Do Work Condition Interventions Affect Quality and Errors in Primary Care? Results from the Healthy Work Place Study.
While primary care work conditions are associated with adverse clinician outcomes, little is known about the effect of work condition interventions on quality or safety.



A cluster randomized controlled trial of 34 clinics in the upper Midwest and New York City.



Primary care clinicians and their diabetic and hypertensive patients.



Quality improvement projects to improve communication between providers, workflow design, and chronic disease management. Intervention clinics received brief summaries of their clinician and patient outcome data at baseline.



We measured work conditions and clinician and patient outcomes both at baseline and 6-12 months post-intervention. Multilevel regression analyses assessed the impact of work condition changes on outcomes. Subgroup analyses assessed impact by intervention category.



There were no significant differences in error reduction (19 % vs. 11 %, OR of improvement 1.84, 95 % CI 0.70, 4.82, p = 0.21) or quality of care improvement (19 % improved vs. 44 %, OR 0.62, 95 % CI 0.58, 1.21, p = 0.42) between intervention and control clinics. The conceptual model linking work conditions, provider outcomes, and error reduction showed significant relationships between work conditions and provider outcomes (p ≤ 0.001) and a trend toward a reduced error rate in providers with lower burnout (OR 1.44, 95 % CI 0.94, 2.23, p = 0.09).



Few quality metrics, short time span, fewer clinicians recruited than anticipated.



Work-life interventions improving clinician satisfaction and well-being do not necessarily reduce errors or improve quality. Longer, more focused interventions may be needed to produce meaningful improvements in patient care.



ClinicalTrials.gov # NCT02542995.
Hennepin County Medical Center, Minneapolis, MN, USA. mark.linzer@hcmed.org.|Minneapolis Medical Research Foundation, Minneapolis, MN, USA. mark.linzer@hcmed.org.|University of Minnesota Medical School, Minneapolis, MN, USA. mark.linzer@hcmed.org.|Division of General Internal Medicine, Hennepin County Medical Center, 701 Park Avenue (P7), Minneapolis, MN, USA. mark.linzer@hcmed.org.
Mark
M
Linzer
Hennepin County Medical Center, Minneapolis, MN, USA.|Minneapolis Medical Research Foundation, Minneapolis, MN, USA.
Sara
S
Poplau
University of Wisconsin School of Medicine and Public Health and the School of Nursing, Madison, WI, USA.
Roger
R
Brown
NYU School of Medicine, New York, NY, USA.|Cambridge Health Alliance, Somerville, MA, USA.
Ellie
E
Grossman
Loyola University Medical Center and Stritch School of Medicine, Maywood, IL, USA.
Anita
A
Varkey
North Florida Regional Medical Center, Gainesville, FL, USA.
Steven
S
Yale
Culverhouse College of Commerce, The University of Alabama, Tuscaloosa, AL, USA.
Eric S
ES
Williams
University of Missouri, Columbia, MO, USA.
Lanis
L
Hicks
Loyola University Medical Center and Stritch School of Medicine, Maywood, IL, USA.
Jill
J
Wallock
Marshfield Clinic Research Foundation, Marshfield, WI, USA.
Diane
D
Kohnhorst
Forward Health Group, Inc., Madison, WI, USA.
Michael
M
Barbouche
D000368:Aged; D002055:Burnout, Professional / Q000517:prevention & control; D016000:Cluster Analysis; D005260:Female; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D019300:Medical Errors / Q000517:prevention & control*; D008875:Middle Aged; D011320:Primary Health Care / Q000458:organization & administration; D058996:Quality Improvement / Q000458:organization & administration*; D011787:Quality of Health Care / Q000458:organization & administration*; D012044:Regression Analysis; D017132:Workplace / Q000458:organization & administration*
burnout; physician burnout; physician stress; work-life; work-life interventions