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Creating Healthy Work Places (HWP) Study (HWP)

Primary Purpose

Burnout, Professional

Status
Completed
Phase
Not Applicable
Locations
Study Type
Interventional
Intervention
QI interventions
Sponsored by
Hennepin Healthcare Research Institute
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional health services research trial for Burnout, Professional

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • 18+,
  • have a primary care provider at one of enrolling institutions,
  • have a primary care visit within year of enrollment

Exclusion Criteria:

  • Deceased,
  • inability to communicate (hard of hearing), etc.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm Type

    No Intervention

    Other

    Arm Label

    Non-intervention

    Intevention

    Arm Description

    Usual clinical conditions

    QI interventions and got to see their own survey data - examples include: Workflow redesign: Medical Assistant (MA) data entry Improved clinic efficiency projects Assessed workflow with staff Provided time for MAs and RNs to perform tasks Paired MAs and providers Non-physician staff assist with forms Communication improvement: Improved teamwork Improved communication between provider groups Routine clinician meetings discussing meaningful topics Survey of providers for "wish list" of issues Routine emails from leaders Clinicians meeting with leaders Chronic disease QI projects: Establishing quality metrics with clinician input Automated Rx refill line Med reconciliation project Screening project for diabetics Screening for depression Improved patient portals

    Outcomes

    Primary Outcome Measures

    Medical provider stress and burnout
    Survey tools: to measure provider stress and burnout developed (for providers), the survey tools were used in the MEMO study and have 1-5 scales.
    Patient satisfaction with care
    Survey tool (patients self reported), the survey tools were used in the MEMO study and have 1-5 scales.
    Patient quality of care
    Chart audits

    Secondary Outcome Measures

    Provider turnover (cost)
    Clinic managers were given a survey (similar to the ones used by provider and patients) and asked to document the clinic staff make up, how often positions were posted and the length of time of the posting to help assess cost of provider turnover.

    Full Information

    First Posted
    August 27, 2015
    Last Updated
    September 3, 2015
    Sponsor
    Hennepin Healthcare Research Institute
    Collaborators
    Agency for Healthcare Research and Quality (AHRQ), University of Wisconsin, Madison, Marshfield Clinic Research Foundation, New York University, Loyola University School of Medicine, University of Alabama, Tuscaloosa, University of Missouri-Columbia
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    1. Study Identification

    Unique Protocol Identification Number
    NCT02542995
    Brief Title
    Creating Healthy Work Places (HWP) Study
    Acronym
    HWP
    Official Title
    Creating Healthy Workplaces: Improving Outcomes for Providers and Patients
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    September 2015
    Overall Recruitment Status
    Completed
    Study Start Date
    November 2009 (undefined)
    Primary Completion Date
    March 2013 (Actual)
    Study Completion Date
    January 2014 (Actual)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Principal Investigator
    Name of the Sponsor
    Hennepin Healthcare Research Institute
    Collaborators
    Agency for Healthcare Research and Quality (AHRQ), University of Wisconsin, Madison, Marshfield Clinic Research Foundation, New York University, Loyola University School of Medicine, University of Alabama, Tuscaloosa, University of Missouri-Columbia

    4. Oversight

    Data Monitoring Committee
    No

    5. Study Description

    Brief Summary
    The health of the public depends upon smoothly functioning physician offices that promote the health of both workers and their patients. This study targets ambulatory health care offices with rapid paced, chaotic environments. Investigators will measure adverse outcomes for providers and staff (e.g., stress and burnout), the impact these have on quality of care for hypertensive, diabetic and depressed patients, and identify areas where practice redesign to create "healthy workplaces" improves these outcomes.
    Detailed Description
    The context in which primary care is delivered is rarely evaluated as part of quality improvement initiatives or research projects. Data from the MEMO Study (Minimizing Error, Maximizing Outcome) confirm a relationship between the work environment, provider reactions, and patient care. Time pressure is associated with physician satisfaction, stress, burnout, and intent to leave as well as lower quality care for hypertensive patients. Lack of values alignment between physicians and leaders is associated with physician satisfaction, stress, burnout, and intent to leave as well as poorer diabetes care and fewer prevention activities. Thus, providers are not the only ones at risk in adverse work conditions. An important coexisting factor is the impending primary care physician shortage. Less than optimal work conditions are associated with physician intent to leave and with reduced medical student interest in primary care. This randomized study assessed the impact of applying a novel quality improvement strategy designed to create "healthy workplaces". The investigators hypothesized that addressing adverse primary care work conditions (workflow, work control, organizational culture) would lead to greater clinician participation in programs to improve health care delivery. As part of MEMO, the investigators developed the Office and Work Life (OWL) measurement tool. The OWL assesses the primary care workplace and identifies specific working conditions that impact provider outcomes and quality of care. The current proposal assessed the ability of the OWL and a focused QI process to facilitate changes in the work environment and improve outcomes for providers and patients. Thirty-four primary care clinics were recruited in New York City and the upper Midwest. Physicians, physician assistants, and nurse practitioners (n=165) were surveyed to collect OWL data on provider outcomes, and organizational structure and culture. Managers were asked to provide information on clinic structure, policies and procedures. Eight patients per provider (n=1131) with hypertension and /or diabetes will be surveyed on health literacy, quality of life, medication compliance, satisfaction, and trust. Patient charts were audited to assess hypertension and diabetes management. The data was then compiled into an OWL measure for each clinic. 34 clinics were randomized. Local leaders, providers, and staff in 17 intervention clinics received their OWL measure and discussed the successes and challenges to care illustrated by the data. Assisted by the study team, they developed QI plans focusing on workplace variables that investigators found contributed to care quality: time pressure, work control, work pace (chaos), and organizational culture. Twelve months later (Aug. 2012 - Jan. 2013), OWL data was recollected in all 34 clinics and compared. New OWL data was fed back to personnel in the 17 intervention clinics to formalize its role in continuous QI processes. Control clinics received their OWL data at study end. Subsets of data were analyzed to determine the best ways to modify the work environment to improve outcomes for underrepresented groups (women and minority providers and minority patients).

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Burnout, Professional

    7. Study Design

    Primary Purpose
    Health Services Research
    Study Phase
    Not Applicable
    Interventional Study Model
    Parallel Assignment
    Masking
    Participant
    Allocation
    Randomized
    Enrollment
    1296 (Actual)

    8. Arms, Groups, and Interventions

    Arm Title
    Non-intervention
    Arm Type
    No Intervention
    Arm Description
    Usual clinical conditions
    Arm Title
    Intevention
    Arm Type
    Other
    Arm Description
    QI interventions and got to see their own survey data - examples include: Workflow redesign: Medical Assistant (MA) data entry Improved clinic efficiency projects Assessed workflow with staff Provided time for MAs and RNs to perform tasks Paired MAs and providers Non-physician staff assist with forms Communication improvement: Improved teamwork Improved communication between provider groups Routine clinician meetings discussing meaningful topics Survey of providers for "wish list" of issues Routine emails from leaders Clinicians meeting with leaders Chronic disease QI projects: Establishing quality metrics with clinician input Automated Rx refill line Med reconciliation project Screening project for diabetics Screening for depression Improved patient portals
    Intervention Type
    Other
    Intervention Name(s)
    QI interventions
    Intervention Description
    Intervention categories: communication improvement, chronic disease QI projects (for patients), workflow redesign
    Primary Outcome Measure Information:
    Title
    Medical provider stress and burnout
    Description
    Survey tools: to measure provider stress and burnout developed (for providers), the survey tools were used in the MEMO study and have 1-5 scales.
    Time Frame
    Provider outcomes were measured approximately one year after the interventions
    Title
    Patient satisfaction with care
    Description
    Survey tool (patients self reported), the survey tools were used in the MEMO study and have 1-5 scales.
    Time Frame
    Patient satisfaction was measured at baseline and approxmiaetly one year after the interventions
    Title
    Patient quality of care
    Description
    Chart audits
    Time Frame
    Patient quality of care was measured at baseline and approxmiaetly one yr after the interventions
    Secondary Outcome Measure Information:
    Title
    Provider turnover (cost)
    Description
    Clinic managers were given a survey (similar to the ones used by provider and patients) and asked to document the clinic staff make up, how often positions were posted and the length of time of the posting to help assess cost of provider turnover.
    Time Frame
    Provider turnover (cost) was mesasured about one year after the interventions

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: 18+, have a primary care provider at one of enrolling institutions, have a primary care visit within year of enrollment Exclusion Criteria: Deceased, inability to communicate (hard of hearing), etc.
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Mark Linzer, MD
    Organizational Affiliation
    MMRF
    Official's Role
    Principal Investigator

    12. IPD Sharing Statement

    Citations:
    PubMed Identifier
    35170482
    Citation
    Khullar D, Prasad K, Neprash H, Poplau S, Brown RL, Williams ES, Audi C, Linzer M. Factors associated with patient trust in their clinicians: Results from the Healthy Work Place Study. Health Care Manage Rev. 2022 Oct-Dec 01;47(4):289-296. doi: 10.1097/HMR.0000000000000336. Epub 2022 Feb 17.
    Results Reference
    derived
    PubMed Identifier
    27612486
    Citation
    Linzer M, Poplau S, Brown R, Grossman E, Varkey A, Yale S, Williams ES, Hicks L, Wallock J, Kohnhorst D, Barbouche M. Do Work Condition Interventions Affect Quality and Errors in Primary Care? Results from the Healthy Work Place Study. J Gen Intern Med. 2017 Jan;32(1):56-61. doi: 10.1007/s11606-016-3856-2. Epub 2016 Sep 9.
    Results Reference
    derived

    Learn more about this trial

    Creating Healthy Work Places (HWP) Study

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