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.
RESULTS Participating 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 hospital-owned 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.
Footnotes
Conflicts of interest: Dr Nichols. received honoraria from the nonprofit Rocky Mountain Health Plans (Grand Junction, Colorado) for organizing content about national trends and facilitating board retreat discussions, and from the American Medical Association for speaking at their annual state advocacy conference on antitrust issues. Dr Nichols is also the Director of George Mason University’s Center for Health Policy Research and Ethics, whose 501(c)(3) Foundation account received a grant from America’s Health Insurance Plans to support graduate student work on health care market issues. Dr Nichols is a member of the unpaid Board of Trustees of the National Committee for Quality Assurance, and an unpaid advisor on payment reform matters to the Patient-Centered Primary Care Collaborative. All other authors declare no conflicts of interest.
Funding support: Publication of this article was supported by the Agency for Healthcare Research and Quality (AHRQ) through contract No. HHSA290201200019I, and grant No. R18 HS023913.
Disclaimer: This work represents the opinions of the authors and should not be interpreted as official positions of the Agency for Healthcare Research and Quality or the US Department of Health and Human Services.
Supplementary materials: Available at http://www.AnnFamMed.org/content/16/Suppl_/S44/suppl/DC1/.
- Received for publication June 15, 2017.
- Revision received December 15, 2017.
- Accepted for publication December 22, 2017.
- © 2018 Annals of Family Medicine, Inc.