Provider burnout and turnover [PDF] is a major challenge for many community health centers. One factor contributing to this problem is workplace climate, or what the experience of working at the health center is like. As anyone in primary care will tell you, at times it can be overwhelming. Thus it was with great interest that I read Friedberg et al’s contribution to this month’s issue of Medical Care, Measuring Workplace Climate in Community Clinics and Health Centers.
Friedberg and colleagues developed a survey to evaluate the workplace environment within ambulatory clinics. The researchers integrated aspects of numerous extant questionnaires and produced a new instrument, composed of 44 items. Importantly, it focuses on workplace characteristics that are essential for primary care practice transformation, such clinic functionality, teamwork, and perception of workload. All of these factors are fundamental to Patient-Centered Medical Home (PCMH) certification.
Given the prevalence of burnout among primary care physicians, it is crucial that the primary care workplace climate is addressed, and researchers are providing some answers. We know that important aspects of a PCMH, such as robust, meaningful team-based care and reducing clerical work such as order entry can improve the workplace experience for primary care providers and co-workers.
Keeping our mission at the center of everyone’s heart and mind, from the call center staff to the medical assistants, from the physicians to the janitors, is an essential step in improving the primary care workplace climate.
But implementing meaningful change that actually changes workplace climate is extremely difficult. Sustained, meaningful change requires change on two levels: that of individual who changes his workflow on one task; and that of the entire organization, shifting the clinic’s culture to adopt new expectations. Some have observed that practices may be implementing small changes to meet PCMH guidelines on paper, but not truly embracing a new model of care that results in any meaningful change in work experience or workplace climate for caregivers.
Having an instrument such as Friedberg et al’s survey can allow clinic administrators to better understand whether their efforts have led to superficial change or more profound change; whether they are making a difference only on paper, or whether providers working in the clinic can appreciate a tangible change in climate. The tool could allow clinic leadership to evaluate progress longitudinally, assess whether change is sustained over months and years, and focus resources on areas of particular need for improvement.
Friedberg and colleagues’ article is particularly timely given a recent breakdown in relations between administrators and providers so severe that it lead to the unionization of clinical staff at a prominent Baltimore FQHC. This is an extreme case, and the workplace climate was clearly polarized. Perhaps a workplace climate survey could have helped administrators appreciate the gulf between themselves and their providers; perhaps not. But it is good to see that there is now a tool available to examine factors particular to the workplace climate in primary care. Next, we need clinic administrators to prioritize provider work experience, and use the survey for evaluation and improvement.
This may be one area where medicine can learn from the private sector. Laszlo Bock is the chief of HR, or “People Ops,” at Google. He wrote a book, Work Rules!, explaining Google’s central tenets on managing their workers and how to keep them happy. His first and strongest piece of advice is to “give your work meaning.” While each clinic is individual and will meet vastly different challenges on the journey to PCMH transformation, team-based care, and a better practice climate, there is no question that every primary care practice does work of the utmost meaning. We take care of people. Keeping our mission at the center of everyone’s heart and mind, from the call center staff to the medical assistants, from the physicians to the janitors, is an essential step in improving the primary care workplace climate.
Audrey Provenzano
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