Creating Healthy Work Places (HWP) Study

NCT ID: NCT02542995

Last Updated: 2015-09-07

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 1296 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2009-11-30
• Study Completion Date: 2014-01-31

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 Description

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=165) were surveyed to collect OWL data on provider outcomes, and organizational structure and culture. Managers were asked to provide information on clinic structure, policies and procedures. Eight patients per provider (n=1131) with hypertension and /or diabetes will be surveyed on health literacy, quality of life, medication compliance, satisfaction, and trust. Patient charts were audited to assess hypertension and diabetes management. The data was then compiled into an OWL measure for each clinic.

34 clinics were randomized. Local leaders, providers, and staff in 17 intervention clinics received their OWL measure and discussed the successes and challenges to care illustrated by the data. Assisted by the study team, they developed QI plans focusing on workplace variables that investigators found contributed to care quality: time pressure, work control, work pace (chaos), and organizational culture. Twelve months later (Aug. 2012 - Jan. 2013), OWL data was recollected in all 34 clinics and compared.

New OWL data was fed back to personnel in the 17 intervention clinics to formalize its role in continuous QI processes. Control clinics received their OWL data at study end. Subsets of data were analyzed to determine the best ways to modify the work environment to improve outcomes for underrepresented groups (women and minority providers and minority patients).

Conditions

Burnout, Professional

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: HEALTH_SERVICES_RESEARCH
• Blinding Strategy: SINGLE

Study Groups

Non-intervention

Usual clinical conditions

Group Type: NO_INTERVENTION

No interventions assigned to this group

Intevention

QI interventions and got to see their own survey data - examples include:

Workflow redesign:

Medical Assistant (MA) data entry Improved clinic efficiency projects Assessed workflow with staff Provided time for MAs and RNs to perform tasks Paired MAs and providers Non-physician staff assist with forms

Communication improvement:

Improved teamwork Improved communication between provider groups Routine clinician meetings discussing meaningful topics Survey of providers for "wish list" of issues Routine emails from leaders Clinicians meeting with leaders

Chronic disease QI projects:

Establishing quality metrics with clinician input Automated Rx refill line Med reconciliation project Screening project for diabetics Screening for depression Improved patient portals

Group Type: OTHER

QI interventions

Intervention Type: OTHER

Intervention categories: communication improvement, chronic disease QI projects (for patients), workflow redesign

Interventions

QI interventions

Intervention categories: communication improvement, chronic disease QI projects (for patients), workflow redesign

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• 18+,
• have a primary care provider at one of enrolling institutions,
• have a primary care visit within year of enrollment

Exclusion Criteria

• Deceased,
• inability to communicate (hard of hearing), etc.

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Agency for Healthcare Research and Quality (AHRQ)

FED

Sponsor Role: collaborator

University of Wisconsin, Madison

OTHER

Sponsor Role: collaborator

Marshfield Clinic Research Foundation

OTHER

Sponsor Role: collaborator

New York University

OTHER

Sponsor Role: collaborator

Loyola University School of Medicine

UNKNOWN

Sponsor Role: collaborator

University of Alabama, Tuscaloosa

OTHER

Sponsor Role: collaborator

University of Missouri-Columbia

OTHER

Sponsor Role: collaborator

Hennepin Healthcare Research Institute

OTHER

Sponsor Role: lead

Responsible Party

Mark Linzer

Division Director of General Internal Medicine

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Mark Linzer, MD

Role: PRINCIPAL_INVESTIGATOR

MMRF

References

Khullar D, Prasad K, Neprash H, Poplau S, Brown RL, Williams ES, Audi C, Linzer M. Factors associated with patient trust in their clinicians: Results from the Healthy Work Place Study. Health Care Manage Rev. 2022 Oct-Dec 01;47(4):289-296. doi: 10.1097/HMR.0000000000000336. Epub 2022 Feb 17.

Reference Type: DERIVED

PMID: 35170482 (View on PubMed)

Linzer M, Poplau S, Brown R, Grossman E, Varkey A, Yale S, Williams ES, Hicks L, Wallock J, Kohnhorst D, Barbouche M. Do Work Condition Interventions Affect Quality and Errors in Primary Care? Results from the Healthy Work Place Study. J Gen Intern Med. 2017 Jan;32(1):56-61. doi: 10.1007/s11606-016-3856-2. Epub 2016 Sep 9.

Reference Type: DERIVED

PMID: 27612486 (View on PubMed)

Other Identifiers

AHRQ 1R18-HSO18160-03

Identifier Type: -

Identifier Source: org_study_id