Learning Health System Characteristics and Burnout in Primary Care

ABSTRACT

Objectives: Although learning-oriented work environments may reduce burnout, practice transformation and technology adoption associated with learning health systems (LHS) have also been linked to increased burnout. Understanding how LHS characteristics relate to burnout is essential to guide implementation. We examined whether primary care clinicians’ and staff members’ perceptions of learning within their clinics were associated with burnout.

Study Design: We conducted cross-sectional surveys in September 2022 and November 2023 among clinicians and staff in Emory Healthcare primary care clinics.

Methods: Burnout was assessed in 2023 using a validated single-item measure rated on a 7-point Likert scale. Perceptions of learning were measured in 2022 using 7 domains from the short-form Learning Organization Survey: supportive learning environment, leadership that reinforces learning, experimentation, time for reflection, knowledge acquisition, training, and performance monitoring. Linear regression models examined associations between learning domains and burnout, adjusting for role, organizational tenure, and exposure to a new electronic health record implementation and an innovation contest. Robust standard errors were used.

Results: The analytic sample included 139 employees who completed both surveys. In 2023, 56% reported burnout (mean [SD], 4.35 [1.81]). Higher perceptions of learning were significantly associated with lower burnout across multiple learning domains, including supportive learning environment, leadership that reinforces learning, experimentation, time for reflection, and knowledge acquisition.

Conclusions: These findings suggest that LHS characteristics may support clinician and staff well-being by addressing organizational contributors to burnout. Embedding learning-oriented leadership, reflection time, and experimentation into care delivery may help align improvements in patient care with workforce sustainability.

Am J Manag Care. 2026;32(10):e353-e354

doi:10.37765/ajmc.2026.90030

Takeaway Points

• Design learning initiatives that mitigate, rather than contribute to, burnout.
• Promote leadership behaviors that support learning, reflection, and psychological safety to mitigate burnout.
• Treat protected time for learning and experimentation as a burnout prevention strategy, not an optional extra.
• Evaluate transformation and technology efforts based on their impact on both learning capacity and workforce well-being.

There is a growing push for health systems to become learning health systems (LHS), in which best practices become embedded in care delivery as they emerge.¹ At the same time, worker burnout is a critical concern.² The movement toward LHS may have mixed implications for burnout: Although work environments that facilitate learning are associated with lower burnout, practice transformation efforts intended to enhance knowledge sharing and care quality have been linked to increased burnout.³ A deeper understanding of how LHS characteristics relate to burnout is needed to inform how LHS are promoted and implemented. Accordingly, we examined the extent to which primary care clinicians’ and staff members' perceptions of learning within their clinics are associated with the experience of burnout at work.

METHODS

We conducted cross-sectional surveys in September 2022 and November 2023 in Emory Healthcare’s primary care clinics. The study context has been described previously.⁴ Burnout was measured using a validated single-item measure (“I feel burned out from my work”⁵), rated on a 7-point Likert scale (1 = strongly disagree; 7 = strongly agree) in 2023. Perceptions of learning, measured in 2022, comprised 7 domains from the short-form Learning Organization Survey⁶: supportive learning environment, leadership that reinforces learning, experimentation, time for reflection, knowledge acquisition, training, and performance monitoring. Table 1 shows the survey items. Respondents agreed or disagreed with the items on a 7-point Likert scale, with higher values indicating greater perceived learning. Control variables included provider role (physician or nurse practitioner vs other staff) and organizational tenure. Two additional variables accounted for significant events that occurred between the 2 surveys: training for the new electronic health record implementation and an innovation contest at Emory Healthcare primary care clinics. We estimated linear regression models to examine associations between perceptions of learning and burnout, adjusting for all control variables and with robust standard errors. A P value of less than .05 was considered statistically significant. The Emory University Institutional Review Board approved the study procedures.

RESULTS

Our study sample consisted of 139 (17%) employees from 48 clinics who completed both surveys, encompassing a range of clinic types, role groups, and geographic locations; 239 (30%) completed the first survey, and 399 (56%) completed the second survey. In our sample, 51 (37%) were providers, and 60 (43%) had worked at Emory Healthcare for 5 years or less, 36 (26%) for 6 to 10 years, and 43 (31%) for more than 10 years.

In 2023, more than half (56%) reported feeling burned out at work (mean [SD], 4.35 [1.81]). Providers (mean, 5.12 [1.56]) reported more burnout than nonproviders (mean, 3.91 [1.80]). Table 2 shows the regression results. We detected significant negative associations between burnout and supportive learning environment (β, –0.24; 95% CI, –0.47 to –0.01; P = .04), leadership that reinforces learning (β, –0.35; 95% CI, –0.57 to –0.13; P = .002), experimentation (β, –0.29; 95% CI, –0.49 to –0.08; P = .006), time for reflection (β, –0.26; 95% CI, –0.45 to –0.07; P = .007), and knowledge acquisition (β, –0.22; 95% CI, –0.43 to –0.01; P = .038).

DISCUSSION

Our findings align with growing calls to address clinician burnout through systemic, rather than individual-level, interventions, as burnout often stems from features of the work environment. LHS characteristics, such as leadership that reinforces learning, protected time for reflection, and opportunities for experimentation, may be particularly salient. These findings underscore the potential of LHS-oriented approaches to support worker well-being alongside improving patient care. Study limitations include being conducted within a single health system, which may limit generalizability; reliance on self-reported measures; and a low response rate, which may introduce selection bias. However, respondents who completed both surveys did not differ from those who completed only 1 survey in role or organizational tenure. Future work should further evaluate how learning-oriented practices can be implemented and sustained.

Acknowledgments

We are grateful to the clinicians and staff who generously shared their time and thoughts for this study.

Author Affiliations: University of California, Los Angeles (OSJ, SH), Los Angeles, CA; Emory University (OSJ, IG, CMM), Atlanta, GA; Emory Healthcare (DAM, CMM), Atlanta, GA.

Source of Funding: This study was funded by the Emory Rollins School of Public Health Dean’s Pilot and Innovation Award.

Author Disclosures: Dr Graetz reports receiving research grants from the Donaghue Foundation, Pfizer, PRIME Education, and the National Institutes of Health outside the submitted work. The other authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design (OSJ, IG, CMM); acquisition of data (OSJ, DAM, CMM); analysis and interpretation of data (OSJ, IG, SH); drafting of the manuscript (OSJ); critical revision of the manuscript for important intellectual content (OSJ, IG, SH, DAM); statistical analysis (OSJ, SH); obtaining funding (OSJ, IG, CMM); and administrative, technical, or logistic support (CMM).

Address Correspondence to: Olivia S. Jung, PhD, University of California, Los Angeles, 650 Charles E Young Dr S, Los Angeles, CA 90095. Email: olivia.jung@ucla.edu.

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