Published in:
01-06-2019 | Care
Provider and Staff Morale, Job Satisfaction, and Burnout over a 4-Year Medical Home Intervention
Published in: Journal of General Internal Medicine | Issue 6/2019
Login to get accessAbstract
Background
The patient-centered medical home (PCMH) is a widely adopted primary care model. However, it is unclear whether changes in provider and staff perceptions of clinic PCMH capability are associated with changes in provider and staff morale, job satisfaction, and burnout in safety net clinics.
Objective
To determine how provider and staff PCMH ratings changed under a multi-year PCMH transformation initiative and assess whether changes in provider and staff PCMH ratings were associated with changes in morale, job satisfaction, and burnout.
Design
Comparison of baseline (2010) and post-intervention (2013–2014) surveys.
Setting
Sixty clinics in five states.
Participants
Five hundred thirty-six (78.2%) providers and staff at baseline and 589 (78.3%) post-intervention.
Intervention
Collaborative learning sessions and on-site coaching to implement PCMH over 4 years.
Measurements
Provider and staff PCMH ratings on 0 (worst) to 100 (best) scales; percent of providers and staff reporting good or better morale, job satisfaction, and freedom from burnout.
Results
Almost half of safety net clinics improved PCMH capabilities from the perspective of providers (28 out of 59, 47%) and staff (25 out of 59, 42%). Over the same period, clinics saw a decrease in the percentage of providers reporting high job satisfaction (− 12.3% points, p = .009) and freedom from burnout (− 10.4% points, p = .006). Worsened satisfaction was concentrated among clinics that had decreased PCMH rating, with those clinics seeing far fewer providers report high job satisfaction (− 38.1% points, p < 0.001).
Limitations
Control clinics were not used. Individual-level longitudinal survey administration was not feasible.
Conclusion
If clinics pursue PCMH transformation and providers do not perceive improvement, they may risk significantly worsened job satisfaction. Clinics should be aware of this potential risk of PCMH transformation and ensure that providers are aware of PCMH improvements.