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Physician burnout intervention not associated with reduced errors, improved quality

An intervention focused on improving physician work-life balance did not improve patient care in primary care settings, according to data published in the Journal of General Internal Medicine.

The intervention did not lead to a reduction in medical errors or an improvement in care quality, Mark Linzer, MD, from the University of Minnesota Medical School and Hennepin County Medical Center in Minneapolis, and colleagues reported.

"In the late 1990s, the Agency for Healthcare Quality and Research (AHRQ) highlighted the potential link between work conditions in doctors' offices and the quality of care they provided," Linzer and colleagues wrote. "Since then, numerous investigations have assessed these connections. The literature shows a clear relationship between work conditions and clinician outcomes such as satisfaction, stress, burnout, and intent to leave the practice, but the relationship between work conditions and patient outcomes has remained elusive."

The researchers assessed data from the Healthy Work Place Study to evaluate work-life interventions and their effect on care quality and medical errors. This data included 34 clinics, 160 primary health care providers and 735 patients with diabetes or hypertension

The clinics were randomized to intervention or control arms. Clinics in the intervention arm received interventions designed based on data from Office and Work Life measures, and were aimed at "improving communication between providers, workflow redesign, and targeted chronic disease management programs."

Results showed that, between the two groups, there was no significant difference in care quality improvement (19% vs. 44%; OR = 0.62; 95% CI, 0.58-1.21) or error reduction (19% vs. 11%; OR = 1.84; 95% CI, 0.7-4.82).

In clinics that utilized it, the Minimizing Error, Maximizing Outcome (MEMO) model demonstrated an association between provider outcomes and working conditions (P .001) and a reduction in error rate in physicians with lower burnout scores (OR = 1.44; 95% CI, 0.94-2.23; P = .09).

"In summary, [the Healthy Work Place Study] has shown that work-life changes can lead to meaningful changes in clinician outcomes, but that these changes do not necessarily translate into improved patient care," Linzer and colleagues concluded. "Improvements in quality and patient safety may require more focused sustainable programs. Interventions will potentially be more effective in clinicians with lower burnout who are better equipped for sustained engagement in QI activities." – by Chelsea Frajerman Pardes

Disclosures: Linzer reports no relevant financial disclosures. Please see the full study for a complete list of all other authors' relevant financial disclosures.