Staff Morale Is Correlated with Perceived PCMH Characteristics

Healthcare providers and staff who perceived more patient-centered medical home (PCMH) characteristics at their workplace were more likely to report higher morale, according to the results of a recent study. The findings from the study were recently published in the Archives of Internal Medicine [2012;172(1):23-31]. Although previous research has been conducted to assess whether PCMHs improve patient outcomes, according to the authors of this latest study, little research has been done to examine the effects of the PCMH on staff satisfaction and work environment. In this study, researchers surveyed providers and clinical staff in 65 safety-net clinics in 5 states who were in their first year of the 5-year Safety Net Medical Home Initiative supported by The Commonwealth Fund to determine whether staff perception of PCMH characteristics had any correlation with morale, job satisfaction, and burnout. The self-administered surveys were sent in 2010 to 391 providers and 382 clinical staff members and evaluated respondents’ perceptions of PCMH characteristics using 5 subscales based on the 2008 National Committee for Quality Assurance PCMH standards. These subscales included access to care and communication with patients, communication with other providers, tracking data, care management, and quality improvement. Participants answered questions that evaluated PCMH characteristics based on a scale of 0 to 100, with 100 being the best possible score. In addition to assessing the data based on the 5 subscales, researchers also calculated a total PCMH score by determining the mean of 4 of the 5 PCMH subscale scores. Communication with other providers was excluded from the total PCMH score because researchers believed these questions may not be relevant to staff. The primary outcomes of the study were based on participant responses to 3 survey questions that asked survey respondents to rate staff morale in their clinic based on a 5-point scale, measure their job satisfaction on a 5-point scale, and assess their level of burnout by selecting 1 of 5 options that ranged from having no symptoms of burnout to feeling “completely burned out.” Researchers found that when using univariate models to assess the results, the subscale scores for access to care and communication with patients were significantly associated with better morale and increased job satisfaction, while care management scores were also associated with higher morale. Multivariate models using designated control variables showed that a 10% increase in the subscale score for quality improvement was associated with higher morale for providers and staff members (provider odds ratio [OR], 2.64; 95% confidence interval [CI], 1.47-4.75; staff OR, 3.62; 95% CI, 1.84-7.09). In addition, the increase in quality improvement scores was also associated with greater job satisfaction for providers (OR, 2.45; 95% CI, 1.42-4.23) and staff members (OR, 2.55; 95% CI, 1.42-4.57), as well as with freedom from burnout for staff (OR, 2.32; 95% CI, 1.31-4.12). Researchers found that when they evaluated the total PCMH score there was a correlation between higher total PCMH scores and higher morale for staff members (OR, 2.63; 95% CI, 1.47-4.71); however, the scores were also correlated with less provider freedom from burnout (OR, 0.48; 95% CI, 0.30-0.77). The study’s authors concluded that although providers and staff were more likely to have higher morale if they perceived more PCMH characteristics in their workplace, providers may feel more burnout. They acknowledged, however, that there were several limitations to their study. For instance, the baseline cross-sectional design of the study is unable to prove causation, the findings are not generalizable to all safety-net clinics because they were not randomly sampled, evaluation did not occur at absolute baseline, response bias cannot be ruled out, and the survey was not based on 2011 PCMH standards. Other limitations include limited information on each clinic’s electronic medical record capability and findings based on perceptions rather than objective criteria.