Measuring Physician Job Satisfaction in a Changing Workplace and a Challenging Environment

Konrad, Thomas R.; Williams, Eric S.; Linzer, Mark; McMurray, Julia E.; Pathman, Donald E.; Gerrity, Martha S.; Schwartz, Mark D.; Scheckler, William E.; Kirk, Judith Van; Rhodes, Elnora; Douglas, J. A.

doi:10.1097/00005650-199911000-00010

Cited by 188 publications

(163 citation statements)

References 26 publications

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“…Work conditions and clinician reactions were measured using survey tools adapted from MEMO 6 and the PWS. 4,5 Managers were questioned about clinic structure (rooms, staffing), policies, finances and procedures. Clinicians were questioned about stress, 15 burnout (a fiveitem scale, focusing primarily on emotional exhaustion, with a score of 3 or higher indicating burnout, 16,17 intent to leave in 2 years, and satisfaction.…”

Section: Methodsmentioning

confidence: 99%

“…Clinicians were questioned about stress, 15 burnout (a fiveitem scale, focusing primarily on emotional exhaustion, with a score of 3 or higher indicating burnout, 16,17 intent to leave in 2 years, and satisfaction. 4 They also provided perceptions of work conditions, including time pressure during visits, work control, emphasis on work home balance, chaotic environments, and organizational culture, such as alignment of values with their leaders. Patient data (up to eight patients with diabetes or hypertension per enrolled clinician) were also included on the OWL worklife and work condition summary.…”

Section: Methodsmentioning

confidence: 99%

“…We also showed that adverse work conditions were associated with an intention to leave the practice and perceptions of suboptimal patient care. 1,4,5 The MEMO study (Minimizing Error, Maximizing Outcome) in [2001][2002][2003][2004][2005] showed that work conditions in primary care were strongly associated with adverse physician outcomes, such as stress, burnout, dissatisfaction and intent to leave. 6 MEMO also demonstrated that some patient outcomes were sensitive to primary care work conditions.…”

Section: Introductionmentioning

confidence: 99%

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A Cluster Randomized Trial of Interventions to Improve Work Conditions and Clinician Burnout in Primary Care: Results from the Healthy Work Place (HWP) Study

et al. 2015

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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.KEY WORDS: burnout; primary care; quality improvement; work conditions.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Cluster Randomized Trial of Interventions to Improve Work Conditions and Clinician Burnout in Primary Care: Results from the Healthy Work Place (HWP) Study

et al. 2015

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“…Drawing from past studies of physician worklife and organizational research 13,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] , items relevant to identified predictors and satisfaction domains were nonparsimoniously compiled into a single item bank. Psychometrically validated attitude questions and scales for established domains of satisfaction were modified to be applicable, meaningful, and appropriate to hospitalists.…”

Section: Survey Instrumentmentioning

confidence: 99%

Worklife and Satisfaction of Hospitalists: Toward Flourishing Careers

et al. 2011

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BACKGROUND:The number of hospitalists in the US is growing rapidly, yet little is known about their worklife to inform whether hospital medicine is a viable longterm career for physicians. OBJECTIVE: Determine current satisfaction levels among hospitalists. DESIGN: Survey study. METHODS: A national random stratified sample of 3,105 potential hospitalists plus 662 hospitalist employees of three multi-state hospitalist companies were administered the Hospital Medicine Physician Worklife Survey. Using 5-point Likert scales, the survey assessed demographic information, global job and specialty satisfaction, and 11 satisfaction domains: workload, compensation, care quality, organizational fairness, autonomy, personal time, organizational climate, and relationships with colleagues, staff, patients, and leader. Relationships between global satisfaction and satisfaction domains, and burnout symptoms and career longevity were explored. RESULTS: There were 816 hospitalist responses (adjusted response rate, 25.6%). Correcting for oversampling of pediatricians, 33.5% of respondents were women, and 7.4% were pediatricians. Overall, 62.6% of respondents reported high satisfaction (≥4 on a 5-point scale) with their job, and 69.0% with their specialty. Hospitalists were most satisfied with the quality of care they provided and relationships with staff and colleagues. They were least satisfied with organizational climate, autonomy, compensation, and availability of personal time. In adjusted analysis, satisfaction with organizational climate, quality of care provided, organizational fairness, personal time, relationship with leader, compensation, and relationship with patients predicted job satisfaction. Satisfaction with personal time, care quality, patient relationships, staff relationships, and compensation predicted specialty satisfaction. Job burnout symptoms were reported by 29.9% of respondents who were more likely to leave and reduce work effort. CONCLUSIONS:Hospitalists rate their job and specialty satisfaction highly, but burnout symptoms are common. Hospitalist programs should focus on organizational climate, organizational fairness, personal time, and compensation to improve satisfaction and minimize attrition.

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“…These factors may, in turn, have a direct impact on patient outcomes including satisfaction, quality, and errors. This model was derived from our earlier work, the Physician Worklife Study 14,15 as well as the pioneering work of Lazarus and Folkman, 16 and Ivancevich and Matteson. 17 Organizational climate in health care (i.e., the perception of culture by those within it) has been described by several authors, including Shortell, 18 Wakefield, 19 and Kralewski.…”

Section: Introductionmentioning

confidence: 99%

Organizational Climate, Stress, and Error in Primary Care:: The MEMO Study

Linzer

Manwell²,

Mundt³

et al. 2005

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Background: The impact of organizational climate on physicians and their patients is not well understood. The Minimizing Error, Maximizing Outcome (MEMO) Study investigates this question through a conceptual model that relates office working conditions to quality of care, as mediated by physician reactions. Methods: MEMO is a longitudinal study of physicians and patients in New York, Chicago, and the state of Wisconsin, including Milwaukee and Madison. Physician surveys assessed office environment and organizational climate (OC). Stress was measured using a 4-item scale, past errors were self reported, and the likelihood of future errors was self-assessed using the OSPRE (Occupational Stress and PReventable Error) measure. Factor analysis revealed new domains of OC. Regression analyses assessed predictors of stress, past errors, and future errors. Results: Among 420 physician respondents, predominantly from general medicine and family medicine practices, 38 percent described their office environment as busy, tending toward chaotic, while another 10 percent described their office environment as hectic or chaotic. Sixty-one percent agreed their work was stressful; 27 percent noted burnout symptoms; and 31 percent of respondents said they were at least moderately likely to leave their jobs within 2 years. The domains of OC (with related Cronbach's alpha values) were: leadership/governance (.86), quality emphasis (.86), belonging/trust (.79), information/communication (.68), and cohesiveness (.66). Chaotic office atmosphere was strongly associated with physician stress (P = .001), while a lack of quality emphasis was associated with past errors (P < .005), and a lack of emphasis on information and communication was associated with a higher likelihood of future errors (P < .02). Less trust in the organization was associated with an intent to leave (P = .001). Other variables associated with physician outcomes included age, gender, ethnicity, work hours, work control, inadequate resources, and a lesser emphasis on diversity. Conclusions: Physician stress is prevalent in primary care; stress and the likelihood of making errors are associated with organizational climate and office environment. Primary care offices could be made safer by emphasizing information systems, promoting a culture of quality, and improving the hectic environment.

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Measuring Physician Job Satisfaction in a Changing Workplace and a Challenging Environment

Abstract: A comprehensive approach to assessing physician job satisfaction yielded 10 facets, some of which had not been previously identified, and generated a matching pool of items for subsequent use in field tests.

Cited by 188 publications

References 26 publications

A Cluster Randomized Trial of Interventions to Improve Work Conditions and Clinician Burnout in Primary Care: Results from the Healthy Work Place (HWP) Study

A Cluster Randomized Trial of Interventions to Improve Work Conditions and Clinician Burnout in Primary Care: Results from the Healthy Work Place (HWP) Study

Worklife and Satisfaction of Hospitalists: Toward Flourishing Careers

Organizational Climate, Stress, and Error in Primary Care:: The MEMO Study

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