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Culture, quality improvement key to preventing health care burnout

OHSU study says teamwork, communication and mindfulness in primary care settings is associated with lower rates of clinician and staff burnout
Group of medical students in a medical training class, all are wearing masks due to COVID-19.
An analysis conducted at OHSU and VA Portland Health Care System finds teamwork, communication and mindfulness may help alleviate clinician and staff burnout in primary care settings. (Getty Images)

Burnout amongst health care workers is a growing concern, particularly during the COVID-19 pandemic. However, a study of health care professionals who work in small or independent primary care practices offers insight into how practice environments may prevent burnout.

The study, conducted at Oregon Health & Science University, analyzed survey responses from 715 small-to-medium-size primary care practices in the United States and determined the least amount of physician and employee burnout occurred in settings that maintained a strong practice culture focused on facilitative leadership that encourages teamwork, enhanced communication and mindfulness. The majority of “zero-burnout” practices also used quality improvement strategies more often than those who experience higher rates of employee burnout.

“Surprisingly, our study showed no association between burnout and the number of patients seen per clinician per day,” says the study’s lead author Samuel T. Edwards, M.D., M.P.H., assistant professor of medicine (general internal medicine and geriatrics) in the OHSU School of Medicine and staff physician (internal medicine) at the Veterans Affairs Portland Health Care System. “However, we did find that the survey respondents who felt a greater sense of support and job control could balance known stressors - including high volume of patients - and showed lower rates of overall burnout.”

Edwards believes that primary care practices of all sizes, from independent clinics to large health care institutions, can implement aspects of leadership, communication and support to help alleviate the impacts of clinical stress.

“Certainly, personal interventions such as counseling or time away from work can be helpful to a distressed individual,” he says. “However, to significantly impact the overall wellness of an entire practice or work unit, leaders should consider an organization-wide approach. Creating supportive environments and offering more local control to help balance employee and patient needs could allow greater opportunity to provide the best care to everyone.”

The results of the study are published online in the journal Health Affairs.

This research is supported by the Agency for Healthcare Research and Quality (Grant No. R01 HS023940, Deborah Cohen, PI); Edwards was also supported by the Department of Veterans Affairs Health Services Research & Development (Grant No. CDA 16-152).

Listen to Edwards further discuss study findings on the Health Affairs’ Health Podyssey podcast.

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