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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.

SUBJECTS:

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

STUDY DESIGN:

This was a cluster randomized controlled trial.

MEASURES:

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.

INTERVENTIONS:

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

ANALYSIS:

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).

LIMITATIONS:

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.