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The Joy of Medicine

Nearly 20 years ago colleagues at the Agency for Healthcare Research and Quality (AHRQ) used the term “healthy workplaces” to describe a positive and productive healthcare environment. Since that time, numerous studies have sought to evaluate and describe how medicine has achieved and failed to achieve that goal. Most recently, studies have focused on clinician satisfaction, or what has also been called the “joy of medicine.”

In the most recent study focusing on the “joy of medicine,” researchers wanted to demonstrated the connection between clinician satisfaction and what they describe as remediable work conditions. That is, they wanted to know what were the characteristics of satisfied clinicians and how did stress, burnout, and intention to leave relate to satisfaction. Also, which workplace structural and cultural factors are associated with a healthy workplace and do those factors improve outcomes for clinicians and patients?

To answer these questions, researchers examined data from the Healthy Work Place trial, a randomized trial that recruited 34 practices in three geographic regions in the U.S. (rural Midwest, suburban Midwest, and inner-city East Coast). All practices in three large health systems were invited to participate, and all clinicians at each practice were recruited.

The primary outcome metric for the study was a five-item clinician job satisfaction manager. There were 168 participants, who were randomly assigned to control or intervention groups before baseline data was collected.

The results showed that job satisfaction (joy of practice) was associated with both structural and cultural aspects of the work environment. Slower paced, less chaotic environments were far more satisfying, as was were practices with cohesion, good communication, high clinician trust in the organization, and high alignment of values between clinicians and leaders.

Also, clinicians’ job satisfaction was strongly associated with lower stress, lower burnout, and less intent to leave the practice, while clinicians who improved their satisfaction were almost three times less likely to burnout and over eight times as likely to intend to stay with the practice.

The researchers also pointed out that while no changes were seen in patient outcomes in this study, other research has shown that higher rates of burnout are associated with increased medical errors, lower quality patient outcomes in people with diabetes, and lower patient satisfaction with care and adherence to treatment recommendations. In addition, according to the researchers, other studies have demonstrated the value of continuity, which results in fewer emergency department visits and hospital admissions.

The implications of the results of this study for researchers is that a large number of practicing clinicians are satisfied, but their satisfaction might be improved by addressing the work environment (making it less chaotic) and by promoting a more positive organization cultural, which includes cohesion, trust, values, and emphasis on good communication.

The researchers emphasized this point – less chaotic workplaces were highly associated with satisfaction and that chaos on the clinic predicts adverse outcomes for clinicians and patients, including having more medical errors.

Linzer M, Sinsky CA, Poplau S, Brown R, Williams E, the Health Work Place Investigators. Joy in Medical Practice: Clinician Satisfaction IN the Health Work Place Trial. Health Aff. 2017 Oct1;36(10):1808-1814.
Shanafelt TD, Bradley KA, Wipf JE, Back AL, Burnout and self-reported patient care in an internal medicine resident program. Ann Intern Med. 2002;136(5):358-67.
Sundquist J, Johansson SE. High demand, low control, and impaired general health: working conditions in a sample of Swedish general practitioners. Scand J Public Health.2000;28(2):123-31.
Barker I, Steventon A, Deeny Sr. Association between continuity of care in general practice and hospital admissions for ambulatory care sensitive conditions: cross sectional study of routinely collected, person level data. BMJ. 2017;356.