Organizational culture associated with provider satisfaction

pre-printBackground: Organizational culture is key to the successful implementation of major improvement strategies. Transformation to a patient-centered medical home (PCHM) is such an improvement strategy, requiring a shift from provider-centric care to team-based care. Because this shift may impact provider satisfaction, it is important to understand the relationship between provider satisfaction and organizational culture, specifically in the context of practices that have transformed to a PCMH model. Methods: This was a cross-sectional study of surveys conducted in 2011 among providers and staff in 10 primary care clinics implementing their version of a PCMH: Care by Design. Measures included the Organizational Culture Assessment Instrument and the American Medical Group Association provider satisfaction survey. Results: Providers were most satisfied with quality of care (mean, 4.14; scale of 1-5) and interactions with patients (mean, 4.12) and were least satisfied with time spent working (mean, 3.47), paperwork (mean, 3.45), and compensation (mean, 3.35). Culture profiles differed across clinics, with family/clan and hierarchical cultures the most common. Significant correlations (P < .05) between provider satisfaction and clinic culture archetypes included family/clan culture negatively correlated with administrative work; entrepreneurial culture positively correlated with the Time Spent Working dimension; market/rational culture positively correlated with how practices were facing economic and strategic challenges; and hierarchical culture negatively correlated with the Relationships with Staff and Resource dimensions. Conclusions: Provider satisfaction is an important metric for assessing experiences with features of a PCMH model. Identification of clinic-specific culture archetypes and archetype associations with provider satisfaction can help inform practice redesign. Attention to effective methods for changing organizational culture is recommended

Connecting the dots and merging meaning: using mixed methods to study primary care delivery transformation

pre-printObjective: To demonstrate the value of mixed methods in the study of practice transformation and illustrate procedures for connecting methods and for merging findings to enhance the meaning derived.. Data Source/Study Setting: An integrated network of university-owned, primary care practices at the University of Utah (Community Clinics or CCs). CC has adopted Care by Design™, its version of the Patient Centered Medical Home. Study Design: Mixed methods. Data Collection/Extraction Methods: Analysis of archival documents, internal operational reports, in-clinic observations, chart audits, surveys, semi-structured interviews, focus groups, Centers for Medicare and Medicaid Services database and the Utah All Payers Claims Database. Principal findings: Each data source enriched our understanding of the change process and understanding of reasons that certain changes were more difficult than others both in general and for particular clinics. Mixed methods enabled generation and testing of hypotheses about change and led to a comprehensive understanding of practice change. Conclusions: Mixed methods are useful in studying practice transformation. Challenges exist but can be overcome with careful planning and persistence

Patient care experiences and perceptions of the patient-provider relationship: A mixed method study

Improving interpersonal continuity of care—the personal relationship forged between a patient and their primary care provider (PCP) over time—is often considered a goal of primary care. Continuity of care is frequently assessed in terms of longitudinal continuity, or the proportion of encounters with one practitioner, overlooking aspects of the patient-provider relationship that are key to interpersonal continuity of care. Further, few studies explore patients’ perspectives regarding which care experiences enhance or detract from the patient-provider relationship. This study, using focus group interviews, a patient experience CAHPS-PCMH survey, and electronic medical records, explored how patients’ experiences at 10 primary care clinics influenced their perceptions of their relationship with their PCPs. Focus group interviews with 63 participants indicated that patients’ experiences in the clinics, such as wait-times, influenced their perceptions of the patient-provider relationship. The relationship between patient experience and interpersonal continuity was empirically assessed using survey responses and medical records (n=645). We used patients’ perceptions that their provider knows them as a person as a measure of interpersonal continuity. Logistic regression results indicated that being seen within 15 minutes, receiving visit reminders, effective provider communication, and satisfaction, positively influenced patient perceptions of the patient-provider relationship. Furthermore, patients’ care experiences shaped their perceptions of the patient-provider relationship independent of their satisfaction with care. The mixed methods design adds depth to our understanding of patients’ care experiences, and illustrates that these experiences are critical for understanding the patient-provider relationship. Future research on interpersonal continuity should take patient experiences into account

No pet left behind: Accommodating pets in emergency planning

New federal legislation requiring accommodation of pets and service animals in emergency planning has garnered broad, bipartisan support. The authors review changes in societal views of pets that may have contributed to the recent passage of the Pets Evacuation and Transportation Standards Act. The authors identify some areas in which interpretation of the provisions of the act will require further debate and definition. Finally, they offer suggestions on how marketing skills can be employed to make emergency planning more effective. © 2007, American Marketing Association

INTERVENOR FUNDING AT THE FTC: BIOPSY OR AUTOPSY&quest;

Intervenor funding, an innovative method for encouraging public participation in government rule-making, is examined by focusing on the experience of the Federal Trade Commission. The paper reviews the program's goals, the arguments of critics, and the perceptions of individuals and groups who applied for intervenor funding. The program's effects on both agency decision-making and on the applicants themselves are evaluated. Copyright 1983 by The Policy Studies Organization.

A tail of two personalities: How canine companions shape relationships and well-being

More people own pets than ever before. Further, people spend more money on pets than they ever have. The increase in pet ownership and spending on pets provides evidence of the importance humans place on the pets in their lives. This study explores the relationships between humans and their animal companions, specifically canine companions. Drawing on decades of research on personality, relationships, and well-being, the current research takes a cross-species approach to examine the influence of pet personalities on human outcomes. Using personality assessments for human and dog, the article examines how both personalities impact relationship satisfaction. The article also examines how human-dog closeness impacts owner well-being. Some findings corroborate results found in the human personality and relationship literature, but others point to some unique aspects of the human-dog bond. These results not only shed light on the human-dog relationship but also suggest some departures from the human relationship literature that could be explored in future research. © 2007 Elsevier Inc. All rights reserved

Practicing with the urban underserved. A qualitative analysis of motivations, incentives, and disincentives

OBJECTIVE: To investigate the personal characteristics and professional experiences of medical providers working with medically underserved urban populations. DESIGN: Focus groups of primary care providers. SETTING: Public and private clinics in Salt Lake City, Utah, in which the providers had ongoing relationships with medically underserved patients. PARTICIPANTS: Twenty-four providers (11 men and 13 women), including 12 physicians (three family physicians, seven pediatricians, and two psychiatrists), one dentist, three physician assistants, and eight nurse practitioners participated in three focus groups. MAIN OUTCOME MEASURE: Interpretative analysis of verbatim quotations regarding personal beliefs, feelings, and practice experiences. RESULTS: Participants revealed a strong sense of service to humanity and pride in making a difference. They thrive on the challenge of creatively dealing with their patients\u27 complex human needs with limited health care resources. Factors critical to survival in an urban underserved setting include a hardy personality style, flexible but controllable work schedule, and multidisciplinary practice team. The camaraderie and synergy of teams generate personal support and opportunities for continuing professional development. CONCLUSIONS: Increasing the numbers of health care professionals wanting to work with the medically underserved may be facilitated through refining admissions criteria to schools for health care professionals to include values and personality characteristics, emphasizing within curricula the important skills and practice styles necessary to work with underserved patients, and ensuring that underserved practice environments provide support through multidisciplinary teams and structured work hours. These potentially effective approaches could increase success in recruiting and retaining health care professionals to work with medically underserved patients