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


METHODS
Primary care clinicians at 34 clinics in the upper Midwest and New York City participated in the study.


METHODS
This was a cluster randomized controlled trial.


METHODS
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.


METHODS
Diverse interventions were grouped into three categories: 1) improved communication; 2) changes in workflow, and 3) targeted quality improvement (QI) projects.


METHODS
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).


CONCLUSIONS
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.
Division of General Internal Medicine, Hennepin County Medical Center, Minneapolis, MN, USA, Mark.linzer@hcmed.org.
Mark
M
Linzer
Sara
S
Poplau
Ellie
E
Grossman
Anita
A
Varkey
Steven
S
Yale
Eric
E
Williams
Lanis
L
Hicks
Roger L
RL
Brown
Jill
J
Wallock
Diane
D
Kohnhorst
Michael
M
Barbouche
D000328:Adult; D002055:Burnout, Professional / Q000517:prevention & control*; D016000:Cluster Analysis; D003142:Communication; D005260:Female; D006801:Humans; D007400:Interprofessional Relations; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D058007:Physicians, Primary Care; D058996:Quality Improvement; D011788:Quality of Life; D013315:Stress, Psychological / Q000517:prevention & control; D057188:Workflow; D017132:Workplace / Q000458:organization & administration*