Improving Working Conditions Reduces Physician Burnout

"I am truly indebted to AHRQ for the support that allowed us to identify the connections between work conditions, clinician reactions (including satisfaction and burnout), and patient outcomes. This work over the past 15 years has allowed us to make concrete recommendations to health systems on how to build healthier workplaces for providers and patients."

Mark Linzer, M.D., has spent more than a decade studying how working conditions in primary care settings affect clinicians and patients. His goal is to improve the care experience for both clinicians and their patients. Dr. Linzer, who is currently director of the Division of General Internal Medicine and director of the Office of Professional Work Life at Hennepin County Medical Center and Professor of Medicine at the University of Minnesota in Minneapolis, embarked on this line of research in 2001 with funding from AHRQ.

His initial AHRQ grant, called Minimizing Error, Maximizing Outcome (MEMO): The Physician Worklife Study II involved more than 400 primary care physicians in more than 100 practices and found that time pressures, chaotic environments, low control over work pace, and unfavorable organizational culture were strongly associated with physicians’ feelings of dissatisfaction, stress, burnout, and intent to leave the practice. The study also found that when practices implement electronic health records (EHRs), stress rises but does not return to the pre-EHR level, and fully mature EHR systems were associated with physician stress, burnout, and intent to leave the practice when coupled with shorter office visits.

His AHRQ-funded research also led to a new measure of burnout, the Mini Z Burnout Survey that allows leaders of medical practices to take a quick temperature of how much stress and burnout they and their staff are experiencing and what might be causing it. Thousands of physicians now use the Mini Z, and it is included in the American Medical Association’s Steps Forward evidence-based module on burnout prevention.

Dr. Linzer has applied his findings to improve work life for Hennepin County Medical Center’s 600 providers. As leader of the Office of Professional Work Life at Hennepin, he deploys the Mini Z regularly to Hennepin’s departments to detect burnout early and meets with department chairs when burnout levels rise. Medical center leaders have used a number of interventions to reduce burnout, including having scribes in treatment rooms during appointments so that doctors can avoid typing and focus on patients, having standing order sets, and reviewing providers’ schedules to create better work-home balance. As a result of these interventions, Dr. Linzer reports that one surgical department saw a reduction in burnout from 40 percent to 19 percent.

"AHRQ was instrumental in launching this agenda," Dr. Linzer said. "This is the waterfront for change in work conditions. If you’re running a large health system, these are what CEOs are now focusing on: the findings that AHRQ has funded over the past 15 years."

Dr. Linzer’s current AHRQ-funded study—Minimizing Stress, Maximizing Success of the EHR—is currently identifying the amount of EHR-related burnout in practices, EHR-related stressors, and solutions for mitigating this stress. "I am truly indebted to AHRQ for the support that allowed us to identify the connections between work conditions, clinician reactions (including satisfaction and burnout) and patient outcomes,” he said. “This work over the past 15 years has allowed us to make concrete recommendations to health systems on how to build healthier workplaces for providers and patients."

Principal Investigator: Mark Linzer, M.D.
Institution: Minneapolis Medical Research Foundation, Inc.
Grantee Since: 2001
Type of Grant: Various

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