Health Services Research & Development

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The Effect of Working Conditions on Patient Care: A Systematic Review

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The Effect of Working Conditions on Patient Care: A Systematic Review (January 2012)

Principal Investigator: Kandice A. Kapinos, PhD
Research Associates: Patrick Fitzgerald, MPH Nancy Greer, PhD Indulis Rutks, BS

Evidence-based Synthesis Program (ESP) Center
Minneapolis VA Medical Center

Minneapolis, MN; Department of Veterans Affairs; January 2012

Download PDF: Complete Report, Executive Summary, Report, Appendices




Background

A large body of evidence shows clear linkages between workplace conditions and employee satisfaction and stress in a wide variety of organizational and industry settings. In the healthcare industry, increasing interest in understanding these linkages stems from the idea that healthcare providers working environments also affect important patient outcomes, including safety, quality of care and satisfication. Additionally, meeting objectives of the current healthcare reform to increase healthcare quality by increasing the availability of primary care providers and making care safer, more efficient, effective and patient-centered hinges on the ability to deal with the documented shortage of primary care providers in the US and at the same time improve patient outcomes. The purpose of this report was to systematically review the evidence on the role of primary care providers workplace conditions in influencing patient outcomes. We focused on patient satisfaction, safety, and quality of care for patient outcomes (note that there may be some overlap in how these patient outcomes are measured). We excluded articles that focused on one specific disease or patient population. The focus on primary care providers� work environment will provide evidence on increasing healthcare quality. Results from this review may inform policymakers as they endeavor to implement aspects of the healthcare reform related to increasing the supply of primary care providers and improving patient outcomes.

The key questions were:

Key Question #1. How are human resources (HR) practices, such as skill levels, training, workload, hours worked, autonomy, and electronic medical records/systems, associated with patient outcomes?

a. quality of care (access and effectiveness)
b. safety (medication errors)
c. patient satisfaction (with provider, with clinic/practice)
Key Question #2. How are other working conditions, such as organizational culture or physical environment, associated with patient outcomes?

a. quality of care (access and effectiveness)
b. safety (medication errors)
c. patient satisfaction (with provider, with clinic/practice)
Key Question #3. In studies that report provider outcomes, how are working conditions associated with provider outcomes (e.g., job satisfaction, productivity, pay)?

See also

A Review of the Evidence: The Effect of Healthcare Providers' Working Conditions on Patient Care, (VA HSR&D Management e-Brief)