Better outcomes through patient - Provider therapeutic connections? An exploratory study of proposed mediating variables
Abstract
Background Patient-provider therapeutic connections (TCs) have been theorized to enhance patient outcomes as well as care provider job satisfaction and to reduce burnout. High-quality TCs may result in better matching of health care to patient needs, and thus, better care quality and patient outcomes. For care providers, work environments that enable high-quality TCs may make the work more motivating and facilitate resilience.Method We surveyed patients (n = 346) and care providers (n = 341) about their experiences of TCs, and how TCs related to outcomes. We tested parallel mediation models to examine relations.Results TCs predicted better patient health status, mental health status, and satisfaction, and predicted greater care provider job satisfaction and lower burnout. TCs were theorized to operate through two sets of mechanisms (health self-efficacy and activation for patients; meaningfulness of work and psychological safety for providers). Results revealed significant indirect associations between TCs and outcomes for both groups.Conclusions TCs are associated with patient and provider outcomes; however, these relations appear to be explained by several mediating variables. It appears that TCs are associated with better outcomes for patients through health self-efficacy and activation, and TCs are associated with better outcomes for care providers through meaningfulness of work and psychological safety.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Strong patient-provider relationships have long been acknowledged as crucial for delivering high-quality, person-centred care.
“Strong patient-provider relationships have long been acknowledged as crucial for delivering high-quality, person-centred care [40–43].”
From Caregiver experiences of an integrative patient-centered digital health application for pediatric type 1 diabetes care: Findings from a pilot clinical trial (2025) · cites this paper as [40]
Cites
(2013) · Cited by 44,563 · see citing works
Self-efficacy: Toward a unifying theory of behavioral change
Bandura, A. (1977) · Psychological Review · doi:10.1037/0033-295x.84.2.191 · Cited by 43,925 · see citing works
Determining sample size for research activities
Krejcie, R. V., & Morgan, D. W. (1970) · Educational and Psychological Measurement · doi:10.1177/001316447003000308 · Cited by 18,930 · see citing works
PSYCHOLOGICAL CONDITIONS OF PERSONAL ENGAGEMENT AND DISENGAGEMENT AT WORK.
Kahn, W. A. (1990) · Academy of Management Journal · doi:10.2307/256287 · Cited by 10,975 · see citing works
Motivation through the design of work: test of a theory
Hackman, J. R., & Oldham, G. R. (1976) · Organizational Behavior and Human Performance · doi:10.1016/0030-5073(76)90016-7 · Cited by 8,962 · see citing works
Cohen, J. (1992) · Psychological Bulletin · doi:10.1037//0033-2909.112.1.155 · Cited by 8,771 · see citing works
The Measurement of Work Engagement With a Short Questionnaire: A Cross-National Study
Schaufeli, W. B., Bakker, A. B., & Salanova, M. (2006) · Educational and Psychological Measurement · doi:10.1177/0013164405282471 · Cited by 7,403 · see citing works
Development and validation of the working alliance inventory
Horvath, A. O., & Greenberg, L. S. (1989) · Journal of Counseling Psychology · doi:10.1037//0022-0167.36.2.223 · Cited by 3,520 · see citing works
May, D. R., Gilson, R. L., & Harter, L. M. (2004) · Journal of Occupational and Organizational Psychology · doi:10.1348/096317904322915892 · Cited by 3,483 · see citing works
From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider
Bodenheimer, T., & Sinsky, C. (2014) · The Annals of Family Medicine · doi:10.1370/afm.1713 · Cited by 3,462 · see citing works
The Copenhagen Burnout Inventory: A new tool for the assessment of burnout
Kristensen, T. S., Borritz, M., Villadsen, E., & Christensen, K. B. (2005) · Work & Stress · doi:10.1080/02678370500297720 · Cited by 3,136 · see citing works
Patient-centredness: a conceptual framework and review of the empirical literature
Mead, N., & Bower, P. (2000) · Social Science & Medicine · doi:10.1016/s0277-9536(00)00098-8 · Cited by 2,993 · see citing works
Organizing Care for Patients with Chronic Illness
Wagner, E. H., Austin, B. T., & Korff, M. V. (1996) · The Milbank Quarterly · doi:10.2307/3350391 · Cited by 2,877 · see citing works
Hibbard, J. H., Stockard, J., Mahoney, E. R., & Tusler, M. (2004) · Health Services Research · doi:10.1111/j.1475-6773.2004.00269.x · Cited by 2,748 · see citing works
Psychological Safety: The History, Renaissance, and Future of an Interpersonal Construct
Edmondson, A. C., & Lei, Z. (2014) · Annual Review of Organizational Psychology and Organizational Behavior · doi:10.1146/annurev-orgpsych-031413-091305 · Cited by 2,577 · see citing works
How does communication heal? Pathways linking clinician–patient communication to health outcomes
Street, R. L., Makoul, G. T., Arora, N. K., & Epstein, R. M. (2009) · Patient Education and Counseling · doi:10.1016/j.pec.2008.11.015 · Cited by 2,540 · see citing works
On the meaning of work: A theoretical integration and review
Rosso, B. D., Dekas, K. H., & Wrzesniewski, A. (2010) · Research in Organizational Behavior · doi:10.1016/j.riob.2010.09.001 · Cited by 2,482 · see citing works
Structural competency: Theorizing a new medical engagement with stigma and inequality
Metzl, J. M., & Hansen, H. (2014) · Social Science & Medicine · doi:10.1016/j.socscimed.2013.06.032 · Cited by 1,873 · see citing works
Relational Job Design and the Motivation to Make a Prosocial Difference
Grant, A. M. (2007) · Academy of Management Review · doi:10.5465/amr.2007.24351328 · Cited by 1,864 · see citing works
Hibbard, J. H., & Greene, J. (2013) · Health Affairs · doi:10.1377/hlthaff.2012.1061 · Cited by 1,787 · see citing works
Psychological Antecedents of Promotive and Prohibitive Voice: A Two-Wave Examination
Liang, J., Farh, C. I. C., & Farh, J.-L. (2012) · Academy of Management Journal · doi:10.5465/amj.2010.0176 · Cited by 1,647 · see citing works
Steger, M. F., Dik, B. J., & Duffy, R. D. (2012) · Journal of Career Assessment · doi:10.1177/1069072711436160 · Cited by 1,585 · see citing works
How to select, calculate, and interpret effect sizes.
Durlak, J. (2009) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsp004 · Cited by 1,487 · see citing works
Do Not Cross Me: Optimizing the Use of Cross-Sectional Designs
Spector, P. E. (2019) · Journal of Business and Psychology · doi:10.1007/s10869-018-09613-8 · Cited by 1,382 · see citing works
To Be Fully There: Psychological Presence at Work
Kahn, W. A. (1992) · Human Relations · doi:10.1177/001872679204500402 · Cited by 1,198 · see citing works
Sheeran, P., Maki, A., Montanaro, E., Avishai-Yitshak, A., Bryan, A., Klein, W. M. P., Miles, E., & Rothman, A. J. (2016) · Health Psychology · doi:10.1037/hea0000387 · Cited by 1,085 · see citing works
Coproduction of healthcare service
Batalden, M., Batalden, P., Margolis, P., Seid, M., Armstrong, G., Opipari-Arrigan, L., & Hartung, H. (2016) · BMJ Quality & Safety · doi:10.1136/bmjqs-2015-004315 · Cited by 1,078 · see citing works
Hayes, A. F., & Rockwood, N. (2019) · American Behavioral Scientist · doi:10.1177/0002764219859633 · Cited by 1,058 · see citing works
Gabriel, A. S., Podsakoff, N. P., Beal, D. J., Scott, B. A., Sonnentag, S., Trougakos, J. P., & Butts, M. M. (2019) · Organizational Research Methods · doi:10.1177/1094428118802626 · Cited by 755 · see citing works
Predicting Mortality and Healthcare Utilization with a Single Question
DeSalvo, K. B., Fan, V. S., McDonell, M. B., & Fihn, S. D. (2005) · Health Services Research · doi:10.1111/j.1475-6773.2005.00404.x · Cited by 677 · see citing works
Sample Size Determination in Survey Research
Adam, A. M. (2020) · Journal of Scientific Research and Reports · doi:10.9734/jsrr/2020/v26i530263 · Cited by 629 · see citing works
Positive Organizational Scholarship
Peterson, C., & Park, N. (2006) · Deutscher Universitätsverlag eBooks · doi:10.1007/978-3-8350-9106-1_2 · Cited by 561 · see citing works
The conceptualization and measurement of therapeutic alliance: An empirical review
Elvins, R., & Green, J. (2008) · Clinical Psychology Review · doi:10.1016/j.cpr.2008.04.002 · Cited by 534 · see citing works
Halbesleben, J. R. B., & Rathert, C. (2008) · Health Care Management Review · doi:10.1097/01.hmr.0000304493.87898.72 · Cited by 519 · see citing works
Self-citationService experience co-creation: conceptualization, implications, and future research directions
Jaakkola, E., Helkkula, A., & Aarikka‐Stenroos, L. (2015) · Journal of service management · doi:10.1108/josm-12-2014-0323 · Cited by 424 · see citing works
Self-Rated Health and Morbidity Onset Among Late Midlife U.S. Adults
Latham-Mintus, K., & Peek, C. W. (2012) · The Journals of Gerontology Series B · doi:10.1093/geronb/gbs104 · Cited by 299 · see citing works
Practices to foster physician presence and connection with patients in the clinical encounter
Zulman, D. M., Haverfield, M. C., Shaw, J. G., Brown-Johnson, C. G., Schwartz, R., Tierney, A. A., Zionts, D. L., Safaeinili, N., Fischer, M., Thadaney Israni, S., et al. (2020) · JAMA · doi:10.1001/jama.2019.19003 · Cited by 287 · see citing works
Mead, N., Bower, P., & Hann, M. (2002) · Social Science & Medicine · doi:10.1016/s0277-9536(01)00171-x · Cited by 275 · see citing works
Collaborative deliberation: A model for patient care
Elwyn, G. J., Lloyd, A., May, C. R., van der Weijden, T., Stiggelbout, A. M., Edwards, A., Frosch, D. L., Rapley, T., Barr, P. J., Walsh, T., et al. (2014) · Patient Education and Counseling · doi:10.1016/j.pec.2014.07.027 · Cited by 261 · see citing works
Grailey, K., Murray, E., Reader, T. W., & Brett, S. J. (2021) · BMC Health Services Research · doi:10.1186/s12913-021-06740-6 · Cited by 249 · see citing works
Brottman, M., Char, D. M., Hattori, R., Desai, R. H., & Taff, S. D. (2019) · Academic Medicine · doi:10.1097/acm.0000000000002995 · Cited by 212 · see citing works
Patient-physician role relationships and patient activation among individuals with chronic illness
Alexander, J. A., Hearld, L. R., Mittler, J. N., & Harvey, J. (2012) · Health Services Research · doi:10.1111/j.1475-6773.2011.01354.x · Cited by 206 · see citing works
Self-citationHamilton, L. C., & Fox, J. P. (1992) · Contemporary Sociology A Journal of Reviews · doi:10.2307/2075925 · Cited by 187 · see citing works
Mercer, S. W., Neumann, M., Wirtz, M. A., Fitzpatrick, B., & Vojt, G. (2008) · Patient Education and Counseling · doi:10.1016/j.pec.2008.07.022 · Cited by 178 · see citing works
Hibbard, J. H., Greene, J., Shi, Y., Mittler, J., & Scanlon, D. P. (2015) · Medical Care Research and Review · doi:10.1177/1077558715573871 · Cited by 160 · see citing works
Self-citationVogus, T. J., & McClelland, L. E. (2015) · Human Resource Management Review · doi:10.1016/j.hrmr.2015.09.005 · Cited by 159 · see citing works
Self-citation‘Being known’: patients' perspectives of the dynamics of human connection in cancer care
Thorne, S. E., Kuo, M. E., Armstrong, E.-A., McPherson, G., Harris, S. R., & Hislop, T. G. (2005) · Psycho-Oncology · doi:10.1002/pon.945 · Cited by 157 · see citing works
Williams, E. S., Rathert, C., & Buttiġieġ, S. C. (2019) · Medical Care Research and Review · doi:10.1177/1077558719856787 · Cited by 153 · see citing works
Self-citationCompassionomics: The Revolutionary Scientific Evidence That Caring Makes a Difference
Jivanelli, B. (2020) · Journal of Consumer Health on the Internet · doi:10.1080/15398285.2019.1710977 · Cited by 151 · see citing works
Research on the alliance: Knowledge in search of a theory
Horvath, A. O. (2018) · Psychotherapy Research · doi:10.1080/10503307.2017.1373204 · Cited by 137 · see citing works
Organizing Care for Patients With Chronic Illness Revisited
WAGNER, E. H. (2019) · The Milbank Quarterly · doi:10.1111/1468-0009.12416 · Cited by 109 · see citing works
Avoiding overuse—the next quality frontier
Berwick, D. M. (2017) · The Lancet · doi:10.1016/s0140-6736(16)32570-3 · Cited by 97 · see citing works
Robertson, K. M.-P., O’Reilly, J., & Hannah, D. R. (2019) · Academy of Management Review · doi:10.5465/amr.2015.0242 · Cited by 93 · see citing works
Sheeran, P., Wright, C. E., Avishai, A., Villegas, M. E., Rothman, A. J., & Klein, W. M. P. (2021) · Health Psychology · doi:10.1037/hea0001111 · Cited by 93 · see citing works
The Kim Alliance Scale: Development and Preliminary Testing
Kim, S. C., Boren, D., & Solem, S. L. (2001) · Clinical Nursing Research · doi:10.1177/c10n3r7 · Cited by 92 · see citing works
Soler-González, J., San-Martín, M., Bolton, R. C. D., & Vivanco, L. (2017) · Frontiers in Psychology · doi:10.3389/fpsyg.2017.01475 · Cited by 75 · see citing works
Holding Fast: The Struggle to Create Resilient Caregiving Organizations
Jennings, B. M. (2007) · Journal of Advanced Nursing · doi:10.1111/j.1365-2648.2006.04164.x · Cited by 69 · see citing works
From assurance to coproduction: a century of improving the quality of health-care service
Batalden, P. B., & Foster, T. C. (2021) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzab059 · Cited by 38 · see citing works
Revision and Psychometric Properties of the Caring Assessment Tool
Duffy, J. R., Brewer, B. B., & Weaver, M. T. (2010) · Clinical Nursing Research · doi:10.1177/1054773810369827 · Cited by 30 · see citing works
Harris, A. B., Kebaish, F. N., Riley, L. H., Kebaish, K. M., & Skolasky, R. L. (2020) · Journal of Neurosurgery Spine · doi:10.3171/2019.11.spine191159 · Cited by 24 · see citing works
Skeff, K. M., Brown‐Johnson, C. G., Asch, S. M., Zionts, D. L., Winget, M., & Kerem, Y. (2022) · Journal of Healthcare Management · doi:10.1097/jhm-d-21-00070 · Cited by 17 · see citing works
Rathert, C., Mittler, J., & Lee, Y. S. H. (2022) · Health Care Management Review · doi:10.1097/hmr.0000000000000339 · Cited by 16 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Amed, S., Pinkney, S., Abdulhussein, F. S., Virani, A., Zachariuk, C., Tamana, S. K., Muralidharan, S., Görges, M., Barrett, B., van Rooij, T., et al. (2025) · PLOS Digital Health · doi:10.1371/journal.pdig.0000861 · Cited by 1 · see citing works
“Strong patient-provider relationships have long been acknowledged as crucial for delivering high-quality, person-centred care [40–43].”
- Authors
- Rathert, C., Mittler, J. N., Vogus, T. J., & Lee, Y. S. H.
- Affiliations
- Saint Louis University (US)
- Virginia Commonwealth University (US)
- Vanderbilt University (US)
- Columbia University (US)
- Corresponding author
- Rathert, Cheryl
- Venue
- Social Science & Medicine
- Publisher
- Elsevier BV
- Published
- 2023-12
- Volume
- 338
- Pages
- 116290
- ISSN
- 0277-9536 (ISSN-L)
- OpenAlex
- W4387652155
- Cited by
- 12
- References
- 62
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 3
- FWCI
- 4.23
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Social Science & Medicine (publishedVersion)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- Funders
- Teachers College
- Topics
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Health Sciences › Medicine › Psychiatry and Mental health › Empathy and Medical Education
- Keywords
- patient outcomes, job satisfaction, burnout, health self-efficacy, activation, meaningful work, psychological safety, patient satisfaction, mental health
- MeSH terms
- Mediation Analysis, Health Facilities, Humans, Job Satisfaction, Patients, Surveys and Questionnaires, Self Efficacy
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
