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01-02-2020 | Care | Original Research

Time Pressure During Primary Care Office Visits: a Prospective Evaluation of Data from the Healthy Work Place Study

Authors: Kriti Prasad, BA, Sara Poplau, BA, Roger Brown, PhD, Steven Yale, MD, MACP, Ellie Grossman, MD, MPH, Anita B. Varkey, MD, Eric Williams, PhD, Hannah Neprash, PhD, Mark Linzer, MD, MACP, for the Healthy Work Place (HWP) Investigators

Published in: Journal of General Internal Medicine | Issue 2/2020

Abstract

Background

The relationship between worklife factors, clinician outcomes, and time pressure during office visits is unclear.

Objective

To quantify associations between time pressure, workplace characteristics ,and clinician outcomes.

Design

Prospective analysis of data from the Healthy Work Place randomized trial.

Participants

168 physicians and advanced practice clinicians in 34 primary care practices in Upper Midwest and East Coast.

Main Measures and Methods

Time pressure was present when clinicians needed more time than allotted to provide quality care. Other metrics included work control, work pace (calm to chaotic), organizational culture and clinician satisfaction, stress, burnout, and intent to leave the practice. Hierarchical analysis assessed relationships between time pressure, organizational characteristics, and clinician outcomes. Adjusted differences between clinicians with and without time pressure were expressed as effect sizes (ESs).

Key Results

Sixty-seven percent of clinicians needed more time for new patients and 53% needed additional time for follow-up appointments. Time pressure in new patient visits was more prevalent in general internists than in family physicians (74% vs 55%, p < 0.05), women versus men (78% vs 55%, p < 0.01), and clinicians with larger numbers of complex psychosocial (81% vs 59%, p < 0.01) and Limited English Proficiency patients (95% vs 57%, p < 0.001). Time pressure in new patient visits was associated with lack of control, clinician stress, and intent to leave (ESs small to moderate, p < 0.05). Time pressure in follow-up visits was associated with chaotic workplaces and burnout (small to moderate ESs, p’s < 0.05). Time pressure improved over time in workplaces with values alignment and an emphasis on quality.

Conclusions

Time pressure, more common in women and general internists, was related to chaos, control and culture, and stress, burnout, and intent to leave. Future studies should evaluate these findings in larger and more geographically diverse samples.

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Title: Time Pressure During Primary Care Office Visits: a Prospective Evaluation of Data from the Healthy Work Place Study
Authors: Kriti Prasad, BA
Sara Poplau, BA
Roger Brown, PhD
Steven Yale, MD, MACP
Ellie Grossman, MD, MPH
Anita B. Varkey, MD
Eric Williams, PhD
Hannah Neprash, PhD
Mark Linzer, MD, MACP
for the Healthy Work Place (HWP) Investigators
Publication date: 01-02-2020
Publisher: Springer US
Keywords: Care
Burnout Syndrome
Published in: Journal of General Internal Medicine / Issue 2/2020
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-019-05343-6

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Abstract

Background

Objective

Design

Participants

Main Measures and Methods

Key Results

Conclusions

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Main Measures and Methods

Key Results

Conclusions

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