Chaos in the clinic: Characteristics and consequences of practices perceived as chaotic

Hector R. Perez, Matthew Beyrouty, Katelyn Bennett, Linda Baier Manwell, Roger L. Brown, Mark Linzer, Mark D. Schwartz

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

The Minimizing Error, Maximizing Outcome (MEMO) study of clinics in New York City, Chicago, and Wisconsin linked primary care work experiences to physician stress. We analyzed MEMO data to determine how chaos in the clinic was associated with work conditions and quality of care measures. Surveys and medical record audits determined practice characteristics and medical errors, respectively. Physicians rated clinic atmosphere on a scale of 1 (calm) to 5 (chaotic). Chaotic clinics were defined as practices rated either 4 or 5 by greater than 50% of clinic physicians. Forty of 112 MEMO clinics (36%) were chaotic. Compared with nonchaotic practices, these clinics served more minority and Medicaid patients and had a greater likelihood of clinic bottlenecks such as phone access (both p < .01). Physicians in chaotic clinics reported lower work control and job satisfaction, less emphasis on teamwork and professionalism, more stress and burnout, and a higher likelihood of leaving the practice within 2 years (all p < .05). Chaotic clinics had higher rates of medical errors and more missed opportunities to provide preventative services (both p < .05). More research should examine the effectiveness of organizational interventions to decrease chaos in the clinic and to mitigate its effects on patient safety.

Original languageEnglish (US)
Pages (from-to)43-53
Number of pages11
JournalJournal for Healthcare Quality
Volume39
Issue number1
StatePublished - 2017

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Physicians
Medical Errors
Job Satisfaction
Medical Audit
Quality of Health Care
Medicaid
Patient Safety
Atmosphere
Medical Records
Primary Health Care
Outcome Assessment (Health Care)
Research
Professionalism
Surveys and Questionnaires

Keywords

  • Medical errors
  • Physician burnout
  • Practice management
  • Primary care

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health

Cite this

Perez, H. R., Beyrouty, M., Bennett, K., Manwell, L. B., Brown, R. L., Linzer, M., & Schwartz, M. D. (2017). Chaos in the clinic: Characteristics and consequences of practices perceived as chaotic. Journal for Healthcare Quality, 39(1), 43-53.

Chaos in the clinic : Characteristics and consequences of practices perceived as chaotic. / Perez, Hector R.; Beyrouty, Matthew; Bennett, Katelyn; Manwell, Linda Baier; Brown, Roger L.; Linzer, Mark; Schwartz, Mark D.

In: Journal for Healthcare Quality, Vol. 39, No. 1, 2017, p. 43-53.

Research output: Contribution to journalArticle

Perez, HR, Beyrouty, M, Bennett, K, Manwell, LB, Brown, RL, Linzer, M & Schwartz, MD 2017, 'Chaos in the clinic: Characteristics and consequences of practices perceived as chaotic', Journal for Healthcare Quality, vol. 39, no. 1, pp. 43-53.
Perez HR, Beyrouty M, Bennett K, Manwell LB, Brown RL, Linzer M et al. Chaos in the clinic: Characteristics and consequences of practices perceived as chaotic. Journal for Healthcare Quality. 2017;39(1):43-53.
Perez, Hector R. ; Beyrouty, Matthew ; Bennett, Katelyn ; Manwell, Linda Baier ; Brown, Roger L. ; Linzer, Mark ; Schwartz, Mark D. / Chaos in the clinic : Characteristics and consequences of practices perceived as chaotic. In: Journal for Healthcare Quality. 2017 ; Vol. 39, No. 1. pp. 43-53.
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