A New Tool Identifies Workplace Factors That Can Affect the Quality of Care Patients Receive

Measurement tools for exploring the impact of the ambulatory care workplace on quality of care in chronic disease

In 2005–07, researchers at the University of Wisconsin School of Medicine and Public Health developed a tool to measure the work environment of ambulatory care clinics. The tool identifies workplace factors that can affect the quality of care patients receive.

To develop the tool, the researchers relied on survey and medical record data from a larger project funded by the Agency for Healthcare Research and Quality (AHRQ), the Minimizing Error, Maximizing Outcome—or MEMO—study. The MEMO study determined the effect of the ambulatory care work environment on quality of care and the role of physicians as mediators of this effect. (Work on the tool began under the MEMO study.)

Researchers analyzed data from 422 family physicians and general internists and 96 clinic managers at clinics in New York City, Chicago and three locations in Wisconsin. The study also examined data on 1,796 patients with one or more of three medical conditions:

  • Type 2 diabetes
  • Hypertension
  • Congestive heart failure

During the project, the researchers:

  • Identified clinics with low rates of medical errors and other indicators of high-quality care, based on indices derived from medical record data on patient care and outcomes.
  • Identified key characteristics of clinics that scored highly on at least two of the five indicators and above average on the others
  • Conducted focus groups with medical providers and staff at four high-scoring clinics to discuss how data assembled for the project reflects clinic practices and how it should be presented
  • Developed and refined a tool for measuring the ambulatory care workplace, based on focus group input

Key Results:

  • The main project result was the final development and refinement of the OWL, the Office & Work Life measure. "The OWL provides a roadmap for areas where quality is present and worklife is healthy, and to areas where both could be improved," according to the project team.

    Project Director Mark Linzer, MD, described the OWL as "a snapshot of a clinic, showing what the physicians are experiencing, what the staff is experiencing and what the patients in the waiting room are experiencing."