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

Abstract

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.

Keywords: burnout; physician burnout; physician stress; work-life; work-life interventions.

Conflict of interest statement

Compliance with Ethical Standards Funders This research was supported by the Agency for Healthcare Research and Quality (AHRQ) grant no. 5R18-HS018160-03. The funder had no role in the design, conduct, analysis, or publication of the study. Conflict of Interest Dr. Hicks acknowledges royalties from a textbook. Mr. Barbouche is the CEO of Forward Health Group, Inc., owns stock in the company, and has patents pending. The other authors declare that they have no conflict of interest.

Figures

Figure 1

Consort diagram for patient flow in the HWP cluster randomized controlled trial of work-life interventions. Additional providers joined the study after allocations.