title: Practice environments and job satisfaction in patient-centered medical homes.
abstract: OBJECTIVE
  We undertook a study to evaluate the effects of medical home transformation on job satisfaction in the primary care setting.
  
  
  METHODS
  We collected primary data from 20 primary care practices participating in medical home pilot projects in Rhode Island and Colorado from 2009 to 2011. We surveyed clinicians and staff about the quality of their practice environments (eg, office chaos, communication, difficulties in providing safe, high-quality care) and job satisfaction at baseline and 30 months, and about stress, burnout, and intention to leave at 30 months. We interviewed practice leaders about the impact of pilot project participation. We assessed longitudinal changes in the practice environment and job satisfaction and, in the final pilot year, examined cross-sectional associations between the practice environment and job satisfaction, stress, burnout, and intention to leave.
  
  
  RESULTS
  Between baseline and 30 months, job satisfaction improved in Rhode Island (P=.03) but not in Colorado. For both pilot projects, reported difficulties in providing safe, high-quality care decreased (P<.001), but emphasis on quality and the level of office chaos did not change significantly. In cross-sectional analyses, fewer difficulties in providing safe, high-quality care and more open communication were associated with greater job satisfaction. Greater office chaos and an emphasis on electronic information were associated with greater stress and burnout.
  
  
  CONCLUSIONS
  Medical home transformations that emphasize quality and open communication while minimizing office chaos may offer the best chances of improving job satisfaction.
authors.affiliation: Harvard School of Public Health, Boston, Massachusetts sha248@mail.harvard.edu.
authors.forename: Shehnaz
authors.initials: S
authors.lastname: Alidina
authors.affiliation: Harvard School of Public Health, Boston, Massachusetts.
authors.forename: Meredith B
authors.initials: MB
authors.lastname: Rosenthal
authors.affiliation: Harvard School of Public Health, Boston, Massachusetts RAND Corporation, Boston, Massachusetts Brigham and Women's Hospital, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts.
authors.forename: Eric C
authors.initials: EC
authors.lastname: Schneider
authors.affiliation: Harvard School of Public Health, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Singer
authors.affiliation: RAND Corporation, Boston, Massachusetts Brigham and Women's Hospital, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Friedberg
mesh_terms: D002055:Burnout, Professional; D003120:Colorado; D003142:Communication; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D007588:Job Satisfaction; D008137:Longitudinal Studies; D008297:Male; D018802:Patient-Centered Care / Q000379:methods*; D010865:Pilot Projects; D012237:Rhode Island; D013315:Stress, Psychological
keywords: job satisfaction; office chaos; patient-centered medical home; practice environment; practice-based research; primary care; quality culture; transformation