Center for Healthcare Organization and Implementation Research (CHOIR), U.S. Department of Veterans Affairs Boston Healthcare System, Boston, MA, USA.
Boston University School of Public Health, Department of Health Law, Policy and Management, Boston, MA, USA.
Med Care Res Rev. 2020 Apr;77(2):131-142. doi: 10.1177/1077558717751445. Epub 2018 Jan 7.
Quality of care worries and rising costs have resulted in a widespread interest in enhancing the efficiency of health care delivery. One area of increasing interest is in promoting teamwork as a way of coordinating efforts to reduce costs and improve quality, and identifying the characteristics of the work environment that support teamwork. Relational climate is a measure of the work environment that captures shared employee perceptions of teamwork, conflict resolution, and diversity acceptance. Previous research has found a positive association between relational climate and quality of care, yet its relationship with costs remains unexplored. We examined the influence of primary care relational climate on health care costs incurred by diabetic patients at the U.S. Department of Veterans Affairs between 2008 and 2012. We found that better relational climate is significantly related to lower costs. Clinics with the strongest relational climate saved $334 in outpatient costs per patient compared with facilities with the weakest score in 2010. The total outpatient cost saving if all clinics achieved the top 5% relational climate score was $20 million. Relational climate may contribute to lower costs by enhancing diabetic treatment work processes, especially in outpatient settings.
医疗质量的担忧和成本的不断上升促使人们广泛关注提高医疗服务效率。越来越受关注的一个领域是促进团队合作，以此协调努力来降低成本和提高质量，并确定支持团队合作的工作环境特征。关系氛围是衡量工作环境的一个指标，它可以捕捉到员工对团队合作、冲突解决和多样性接受的共同看法。先前的研究发现，关系氛围与医疗质量之间存在正相关关系，但它与成本之间的关系尚未得到探索。我们研究了美国退伍军人事务部（VA）在 2008 年至 2012 年间，初级保健关系氛围对糖尿病患者医疗成本的影响。我们发现，更好的关系氛围与更低的成本显著相关。与得分最低的诊所相比，关系氛围最强的诊所每位患者的门诊费用节省了 334 美元。如果所有诊所都达到了前 5%的关系氛围评分，那么门诊总费用节省将达到 2000 万美元。关系氛围可能通过增强糖尿病治疗工作流程来降低成本，特别是在门诊环境中。
