Measuring burnout in paediatric oncology staff. Should we be using the Maslach Burnout Inventory?

Burnout in health service staff is a cause for concern since it has negative consequences for the individual affected, the wider organisation, and patients themselves. The Maslach Burnout Inventory-Human Services Survey (MBI-HSS) has been widely used to assess the prevalence of burnout within oncology services. The MBI-HSS is a self-report measure comprised of three sub-scales - Emotional Exhaustion (EE), Depersonalisation (DP), and Personal Accomplishment (PA). This paper reports on the first study to investigate the psychometric properties of the MBI-HSS when administered to paediatric oncology staff. Two hundred and three paediatric oncology staff recruited through seven UK Principal Treatment Centres (PTCs) and a children’s cancer charity completed the MBI-HSS. The factor structure of the instrument was tested using confirmatory and exploratory factor analysis, with Rasch analysis applied to assess whether the measure meets the requirements of an interval level scale. Cronbach alpha was used to assess internal reliability. Factor analysis did not support the traditional three factor structure of the MBI-HSS but instead suggested seven factors. Rasch analysis and alpha coefficients indicated that while the EE and the PA subscales fulfilled the requirements of an interval level measure for group level diagnosis, DP did not. Further investigation revealed a ‘floor effect’ on many DP items. Whereas the EE and PA subscales of the MBI-HSS can be used in research with paediatric oncology staff working in PTCs, there are considerable problems with the DP subscale and researchers should be cautious in interpreting data from this subscale.