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The Best Defense May Indeed Be a Good Offense - Part 2
By Caterina Spinaris & Gregory Morton
Published: 06/12/2017

Jail door The following is the conclusion of a two part article.

The first paper[1] involved the review of both randomized controlled trials (15 trials, 716 physicians) and observational studies (37 studies, 2914 physicians), which met consistent inclusion criteria. Both types of studies showed that both individual-focused (bottom-up) and organizational (top-down) strategies were successful in reducing burnout—as measured by overall burnout score, and by measuring the burnout components of emotional exhaustion (14% reduction) and depersonalization (4% reduction). However, only organizational, top-down strategies lowered the overall (total) burnout score to a statistically significant degree —10%. That is, for reducing overall burnout, top-down interventions were more effective.

For this population, individual-focused (bottom-up) interventions were similar to those presented in Desert Waters’ signature CF2F course:
  • facilitated and non-facilitated small group curricula,
  • stress management and self-care training,
  • communication skills training,
  • a "belonging" intervention to emphasize connections with others, and
  • mindfulness-based approaches.
Top-down, organizational interventions included:
  • shortened attending rotation length,
  • clinical work process modifications,
  • shortened resident shifts,
  • changes in duty hour requirements, and
  • changes in practice delivery.
The second paper[2] conducted a meta-analysis of randomized clinical trials and controlled pre/post studies. The effectiveness of physician-directed (bottom-up) and organization-directed (top-down) burnout interventions were again compared. Individual (bottom-up) interventions included techniques such as mindfulness-based stress reduction, exercise, and educational programs focusing on improving self-confidence and communication skills, individually or in combination. Organizational (top-down) interventions included workload interventions, (such as rescheduling hourly shifts and reducing overall workloads), teamwork and leadership.

Burnout scores of most studies reviewed in this paper focused on the emotional exhaustion component of burnout. Both types of strategies (individual and organizational) led to small, but statistically significant reductions in burnout. However, treatment effects were greater with organization-directed approaches, that is, with interventions which took into consideration the effect of the work environment.

These findings provide support for the view that burnout is inherently a problem of health care organizations, rather than only being a problem of inadequate individual adaptations to work stressors. The similarity to the challenges built into the corrections environment should be obvious. Yes, some staff adapt better than others. That’s only to be expected. But it is the overall environment and workplace culture that are most influential, so much so, that their negative influence contributes to a universal condition of the profession.

The authors of this study concluded, in language that should be familiar to all corrections leaders, that "[o]rganization-directed [top-down] interventions...that combined several elements such as structural changes, fostering communication between members of the health care team, and cultivating a sense of teamwork and job control tended to be the most effective in reducing burnout."

And this is where the challenge lies for correctional leadership: what staff-focused supports can we design into our traditional corrections environment on a system-wide basis to reduce Fatigue and enhance Fulfillment? Where can we take the offensive and proactively create conditions for improved resilience in our workforce? What strategies and what resources are needed to combat what we all recognize as a long-standing condition? Which programs work? Which don’t? And for that matter, why do it?

Indeed, why pursue ways to reduce burnout (and overall Corrections Fatigue) among corrections personnel?

The reason is simple and obvious, and once again supported by physician burnout data in a recent third study[3]. Yet another systematic review and meta-analysis of physician burnout, which included 82 studies with 210,669 healthcare providers, showed that burnout was negatively correlated to a statistically significant degree with patient safety and quality of healthcare. That is, the higher the physician’s burnout score, the lower the patient safety (in terms of physician errors), and the lower the quality of care. Physician burnout is in fact mission-critical.

With this robust research-based evidence as support, it is not much of a leap to suggest that burnout and overall Corrections Fatigue could have adverse consequences among corrections professionals also; that Fatigue could negatively impact the quality of offender management, and increase the likelihood of errors or lapses, resulting in policy violations, and hence reduced safety—with ensuing increases in incidents, injuries, death and litigation risks. In other words, it does not seem to be far-fetched to conclude that countering Corrections Fatigue is in fact a mission-critical issue. So much so, that if we are going to do for the public what we say we are going to do, then proactively attending to the well-being of our staff is a crucial matter for corrections leadership.

Where does one start?

An easy answer is, start with what you’ve already got in place.

At Desert Waters we do not assume that an agency has not thought of these concepts before, and that no one has taken steps to address this long-standing condition. Quite the opposite. It’s very likely that you already have related training programs in your catalog, or that after-action employee support is

currently written into physical force policy, or that creative scheduling has long been an issue you’ve wanted to address. Maybe now is the time to proactively enhance those programs. Maybe even do that by reassigning some resources for the purpose of giving these programs a renewed jump-start towards success. Perhaps it is as simple as just measuring the effectiveness of what you presently have in place. Or maybe it’s bigger than that. Maybe it’s a system-wide initiative to uncover and address Fatiguing conditions wherever they are found, and then strategically and intentionally target them to enhance Fulfillment for each and every employee. You know your agency better than we do.

In any case, we urge you to recognize and benefit from the research: the best defense may indeed be a strategically targeted, proactive offense. We are here to discuss these mission-critical matters with you further, bringing to the table our various approaches to complement yours.


*Meta-analysis is the research method whereby pertinent data from multiple selected studies are systematically combined and reviewed to draw conclusions of greater statistical power.

** Physician burnout is typically studied by using the Maslach Burnout Inventory (Maslach, Jackson, & Leiter, 1996), which measures three dimensions of burnout: emotional exhaustion, depersonalization, and a reduced sense of accomplishment.


[1]West, C.P.; Dyrbye, L.N.; Erwin, P.J., Shanafelt, T.D. Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. The Lancet (2016). First published online 28 September 2016. doi: http://dx.doi.org/10.1016/S0140-6736(16)31279-X

[2]Panagioti, M.; Panagopoulou, E.; Bower, P.; Lewith, G.; Kontopantelis, E.; Chew- Graham, C.; Dawson, S.; van Marwijk, H; Geraghty, K. ; Esmail, A. Controlled Interventions to Reduce Burnout in Physicians: A Systematic Review and Meta-analysis. JAMA Intern Med. First published online December 5, 2016. doi:10.1001/jamainternmed.2016.7674

[3]Salyers, M.P., Bonfils, K.A., Luther, L., Firmin, R.L., White, D.A., Adams, E.L., Rollins, A.L. The Relationship Between Professional Burnout and Quality and Safety in Healthcare: A Meta-Analysis. J GEN INTERN MED(2016). First published online 26 October 2016. doi:10.1007/s11606-016-3886-9

This article as been reprinted with permission from the March 2017 Issue of Correctional Oasis, a monthly e-publication of "Desert Waters Correctional Outreach".

Editor's note: Caterina Spinaris is the Executive Director at Desert Waters Correctional Outreach and a Licensed Professional Counselor in the State of Colorado. She continues to contribute to the field of corrections staff well-being individually and organizationally, in particularly regarding issues of traumatic stress due to exposure to violence, injury, death on the job, and also issues of organizational climate improvement.

Gregory Morton serves as Training Manager at Desert Waters Correctional Outreach. Prior to that he worked for Oregon State Corrections nearly his entire adult life—a total of more than 34 years—after graduating from Oregon State University with a Bachelor’s degree in Psychology. He started his career at the Oregon State Penitentiary (OSP) as an academic counselor in 1975, and progressed to Staff Training / Employee Development shortly thereafter. Greg served as the department’s Leadership Program Manager and as Staff Training Administrator until 2006. He was the ORDOC’s Labor Relations Administrator until he retired in 2009. His concern for the professional and life skills of the corrections workforce has been his motivation throughout his career.

Visit the Caterina Spinaris page

Other articles by Spinaris:


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