Organizational influences on time pressure stressors and potential patient consequences in primary care

Kathryn M. McDonald, Hector P. Rodriguez, Stephen M. Shortell

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Background: Primary care teams face daily time pressures both during patient encounters and outside of appointments. Objectives: We theorize 2 types of time pressure, and test hypotheses about organizational determinants and patient consequences of time pressure. Research Design: Cross-sectional, observational analysis of data from concurrent surveys of care team members and their patients. Subjects: Patients (n =1291 respondents, 73.5% response rate) with diabetes and/or coronary artery disease established with practice teams (n= 353 respondents, 84% response rate) at 16 primary care sites, randomly selected from 2 Accountable Care Organizations. Measures and Analysis: We measured team member perceptions of 2 potentially distinct time pressure constructs: (1) encounter-level, from 7 questions about likelihood that time pressure results in missing patient management opportunities; and (2) practice-level, using practice atmosphere rating from calm to chaotic. The Patient Assessment of Chronic Illness Care (PACIC-11) instrument measured patient-reported experience. Multivariate logistic regression models examined organizational predictors of each time pressure type, and hierarchical models examined time pressure predictors of patient-reported experiences. Results: Encounter-level and practice-level time pressure measures were not correlated, nor predicted by the same organizational variables, supporting the hypothesis of two distinct time pressure constructs. More encounter-level time pressure was most strongly associated with less health information technology capability (odds ratio, 0.33; P<0.01). Greater practice-level time pressure (chaos) was associated with lower PACIC-11 scores (odds ratio, 0.74; P<0.01). Conclusions: Different organizational factors are associated with each forms of time pressure. Potential consequences for patients are missed opportunities in patient care and inadequate chronic care support.

Original languageEnglish (US)
Pages (from-to)822-830
Number of pages9
JournalMedical care
Issue number10
StatePublished - Oct 1 2018
Externally publishedYes


  • measurement
  • organizational performance
  • patient safety
  • patient-centered
  • teams
  • time pressure
  • time stress
  • work conditions

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


Dive into the research topics of 'Organizational influences on time pressure stressors and potential patient consequences in primary care'. Together they form a unique fingerprint.

Cite this