Organizational Culture, Job Satisfaction, and Clinician Turnover in Primary Care

Abstract

The purpose of this study is to examine how organizational culture and job satisfaction affect clinician turnover in primary care pediatric practices. One hundred thirty clinicians from 36 primary care pediatric practices completed the Primary Care Organizational Questionnaire (PCOQ), which evaluates interactions among members of the practice and job-related attributes measuring 8 organizational factors, along with a separate 3-item instrument measuring job satisfaction. Random effects logistic models were used to assess the associations between job satisfaction, the organizational factors from the PCOQ, and clinician turnover over the subsequent year. All 8 measured organizational factors from the PCOQ, particularly perceived effectiveness, were associated with job satisfaction. Five of the 8 organizational factors were also associated with clinician turnover. The effects of the organizational factors on turnover were substantially reduced in a model that included job satisfaction; only 1 organizational factor, communication between clinicians and nonclinicians, remained significant (P = .05). This suggests that organizational culture affects subsequent clinician turnover primarily through its effect on job satisfaction. Organizational culture, in particular perceived effectiveness and communication, affects job satisfaction, which in turn affects clinician turnover in primary care pediatric practices. Strategies to improve job satisfaction through changes in organizational culture could potentially reduce clinician turnover.

Practice Environments and Job Satisfaction in Patient-Centered Medical Homes

“…The associations we observed between a quality emphasis, fewer quality problems, and job satisfaction corroborate research showing associations between greater engagement in quality-improvement activities, higher physician satisfaction, and less work-life stress. 9 Similar to Hall et al, 23 we found that a culture of open communication was associated with greater job satisfaction and less burnout. As suggested by other studies, 7 our cross-sectional analysis found that greater office chaos was a key driver of dissatisfaction.…”

Provider's Perspectives on Building Research and Quality Improvement Capacity in Primary Care: A Strategy to Improve Workforce Satisfaction

“…Preliminary evidence suggests that engaging safety‐net providers in research and QI may also improve provider career satisfaction and retention, thereby ameliorating the primary care workforce shortage faced by many safety‐net institutions. Providers at safety‐net institutions face high demands with large patient volumes and work burden, two factors associated with low satisfaction and high turnover rates . Participation in research may lead to more career autonomy which may increase career satisfaction ( Figure ) .…”

“…Providers at safety-net institutions face high demands with large patient volumes and work burden, 2 two factors associated with low satisfaction and high turnover rates. 15,16 Participation in research may lead to more career autonomy which may increase career satisfaction ( Figure 1 ). 16 Th is increased career satisfaction may not only improve provider retention rates, but also improve the quality of care delivered, 16 adherence to medical treatment, 17 and patient satisfaction.…”

Effects of Practice Turnover on Primary Care Quality Improvement Implementation

“…The current literature on turnover in the medical field primarily explores predictive factors, especially among clinicians, as a means for prevention, 14-16 and the impacts of turnover on primary care generally. 10-13 However, little is known about the effects of staff turnover on a practice’s ability to engage in quality improvement (QI) activities, specifically the ways in which turnover can affect a practice’s ability to implement QI activities and sustain practice changes made.…”