A Cluster Randomized Trial of Interventions to Improve Work Conditions and Clinician Burnout in Primary Care: Results from the Healthy Work Place (HWP) Study

J Gen Intern Med. 2015 Aug;30(8):1105-11. doi: 10.1007/s11606-015-3235-4. Epub 2015 Feb 28.


Background: Work conditions in primary care are associated with physician burnout and lower quality of care.

Objective: We aimed to assess if improvements in work conditions improve clinician stress and burnout.

Subjects: Primary care clinicians at 34 clinics in the upper Midwest and New York City participated in the study.

Study design: This was a cluster randomized controlled trial.

Measures: Work conditions, such as time pressure, workplace chaos, and work control, as well as clinician outcomes, were measured at baseline and at 12-18 months. A brief worklife and work conditions summary measure was provided to staff and clinicians at intervention sites.

Interventions: Diverse interventions were grouped into three categories: 1) improved communication; 2) changes in workflow, and 3) targeted quality improvement (QI) projects.

Analysis: Multilevel regressions assessed impact of worklife data and interventions on clinician outcomes. A multilevel analysis then looked at clinicians whose outcome scores improved and determined types of interventions associated with improvement.

Results: Of 166 clinicians, 135 (81.3%) completed the study. While there was no group treatment effect of baseline data on clinician outcomes, more intervention clinicians showed improvements in burnout (21.8% vs 7.1% less burned out, p = 0.01) and satisfaction (23.1% vs 10.0% more satisfied, p = 0.04). Burnout was more likely to improve with workflow interventions [Odds Ratio (OR) of improvement in burnout 5.9, p = 0.02], and with targeted QI projects than in controls (OR 4.8, p = 0.02). Interventions in communication or workflow led to greater improvements in clinician satisfaction (OR 3.1, p = 0.04), and showed a trend toward greater improvement in intention to leave (OR 4.2, p = 0.06).

Limitations: We used heterogeneous intervention types, and were uncertain how well interventions were instituted.

Conclusions: Organizations may be able to improve burnout, dissatisfaction and retention by addressing communication and workflow, and initiating QI projects targeting clinician concerns.

Publication types

  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Burnout, Professional / prevention & control*
  • Cluster Analysis
  • Communication*
  • Female
  • Humans
  • Interprofessional Relations
  • Job Satisfaction
  • Male
  • Middle Aged
  • Physicians, Primary Care*
  • Quality Improvement*
  • Quality of Life
  • Stress, Psychological / prevention & control
  • Workflow*
  • Workplace / organization & administration*