Burnout: effect of participation in quality-improvement projects

A living systematic review

Short url: https://openMetaAnalysis.github.io/Burnout-and-quality-improvement

“Quality indices, which are supposed to improve care, ‘are the bane of my existence ,’ she says. ‘Many times those numbers reflect not what my patients or I perceive as quality of care, but simply what managers are able to extract from the health record system.’ “ Gunderman R. NEJM Catalyst. Jan 10, 2017

“the E.M.R. has become the convenient vehicle to channel every quandary in health care. New state regulation? Add a required field in the E.M.R. New insurance requirement? Add two fields. New quality control initiative? Add six" Ofri, D. NY Times. Nov 14, 2017

Clinical summary: This meta-analysis suggests that QI projects that either empower the workforce to design the projet, or projects that are designed to benefit the workforce may be effective in reducing burnout. Heterogeneity of results as measured by I² was 'substantial' at 75%. Heterogeneity is partly explained by the degree of control over project implementation by the frontline workforce. This review updates previously published meta-analyses listed below.

• Reconciliation of conclusions with prior meta-analyses (under construction)
• Keep current with this topic (under construction)

Acknowledgement: we acknowledge the essential work by the authors of the prior systematic review(s) listed below.

Methods overview: This repository is an openMetaAnalysis that combines methods of scoping, rapid, and living systematic reviews. This analysis updates one or more previously published review(s) below. A comparison of studies included in this review compared to prior reviews are in the table, reconciliation of trials included with prior meta-analyses/. Newer studies included are listed in the references below. Rationale for newer trials excluded may be listed at the end of the references.

• Methods for openMetaAnalysis
• Evidence search for this review (under construction)

Results: Details of the studies included are in the:

• Reconciliation of trials included with prior meta-analyses/ (under construction)

• Description of studies (PICO table)

• Risk of bias assessment (under construction)

• Forest plots (source data)

• Reconciliation of conclusions with prior meta-analyses (under construction)

The forest plot for the primary outcomes are below. Additional forest plots of secondary analyses may be available.

References:

Systematic review(s)

Most recent review at time of last revision of this repository

1. Kalani SD, Azadfallah P, Oreyzi H, Adibi P. Interventions for Physician Burnout: A Systematic Review of Systematic Reviews. Int J Prev Med. 2018 Sep 17;9:81. doi: 10.4103/ijpvm.IJPVM_255_18. PMID: 30283613; PMCID: PMC6151971.
2. Brand SL, Thompson Coon J, Fleming LE, Carroll L, Bethel A, Wyatt K. Whole-system approaches to improving the health and wellbeing of healthcare workers: A systematic review. PLoS One. 2017 Dec 4;12(12):e0188418. doi: 10.1371/journal.pone.0188418. eCollection 2017. PMID: 29200422; PMCID: PMC5714334.
3. Panagioti M, Panagopoulou E, Bower P, Lewith G, Kontopantelis E, Chew-Graham C, Dawson S, van Marwijk H, Geraghty K, Esmail A. Controlled Interventions to Reduce Burnout in Physicians: A Systematic Review and Meta-analysis. JAMA Intern Med. 2017 Feb 1;177(2):195-205. doi: 10.1001/jamainternmed.2016.7674. PMID: 27918798.
4. West CP, Dyrbye LN, Erwin PJ, Shanafelt TD. Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. Lancet. 2016 Nov 5;388(10057):2272-2281. doi: 10.1016/S0140-6736(16)31279-X. PMID: 27692469.
5. Jackson GL, Powers BJ, Chatterjee R, Bettger JP, Kemper AR, Hasselblad V, Dolor RJ, Irvine RJ, Heidenfelder BL, Kendrick AS, Gray R, Williams JW. The patient centered medical home. A systematic review. Ann Intern Med. 2013 Feb 5;158(3):169-78. PMID: 24779044.

Studie(s)

New studie(s) not included in the most recent review above

1. Meredith LS, Batorsky B, Cefalu M, Darling JE, Stockdale SE, Yano EM, Rubenstein LV. Long-term impact of evidence-based quality improvement for facilitating medical home implementation on primary care health professional morale. BMC Fam Pract. 2018 Aug 31;19(1):149. doi: 10.1186/s12875-018-0824-4. PMID: 30170541; PMCID: PMC6119243.
2. Peikes DN, Swankoski K, Hoag SD, Duda N, Coopersmith J, Taylor EF, Morrisson N, Palakal M, Holland J, Day TJ, Sessums LL. The Effects of a Primary Care Transformation Initiative on Primary Care Physician Burnout and Workplace Experience. J Gen Intern Med. 2019 Jan;34(1):49-57. doi: 10.1007/s11606-018-4545-0. Epub 2018 Jul 17. PMID: 30019124; PMCID: PMC6318185.
3. Hung DY, Harrison MI, Truong Q, Du X. Experiences of primary care physicians and staff following lean workflow redesign. BMC Health Serv Res. 2018 Apr 10;18(1):274. doi: 10.1186/s12913-018-3062-5. PMID: 29636052; PMCID: PMC5894127.
4. Linzer M, Poplau S, Grossman E, Varkey A, Yale S, Williams E, Hicks L, Brown RL, Wallock J, Kohnhorst D, Barbouche M. A Cluster Randomized Trial of Interventions to Improve Work Conditions and Clinician Burnout in Primary Care: Results from the Healthy Work Place (HWP) Study. J Gen Intern Med. 2015 Aug;30(8):1105-11. doi: 10.1007/s11606-015-3235-4. PMID: 25724571; PMCID: PMC4510236.
5. Reid RJ, Coleman K, Johnson EA, Fishman PA, Hsu C, Soman MP, Trescott CE, Erikson M, Larson EB. The Group Health medical home at year two: cost savings, higher patient satisfaction, and less burnout for providers. Health Aff (Millwood). 2010 May;29(5):835-43. doi: 10.1377/hlthaff.2010.0158. PMID: 20439869. See also their report from year one of their project, PMID 19728768
6. Dunn PM, Arnetz BB, Christensen JF, Homer L. Meeting the imperative to improve physician well-being: assessment of an innovative program. J Gen Intern Med. 2007 Nov;22(11):1544-52. PMID: 17891503; PMCID: PMC2219814.
7. Helfrich CD, Dolan ED, Simonetti J, Reid RJ, Joos S, Wakefield BJ, Schectman G, Stark R, Fihn SD, Harvey HB, Nelson K. Elements of team-based care in a patient-centered medical home are associated with lower burnout among VA primary care employees. J Gen Intern Med. 2014 Jul;29 Suppl 2:S659-66. doi: 10.1007/s11606-013-2702-z. PMID: 24715396; PMCID: PMC4070238.

Studie(s) included in the review(s) above

NA

Studie(s) undergoing review

1. Lewis SE, Nocon RS, Tang H, Park SY, Vable AM, Casalino LP, Huang ES, Quinn MT, Burnet DL, Summerfelt WT, Birnberg JM, Chin MH. Patient-centered medical home characteristics and staff morale in safety net clinics. Arch Intern Med. 2012 Jan 9;172(1):23-31. doi: 10.1001/archinternmed.2011.580. PubMed PMID: 22232143
2. Nocon RS, Fairchild PC, Gao Y, Gunter KE, Lee SM, Quinn M, Huang ES, Chin MH. Provider and Staff Morale, Job Satisfaction, and Burnout over a 4-Year Medical Home Intervention. J Gen Intern Med. 2019 Jun;34(6):952-959. doi: 10.1007/s11606-019-04893-z. Epub 2019 Mar 18. PubMed PMID: 30887431
3. Mahmoud Z, Angelé-Halgand N, Churruca K, Ellis LA, Braithwaite J. The impact of lean management on frontline healthcare professionals: a scoping review of the literature. BMC Health Serv Res. 2021 Apr 26;21(1):383. doi: 10.1186/s12913-021-06344-0. PMID: 33902552; PMCID: PMC8074224.
4. Wong WJ, Mohd Norzi A, Ang SH, Chan CL, Jaafar FSA, Sivasampu S. The effects of enhanced primary healthcare interventions on primary care providers' job satisfaction. BMC Health Serv Res. 2020 Apr 15;20(1):311. doi: 10.1186/s12913-020-05183-9. PMID: 32293446; PMCID: PMC7158075.
5. DeChant PF, Acs A, Rhee KB, Boulanger TS, Snowdon JL, Tutty MA, Sinsky CA, Thomas Craig KJ. Effect of Organization-Directed Workplace Interventions on Physician Burnout: A Systematic Review. Mayo Clin Proc Innov Qual Outcomes. 2019 Sep 26;3(4):384-408. doi: 10.1016/j.mayocpiqo.2019.07.006. PMID: 31993558; PMCID: PMC6978590.

Studie(s) excluded - selected list of important trial(s)

1. Arnetz B, Blomkvist V. Leadership, mental health, and organizational efficacy in health care organizations. Psychosocial predictors of healthy organizational development based on prospective data from four different organizations. Psychother Psychosom. 2007;76(4):242-8. PMID: 17570963. * workforce mental health rather than burnout*
2. Boult C, Reider L, Frey K, Leff B, Boyd CM, Wolff JL, Wegener S, Marsteller J, Karm L, Scharfstein D. Early effects of "Guided Care" on the quality of health care for multimorbid older persons: a cluster-randomized controlled trial. J Gerontol A Biol Sci Med Sci. 2008 Mar;63(3):321-7. PMID: 18375882. Studied provider satisfaction, but not burnout
3. Lewis SE, Nocon RS, Tang H, Park SY, Vable AM, Casalino LP, Huang ES, Quinn MT, Burnet DL, Summerfelt WT, Birnberg JM, Chin MH. Patient-centered medical home characteristics and staff morale in safety net clinics. Arch Intern Med. 2012 Jan 9;172(1):23-31. doi: 10.1001/archinternmed.2011.580. PubMed PMID: 22232143;Correlated extent of PCMH implementation with burnout. No true control group thus could not exclude the Matthew effect
4. Locatelli SM, LaVela SL. Professional Quality of Life of Veterans Affairs Staff and Providers in a Patient-Centered Care Environment. Health Care Manag (Frederick). 2015 Jul-Sep;34(3):246-54. doi: 10.1097/HCM.0000000000000070. PMID: 26218000.Correlated extent of PCMH implementation with burnout. No true control group thus could not exclude the Matthew effect
5. Nelson KM, Helfrich C, Sun H, Hebert PL, Liu CF, Dolan E, Taylor L, Wong E, Maynard C, Hernandez SE, Sanders W, Randall I, Curtis I, Schectman G, Stark R, Fihn SD. Implementation of the patient-centered medical home in the Veterans Health Administration: associations with patient satisfaction, quality of care, staff burnout, and hospital and emergency department use. JAMA Intern Med. 2014 Aug;174(8):1350-8. doi: 10.1001/jamainternmed.2014.2488. PMID: 25055197. Correlated extent of PCMH implementation with burnout. No true control group thus could not exclude the Matthew effect
6. Nutting PA, Crabtree BF, Miller WL, Stewart EE, Stange KC, Jaén CR. Journey to the patient-centered medical home: a qualitative analysis of the experiences of practices in the National Demonstration Project. Ann Fam Med. 2010;8 Suppl 1:S45-56; S92. doi: 10.1370/afm.1075. Erratum in: Ann Fam Med. 2010 Jul-Aug;8(4):369. PMID: 20530394 Qualitative study that did not measure burnout but comment on 'local control of the developmental pathway'
7. Parker LE, de Pillis E, Altschuler A, Rubenstein LV, Meredith LS. Balancing participation and expertise: a comparison of locally and centrally managed health care quality improvement within primary care practices. Qual Health Res. 2007 Nov;17(9):1268-79. PMID: 17968043. Did not measure burnout; but did compare workforce preference for method of QI implementation.
8. Salyers MP, Garabrant JM, Luther L, Henry N, Fukui S, Shimp D, Wu W, Gearhart T, Morse G, York MM, Rollins AL. A Comparative Effectiveness Trial to Reduce Burnout and Improve Quality of Care. Adm Policy Ment Health. 2018 Nov 28. doi: 10.1007/s10488-018-0908-4. PMID: 30488144. Did not study participation in quality improvement

Cited by

This repository is cited by:

1. Badgett RG, Duran BA. Does Participation in QI Affect Clinician Burnout?. 2019 Annual Meeting of the Society of General Internal Medicine; 2019 May 9; Washington, DC, United States. Society of General Internal Medicine. PMID 31090026

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