| Medical group practices face increasing pressures to reduce their variations by improving their quality of care. In attempting to achieve this task, the focus is shifting from examining the physician as an individual practitioner to examining the physician within her group practice, as part of an organizational system. And while incentives may buy short-term benefits and temporary priorities from providers, achieving sustained change and improved quality requires energy to be invested to address underlying organizational mechanisms, e.g. culture and structure, which may reinforce desired behaviors.; The main research question is: "Controlling for case and illness severity, physician characteristics and specific environmental factors, what effect do physician group's culture and structures have on the specified quality of care outcomes?" This study examines the culture and structure of physician groups in Massachusetts, linking these variables to the groups' patients' outcomes using Nadler et al's Congruence Model. Statistical analyses performed include basic descriptive statistics, OLS and DEA (Data Envelopment Analysis).; Surveys were sent to 1236 physicians from 57 physician groups in the state of Massachusetts, as well one office managers/administrators from each group. The culture survey, which was mailed to the physicians, is based on a survey developed by Dr. John Kralewski and colleagues for the University of Minnesota. The structure survey, which was mailed to the office managers/administrators, was based on previous surveys developed by Dr.'s Kralewski, Chilingerian and Gittell. A total of 734 physicians and 50 office managers/administrators responded to the surveys, for an average response rate of 73% for physicians and 89% for the office managers/administrators.; The culture survey has high reliability among physicians in the same group. The regression analyses reveal that culture and structure variables are statistically significant in explaining variance among six of the eight quality of care outcomes studied: Diabetic Eye Exam Rates, HbAlc Control Rates, Cholesterol Management Rates, Adolescent Well Visits, High Blood Pressure Management Rates and Chlamydia Screening Rates for Young Adults (Aged 21--26). The DEA analysis demonstrates nine out of the fifty physician groups studies are members of the frontier, i.e., they are the best performers. Culturally and structurally, these nine groups are statistically different from the remaining 41 physician groups. Two governing models of physician groups were discovered, both of which may lead to improved quality of care outcomes: the professional model, stressing business emphasis, collegiality/organization trust and identity and the administrative model stressing information emphasis.; The findings of this study support the claims that culture and structure are variables deserving to be studied in the physician group (outpatient) setting. This research has helped apply this perspective to specific quality of care outcomes, an area where past problem solving and corrective action, e.g., physician profiling and incentive offerings, has only been partially effective. Providing physicians and management with information regarding the cultural and structural make-up of their practicing physician groups has important implications: it will lead to a better understanding of which governing model exists in the practice, either professional or administrative, and this has the potential to result in improved quality of care outcomes, as well as reduced variations among physician groups. |
