Clinical Trial: Creating Healthy Work Places (HWP) Study

Study Status: Completed
Recruit Status: Completed
Study Type: Interventional

Official Title: Creating Healthy Workplaces: Improving Outcomes for Providers and Patients

Brief Summary: The health of the public depends upon smoothly functioning physician offices that promote the health of both workers and their patients. This study targets ambulatory health care offices with rapid paced, chaotic environments. Investigators will measure adverse outcomes for providers and staff (e.g., stress and burnout), the impact these have on quality of care for hypertensive, diabetic and depressed patients, and identify areas where practice redesign to create "healthy workplaces" improves these outcomes.

Detailed Summary:

The context in which primary care is delivered is rarely evaluated as part of quality improvement initiatives or research projects. Data from the MEMO Study (Minimizing Error, Maximizing Outcome) confirm a relationship between the work environment, provider reactions, and patient care. Time pressure is associated with physician satisfaction, stress, burnout, and intent to leave as well as lower quality care for hypertensive patients. Lack of values alignment between physicians and leaders is associated with physician satisfaction, stress, burnout, and intent to leave as well as poorer diabetes care and fewer prevention activities. Thus, providers are not the only ones at risk in adverse work conditions. An important coexisting factor is the impending primary care physician shortage. Less than optimal work conditions are associated with physician intent to leave and with reduced medical student interest in primary care. This randomized study assessed the impact of applying a novel quality improvement strategy designed to create "healthy workplaces".

The investigators hypothesized that addressing adverse primary care work conditions (workflow, work control, organizational culture) would lead to greater clinician participation in programs to improve health care delivery. As part of MEMO, the investigators developed the Office and Work Life (OWL) measurement tool. The OWL assesses the primary care workplace and identifies specific working conditions that impact provider outcomes and quality of care. The current proposal assessed the ability of the OWL and a focused QI process to facilitate changes in the work environment and improve outcomes for providers and patients.

Thirty-four primary care clinics were recruited in New York City and the upper Midwest. Physicians, physician assistants, and nurse practitioners (n=1
Sponsor: Minneapolis Medical Research Foundation

Current Primary Outcome:

  • Medical provider stress and burnout [ Time Frame: Provider outcomes were measured approximately one year after the interventions ]
    Survey tools: to measure provider stress and burnout developed (for providers), the survey tools were used in the MEMO study and have 1-5 scales.
  • Patient satisfaction with care [ Time Frame: Patient satisfaction was measured at baseline and approxmiaetly one year after the interventions ]
    Survey tool (patients self reported), the survey tools were used in the MEMO study and have 1-5 scales.
  • Patient quality of care [ Time Frame: Patient quality of care was measured at baseline and approxmiaetly one yr after the interventions ]
    Chart audits


Original Primary Outcome: Same as current

Current Secondary Outcome: Provider turnover (cost) [ Time Frame: Provider turnover (cost) was mesasured about one year after the interventions ]

Clinic managers were given a survey (similar to the ones used by provider and patients) and asked to document the clinic staff make up, how often positions were posted and the length of time of the posting to help assess cost of provider turnover.


Original Secondary Outcome: Same as current

Information By: Minneapolis Medical Research Foundation

Dates:
Date Received: August 27, 2015
Date Started: November 2009
Date Completion:
Last Updated: September 3, 2015
Last Verified: September 2015