Patient-Centered Medical Home Characteristics and Staff Morale in Safety Net Clinics

Abstract

Background We sought to determine whether perceived patient-centered medical home (PCMH) characteristics are associated with staff morale, job satisfaction, and burnout in safety net clinics. Methods Self-administered survey among 391 providers and 382 clinical staff across 65 safety net clinics in 5 states in 2010. The following 5 subscales measured respondents’ perceptions of PCMH characteristics on a scale of 0 to 100 (0 indicates worst and 100 indicates best): access to care and communication with patients, communication with other providers, tracking data, care management, and quality improvement. The PCMH sub-scale scores were averaged to create a total PCMH score. Results Six hundred three persons (78.0%) responded. In multivariate generalized estimating equation models, a 10% increase in the quality improvement subscale score was associated with higher morale (provider odds ratio [OR], 2.64; 95% CI, 1.47–4.75; staff OR, 3.62; 95% CI, 1.84–7.09), greater job satisfaction (provider OR, 2.45; 95% CI, 1.42–4.23; staff OR, 2.55; 95% CI 1.42–4.57), and freedom from burnout (staff OR, 2.32; 95% CI, 1.31–4.12). The total PCMH score was associated with higher staff morale (OR, 2.63; 95% CI, 1.47–4.71) and with lower provider freedom from burnout (OR, 0.48; 95% CI, 0.30–0.77). A separate work environment covariate correlated highly with the quality improvement subscale score and the total PCMH score, and PCMH characteristics had attenuated associations with morale and job satisfaction when included in models. Conclusions Providers and staff who perceived more PCMH characteristics in their clinics were more likely to have higher morale, but the providers had less freedom from burnout. Among the PCMH subscales, the quality improvement subscale score particularly correlated with higher morale, greater job satisfaction, and freedom from burnout.

Team Structure and Culture Are Associated With Lower Burnout in Primary Care

“…1 A study using crosssectional methods found that patient-centered medical home attributes were associated with lower morale at a group of safety net clinics, 36 although there is evidence that improvements in quality and care delivery at safety net clinics are associated with higher morale and lower burnout when there is adequate staffing, fair distribution of responsibility, and training infrastructure. 37 Keeping a focus on team culture could enhance the effects of practice transformation on work life experiences.…”

Is Training in a Primary Care Internal Medicine Residency Associated with a Career in Primary Care Medicine?

“…31,32 A recent study compared internal medicine residents' likelihood of entering GIM as a result of clinic to likelihood of entering a career in GIM before clinic, and demonstrated that 28 % were less likely to enter GIM as a result of their clinic experience, 59 % had no difference in likelihood, and only 11 % were more likely to enter general IM as a result of clinic. 34 Current attempts to improve the outpatient clinic experience include the development of patientcentered medical homes and accountable care organizations, 35,36 efforts to decrease panel size, and the creation of multidisciplinary, inter-professional teams. 10 These changes should help to train residents in team environments that allow physicians to work at the peak of their training levels and in more satisfying work conditions.…”

“…10 These changes should help to train residents in team environments that allow physicians to work at the peak of their training levels and in more satisfying work conditions. 36 Additionally, increased support of non-face to face patient care encounters as well as ambulatory payment reforms 37 might entice debt-ridden residents 38,39 to enter the primary care field.…”

Elements of Team-Based Care in a Patient-Centered Medical Home Are Associated with Lower Burnout Among VA Primary Care Employees

“…26 However, Nutting and colleagues reported change fatigue, including burnout and turnover, among participants in the National Demonstration Project, 27 and Lewis and colleagues found greater PCMH characteristics associated with high staff morale, but also higher provider burnout, among 65 safety-net clinics in a 2010 survey. 28 Moreover, organizational research has previously found workplace change-particularly frequent change or multiple changes-associated with greater burnout. 29,30 In addition to offering conflicting findings, the existing literature on PCMH implementation and burnout is limited by small sample sizes, generally restricted to PCMH demonstration sites, and a focus almost exclusively on the physician experience.…”