Article Figures & Data
Figures
- Figure 1.
Interaction between team structure and team culture on exhaustion for clinicians (adjusted for covariates). A median split is used to define low versus high team culture.
Tables
Item Mean Median Standard Deviation Range Factor Loading The group of staff and providers I work with most regularly work well together as a team. 7.09 7.00 2.35 1–10 0.80 My most important task in clinic is to manage patient flow.* 6.52 7.00 2.71 1–10 0.20 We have a “we are in it together” attitude at my clinic. 6.42 7.00 2.60 1–10 0.87 I feel unprepared for many of the tasks that I am asked to do every day.†‡ 7.76 9.00 2.47 1–10 0.35 My professional skills are used to the fullest at my clinic. 6.39 7.00 2.96 1–10 0.64 It is hard to get things to change in my clinic.† 4.77 5.00 2.56 1–10 0.60 I can rely on other people at my clinic to do their jobs well. 6.66 7.00 2.25 1–10 0.72 We regularly take time to consider ways to improve how we do things at my clinic. 6.87 7.00 2.47 1–10 0.69 ↵* This item was removed from the final scale.
↵† These items were reverse-coded to develop a composite score. The results presented here are reverse-coded.
↵‡ The factor loading score for this item is low, but removal of this item did not improve the Cronbach α, and it was retained in the final scale.
Characteristics Clinicians (n = 231) Staff (n = 280) Half days of patient care per week 1–2 116 (50) — 3–5 75 (33) — ≥6 40 (17) — Work hours per week <20 — 28 (9) ≥20 — 252 (91) Tenure (years) <1 38 (17) 61 (22) 1–5 99 (43) 101 (36) ≥5 94 (41) 118 (42) System Public 138 (60) 183 (65) University 93 (40) 97 (35) EHR in transition (±6 months) No 213 (92) 248 (89) Yes 18 (8) 32 (11) Clinician type Attending physician 115 (50) — Nurse practitioner/physician assistant 31 (13) — Resident 85 (37) — Direct role in patient care No — 123 (44) Yes — 157 (56) Staff team structure No team — 104 (39) Team or teamlet — 162 (61) Clinician team structure No team 22 (10) — Team 164 (72) — Teamlet 42 (18) — Team culture, mean (SD) 6.17 (1.62) 6.90 (1.65) MBI emotional exhaustion Exhaustion score, mean (SD) 3.43 (1.42) 2.81 (1.66) Low exhaustion 24 (11) 64 (24) Moderate exhaustion 63 (29) 89 (33) High exhaustion 129 (60) 117 (43) Data are n (%) unless otherwise indicated.
EHR, electronic health record; MBI, Maslach Burnout Inventory; SD, standard deviation.
Variable Model 1 Model 2 Model 3 Model 4 β 95% CI β 95% CI β 95% CI β 95% CI Half days worked 1–2 Ref Ref Ref Ref 3–5 0.35 −0.31 to 1.01 0.58* 0.15 to 1.01 0.58* 0.25 to 0.91 0.53* 0.23 to 0.83 ≥6 0.73* 0.20 to 1.25 1.23† 0.83 to 1.64 1.40† 0.97 to 1.84 1.38† 0.98 to 1.78 Tenure (years) <1 Ref Ref Ref Ref 1–5 0.48 −0.14 to 1.10 0.24 −0.13 to 0.62 −0.09 −0.60 to 0.43 0.04 −0.45 to 0.53 >5 0.03 −0.88 to 0.93 0.08 −0.72 to 0.89 −0.15 −0.91 to 0.62 −0.13 −0.85 to 0.59 System County Ref Ref Ref Ref University −0.20 −0.55 to 0.16 −0.15 −0.38 to 0.09 −0.21 −0.49 to 0.06 −0.20 -0.47 to 0.07 EHR in transition No Ref Ref Ref Ref Yes 0.73* 0.19 to 1.26 0.87† 0.37 to 1.37 0.81* 0.19 to 1.44 0.80‡ 0.16 to 1.44 Clinician type Attending physician Ref Ref Ref Ref Nurse practitioner/physician assistant 0.01 −0.52 to 0.53 −0.31 −0.69 to 0.08 −0.21 −0.45 to 0.02 −0.17 −0.35 to 0.01 Resident 0.56‡ 0.02 to 1.10 0.86† 0.48 to 1.25 0.66† 0.36 to 0.97 0.64† 0.36 to 0.92 Team structure No teams Ref Ref Ref Ref Team −0.62‡ −1.17 to −0.07 −0.52‡ −0.92 to −0.12 −0.42‡ −0.79 to −0.04 −0.56‡ −0.95 to −0.17 Teamlet −1.19† −1.61 to −0.78 −0.99† −1.46 to −0.53 −0.60‡ −1.07 to −0.13 −0.50‡ 0.97 to −0.04 Team culture −0.37† −0.44 to −0.30 −0.37† −0.53 to −0.20 −0.34† −0.48 to −0.21 Team structure × team culture −0.31† −0.39 to −0.23 QIC fit index 364.19 308.56 294.10 β Values are coefficients of linear regressions using generalized estimated equations associated with changes in the exhaustion score; positive numbers represent greater exhaustion and negative numbers represent less exhaustion.
↵‡ P < .05.
↵* P < .01.
↵† P < .001.
CI, confidence interval; EHR, electronic health record; QIC, quasi-likelihood under the independence model criterion; Ref, reference category.
Variable Model 1 Model 2 Model 3 Model 4 β 95% CI β 95% CI β 95% CI β 95% CI Hours worked per week ≤20 Ref Ref Ref Ref >20 0.59* 0.09 to 1.10 0.33 −0.10 to 0.76 0.29 −0.18 to 0.76 0.31 −0.15 to 0.77 Tenure (years) <1 Ref Ref Ref Ref 1–5 0.47 −0.07 to 1.00 0.46 −0.03 to 0.94 0.34 −0.11 to 0.80 0.35 −0.12 to 0.82 >5 0.73* 0.12 to 1.35 0.63* 0.09 to 1.17 0.50* 0.06 to 0.94 0.50* 0.06–0.94 System County Ref Ref Ref Ref University 0.22 −0.41 to 0.85 0.53* 0.02 to 1.04 0.40 −0.13 to 0.93 0.40 −0.13 to 0.94 EHR in transition No Ref Ref Ref Ref Yes 1.42† 1.08 to 1.77 1.49† 1.01 to 1.98 1.40† 0.84–1.95 1.38† 0.82–1.95 Room patients/take vitals No Ref Ref Ref Ref Yes 0.28 −0.17 to 0.72 0.24 −0.14 to 0.62 0.27 −0.07 to 0.61 0.28 −0.05 to 0.60 Team structure No team Ref Ref Ref Ref Team or teamlet 0.04 −0.42 to 0.50 −0.08 −0.45 to 0.29 0.16 −0.17 to 0.49 0.15 −0.17 to 0.46 Team culture −0.34† −0.46 to −0.21 −0.33† −0.45 to −0.21 −0.33† −0.45 to −0.21 Team structure × team culture −0.08 −0.29 to 0.12 QIC fit index for model 618.99 535.43 536.27 β Values are coefficients of linear regressions using generalized estimated equations associated with changes in the exhaustion score; positive numbers represent greater exhaustion and negative numbers represent less exhaustion.
↵* P < .05.
↵† P < .001.
CI, confidence interval; EHR, electronic health record; QIC, quasi-likelihood under the independence model criterion; Ref, reference category.
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