Excerpt

A large body of evidence shows clear linkages between workplace conditions and employee satisfaction and stress in a wide variety of organizational and industry settings. In the healthcare industry, increasing interest in understanding these linkages stems from the idea that healthcare providers’ working environments also affect important patient outcomes, including safety, quality of care and satisfication. Additionally, meeting objectives of the current healthcare reform to increase healthcare quality by increasing the availability of primary care providers and making care safer, more efficient, effective and patient-centered hinges on the ability to deal with the documented shortage of primary care providers in the US and at the same time improve patient outcomes. The purpose of this report was to systematically review the evidence on the role of primary care providers’ workplace conditions in influencing patient outcomes. We focused on patient satisfaction, safety, and quality of care for patient outcomes (note that there may be some overlap in how these patient outcomes are measured). We excluded articles that focused on one specific disease or patient population. The focus on primary care providers’ work environment will provide evidence on increasing healthcare quality. Results from this review may inform policymakers as they endeavor to implement aspects of the healthcare reform related to increasing the supply of primary care providers and improving patient outcomes.

Contents

• PREFACE
• EXECUTIVE SUMMARY
  • BACKGROUND
  • METHODS
  • DATA SYNTHESIS
  • PEER REVIEW
  • RESULTS
  • CONCLUSIONS
  • FUTURE RESEARCH
• INTRODUCTION
  • BACKGROUND
  • WORKING CONDITIONS
  • CONCEPTUAL MODEL
  • PATIENT OUTCOMES
  • PROVIDER OUTCOMES
• METHODS
  • TOPIC DEVELOPMENT
  • SEARCH STRATEGY
  • STUDY SELECTION
  • DATA ABSTRACTION
  • QUALITY ASSESSMENT
  • DATA SYNTHESIS
  • RATING THE BODY OF EVIDENCE
  • PEER REVIEW
• RESULTS
  • LITERATURE FLOW
  • KEY QUESTION #1 How are human resource practices, such as skill levels, training, workload, hours worked, autonomy, and electronic medical records/systems, associated with patient outcomes?
  • KEY QUESTION #2 How are other working conditions, such as organizational culture or physical environment, associated with patient outcomes?
  • KEY QUESTION #3 In studies that report provider outcomes, how are working conditions associated with provider outcomes (e.g., job satisfaction, productivity, pay)?
• SUMMARY AND DISCUSSION
  • SUMMARY OF EVIDENCE BY KEY QUESTION
  • RECOMMENDATIONS FOR FUTURE RESEARCH
  • CONCLUSIONS
• REFERENCES
• APPENDIX A SEARCH STRATEGIES
• APPENDIX B CRITERIA USED IN QUALITY ASSESSMENT OF NON-RANDOMIZED STUDIES
• APPENDIX C PEER REVIEW COMMENTS/AUTHOR RESPONSES
• APPENDIX D EVIDENCE TABLES

Prepared for: Department of Veterans Affairs, Veterans Health Administration, Health Services Research & Development Service, Washington, DC 20420. Prepared by: Evidence-based Synthesis Program (ESP) Center, Minneapolis VA Medical Center, Minneapolis, MN, Timothy J. Wilt, MD, MPH, Director.

Suggested citation:

Kapinos KA, Fitzgerald P, Greer N, Rutks I, Wilt TJ. The Effect of Working Conditions on Patient Care: A Systematic Review. VA-ESP Project #09-009; 2012.

This report is based on research conducted by the Evidence-based Synthesis Program (ESP) Center located at the Minneapolis VA Medical Center, Minneapolis, MN funded by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development. The findings and conclusions in this document are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs. No investigators have any affiliations or financial involvement (e.g., employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in the report.