Physicians, get ready to "adapt"

http://www.ncbi.nlm.nih.gov/pubmed/21934512

Health Care Manage Rev. 2011 Sep 19. [Epub ahead of print]
The cultural complexity of medical groups.
Nembhard IM, Singer SJ, Shortell SM, Rittenhouse D, Casalino LP.
Source
Ingrid M. Nembhard, PhD, MS*, is Assistant Professor, Yale School of Public Health and Yale School of Management, Yale University, New Haven, Connecticut. E-mail: ingrid.nembhard@yale.edu. Sara J. Singer, PhD, MBA*, is Assistant Professor, Harvard School of Public Health and Harvard Medical School, Boston, Massachusetts. E-mail: ssinger@hsph.harvard.edu. Stephen M. Shortell, PhD, MPH, MBA, is Blue Cross of California Distinguished Professor of Health Policy and Management, School of Public Health, Haas School of Business, and is Dean, School of Public Health, University of California, Berkeley. E-mail: shortell@berkeley.edu. Diane Rittenhouse, MD, MPH, is Associate Professor, Department of Family and Community Medicine, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. E-mail: Rittenhouse@fcm.ucsf.edu. Lawrence P. Casalino, MD, PhD, is Chief of the Division of Outcomes and Effectiveness Research and The Livingston Farrand Associate Professor of Public Health, Department of Public Health, Weill Cornell Medical College, New York, New York. E-mail: lac2021@med.cornell.edu.

Abstract
BACKGROUND:
Organizational culture is an important driver of organizational performance. However, little is known about the cultures of medical groups, which play an important role in health care.

PURPOSE:
We sought to characterize the cultures of medical groups and identify factors that influence these cultures.

METHODOLOGY:
We conducted a qualitative study of the organizational cultures of 8 U.S. multispecialty medical groups, using data collected during site visits and in-depth interviews with clinical and administrative staff (N = 69). Groups were randomly selected from those that participated in the second National Study of Physician Organizations using stratified sampling along three dimensions (i.e., ownership type, use of care management practices, and outcome performance). We analyzed the data to assess the presence of seven culture types-group, hierarchical, rational, developmental, quality oriented, patient centered, and physician centered-using the constant comparative method.

FINDINGS:
We found that a multiplicity and diversity of cultures exist within and across multispecialty medical groups, with a dominance of patient-centered, physician-centered, rational, or quality-oriented cultures and less emphasis on group, developmental, and hierarchical cultures. Culture types that may seem antithetical, for example, patient-centered and physician-centered cultures, often coexisted within the same group. Across culture types, we found that six factors influenced medical group culture: financial, people, leadership, structural, processes, and environmental.

PRACTICE IMPLICATIONS:
As medical groups adapt to changes under health care reform, their success likely depends on their having cultures that facilitate collaboration with other organizations (e.g., hospitals) that possess different cultures and adaptation to changes in payment and regulation. Our study suggests that some groups may not have the developmental and group cultures needed to adapt. Our study identifies six categories of levers they can use to alter their culture as desired.