MEMO Minimizing Error, Maximizing Outcome The Physician Worklife Study II

1. MEMO Minimizing Error, Maximizing Outcome The Physician Worklife Study II Mark Linzer, UW, Principal Investigator Mark Schwartz, NYU, Co-PI Linda Baier Manwell, UW, Project Director

2. Learning Objectives To better understand how the work environment affects physicians and patients To learn more about the MEMO project To see how gender, race, and ethnicity interact with working conditions To realize the impact of a hectic or chaotic work environment

3. Background Physician Worklife Study I (PWS) Funded by Robt Wood Johnson Found, 1995-1998 National, random sample of 5,704 MDs Stratified by five specialties Findings Time pressure is major source of stress/dissatisfaction Stress and dissatisfaction predict burnout and intent to leave Work control is powerful predictor of satisfaction Burnout is 60% higher in women MDs

4. What is MEMO?

5. MEMO Conceptual Model

6. MEMO Data Collection Points

7. Measuring Quality

8. Determining Errors Clinicians reported errors in disease management during past year Clinicians rated their stress & predicted likelihood of making future errors on the OSPRE (Occupational Stress and PReventable Error) instrument Researchers performed confidential chart reviews

9. 420 primary care physicians (85.2% of target 500) 59.2% of those surveyed responded 51% GIM 49% FP 44% female 83% white 83% full-time Age 44 (range 29-89) Physician Participants

10. MEMO Results: Measures

11. MEMO Results: MD Outcomes Of 420 physicians... 79% highly satisfied with their jobs 61% said jobs were stressful 53% need more time for physical exams 27% burning out or burned out 31% moderately or more likely to leave job within 2 years

12. MEMO Results: Organizational Culture Predict job satisfaction: Work control (.001) Trust in the organization (.001) Resource availability (.001) Less clinic chaos (.001) Predict poorer MD mental health: Fewer resources (.001) Less work control (.006) More clinic chaos (.001) Predict future error: Less clinic emphasis on information (.017) Less clinic emphasis on diversity (.001) Predict intent to leave: Less trust in the organization (.001) Fewer resources (.001)

13. �Describe the atmosphere in your office� MEMO Results: Chaos in the Clinic

14. Chaotic offices are associated with: More minority patients More patients with public or no insurance Fewer exam rooms Fewer staff Less practice emphasis on communication Less practice emphasis on information technology MEMO Results: Chaos in the Clinic

15. Impact of Chaos on MDs

16. Perceived Leadership Integrity Index (PLII) Attitudes of organizational leaders to (e.g.) physician�s core values controlling costs vs. quality Negative perceptions about perceived integrity correlated with physician stress, burnout, and intent to leave the practice MEMO Results: Organizational Culture

17. MEMO Results: Gender Differences

18. Background The 1995-98 Physician Worklife Study found Women MDs have more female patients complex patients managed care, uninsured, and Medicaid patients Women MDs have less work control All MDs need more time than allotted to see patients, but women need a greater percentage Burnout was 60% higher in women physicians

21. Despite widespread dissemination of similar data, assessments of organizational climate and worklife by women MDs continue to be lower compared to males, and in many areas have worsened. Non-alignment of values may explain lower perceptions of work control and higher levels of stress and burnout among women MDs. Women MDs and their patients remain at higher risk for the effects of stress and poor working climates.

22. MEMO Results: Effect of the Workplace on Healthcare Disparities

28. Patient outcomes (n=1785, ave 4/MD) Focus groups in minority clinics to identify factors that create barriers to quality care and exacerbate disparities Focus groups in high quality clinics to identify factors/processes that facilitate quality care and minimize disparities. Development of Office and Work Life (OWL) tool MEMO: Current Activities

30. Next Steps for MEMO Analyses: Patient outcomes Regression analyses Research: Practice Redesign Preventing burnout Ameliorating chaos Improving work control Facilitating communication (language, literacy)

31. Modifiable Factors Find ways to better manage resources to reduce disparities and improve physician and patient health. Assess methods to reduce clinic chaos. Study practices that accomplish a lot with few resources. Develop a tool kit for other practices to use.

32. Upcoming MEMO Papers MEMO main results paper! Impact of the work environment on care quality and errors Other upcoming papers: Errors in primary care: prediction & relationship to quality Role of physician gender in quality & errors Effect of physician burnout on quality & errors Managing an ambulatory practice: lessons from MEMO Separate but unequal: where minority and non-minority patients receive primary care

33. MEMO Limitations Only primary care practices enrolled Only 5 regions included (NYC and upper Midwest) Self-reported data

34. MEMO Staff Jim Bobula Marlon Mundt Roger Brown Carolyn Egan Chicago Region Anita Varkey Bernice Man Elizabeth Arce Milwaukee Region Ann Maguire Barb Horner-Ibler Laura Paluch MEMO Team