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The relationship of organizational culture, stress, satisfaction, and burnout with physician-reported error and suboptimal patient care: Results from the MEMO study

Williams, Eric S.; Manwell, Linda Baier; Konrad, Thomas R.; Linzer, Mark

doi: 10.1097/01.HMR.0000281626.28363.59
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Background: A report by the Institute of Medicine suggests that changing the culture of health care organizations may improve patient safety. Research in this area, however, is modest and inconclusive. Because culture powerfully affects providers, and providers are a key determinant of care quality, the MEMO study (Minimizing Error, Maximizing Outcome) introduces a new model explaining how physician work attitudes may mediate the relationship between culture and patient safety.

Research Questions: (1) Which cultural conditions affect physician stress, dissatisfaction, and burnout? and (2) Do stressed, dissatisfied, and burned out physicians deliver poorer quality care?

Methods: A conceptual model incorporating the research questions was analyzed via structural equation modeling using a sample of 426 primary care physicians participating in MEMO.

Findings: Culture, overall, played a lesser role than hypothesized. However, a cultural emphasis on quality played a key role in both quality outcomes. Further, we found that stressed, burned out, and dissatisfied physicians do report a greater likelihood of making errors and more frequent instance of suboptimal patient care.

Practice Implications: Creating and sustaining a cultural emphasis on quality is not an easy task, but is worthwhile for patients, physicians, and health care organizations. Further, having clinicians who are satisfied and not burned out or stressed contributes substantially to the delivery of quality care.

Eric S. Williams, PhD, is Associate Professor of Health Care Management and Minnie Miles Research Professor, Department of Management and Marketing, Culverhouse College of Commerce and Business Administration, University of Alabama, Tuscaloosa. E-mail: ewilliam@cba.ua.edu.

Linda Baier Manwell, MS, is MEMO Project Director, Section of General Internal Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison. E-mail: Imanwell@wisc.edu.

Thomas R. Konrad, PhD, is Senior Fellow, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill. E-mail: Bob_Konrad@unc.edu.

Mark Linzer, MD, is Chief, Section of General Internal Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison. E-mail: mxl@medicine.wsc.edu.

For the MEMO Investigators.

© 2007 Lippincott Williams & Wilkins, Inc.