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The Healthy Work Place (HWP) study investigated methods to improve clinicians’ dissatisfaction and burnout. The purpose of this paper is to identify factors that influenced study enrollment and completion and assess effects of initial clinic site enrollment rates on clinician outcomes, including satisfaction, burnout, stress and intent to leave practice.

In total, 144 primary care clinicians (general internists, family physicians, nurse practitioners and physician assistants) at 14 primary care clinics were analyzed.

In total, 72 clinicians enrolled in the study and completed the first survey (50 percent enrollment rate). Of these, 10 did not complete the second survey (86 percent completion rate). Gender, type, burnout, stress and intervention did not significantly affect survey completion. Hence, widespread agreement about most moral/ethical issues (72 percent vs 22 percent; p=0.0060) and general agreement on treatment methods (81 percent vs 50 percent; p=0.0490) were reported by providers that completed both surveys as opposed to just the initial survey. Providers with high initial clinic site enrollment rates (=50 percent providers) obtained better outcomes, including improvements in or no worsening of satisfaction (odds ratio (OR)=19.16; p=0.0217) and burnout (OR=6.24; p=0.0418).

More providers experiencing workplace agreement completed the initial and final surveys, and providers at sites with higher initial enrollment rates obtained better outcomes including a higher rate of improvement or no worsening of job satisfaction and burnout.

There is limited research on clinicians’ workplace and other factors that influence their participation in survey-based studies. The findings help us to understand how these factors may affect quality of data collecting and outcome. Thus, the study provides us insight for improvement of quality in primary care.

This study explores the role of procedural and distributive justice in influencing supervisory trust, job satisfaction, and organizational commitment. Past work in U.S. settings has shown the differential effects of procedural and distributive justice on job attitudes while other work supports the relationship between both procedural and distributive justice with trust. This study attempts to replicate the US findings and extend them to samples from India, Germany, and China (Hong Kong). A theoretical model was tested via structural equation analysis. Organizational justice was found to be an important predictor of trust in all the samples, indicating the importance of these concepts in organizational life in different cultures. The implications of these results for future research are discussed.

Eric Williams and his colleagues review the literature on both physician burnout and physician–patient communication. A major contribution in this chapter is a model based on these two literatures, which outlines the impact that physician burnout can have on the physician–patient interaction and, therefore, patient outcomes. When physicians become emotionally exhausted, they begin to depersonalize to cope and focus on biomedical issues rather than communicating with the patient. When the patient is approached with this communication style from their physicians, they become less satisfied, trusting, and compliant. Less compliance results in worsened clinical outcomes, especially for patients with chronic disease. The authors discuss both the implications of this model and future directions for research.

A fundamental assumption by the Institute of Medicine (IOM) is that evidence-based medicine (EBM) improves the effectiveness of medical diagnosis and treatment and, thus, the safety of patients. However, EBM remains controversial, especially its links to patient safety. This chapter addresses three research questions: (1) How does EBM contribute to patient safety? (2) How and why is EBM limited in improving patient safety? and (3) How can patient safety be maximized, given the limitations of EBM? Currently, EMB contributes to patient safety both by educating clinicians on the value and use of empirical evidence for medical practice and via large-scale initiatives to improve care processes. Attempts to apply EBM to individual patient care are limited, in part, because EMB relies on biostatisical and epidemiological reasoning to assess whether a screening, diagnostic, or treatment process produces desired health outcomes for a general population. Health care processes that are most amenable to EBM are those that can be standardized or routinized; non-routine processes, such as diagnosing and treating a person with both acute and chronic co-morbidities, are cases where EBM has limited applicability. To improve patient safety, health care organizations should not rely solely on EBM, but also recognize the need to foster mindfulness within the medical professions and develop patient-centric organizational systems and cultures.

THE MIXED reaction to the proposal for a diploma of higher education appears to be based not on the qualities or defects of the curriculum for the diploma—for no‐one yet really knows what it is going to be—but on attitudes which relate not to educational problems, but to social or political assumptions. The great British public has never wanted to spend more than it must on education. Expenditure on universities was never questioned when it was a fraction of the budget: since it has been a significant figure, the government of the day, whatever its complexion, has sought to economise. The polytechnics were supposed to be cheaper than universities; four term years cheaper than three term years. Now it is two‐year diplomas that are cheaper than three or four year degrees. No‐one with experience of the various changes in educational policy made by successive governments can, it seems to me, be other than cynical about the educational motives of politicians in making changes in the educational system. The case for the introduction of a two‐year course for a diploma in higher education is that many students would prefer to undertake a shorter course, with the possibility of topping it up later to degree standard if they wish to do so. This is presumably one example of the current fashionable phrase ‘continuous education’. Bodies such as the AUT and some members of professional associations fear that the introduction of the diploma will lead to a reduction in standards in the education students receive. The AUT also thinks it will affect the salaries of teaching staff.

Health care organizations may incur high costs due to a stressed, dissatisfied physician workforce. This study proposes and tests a model relating job stress to four intentions to withdraw from practice mediated by job satisfaction and perceptions of physical and mental health. The test used a sample of 1735 physicians and generally supported the model. Given the movement of physicians into increasingly bureaucratic structures, the clinical work environment must be effectively managed.