The relationship of organizational culture, stress, satisfaction, and burnout with physician-reported error and suboptimal patient care: results from the MEMO study.
BACKGROUND
A report by the Institute of Medicine suggests that changing the culture of health care organizations may improve patient safety. Research in this area, however, is modest and inconclusive. Because culture powerfully affects providers, and providers are a key determinant of care quality, the MEMO study (Minimizing Error, Maximizing Outcome) introduces a new model explaining how physician work attitudes may mediate the relationship between culture and patient safety.


OBJECTIVE
(1) Which cultural conditions affect physician stress, dissatisfaction, and burnout? and (2) Do stressed, dissatisfied, and burned out physicians deliver poorer quality care?


METHODS
A conceptual model incorporating the research questions was analyzed via structural equation modeling using a sample of 426 primary care physicians participating in MEMO.


RESULTS
Culture, overall, played a lesser role than hypothesized. However, a cultural emphasis on quality played a key role in both quality outcomes. Further, we found that stressed, burned out, and dissatisfied physicians do report a greater likelihood of making errors and more frequent instance of suboptimal patient care.


CONCLUSIONS
Creating and sustaining a cultural emphasis on quality is not an easy task, but is worthwhile for patients, physicians, and health care organizations. Further, having clinicians who are satisfied and not burned out or stressed contributes substantially to the delivery of quality care.
Williams
Eric S
ES
Department of Management and Marketing, Culverhouse College of Commerce and Business Administration, University of Alabama, Tuscaloosa, AL, USA. ewilliam@cba.ua.edu
Manwell
Linda Baier
LB
Konrad
Thomas R
TR
Linzer
Mark
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002055:Burnout, Professional; D005260:Female; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D019300:Medical Errors / Q000517:prevention & control*; D008875:Middle Aged; D015279:Organizational Culture; D010820:Physicians / Q000523:psychology*; D011787:Quality of Health Care; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D014481:United States