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A Cluster Randomized Trial of Interventions to Improve Work Conditions and Clinician Burnout in Primary Care: Results from the Healthy Work Place (HWP) Study
Open accessAbstract
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.
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“programs that fostered more intensive, sustained, and meaningful interpersonal connections horizontally among peers,18-21 as well as vertically with supervisors,22 produced more consistent positive effects.”
From What do we really know about addressing burnout among healthcare workers? Maybe less than we think (2026) · cites this paper as [21]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“while communication skills trainings may be more likely to improve HCP's satisfaction and decrease the intention to leave the job [32].”
From The efficacy of applying the Interpersonal Effectiveness skills of dialectical behavior therapy into communication skills workshop for clinical nurses (2023) · cites this paper as [32]
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“Linzer et al. described that those who received interventions on improving communication skills had greater improvements in professional fulfillment or career satisfaction (OR = 3.1, p = 0.04), and trends in burnout (OR = 3.0, p = 0.08), or intentions to leave the job (OR = 4.2, p = 0.06) than controls [32].”
From The efficacy of applying the Interpersonal Effectiveness skills of dialectical behavior therapy into communication skills workshop for clinical nurses (2023) · cites this paper as [32]
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“This trial found that clinics that implement workflow enhancements and target QI processes were more effective in reducing burnout than usual practice controls [39].”
From The Work-life Check-ins randomized controlled trial: a leader-based adaptive, semi-structured burnout intervention in primary care clinics (2024) · cites this paper as [39]
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“A prior cluster randomized controlled trial at 34 primary care clinics was able to reduce burnout through an adaptive intervention approach, allowing clinics to decide priorities and tactics to address stressors.”
From The Work-life Check-ins randomized controlled trial: a leader-based adaptive, semi-structured burnout intervention in primary care clinics (2024) · cites this paper as [39]
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“the effect was likely small, and not apparent when using continuous measures of burnout19 or on the initial analysis.21”
From What do we really know about addressing burnout among healthcare workers? Maybe less than we think (2026) · cites this paper as [21]
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“they did report a significant difference in the proportion of clinicians with reduced burnout at least 1 year later.21”
From What do we really know about addressing burnout among healthcare workers? Maybe less than we think (2026) · cites this paper as [21]
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Metadata
- Authors
- Linzer, M., Poplau, S., Grossman, E., Varkey, A., Yale, S., Williams, E., Hicks, L., Brown, R. L., Wallock, J., Kohnhorst, D., & Barbouche, M.
- Affiliations
- University of Minnesota (US)
- New York University (US)
- Loyola University Medical Center (US)
- Marshfield Clinic (US)
- University of Alabama (US)
- University of Missouri (US)
- University of Wisconsin–Madison (US)
- Corresponding author
- Linzer, Mark
- Venue
- Journal of General Internal Medicine
- Published
- 2015-02-28
- Volume
- 30
- Issue
- 8
- Pages
- 1105-1111
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC4510236
- OpenAlex
- W2057226650
- Cited by
- 376
- References
- 24
- Citations by year
- 2026: 23 · 2025: 28 · 2024: 36 · 2023: 28 · 2022: 30 · 2021: 50 · 2020: 57 · 2019: 53 · 2018: 25 · 2017: 23 · 2016: 16 · 2015: 6
- FWCI
- 42.66
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of General Internal Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Agency for Healthcare Research and Quality (5r18hs018160-03, R18HS018160)
- Topics
- Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Occupational Health and Burnout
- Social Sciences › Psychology › Social Psychology › Stress and Burnout Research
- Keywords
- clinician burnout, working conditions, primary care, workflow redesign, communication intervention, quality improvement projects, provider satisfaction, turnover intention, time pressure, job control
- MeSH terms
- Adult, Burnout, Professional, Communication, Female, Humans, Interprofessional Relations, Job Satisfaction, Male, Middle Aged, Quality of Life, Stress, Psychological, Cluster Analysis, Workplace, Workflow, Physicians, Primary Care, Quality Improvement
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