Cultural And Structural Features Of Zero-Burnout Primary Care Practices
Cultural And Structural Features Of Zero-Burnout Primary Care Practices
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DOI：
10.1377/hlthaff.2020.02391
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发表时间：
2021-06-01
期刊：
影响因子：
9.7
通讯作者：
Cohen, Deborah J.
中科院分区：
文献类型：
--
作者：
Edwards, Samuel T.;Marino, Miguel;Cohen, Deborah J.
尽管人们的注意力主要集中在初级保健机构中个人层面的倦怠驱动因素上，但检查没有倦怠的实践环境的结构和文化因素可以找到解决方案。在对参与医疗保健研究和质量机构 EvidenceNOW 计划的美国 715 个中小型初级保健机构的调查数据进行横断面分析时，我们发现零倦怠实践具有更高水平的心理安全性和适应性储备，这是衡量学习和发展实践能力的指标。与高倦怠实践相比，零倦怠实践还报告使用了更多的质量改进策略，更常见的是单独和临床医生拥有的，并且不太常见的是参与负责任的护理组织或其他示范项目。预防初级保健职业倦怠的努力可能会受益于加强组织和实践文化，包括促进领导力发展和培养实践机构。
Although much attention has been focused on individual-level drivers of burnout in primary care settings, examining the structural and cultural factors of practice environments with no burnout could identify solutions. In this cross-sectional analysis of survey data from 715 small-to-medium-size primary care practices in the United States participating in the Agency for Healthcare Research and Quality's EvidenceNOW initiative, we found that zero-burnout practices had higher levels of psychological safety and adaptive reserve, a measure of practice capacity for learning and development. Compared with high-burnout practices, zero-burnout practices also reported using more quality improvement strategies, more commonly were solo and clinician owned, and less commonly had participated in accountable care organizations or other demonstration projects. Efforts to prevent burnout in primary care may benefit from focusing on enhancing organization and practice culture, including promoting leadership development and fostering practice agency.