Yale School of Public Health and Yale School of Management, Yale University, New Haven, CT, USA.
Health Care Manage Rev. 2012 Jul-Sep;37(3):200-13. doi: 10.1097/HMR.0b013e31822f54cd.
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.
We sought to characterize the cultures of medical groups and identify factors that influence these cultures.
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.
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.
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.
组织文化是组织绩效的重要驱动因素。然而，对于在医疗保健中发挥重要作用的医疗集团的文化，我们知之甚少。
我们试图描述医疗集团的文化，并确定影响这些文化的因素。
我们对美国 8 家多专科医疗集团的组织文化进行了定性研究，使用在现场访问和对临床及行政人员进行深入访谈（N=69）期间收集的数据。这些集团是根据所有权类型、使用管理实践和结果表现这三个维度，从参与第二次全国医师组织研究的集团中随机抽取的。我们使用恒定性比较法分析数据，以评估七种文化类型（集团型、层级型、理性型、发展型、质量导向型、以患者为中心型和以医生为中心型）的存在情况。
我们发现，多专科医疗集团内部和之间存在多种文化多样性，以以患者为中心、以医生为中心、理性或质量导向的文化为主，而集团、发展和层级文化的重视程度较低。例如，看似对立的文化类型，如以患者为中心和以医生为中心的文化，往往在同一集团中共存。在不同的文化类型中，我们发现有六个因素影响医疗集团文化：财务、人员、领导力、结构、流程和环境。
随着医疗集团在医疗改革下适应变化，他们的成功可能取决于他们拥有促进与其他组织（如医院）合作的文化，这些组织拥有不同的文化，并适应支付和监管方面的变化。我们的研究表明，一些集团可能没有适应所需的发展和集体文化。我们的研究确定了他们可以使用的六个类别的杠杆，以根据需要改变他们的文化。
