Addressing Organizational Quality, Communication Improves Clinician Satisfaction, Stress

Mark Linzer, MD, vice chief of the Department of Medicine for mentoring and research at Hennepin Healthcare and Professor of Medicine at the University of Minnesota, explains why stress, a strong predictor of burnout, was reduced when trust improved, as well as intention to leave the practice. 

“While trust has long been understood as vital for the patient-clinician relationship, less attention has been given to the degree to which physicians and other clinicians trust the organizations in which they work and the association of trust or distrust with organizational performance and patient outcomes,” wrote Dr Linzer and colleagues in their recent study. “This is starting to change amid increasing recognition of stress associated with work and professional dissatisfaction among physicians as well as a policy shift toward measuring the performance of health care organizations.” Integrated Healthcare Executive spoke with Dr Linzer about his study. 

Please tell us about yourself. 

My name is Mark Linzer. I am vice chief of the department of medicine for mentoring and research at Hennepin Healthcare and professor of medicine at the University of Minnesota in Minneapolis, MN. I also direct the office of professional work life at Hennepin Healthcare, which oversees the worklives and wellness of 700 Hennepin providers. 

Our research team has been studying the relationship between work conditions and clinician and
patient outcomes for the past 20 years with support from the Robert Wood Johnson Foundation and
the Agency for Healthcare Research and Quality.

Can you highlight why there is little data regarding the association of trust or distrust with organizational performance and patient outcomes?

Only lately has trust in the organization become a central focus within the literature. A series of viewpoint articles on trust has been published in JAMA this year and the American Board of Internal Medicine has sponsored national sessions on organizational trust. Thus, there seems to be a gradual realization that trust can be a critical organizational component which, if missing, could relate to clinician dissatisfaction, turnover, and perhaps even patient outcomes.

How does physician burn out and clinician trust relate to one another?

In the Healthy Work Place study (doi:10.1001/jamanetworkopen.2019.6201), burnout was only modestly related to trust. But stress, a strong predictor of burnout, was reduced when trust improved, as was intention to leave the practice. Satisfaction, a key component of morale and the joy of practice, was substantially higher when trust waspresent, and was high when trust improved over time.

How can health care organizations take your findings in order to improve their practice and levels of trust?

Certain key organizational characteristics were present when trust was present, including control of the work environment, and several organizational cultural aspects, including cohesion, an emphasis on communication and information, an emphasis on quality over productivity, and values alignment between clinicians and leaders. 

Thus, the first step is to measure trust, and we provide a straightforward, five-item-measure for doing so. Then, when one finds that trust is either low or has been eroded, there are several mechanisms for building trust, including addressing lack of control in the workplace (eg, clinicians’ schedules), and working to explicitly improve organizational culture with values aligning sessions, emphases on communication, a more streamlined electronic record, and restoring a balance between emphasizing quality of care and productivity.

What challenges are faced when attempting to improve trust within health organizations? 

Very little has been done to operationalize the findings; there is, indeed, little literature about these findings nor a roadmap that has been, to our knowledge, used to restore trust when absent.

We will have to see how organizations choose to implement the findings and then we can say. Our sense is that trust matters and may be low in many places that simply do not know because they have not tested for it. Knowing that trust is low is likely to spark important conversations and, hopefully, interventions.

Is there anything else you would like to add?  

We are very pleased with the recent interest in measuring and building clinician trust within health care organizations. Thank you for your interest in this!