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Background: Burnout is very common and has significant negative outcomes for both nurses and patients. However, this literature has only recently begun to address the processes that explain why health care provider burnout leads to negative patient outcomes. This article extends that literature by examining how satisfaction with work processes impacts the link between nurse burnout and work-arounds., Purpose: The purpose of this study was to examine the relationships between emotional exhaustion and potentially unsafe work practices (work-arounds) in the context of nursing administration of medication., Methodology/approach: The data were collected using online survey software and pencil-and-paper surveys returned directly to the researchers. The study was conducted among nurses in 2 acute care hospitals in the Midwestern United States. For one of the samples, data on work-arounds were provided by the nurses' supervisors. For the other sample, data were collected at a 6-month interval. The survey included measures of emotional exhaustion (the Maslach Burnout Inventory), work-arounds, and nurse satisfaction with medication administration processes., Findings: We found that exhaustion was associated with greater use of work-arounds of medication administration processes. We also found that when nurses were more satisfied with the medication administration process, exhausted nurses were less likely to engage in work-arounds., Practice Implications: The findings suggest that although exhaustion in nurses can lead to potentially unsafe practices, satisfaction with the work process can either exacerbate or reduce the problem.

Background: Difficult patient encounters in the primary care office are frequent and are associated with physician burnout. However, their relationship to patient care outcomes is not known., Objective: To determine the effect of difficult encounters on patient health outcomes and the role of physician dissatisfaction and burnout as mediators of this effect., Design: A total of 422 physicians were sorted into 3 clusters based on perceived frequency of difficult patient encounters in their practices. Patient charts were audited to assess the quality of hypertension and diabetes management and preventive care based on national guidelines. Summary measures of quality and errors were compared among the 3 physician clusters., Results: Of the 1384 patients, 359 were cared for by high-cluster physicians (those who had a high frequency of difficult encounters), 871 by medium-cluster physicians, and 154 by low-cluster physicians. Dissatisfaction and burnout were higher among physicians reporting higher frequencies of difficult encounters. However, quality of patient care and management errors were similar across all 3 groups., Conclusions: Physician perception of frequent difficult encounters was not associated with worse patient care quality or more medical errors. Future studies should investigate whether other patient outcomes, including acute care and patient satisfaction, are affected by difficult encounters.

Background: Adverse primary care work conditions could lead to a reduction in the primary care workforce and lower-quality patient care., Objective: To assess the relationship among adverse primary care work conditions, adverse physician reactions (stress, burnout, and intent to leave), and patient care., Design: Cross-sectional analysis., Setting: 119 ambulatory clinics in New York, New York, and in the upper Midwest., Participants: 422 family practitioners and general internists and 1795 of their adult patients with diabetes, hypertension, or heart failure., Measurements: Physician perception of clinic workflow (time pressure and pace), work control, and organizational culture (assessed survey); physician satisfaction, stress, burnout, and intent to leave practice (assessed by survey); and health care quality and errors (assessed by chart audits)., Results: More than one half of the physicians (53.1%) reported time pressure during office visits, 48.1% said their work pace was chaotic, 78.4% noted low control over their work, and 26.5% reported burnout. Adverse workflow (time pressure and chaotic environments), low work control, and unfavorable organizational culture were strongly associated with low physician satisfaction, high stress, burnout, and intent to leave. Some work conditions were associated with lower quality and more errors, but findings were inconsistent across work conditions and diagnoses. No association was found between adverse physician reactions, such as stress and burnout, and care quality or errors., Limitation: The analyses were cross-sectional, the measures were self-reported, and the sample contained an average of 4 patients per physician., Conclusion: Adverse work conditions are associated with adverse physician reactions, but no consistent associations were found between adverse work conditions and the quality of patient care, and no associations were seen between adverse physician reactions and the quality of patient care.

Background: A report by the Institute of Medicine suggests that changing the culture of health care organizations may improve patient safety. Research in this area, however, is modest and inconclusive. Because culture powerfully affects providers, and providers are a key determinant of care quality, the MEMO study (Minimizing Error, Maximizing Outcome) introduces a new model explaining how physician work attitudes may mediate the relationship between culture and patient safety., Research Questions: (1) Which cultural conditions affect physician stress, dissatisfaction, and burnout? and (2) Do stressed, dissatisfied, and burned out physicians deliver poorer quality care?, Methods: A conceptual model incorporating the research questions was analyzed via structural equation modeling using a sample of 426 primary care physicians participating in MEMO., Findings: Culture, overall, played a lesser role than hypothesized. However, a cultural emphasis on quality played a key role in both quality outcomes. Further, we found that stressed, burned out, and dissatisfied physicians do report a greater likelihood of making errors and more frequent instance of suboptimal patient care., Practice Implications: Creating and sustaining a cultural emphasis on quality is not an easy task, but is worthwhile for patients, physicians, and health care organizations. Further, having clinicians who are satisfied and not burned out or stressed contributes substantially to the delivery of quality care.

The decline in physician job satisfaction is well documented, but its impact on physicians and patients is not. This article reviews 44 articles that address these impacts. Four findings emerge from this study along with recommendations for improving the measurement and management of job satisfaction.

This article explores the question of what physicians want in their "ideal job" using a nationally representative sample of physicians in ambulatory practice. The importance of ten work values was examined overall by specialty, practice setting, race/ethnicity, age, and gender. More than 90% of physicians rated the following as very important: good relationships with staff and colleagues; control of time off; adequate material resources; and autonomy in decision making. Remarkably, the relative importance of these work values remained consistent across each grouping. As more physicians practice in organized settings, there is a greater potential for a clash of work values to occur between physicians and their practice organizations. The consequences for physicians include lower job satisfaction and a greater likelihood of quitting. Practice organizations suffer through lower patient satisfaction and increased recruiting costs. Based on our findings, we offer five recommendations to maximize the well-being of physicians in ambulatory care settings.

Objectives: We studied how physicians' relative satisfaction and/or dissatisfaction with 10 distinct aspects of their work protected against or promoted their plans for leaving their jobs., Study Design: Cross-sectional mail survey., Population: A total of 1939 practicing generalists and specialists across the United States., Outcome Measured: We used logistic regression analysis to assess whether physicians in the top and bottom quartiles of satisfaction for each of 10 aspects of their work and communities were more or less likely to anticipate leaving their jobs within 2 years, compared with physicians in mid-satisfaction quartiles. Separate analyses were compiled for generalists vs specialists, and physicians by age groups (27-44 years, 45-54 years, and 55 years and older)., Results: Generalists and specialists had generally comparable levels of satisfaction, whereas physicians in the oldest age group indicated greater satisfaction than younger physicians in 8 of the 10 work areas. One quarter (27%) of physicians anticipated a moderate- to-definite likelihood of leaving their practices within 2 years. The percentage that anticipated leaving varied with physicians' age, starting at 29% of those 34 years or younger, steadily decreasing with age until reaching a nadir of 22% of those from 45 to 49 years, then reversing direction to steadily increase thereafter. Relative dissatisfaction with pay and with relationships with communities was associated with plans for leaving in nearly all physician groups. For specific specialty and age groups, anticipated departure also correlated with relative dissatisfaction with other selected areas of work., Conclusions: To promote retention, these data suggest that physicians and their employers should avoid physician dissatisfaction in particular. Building particularly high levels of satisfaction generally is not helpful for this end. Avoiding relative dissatisfaction with pay and with community relationships appears broadly important.

Objective: To study the impact that physician, practice, and patient characteristics have on physician stress, satisfaction, mental, and physical health., Data Sources: Based on a survey of over 5,000 physicians nationwide. Four waves of surveys resulted in 2,325 complete responses. Elimination of ineligibles yielded a 52 percent response rate; 1,411 responses from primary care physicians were used., Study Design: A conceptual model was tested by structural equation modeling. Physician job satisfaction and stress mediated the relationship between physician, practice, and patient characteristics as independent variables and physician physical and mental health as dependent variables., Principle Findings: The conceptual model was generally supported. Practice and, to a lesser extent, physician characteristics influenced job satisfaction, whereas only practice characteristics influenced job stress. Patient characteristics exerted little influence. Job stress powerfully influenced job satisfaction and physical and mental health among physicians., Conclusions: These findings support the notion that workplace conditions are a major determinant of physician well-being. Poor practice conditions can result in poor outcomes, which can erode quality of care and prove costly to the physician and health care organization. Fortunately, these conditions are manageable. Organizational settings that are both "physician friendly" and "family friendly" seem to result in greater well-being. These findings are particularly important as physicians are more tightly integrated into the health care system that may be less clearly under their exclusive control.

Background: While primary care work conditions are associated with adverse clinician outcomes, little is known about the effect of work condition interventions on quality or safety.Design: A cluster randomized controlled trial of 34 clinics in the upper Midwest and New York City.Participants: Primary care clinicians and their diabetic and hypertensive patients.Interventions: Quality improvement projects to improve communication between providers, workflow design, and chronic disease management. Intervention clinics received brief summaries of their clinician and patient outcome data at baseline.Main Measures: We measured work conditions and clinician and patient outcomes both at baseline and 6-12 months post-intervention. Multilevel regression analyses assessed the impact of work condition changes on outcomes. Subgroup analyses assessed impact by intervention category.Key Results: There were no significant differences in error reduction (19 % vs. 11 %, OR of improvement 1.84, 95 % CI 0.70, 4.82, p = 0.21) or quality of care improvement (19 % improved vs. 44 %, OR 0.62, 95 % CI 0.58, 1.21, p = 0.42) between intervention and control clinics. The conceptual model linking work conditions, provider outcomes, and error reduction showed significant relationships between work conditions and provider outcomes (p ≤ 0.001) and a trend toward a reduced error rate in providers with lower burnout (OR 1.44, 95 % CI 0.94, 2.23, p = 0.09).Limitations: Few quality metrics, short time span, fewer clinicians recruited than anticipated.Conclusions: Work-life interventions improving clinician satisfaction and well-being do not necessarily reduce errors or improve quality. Longer, more focused interventions may be needed to produce meaningful improvements in patient care.Clinical Trial Registration Number: ClinicalTrials.gov # NCT02542995. [ABSTRACT FROM AUTHOR]

This study explores the role of procedural and distributive justice in influencing supervisory trust, job satisfaction, and organizational commitment. Past work in U.S. settings has shown the differential effects of procedural and distributive justice on job attitudes while other work supports the relationship between both procedural and distributive just ice with trust This study attempts to replicate the US findings and extend them to samples from India, Germany, and China (Hong Kong). A theoretical model was tested via structural equation analysis. Organizational justice was found to be an important predictor of trust in all the samples, indicating the importance of these concepts in organizational life in different cultures. The implications of these results for future research are discussed, [ABSTRACT FROM AUTHOR]

This research presents a comprehensive model of relationships between transformational and transactional leadership, procedural and distributive justice, trust, job satisfaction, organizational commitment, and organizational citizenship behaviors (OCBs). Structural equation modeling was used to test a theoretical model with two independent samples that were comprised of 192 and 155 matched leaders and subordinates. Several rival models were also tested. Finally, "stacked" modeling techniques showed that the parameter estimates developed from the two samples were invariant except for one additional relationship, which was significant in the second sample only. The results supported the indirect effect of transformational leadership on OCBs through procedural justice and trust. implications and directions for future research are discussed. [ABSTRACT FROM AUTHOR]