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.

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.

Rank: 47

First Author: Linzer

Outcome: Stress,Burnout,Turnover Intentions,Job Satisfaction

Outcome p-value: Stress:●, Burnout:●, Turnover Intentions:●, Job Satisfaction:●

Intervention Category: Organizational and System-Level

Time per Employee (hours): No time specified.

D&B Study Quality Rating: 16.5

Reviewer Confidence: 3

Country: US

Study Design Type: RCT

Materials Available to Implement: Intervention(s) were customized at the individual clinic level. A PDF with extensive information about the intervention is available at: https://amaalliance.org/wp-content/uploads/2019/01/preventing_physician_burnout-stepsforward-ama.pdf. Corresponding author: Mark.linzer@hcmed.org.

Materials Available: yes

Organiz./Individ. Focus: Organizational

Prevention Category: Primary,Secondary

Effect size Small:

Effect size Medium:

Reference: Linzer, Mark, Sara Poplau, Ellie Grossman, Anita Varkey, Steven Yale, Eric Williams, Lanis Hicks, et al. “A Cluster Randomized Trial of Interventions to Improve Work Conditions and Clinician Burnout in Primary Care: Results from the Healthy Work Place (HWP) Study.” Journal of General Internal Medicine 30, no. 8 (August 2015): 1105–11. https://doi.org/10.1007/s11606-015-3235-4.