University of Colorado Health Sciences Center, Denver, Colorado, USA.
Health Aff (Millwood). 2012 Nov;31(11):2417-22. doi: 10.1377/hlthaff.2011.0974.
Transforming small independent practices to patient-centered medical homes is widely believed to be a critical step in reforming the US health care system. Our team has conducted research on improving primary care practices for more than fifteen years. We have found four characteristics of small primary care practices that seriously inhibit their ability to make the transformation to this new care model. We found that small practices were extremely physician-centric, lacked meaningful communication among physicians, were dominated by authoritarian leadership behavior, and were underserved by midlevel clinicians who had been cast into unimaginative roles. Our analysis suggests that in addition to payment reform, a shift in the mind-set of primary care physicians is needed. Unless primary care physicians can adopt new mental models and think in new ways about themselves and their practices, it will be very difficult for them and their practices to create innovative care teams, become learning organizations, and act as good citizens within the health care neighborhood.
将小型独立实践转变为以患者为中心的医疗之家被广泛认为是改革美国医疗保健系统的关键步骤。我们的团队已经进行了超过十五年的研究，以改善初级保健实践。我们发现了四个严重抑制小型初级保健实践向这种新的护理模式转变的能力的特征。我们发现，小型实践极其以医生为中心，医生之间缺乏有意义的沟通，以专制领导行为为主导，中层临床医生服务不足，这些医生一直处于缺乏想象力的角色中。我们的分析表明，除了支付方式改革之外，还需要改变初级保健医生的思维模式。除非初级保健医生能够采用新的思维模式，以新的方式思考自己和自己的实践，否则他们和他们的实践将很难组建创新的护理团队，成为学习型组织，并在医疗保健领域中充当好公民。
