Zazzali James L, Alexander Jeffrey A, Shortell Stephen M, Burns Lawton R
RAND Corporation, 1776 Main St. Santa Monica, CA 90407, USA.
Health Serv Res. 2007 Jun;42(3 Pt 1):1150-76. doi: 10.1111/j.1475-6773.2006.00648.x.
To assess the extent to which the organizational culture of physician group practices is associated with individual physician satisfaction with the managerial and organizational capabilities of the groups.
Physician surveys from 1997 to 1998 assessing the culture of their medical groups and their satisfaction with six aspects of group practice. Organizational culture was conceptualized using the Competing Values framework, yielding four distinct cultural types. Physician-level data were aggregated to the group level to attain measures of organizational culture. Using hierarchical linear modeling, individual physician satisfaction with six dimensions of group practice was predicted using physician-level variables and group-level variables. Separate models for each of the four cultural types were estimated for each of the six satisfaction measures, yielding a total of 24 models. SAMPLE STUDIED: Fifty-two medical groups affiliated with 12 integrated health systems from across the U.S., involving 1,593 physician respondents (38.3 percent response rate). Larger medical groups and multispecialty groups were over-represented compared with the U.S. as a whole.
Our models explain up to 31 percent of the variance in individual physician satisfaction with group practice, with individual organizational culture scales explaining up to 5 percent of the variance. Group-level predictors: group (i.e., participatory) culture was positively associated with satisfaction with staff and human resources, technological sophistication, and price competition. Hierarchical (i.e., bureaucratic) culture was negatively associated with satisfaction with managerial decision making, practice level competitiveness, price competition, and financial capabilities. Rational (i.e., task-oriented) culture was negatively associated with satisfaction with staff and human resources, and price competition. Developmental (i.e., risk-taking) culture was not significantly associated with any of the satisfaction measures. In some of the models, being a single-specialty group (compared with a primary care group) and a group having a higher percent of male physicians were positively associated with satisfaction with financial capabilities. Physician-level predictors: individual physicians' ratings of organizational culture were significantly related to many of the satisfaction measures. In general, older physicians were more satisfied than younger physicians with many of the satisfaction measures. Male physicians were less satisfied with data capabilities. Primary care physicians (versus specialists) were less satisfied with price competition.
Some dimensions of physician organizational culture are significantly associated with various aspects of individual physician satisfaction with group practice.
评估医师团体执业的组织文化在多大程度上与医师个人对团体管理和组织能力的满意度相关。
1997年至1998年对医师进行的调查，评估他们所在医疗团体的文化以及他们对团体执业六个方面的满意度。组织文化采用竞争价值观框架进行概念化，产生四种不同的文化类型。医师层面的数据汇总到团体层面以获得组织文化的衡量指标。使用分层线性模型，利用医师层面变量和团体层面变量预测医师个人对团体执业六个维度的满意度。针对六种满意度衡量指标中的每一项，为四种文化类型中的每一种估计单独的模型，共产生24个模型。研究样本：来自美国各地12个综合医疗系统的52个医疗团体，涉及1593名医师受访者（回复率为38.3%）。与美国整体情况相比，规模较大的医疗团体和多专科团体的占比过高。
我们的模型解释了医师个人对团体执业满意度差异的31%，其中个体组织文化量表解释了5%的差异。团体层面预测因素：团体（即参与型）文化与对员工和人力资源、技术复杂性以及价格竞争的满意度呈正相关。层级（即官僚型）文化与对管理决策、执业层面竞争力、价格竞争和财务能力的满意度呈负相关。理性（即任务导向型）文化与对员工和人力资源以及价格竞争的满意度呈负相关。发展型（即冒险型）文化与任何一项满意度衡量指标均无显著关联。在一些模型中，作为单专科团体（与初级保健团体相比）以及男性医师占比更高的团体与对财务能力的满意度呈正相关。医师层面预测因素：医师个人对组织文化的评分与许多满意度衡量指标显著相关。总体而言，在许多满意度衡量指标方面，年长医师比年轻医师更满意。男性医师对数据能力的满意度较低。初级保健医师（与专科医师相比）对价格竞争的满意度较低。
医师组织文化的某些维度与医师个人对团体执业各个方面的满意度显著相关。
