IMPROVEjob – Participatory intervention to improve job satisfaction of general practice teams: a model for structural and behavioural prevention in small and medium-sized enterprises – a study protocol of a cluster-randomised controlled trial
Authors: Weltermann Birgitta M. , Kersting Christine , Pieper Claudia , Seifried-Dübon Tanja , Dreher Annegret , Linden Karen , Rind Esther , Ose Claudia , Jöckel Karl-Heinz , Junne Florian , Werners Brigitte , Schroeder Verena , Bois Jean-Marie , Siegel Achim , Thielmann Anika , Rieger Monika A. , Kasten Stefanie ,   on behalf of the IMPROVEjob consortium, Rieger M. A. , Rind E. , Siegel A. , Wagner A. , Tsarouha E. , Weltermann B. , Kasten S. , Linden K. , Degen L. , Thielmann A. , Junne F. , Seifried-Dübon T. , Hermann-Werners A. , Stuber F. , Zipfel S. , Werners B. , Grot M. , Jöckel K-H , Pieper C. , Schröder V. , Bois J-M , Eilerts A-L , Brinkmann M. , Kersting C. , Emerich S. , Burgess S. , Hippler M. , Dreher A. , Ose C. , Koppka L. , Block J. 
Published: June 2020

Abstract
Background
Perceived high chronic stress is twice as prevalent among German general practitioners (GPs) and non-physician medical staff compared to the general population. The reasons are multi-factorial and include patient, practice, healthcare system and societal factors, such as multi-morbidity, the diversity of populations and innovations in medical care. Also, practice-related factors, like stressful patient-staff interactions, poor process management of waiting times and lack of leadership, play a role. This publicly funded study evaluates the effectiveness of the newly developed participatory, interdisciplinary, and multimodal IMPROVEjob intervention on improving job satisfaction among general practice personnel. The intervention aims at structural stress prevention with regard to working conditions and behavioural stress prevention for leaders and other practice personnel.

Methods
In this cluster-randomised controlled trial, a total of 56 general practices will be assigned to either (1) participation in the IMPROVEjob intervention or (2) the waiting-list control group. The IMPROVEjob intervention consists of the following elements: three workshops, a toolbox with supplemental material and an implementation period with regular contact to so-called IMPROVEjob facilitators. The first workshop, addressing leadership issues, is designed for physicians with leadership responsibilities only. The two subsequent workshops target all GP and non-physician personnel; they address issues of communication (with patients and within the team), self-care and team-care and practice organisation. During the 9-month implementation period, practices will be contacted by IMPROVEjob facilitators to enhance motivation. Additionally, the practices will have access to the toolbox materials online. All participants will complete questionnaires at baseline and follow up. The primary outcome is the change in job satisfaction as measured by the respective scale of the validated German version of the Copenhagen Psychosocial Questionnaire (COPSOQ, version 2018). Secondary outcomes obtained by questionnaires and - qualitatively - by facilitators comprise psychosocial working conditions including leadership aspects, expectations and experiences of the workshops, team and individual efforts and organisational changes.

Discussion
It is hypothesised that participation in the IMPROVEjob intervention will improve job satisfaction and thus constitute a structural and behavioural prevention strategy for the promotion of psychological wellbeing of personnel in general practices and prospectively in other small and medium sized enterprises.

Trial registration
German Clinical Trials Register: DRKS00012677. Registered on 16 October 2019. Retrospectively, https://www.drks.de/drks_web/navigate.do?navigationId=trial. HTML&TRIAL_ID = DRKS00012677.