Provider workload and quality of care in primary care settings: moderating role of relational climate

Med Care. 2013 Jan;51(1):108-14. doi: 10.1097/MLR.0b013e318277f1cb.


Primary care providers are increasingly under pressure to do more with fewer resources. We examined the effect of workload on patients' experiences of quality of care, measured through approximately 44,000 patient experience surveys in a sample of 222 primary care clinics in the Veterans Health Administration. We tested the extent to which relational climate, a measure of teamwork, moderated the relationship between workload and patient ratings of quality of care. Our outcome measures included patient complaints, time spent with provider, and overall visit quality. Workload was negatively associated with patients' quality of care ratings and relational climate moderated the relation between workload and quality of care ratings. Patients seen in clinics with higher workload and greater relational climate reported better care compared with patients in clinics with higher workload but lower relational climate. Findings highlight the importance of relational climate as an important teamwork factor when managing and developing clinic policies, practices, and procedures in resource-constrained settings.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Ambulatory Care Facilities / organization & administration*
  • Cooperative Behavior
  • Female
  • Group Processes
  • Humans
  • Male
  • Middle Aged
  • Patient Care Team / organization & administration
  • Patient Satisfaction / statistics & numerical data*
  • Primary Health Care / organization & administration*
  • Quality of Health Care / organization & administration*
  • Sex Factors
  • Time Factors
  • United States
  • United States Department of Veterans Affairs / organization & administration
  • Workload / statistics & numerical data*