Assessing the Culture of Medical Group Practices

Abstract

Background:The culture of medical group practices is gaining increasing attention as one of the most important organizational factors influencing the costs and quality of health care. Based on organizational theory, we propose that the culture of the practice differs depending on size, ownership, location, and the number of medical specialties.Methods: A survey was sent to 1223 physicians in 191 clinics in the upper Midwest. The clinic response rate was 77%. The survey instrument identifies 9 culture dimensions, each with 3 to 6 measurement statements.Results: Smaller clinics had higher scores on 6 of the 9 dimensions. Physician-owned clinics had higher scores on 4 of the 9 dimensions, whereas system-owned clinics had a higher score on only 1 dimension. Only 1 dimension differed among the locations. Single-specialty clinics had higher scores on 4 dimensions and multispecialty clinics had higher scores on 2 dimensions. Conclusion: Our data confirm the contention that the culture of medical group practices varies considerably; to a degree, this variance is as predicted by organizational theory. The culture changes as group practices become larger and more complex through diversification into multispecialty practices or become part of larger health care systems. (J Am Board Fam Pract 2003;16:394 -8.)

Organizational Climate, Stress, and Error in Primary Care:: The MEMO Study

“…20 We tested the six domains thought to be pertinent to the current study (the first six listed), and found four that remained in the new factor analyses (cohesiveness, trust, quality, and information), while a fifth (leadership values alignment) emerged. Two scales (collegiality and identity) were dropped, as some of their items shifted to the remaining domains.…”

“…These scales overlap, and further extend Kralewski's work on the structure and culture of medical group practices. 20 These five domains, along with the pace of the office, are associated with multiple physician reactions including satisfaction, stress, tendency to err, and intent to leave the practice. We have thus demonstrated a relationship between organizational climate and undesirable reactions by physicians.…”

“…21 Organizational climate was measured using a scale adapted from Kralewski's instrument, 20 which was developed for use in physician offices. We asked physicians about burnout (using a single-item measure from Freeborn 22 ) and whether they intended to leave the practice.…”

“…17 Organizational climate in health care (i.e., the perception of culture by those within it) has been described by several authors, including Shortell, 18 Wakefield, 19 and Kralewski. 20 We chose to modify scales from Kralewski's work for use in new analyses designed to define domains of organizational climate within the offices of ambulatory care physicians. We further sought to determine the impact of office environment pace on physician stress.…”

Part-Time Physicians…Prevalent, Connected, and Satisfied

“…14 Organizational climate was assessed by incorporating scales selected from Kralewski's multidimensional measure 15 into a factor analysis. We identified 5 domains: (1) A 2-step regression analysis was performed to assess outcomes associated with working part-time.…”