Robert S Nocon1,2,3, Paige C Fairchild4, Yue Gao4, Kathryn E Gunter4, Sang Mee Lee5, Michael Quinn4, Elbert S Huang4, Marshall H Chin4. 1. Department of Medicine, University of Chicago, Chicago, IL, USA. rnocon@bsd.uchicago.edu. 2. Department of Public Health Sciences, University of Chicago, Chicago, IL, USA. rnocon@bsd.uchicago.edu. 3. University of Chicago, 5841 S. Maryland Ave. MC2007, Chicago, IL, 60637, USA. rnocon@bsd.uchicago.edu. 4. Department of Medicine, University of Chicago, Chicago, IL, USA. 5. Department of Public Health Sciences, University of Chicago, Chicago, IL, USA.
Abstract
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.
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.
Entities:
Keywords:
job satisfaction; medical home; morale; primary care; safety net
Authors: Jonathan M Birnberg; Melinda L Drum; Elbert S Huang; Lawrence P Casalino; Sarah E Lewis; Anusha M Vable; Hui Tang; Michael T Quinn; Deborah L Burnet; Thomas Summerfelt; Marshall H Chin Journal: J Gen Intern Med Date: 2011-08-12 Impact factor: 5.128
Authors: Farr A Curlin; Karen D Serrano; Matthew G Baker; Sarah L Carricaburu; Douglas R Smucker; Marshall H Chin Journal: J Health Care Poor Underserved Date: 2006-11
Authors: Paul A Nutting; William L Miller; Benjamin F Crabtree; Carlos Roberto Jaen; Elizabeth E Stewart; Kurt C Stange Journal: Ann Fam Med Date: 2009 May-Jun Impact factor: 5.166
Authors: Robert J Reid; Katie Coleman; Eric A Johnson; Paul A Fishman; Clarissa Hsu; Michael P Soman; Claire E Trescott; Michael Erikson; Eric B Larson Journal: Health Aff (Millwood) Date: 2010-05 Impact factor: 6.301
Authors: Sarah E Lewis; Robert S Nocon; Hui Tang; Seo Young Park; Anusha M Vable; Lawrence P Casalino; Elbert S Huang; Michael T Quinn; Deborah L Burnet; Wm Thomas Summerfelt; Jonathan M Birnberg; Marshall H Chin Journal: Arch Intern Med Date: 2012-01-09
Authors: Mark Linzer; Linda Baier Manwell; Eric S Williams; James A Bobula; Roger L Brown; Anita B Varkey; Bernice Man; Julia E McMurray; Ann Maguire; Barbara Horner-Ibler; Mark D Schwartz Journal: Ann Intern Med Date: 2009-07-07 Impact factor: 25.391
Authors: Eric A Apaydin; Danielle Rose; Lisa S Meredith; Michael McClean; Timothy Dresselhaus; Susan Stockdale Journal: J Gen Intern Med Date: 2020-04-06 Impact factor: 5.128