Do Work Condition Interventions Affect Quality and Errors in Primary Care? Results from the Healthy Work Place Study

Mark Linzer, Sara Poplau, Roger Brown, Ellie Grossman, Anita Varkey, Steven Yale, Eric S. Williams, Lanis Hicks, Jill Wallock, Diane Kohnhorst, Michael Barbouche

Research output: Contribution to journalArticlepeer-review

31 Scopus citations


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: # NCT02542995.

Original languageEnglish (US)
Pages (from-to)56-61
Number of pages6
JournalJournal of general internal medicine
Issue number1
StatePublished - Jan 1 2017

Bibliographical note

Funding Information:
This research was supported by the Agency for Healthcare Research and Quality (AHRQ) grant no. 5R18-HS018160-03. The funder had no role in the design, conduct, analysis, or publication of the study.

Publisher Copyright:
© 2016, Society of General Internal Medicine.


  • burnout
  • physician burnout
  • physician stress
  • work-life
  • work-life interventions


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