Effect of Practice Ownership on Work Environment, Learning Culture, Psychological Safety, and Burnout

Abstract

PURPOSE Physicians have joined larger groups and hospital systems in the face of multiple environmental challenges. We examine whether there are differences across practice ownership in self-reported work environment, a practice culture of learning, psychological safety, and burnout.METHODS Using cross-sectional data from staff surveys of small and medium-size practices that participated in EvidenceNOW in Virginia, we tested for differences in work environment, culture of learning, psychological safety, and burnout by practice type. We conducted weighted multivariate linear regression of outcomes on ownership, controlling for practice size, specialty mix, payer mix, and whether the practice was located in a medically underserved area. We further analyzed clinician and staff responses separately. RESULTSParticipating were 104 hospital-owned and 61 independent practices and 24 federally qualified health centers (FQHCs). We analyzed 2,005 responses from practice clinicians and staff, a response rate of 49%. Working in a hospitalowned practice was associated with favorable ratings of work environment, psychological safety, and burnout compared with independent practices. When we examined separately the responses of clinicians vs staff, however, the association appears to be largely driven by staff.CONCLUSIONS Hospital ownership was associated with positive perceptions of practice work environment and lower burnout for staff relative to independent ownership, whereas clinicians in FQHCs perceive a more negative, less joyful work environment and burnout. Our findings are suggestive that clinician and nonclinician staff perceive practice adaptive reserve differently, which may have implications for creating the energy for ongoing quality improvement work.

Does Ownership Make a Difference in Primary Care Practice?

“…They were also characterized by a comparatively larger practice size as well as higher level of disruption, which may make it difficult for these practices to implement and sustain quality-aligned care delivery processes. Unlike a recent study conducted by 1 of the cooperatives, we did not find lower levels of burnout among health system practices, 43 which is likely explained by heterogeneity in the work environment among health system practices across regions, possibly related to how long they have been in the system. The column "Observations" shows the number of practices with an observed value for the respective measure.…”

Burnout Among Physicians, Advanced Practice Clinicians and Staff in Smaller Primary Care Practices

“…22 Other studies have focused on large health systems 9,23 and have included relatively few physicians, advanced practice clinicians (nurse practitioners, physician assistants [APCs]), and staff from small, independent primary care practices. 24,25 Little is known about how structural, organizational, and contextual characteristics relate to burnout in smaller practices, where over 75% of Americans receive primary care, 26 or whether non-physician team members also suffer from burnout. Therefore, we examined the prevalence of burnout among physicians, APCs and staff, and the relationship between practice-level organizational characteristics and burnout in a large national sample of smaller primary care practices, with the aim of identifying practice characteristics and environments that may provide protection or risk for burnout.…”

A Qualitative Analysis of Implementing EvidenceNOW to Improve Cardiovascular Care

“…In Virginia, 220 primary care practices participated in the HVH initiative. Early findings help portray participating practices, 9 which included a diversity of practice ownership (32% independent, 55% health system owned, and 13% health center). Typical practices were small, including 71% with 1 Figure 1.…”