Clinicians With High Trust in Their Practice Are More Satisfied, Feel Less Stress and Are More Likely To Stay

Survey responses from 165 clinicians at 34 Midwest and East Coast primary care practices showed that clinicians with improved or stable high trust in their organizations reported higher satisfaction and less stress, and were less likely to think about leaving the practice compared with clinicians whose trust declined or remained low. Trust was higher in practices that, among other qualities, offered workload control, had cultures that encouraged cohesiveness, and emphasized quality versus productivity. Researchers also found that female clinicians were less likely than males to express a high level of trust in their organizations. The researchers concluded that trust can be improved and may lead to lower burnout rates, better patient outcomes and less turnover. Access the abstract of the study published in JAMA Network Open.

2019 Jun 5;2(6):e196201. doi: 10.1001/jamanetworkopen.2019.6201.

Characteristics of Health Care Organizations Associated With Clinician Trust: Results From the Healthy Work Place Study.

Linzer M1, Poplau S1, Prasad K1, Khullar D2, Brown R3, Varkey A4, Yale S5, Grossman E6, Williams E7, Sinsky C8; Healthy Work Place Investigators.

Author information

Abstract

IMPORTANCE:

There is new emphasis on clinician trust in health care organizations but little empirical data about the association of trust with clinician satisfaction and retention.

OBJECTIVE:

To examine organizational characteristics associated with trust.

DESIGN, SETTING, AND PARTICIPANTS:

This prospective cohort study uses data collected from 2012 to 2014 from 34 primary care practices employing physicians (family medicine and general internal medicine) and advanced practice clinicians (nurse practitioners and physician assistants) in the upper Midwest and East Coast of the United States as part of the Healthy Work Place randomized clinical trial. Analyses were performed from 2015 to 2016.

MAIN OUTCOMES AND MEASURES:

Clinician trust was measured using a 5-item scale, including belonging, loyalty, safety focus, sense of trust, and responsibility to clinicians in need (range, 1-4, with 1 indicating low and 4 indicating high; Cronbach α = 0.77). Other metrics included work control, work atmosphere (calm to chaotic), organizational culture (cohesiveness, emphases on quality and communication, and values alignment; range, 1-4, with 1 indicating low and 4 indicating high), and clinician stress (range, 1-5, with 1 indicating low and 5 indicating high), satisfaction (range, 1-5, with 1 indicating low and 4 indicating high), burnout (range, 1-5, with 1 indicating no burnout and 5 indicating very high feeling of burnout), and intention to leave (range, 1-5, with 1 indicating no intention to leave and 5 indicating definite intention to leave). Analyses included 2-level hierarchical modeling controlling for age, sex, specialty, and clinician type. Cohen d effect sizes (ESs) were considered small at 0.20, moderate at 0.50, and large at 0.80 or more.

RESULTS:

The study included 165 clinicians (mean [SD] age, 47.3 [9.2] years; 86 [52.1%] women). Of these, 143 (87.7%) were physicians and 22 (13.3%) were advanced practice clinicians; 105 clinicians (63.6%) worked in family medicine, and 60 clinicians (36.4%) worked in internal medicine. Compared with clinicians with low levels of trust, clinicians who reported high levels of trust had higher mean (SD) scores for work control (2.49 [0.52] vs 2.18 [0.45]; P < .001), cohesiveness (3.11 [0.46] vs 2.51 [0.51]; P < .001), emphasis on quality vs productivity (3.12 [0.48] vs 2.58 [0.41]; P < .001), emphasis on communication (3.39 [0.41] vs 3.01 [0.44]; P < .001), and values alignment (2.61 [0.59] vs 2.12 [0.52]; P < .001). Men were more likely than women to express loyalty (ES, 0.35; 95% CI, 0.05-0.66; P = .02) and high trust (ES, 0.31; 95% CI, 0.01-0.62; P = .04). Compared with clinicians with low trust at baseline, clinicians with high trust at baseline had a higher mean (SD) satisfaction score (3.99 [0.08] vs 3.51 [0.07]; P < .001; ES, 0.70; 95% CI, 0.39-1.02). Compared with clinicians in whom trust declined or remained low, clinicians with improved or stable high trust reported higher mean (SD) satisfaction (4.01 [0.07] vs 3.43 [0.06]; P < .001; ES, 0.98; 95% CI, 0.66-1.31) and lower stress (3.21 [0.09] vs 3.53 [0.09]; P = .02; ES, -0.39; 95% CI, -0.70 to -0.08) scores and had approximately half the odds of intending to leave (odds ratio, 0.481; 95% CI, 0.241-0.957; P = .04).

CONCLUSIONS AND RELEVANCE:

Addressing low levels of trust by improving work control and emphasizing quality, cohesion, communication, and values may improve clinician satisfaction, stress, and retention.