Face-to-Face Teamwork Key to Job Satisfaction in Primary Care

Diana Phillips

September 10, 2019

When it comes to team collaboration among care providers and staff in primary care clinics, it's not just what you say but also how you say it that matters, according to a study published online today in the Annals of Family Medicine.

Regular face-to-face communication is tied to greater job satisfaction for clinicians and staff, but no similar benefit is associated with electronic communication, report Marlon P. Mundt, PhD, of the Department of Family Medicine and Community Health at the University of Wisconsin School of Medicine and Public Health in Madison, and colleagues.

In a cross-sectional study of 143 physicians and clinical staff from five US primary care clinics, the investigators used social network analyses to determine how the flow of professional communication influences job satisfaction among physicians, nurses, advanced care providers, medical assistants, technicians, and administrative staff. They found that, despite the proliferation of electronic communication, collaboration via face-to-face communication appears to significantly boost job satisfaction among physicians and staff, whereas electronic communication does not.

The findings suggest that interventions designed to promote in-person communication among all care team members may enhance clinician and staff resilience to burnout by improving how they feel about their work, according to the authors.

To measure face-to-face and electronic communication flow, the researchers developed surveys that asked participants to estimate how often per day, in the past 6 months, they communicated face to face or via electronic medical records about patient care with other clinicians and clinic staff. Responses were ranked from 0 (less than 1–2 times per month) to 5 (multiple times per day). The responses were organized into a core-periphery structure for face-to-face and electronic communication networks for each clinic. Core nodes in the model represent individuals who are highly interconnected with others in a concentrated area; peripheral nodes represent individuals who are loosely connected to the core network and are not highly interconnected with each other, the authors explain.

Of the respondents — 92% of whom were women — 82 (57%) were located in the face-to-face communication core of their clinics, and 83 (58%) were located in the electronic communication core of their clinics, the authors report.

However, when segmented by job type, only six (19%) of the physician and nurse practitioner respondents were in the face-to-face communication core, which was made up mostly of registered nurses, medical assistants, and receptionists. In contrast, 20 (65%) of the physician and nurse practitioner respondents were in the electronic communication core.

The researchers used the Warr-Cook-Wall job satisfaction survey to measure overall job satisfaction as well as satisfaction with regard to nine specific aspects of work: amount of responsibility; freedom of working method; amount of variety in work; colleagues and fellow workers; physical working conditions; opportunity to use abilities; income; recognition for work; and hours of work.

The results showed that overall job satisfaction varied by job type and by the percentage of full-time employment. The comparison by job title showed that the lowest degree of job satisfaction was among female physicians, with a mean score of 5.1 on a 7-point scale, compared with 6.1 for male physicians, 6.2 for clinic managers, 6.3 for licensed practical nurses, and 6.4 for radiology technicians. By employment status, the lowest satisfaction, 5.0, was found among individuals who worked part time, from 70% to <80%, compared with 6.3 among those who worked 90% to <100% of the time.

In multivariate analyses, clinicians and staff in the face-to-face communication network core had greater overall job satisfaction (β = 0.33; P < .05), compared with those who were not included in the core. Similarly, they reported greater satisfaction with regard to the amount of responsibility they were given (β = 0.73; P < .01) and greater satisfaction with the opportunity to use their abilities (β = 0.79; P < .01).

In contrast, clinicians and staff in the electronic communication network core did not have significantly greater overall job satisfaction (β = 0.29; P = .145) compared with those on the periphery.

In adjusted analyses, different trends were observed for female physicians. Not only was membership in the face-to-face communication core not associated with statistically significant improvements in job satisfaction, it was associated with lower overall job satisfaction, although the difference was not statistically significant. Further, for female physicians, there was a trend toward greater overall job satisfaction for those who were members of the electronic communication core, the authors report.

In the satisfaction subsets, the authors write, "in contrast to male physicians, female physicians were satisfied with their variety of work, the opportunity to use their abilities, and income but dissatisfied with work hours and the job overall." This finding, they hypothesize, indicates "a less-than-desirable work-life balance."

Hypothesizing on the interaction between job satisfaction and interconnectedness with the face-to-face communication core in the cohort overall, the authors suggest the link may be a function of team cognition. "Team cognition (ie, team-shared understanding of the capabilities of each team member, who is good at what, who should be assigned what at what time) allows a team to be more than the sum of its parts. It affords teams flexibility and adaptability and enables teammates to relate to each other and to newly emerging information in the process of task performance," they write. "In view of better team performance, team members might experience better job satisfaction if they experience constructive working relationships and engage in shared team care delivery."

The findings have important implications for primary care, the authors stress. "To increase job satisfaction among primary care professionals, it might be necessary to look beyond individual practitioners to consider how to support frequent daily communication among all team members and how to allow all team members to be interconnected in their face-to-face communication and to share in team-based care," they write. They note that structured team communication, such as daily huddles, might improve job satisfaction outcomes.

"To increase clinician job satisfaction, primary care leadership and stakeholders might be well advised to support efforts to develop highly interconnected face-to-face communication among all team members to leverage the strengths of all health care practitioners and to avoid silo effects among the primary care workforce," the authors conclude.

The authors have disclosed no relevant financial relationships.

Ann Fam Med. 2019;17:428-435. Abstract

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