Minimizing Errors, Maximizing Outcomes (MEMO)

Presenter: Mary Beth Plane, PhD

Institution: UW Department of Family Medicine, Bernice Man, MD; Cook County Hospital

Introduction: Factors that increase stress and dissatisfaction in primary care include time pressures and a lack of work control. Stress and dissatisfaction lead to physician burnout and intention to leave. Little is known about how workplace characteristics affect physicians and their interplay on quality of care, including medical errors. We hypothesize with our study, Minimizing Errors, Maximizing Outcomes (MEMO), that a work environment promoting physician satisfaction will provide higher quality care with fewer errors. We aim to identify workplace characteristics that result in low error rates and excellent outcomes.

Methods: More than 350 internists (IM) and family physicians (FP) are participating in this ongoing prospective multi-site study. Instruments include physician, patient, and office staff focus groups, a physician survey, and an organization assessment administered to practice managers. Variables of interest include: modified Kralewski medical organization culture scale, staffing, scheduling, information systems, time pressure, case-mix, work control, work-home balance, professionalism, satisfaction, stress and burnout. Information regarding quality of life and disease management of diabetes, hypertension and/or heart failure will be collected from 6 patients per physician via interviews and chart review. Quality measures include HgbA1c, blood pressure readings, ace inhibitor use and preventive care. Error rates will be determined by 1) physician self-estimation of the likelihood of committing an error with the OSPRE (Occupational Stress and Preventable Errors) measure and 2) chart reviews.

Results: Preliminary data from 185 physician surveys (51% IM, 56% men, 83% white, mean age 44) demonstrate the OSPRE stress scale has a reliability alpha=.84 and prediction errors scale alpha=.85. Modified Kralewski subscales include information emphasis, collegiality, cohesiveness, trust, organizational identity, and quality emphasis with alpha range=0.68=0.86.

Discussion: Physician recruitment for a study on errors is feasible (>70% of target sample recruited to date). Measures of culture and error have good to excellent reliability.