Journal Article

A Cluster Randomized Trial of Interventions to Improve Work Conditions and Clinician Burnout in Primary Care: Results from the Healthy Work Place (HWP) Study

Brown, Roger L., Hicks, Lanis, Wallock, Jill, Yale, Steven, Williams, Eric, Poplau, Sara, Linzer, Mark, Kohnhorst, Diane, Varkey, Anita, Grossman, Ellie, Barbouche, Michael

2015

Overview

ABSTRACT BACKGROUND Work conditions in primary care are associated with physician burnout and lower quality of care. OBJECTIVE We aimed to assess if improvements in work conditions improve clinician stress and burnout. SUBJECTS Primary care clinicians at 34 clinics in the upper Midwest and New York City participated in the study. STUDY DESIGN This was a cluster randomized controlled trial. MEASURES Work conditions, such as time pressure, workplace chaos, and work control, as well as clinician outcomes, were measured at baseline and at 12–18 months. A brief worklife and work conditions summary measure was provided to staff and clinicians at intervention sites. INTERVENTIONS Diverse interventions were grouped into three categories: 1) improved communication; 2) changes in workflow, and 3) targeted quality improvement (QI) projects. ANALYSIS Multilevel regressions assessed impact of worklife data and interventions on clinician outcomes. A multilevel analysis then looked at clinicians whose outcome scores improved and determined types of interventions associated with improvement. RESULTS Of 166 clinicians, 135 (81.3 %) completed the study. While there was no group treatment effect of baseline data on clinician outcomes, more intervention clinicians showed improvements in burnout (21.8 % vs 7.1 % less burned out, p  = 0.01) and satisfaction (23.1 % vs 10.0 % more satisfied, p  = 0.04). Burnout was more likely to improve with workflow interventions [Odds Ratio (OR) of improvement in burnout 5.9, p  = 0.02], and with targeted QI projects than in controls (OR 4.8, p  = 0.02). Interventions in communication or workflow led to greater improvements in clinician satisfaction (OR 3.1, p  = 0.04), and showed a trend toward greater improvement in intention to leave (OR 4.2, p  = 0.06). LIMITATIONS We used heterogeneous intervention types, and were uncertain how well interventions were instituted. CONCLUSIONS Organizations may be able to improve burnout, dissatisfaction and retention by addressing communication and workflow, and initiating QI projects targeting clinician concerns.

• Publisher: Springer US,Springer Nature B.V
• Subject: Adult / Burnout / Burnout, Professional - prevention & control / Cluster Analysis / Communication / Female / Humans / Internal Medicine / Interprofessional Relations / Intervention / Job Satisfaction / Male / Medicine / Medicine & Public Health / Middle Aged / Original Research / Physicians / Physicians, Primary Care / Primary care / Quality Improvement / Quality of Life / Stress, Psychological - prevention & control / Workflow / Working conditions / Workplace - organization & administration