Howell, Thomas G.

Research has shown a consistent positive association between patient and provider experience and improved patient outcomes and safety. There is a belief that patient satisfaction and physician productivity are competing interests. The relationship for primary care physicians, in a Midwest Health system was evaluated as part of this project. Data from Press Ganey patient satisfaction surveys on likelihood of recommending the practice and the physician were compared between primary care physicians in the top quartile of average monthly patient visits and those that were in the three lower quartiles. A secondary analysis of patient satisfaction scores related to continuous years of service was also performed. Results of a multi-level logistic regression analysis showed a statistically significant difference between quartiles on average monthly visits and the likelihood of receiving a top box score on recommendation of the practice, but not the provider. The odds ratio was 0.7 for lower quartiles compared to highest quartile of visits. There was not a statistically significant difference for the categories of continuous years of service. On the question of recommending the physician, the odds ratios were not different, although there was a significant difference for the categories of years of service, with those between 0-5 years having a 0.62 odds ratio of a top box score compared to greater than 10 years. The results would tend to refute the belief that patient satisfaction must be sacrificed for physician productivity.

Clinician burnout and patient experience are important issues that are often considered separately. New measures of resilience may influence both. We explored relationships among clinician resilience, burnout, and patient experience. Analysis included 490 physicians who completed surveys measuring burnout and resilience (decompression and activation) and had at least 30 patient experience surveys available for analysis. Burnout was measured with 2 items from the Maslach Burnout Inventory (MBI) which were part of the organization’s ongoing measurement of clinician experience. Resilience was measured with 8 items from 2 Press Ganey validated subscales related to clinicians’ ability to decompress from work and their experience of feeling of activation and connection to purpose while at work. Clinicians reporting more frequent symptoms of burnout based on the MBI items reported less ability to decompress ( r for individual measures ranged from −.183 to −.475, P < .01) and less feeling of activation ( r for individual measures ranged from −.116 to −.401, P < .01). Individual elements of decompression and activation were significantly associated with patient experience. In terms of activation, feeling that one’s work makes a difference ( r ranged from .121 to .159, P < .05) and believing one’s work to be meaningful ( r ranged from .102 to .135, P < .05) were positively associated with patient experience with their care provider. However, elements of decompression such as being able to free one’s mind from work ( r ranged from −.092 to −.119, P < .05) and being able to disconnect from work communications such as e-mails ( r ranged from −.094 to −.130, P < .05) were negatively associated with patient experience with their care providers. Patient and provider experience are intertwined in that clinician resilience is associated with both burnout and patient experience, but individual mechanisms of resilience may be beneficial for the clinician but not for the patient.