Gillies R R, Zuckerman H S, Burns L R, Shortell S M, Alexander J A, Budetti P P, Waters T M
School of Public Health, University of California, Berkeley, 94720-7360, USA.
Med Care. 2001 Jul;39(7 Suppl 1):I92-106.
To identify the barriers, facilitators, and potential better practices to achieving physician-system alignment.
Interviews using a semi-structured, open-ended protocol were conducted during a total of 18 site visits, each usually 2 days in length, covering multiple topics of physician group-system alignment. Interviews were conducted with members of the target physician group, key leaders of the health care system, and representatives of physicians not in the target group. The summary of the interviews for each of the site visits was analyzed to determine barriers, facilitators, and better practices for achieving more effective relationships between physician groups and health care systems.
A number of barriers to more effective relationships between physician groups and health systems were identified. Barriers related to environment, culture, and information systems were most prevalent. Other major general areas of barriers encountered were physician leadership, group-system relationship, compensation and productivity, care management practices, group strategy, and accountability. Examples of practices that may help to resolve some of these issues were also identified.
Physician-system relationships can and do cause problems for improving health care. The evidence from the conducted site visits suggests that specific strategies may help improve these relationships but more research is needed in order assess the actual impact of these strategies.
确定实现医生与医疗系统协同一致的障碍、促进因素和潜在的更佳做法。
在总共18次实地考察期间进行了采用半结构化、开放式方案的访谈，每次考察通常为期2天，涵盖医生群体与医疗系统协同一致的多个主题。访谈对象包括目标医生群体的成员、医疗系统的关键领导者以及非目标群体的医生代表。对每次实地考察的访谈总结进行分析，以确定在实现医生群体与医疗系统之间更有效关系方面的障碍、促进因素和更佳做法。
确定了医生群体与医疗系统之间建立更有效关系的若干障碍。与环境、文化和信息系统相关的障碍最为普遍。遇到的其他主要障碍领域包括医生领导力、群体与系统的关系、薪酬与生产力、护理管理做法、群体战略和问责制。还确定了可能有助于解决其中一些问题的做法示例。
医生与医疗系统的关系会且确实给改善医疗保健带来问题。实地考察的证据表明，特定策略可能有助于改善这些关系，但需要更多研究来评估这些策略的实际影响。
