Workplace Improvements May Promote 'Joy in Medical Practice'

Diana Phillips

October 04, 2017

Improving structural and functional aspects of the practice environment can increase clinician job satisfaction and potentially reduce burnout, a prospective study of 168 clinicians in 34 medical practices has shown.

Factors such as practice efficiency, teamwork, communication, trust, and value alignment were associated with job satisfaction, or "joy in practice," which in turn was associated with lower levels of stress, burnout, and intent to leave the practice, the researchers write.

Mark Linzer, MD, director of the Division of General Internal Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, and colleagues report their findings online in the October issue of Health Affairs.

Using data collected between 2011 and 2014 from the Healthy Work Place trial, they analyzed the link between clinician satisfaction and remediable work conditions to identify the characteristics of satisfied clinicians, the workplace factors associated with clinician satisfaction, and whether increasing satisfaction improves clinician and patient outcomes.

The investigators pooled data from the trial's control and intervention groups at baseline and follow-up, including descriptive statistics to describe the characteristics of clinicians with scores of 3.5 or higher on a 5-item satisfaction metric, and associations between job satisfaction and specific work conditions, such as manageable stress, control over work, and pace of work.

Nearly three quarters of the participating clinicians (74%) indicated job satisfaction at baseline. "[W]e found that job satisfaction (joy in practice) was associated with both structural and cultural aspects of the work environment: slower paced, less chaotic environments were far more satisfying, as were practices with cohesion, good communication, high clinician trust in the organization, and high alignment of values between clinicians and leaders," the authors write.

Correlation analysis of satisfaction and clinician outcomes at baseline identified a strong association between job satisfaction, stress, burnout, and intent to leave. "For example, 50 percent of clinicians who intended to leave were satisfied, while 83 percent of the clinicians who planned to stay were satisfied," the authors report.

Strong relationships were also observed between satisfaction and work pace, the authors note. "[T]he odds of satisfaction were 79 percent less if the workplace was chaotic," they report. "Satisfaction was also related to culture — especially cohesiveness and trust ([odds ratios]: 4.5 and 4.2, respectively) — and to all clinician outcomes including stress, burnout, and intent to leave ([odds ratios]: 0.19, 0.08, and 0.18, respectively)."

The researchers also conducted an improvement analysis using hierarchical regressions to determine whether improvement in satisfaction during the trial led to improved outcomes. Of 135 clinicians from 32 clinics with available satisfaction data at baseline and follow-up, 20 with improved satisfaction demonstrated significant improvements in burnout and intent to leave.

A comparison of outcomes between those with and without improved satisfaction showed respective improvements in burnout scores of 38% and 13%, and in intent to leave scores of 34% and 4%.

On the patient side, improvement in clinician satisfaction was not associated with improvements in safety and quality of care outcomes for patients with hypertension and diabetes (the conditions included in the Healthy Work Place trial). "While no changes were seen in patient outcomes with improved satisfaction, other research has demonstrated that higher rates of burnout are associated with increased medical errors, lower-quality patient outcomes in people with diabetes, and lower patient satisfaction with care and adherence to treatment recommendations," the authors explain. The current analysis did not include patient satisfaction with their care.

Previous research, including a study reported by Medscape Medical News, echo this study's findings.

"Many roadblocks to joy in practice exist, including regulations, electronic medical records, the push for productivity, and the challenges of promoting work/life balance," the authors write. "Our data show that a large number of practicing clinicians are satisfied, but their satisfaction might be improved by addressing the work environment (making it less chaotic) and by promoting a more positive organizational culture, including cohesion, trust, values, and an emphasis on good communication."

Possible mechanisms for supporting more efficient and sustainable practices include building cohesion, aligning clinicians' and leaders' values, and building trust through better communication, the authors suggest. Further, considering the connection between workplace chaos and clinician satisfaction, "careful attention to work pace and engineering clinical spaces for quiet and smooth connections and communication may benefit both clinicians and patients," they explain.

Attention should also be given to the aspects of organizational culture addressed in the study (cohesion, communication, value alignment and trust), the authors stress. "If an organization wishes to promote clinician job satisfaction, reduce burnout, and increase loyalty to the organization (as measured by intent to stay), these culture domains may be critical areas for quality improvement."

The authors conclude that clinicians' job satisfaction may be an important metric for clinical practices and large practice organizations. "Because improved satisfaction in our study was associated with decreases in burnout and intent to leave among physicians and advanced practice providers, the joy in practice may be of considerable importance to primary care clinicians and their practices," they write.

Financial support for this study was provided by the Agency for Healthcare Research and Quality. The authors have disclosed no relevant financial relationships.

Health Affairs. 2017;36:1808-1814. Abstract

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