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J Am Board Fam Med. 2014 Mar-Apr;27(2):229-38. doi: 10.3122/jabfm.2014.02.130215.

Team structure and culture are associated with lower burnout in primary care.

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the Department of Family and Community Medicine, University of California, San Francisco, the Center for Excellence in Primary Care, and Divisions of General Internal Medicine and Pediatrics, University of California, San Francisco.



Burnout is a threat to the primary care workforce. We investigated the relationship between team structure, team culture, and emotional exhaustion of clinicians and staff in primary care practices.


We surveyed 231 clinicians and 280 staff members of 10 public and 6 university-run primary care clinics in San Francisco in 2012. Predictor variables included team structure, such as working in a tight teamlet, and perception of team culture. The outcome variable was the Maslach emotional exhaustion scale. Generalized estimation equation models were used to account for clustering at the clinic level.


Working in a tight team structure and perceptions of a greater team culture were associated with less clinician exhaustion. Team structure and team culture interacted to predict exhaustion: among clinicians reporting low team culture, team structure seemed to have little effect on exhaustion, whereas among clinicians reporting high team culture, tighter team structure was associated with less exhaustion. Greater team culture was associated with less exhaustion among staff. However, unlike for clinicians, team structure failed to predict exhaustion among staff.


Fostering team culture may be an important strategy to protect against exhaustion in primary care and enhance the benefit of tight team structures.


Burnout; Organizational Culture; Patient Care Team; Primary Health Care

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