A Systematic Review of the Impact of Physicians’ Occupational Well-Being on the Quality of Patient Care

Scheepers, Renée A.; Boerebach, Benjamin C. M.; Arah, Onyebuchi A.; Heineman, Maas Jan; Lombarts, Kiki M. J. M. H.

doi:10.1007/s12529-015-9473-3

Cited by 182 publications

(175 citation statements)

References 67 publications

(187 reference statements)

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“…23 Since 24 most error reduction programs have targeted inpatient settings. However, it is likely that the substantially broader scope of outpatient medicine would allow for far more errors and thus a greater impact if structural determinants of and activities for preventing outpatient mistakes could be discerned.…”

Section: Resultsmentioning

confidence: 99%

Do Work Condition Interventions Affect Quality and Errors in Primary Care? Results from the Healthy Work Place Study

et al. 2016

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BACKGROUND: 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. DESIGN: A cluster randomized controlled trial of 34 clinics in the upper Midwest and New York City. PARTICIPANTS: Primary care clinicians and their diabetic and hypertensive patients. INTERVENTIONS: 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. MAIN MEASURES: 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. KEY RESULTS: 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). LIMITATIONS: Few quality metrics, short time span, fewer clinicians recruited than anticipated. CONCLUSIONS: 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. Clinical trial registration number: ClinicalTrials.gov # NCT02542995.KEY WORDS: burnout; work-life; physician stress; physician burnout; work-life interventions.

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Section: Resultsmentioning

confidence: 99%

Do Work Condition Interventions Affect Quality and Errors in Primary Care? Results from the Healthy Work Place Study

et al. 2016

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“…Sixth, another potential confounder might be provider characteristics, for example, perceived responsiveness to patient requests or provider well-being. However, interpersonal behaviours and clinicians’ personality are of limited influence on patient perceptions of care,46 whereas occupational well-being of healthcare providers has a more profound effect on patient satisfaction 47…”

Section: Discussionmentioning

confidence: 99%

Provider interruptions and patient perceptions of care: an observational study in the emergency department

2018

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BackgroundInterruptions are endemic in healthcare work environments. Yet, they can have positive effects in some instances and negative in others, with their net effect on quality of care still poorly understood. We aimed to distinguish beneficial and detrimental forms of interruptions of emergency department (ED) providers using patients’ perceptions of ED care as a quality measure.MethodsAn observational design was established. The study setting was an interdisciplinary ED of an academic tertiary referral hospital. Frequencies of interruption sources and contents were identified in systematic expert observations of ED physicians and nurses. Concurrently, patients rated overall quality of care, ED organisation, patient information and waiting times using a standardised survey. Associations were assessed with hierarchical linear models controlling for daily ED workload. Regression results were adjusted for multiple testing. Additionally, analyses were computed for ED physicians and nurses, separately.ResultsOn 40 days, 160 expert observation sessions were conducted. 1418 patients were surveyed. Frequent interruptions initiated by patients were associated with higher overall quality of care and ED organisation. Interruptions relating to coordination activities were associated with improved ratings of ED waiting times. However, interruptions containing information on previous cases were associated with inferior ratings of ED organisation. Specifically for nurses, overall interruptions were associated with superior patient reports of waiting time.ConclusionsProvider interruptions were differentially associated with patient perceptions of care. Whereas coordination-related and patient-initiated interruptions were beneficial to patient-perceived efficiency of ED operations, interruptions due to case-irrelevant communication were related to inferior patient ratings of ED organisation. The design of resilient healthcare systems requires a thorough consideration of beneficial and harmful effects of interruptions on providers’ workflows and patient safety.

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“…A recent systematic review (Scheepers, Boerebach, Arah, Heineman, & Lombarts, 2015) identified 18 studies relating occupational well-being of physicians to quality of care. Occupational well-being was defined as a positive experience with or evaluation of one's work involving satisfaction, commitment, involvement, or engagement.…”

Section: Concluding Observationsmentioning

confidence: 99%

Measures, Methods, and Models of Doctor Satisfaction: Future Research Challenges

Konrad

2015

P&P

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This paper outlines the way in which various concepts measuring doctor reactions to their jobs and careers (e.g., satisfaction, burnout, etc.) have been developed. The variety of measures, methods, and models reflect differing disciplinary and theoretical approaches and research traditions. In order to identify productive ways to advance the field, this paper presents a proposal for how multidisciplinary, cross-national comparative research might be conducted to resolve some of the issues linking medical care organization, physicians' experiences, and patient outcomes. In seeking buy-in from stakeholders, researchers need to be cognizant that various ideologies and agendas shape the nature of the concerns that these interest groups (e.g., professional associations, clinical managers, payers, patient advocates, etc.) have about physician satisfaction, its precursors, and its consequences.Keywords: Physician satisfaction, burnout, measurement, methodology, medical autonomy Various concepts measuring doctor discontent (e.g., satisfaction, burnout, etc.) have been employed and measured. The measures, methods, and models used by academic researchers represent a wide variety of theoretical formulations and disciplinary approaches. I discuss the notion that variables operating at different levels of analysis have been posited as underlying factors accounting variation in physicians' attitudes. These include health system organization and workplace variables, as well as different individual level life experiences and personalities. Patients' clinical outcomes and satisfaction have been posited as being affected by doctor's satisfaction. In order to identify productive ways to advance the field, this paper provides an example of how research has been conducted in the US and suggests how cross-national research might be conducted in response to the concerns that physicians, their employers, and their patients experience in the process of providing, overseeing, and receiving medical care.

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A Systematic Review of the Impact of Physicians’ Occupational Well-Being on the Quality of Patient Care

Cited by 182 publications

References 67 publications

Do Work Condition Interventions Affect Quality and Errors in Primary Care? Results from the Healthy Work Place Study

Do Work Condition Interventions Affect Quality and Errors in Primary Care? Results from the Healthy Work Place Study

Provider interruptions and patient perceptions of care: an observational study in the emergency department

Measures, Methods, and Models of Doctor Satisfaction: Future Research Challenges

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