Although general supervisor support enhances personal accomplishment, the negative association with FSSB suggests more complex supervisory dynamics. Plain Language Summary: Burnout is common among healthcare workers and has worsened since the pandemic. This study examined the impact of various workplace factors—such as the alignment of values with leaders, organizational barriers, psychological safety, and supervisor support—on burnout in primary care. We surveyed 338 clinicians and staff at 12 clinics in Portland, Oregon, in 2023. Burnout was measured using the Maslach Burnout Inventory, and we employed statistical modeling to examine the relationships among workplace factors and the three burnout components: emotional exhaustion, depersonalization, and personal accomplishment. We found that when employees felt their values did not align with those of their leaders, they were more likely to experience emotional exhaustion. Organizational barriers, such as a lack of resources, also increased exhaustion and depersonalization. Low psychological safety also contributed to exhaustion. In contrast, values alignment and supportive supervisors were linked to a stronger sense of accomplishment. However, family-supportive supervisor behaviors were surprisingly tied to lower accomplishment, suggesting that this type of support may sometimes create challenges. Overall, our findings indicate that leadership alignment and a culture of safety are crucial for mitigating burnout, and that supervisor support may have complex effects. Keywords: psychological safety, organizational barriers, supervisor support, clinician well-being