Health Care Manage Rev. 2022;47(4):360-368. doi: 10.1097/HMR.0000000000000334.
Health care delivery system features can have a profound effect on how frontline physicians and other clinical personnel in primary care practices (primary care providers [PCPs]) view the quality and safety of what they deliver and, ultimately, their clinical work satisfaction.
The aim of this study was to investigate the combinations of system features (i.e., team dynamics, provider-perceived safety culture, and patient care coordination between PCPs) that are most conducive to positively enhancing PCPs' clinical work satisfaction.
Nineteen Harvard-affiliated primary care practice sites participated in the Academic Innovations Collaborative 2012-2016, which aimed to establish team-based care and improve patient safety. An All-Staff Survey was administered to 854 PCPs in 2015. The survey measured provider experience of team dynamics, provider-perceived safety culture, patient care coordination between PCPs, and providers' clinical work satisfaction. We performed a qualitative comparative analysis to identify "recipes," that is, combinations of conditions necessary and sufficient for enhancing PCPs' clinical work satisfaction.
Strong provider-perceived safety culture and effective team dynamics constitute sufficient conditions that, when present in practices, could best support PCPs to achieve greater clinical work satisfaction.
Our findings suggest the importance of creating and sustaining a strong safety culture and of establishing and implementing highly functioning teams in primary care practices for enhancing PCPs' clinical work satisfaction.
Conducting the qualitative comparative analysis provides a new perspective for informing primary care and encouraging primary care practices to pursue strategic priorities for enhancing PCPs' clinical work satisfaction and providing safe, high-quality care.
医疗服务提供系统的特征会对初级保健实践中的一线医生和其他临床人员（初级保健提供者 [PCP]）如何看待他们提供的服务的质量和安全性产生深远影响，最终影响他们对临床工作的满意度。
本研究旨在探讨系统特征（即团队动态、提供者感知的安全文化以及 PCP 之间的患者护理协调）的组合，这些组合最有利于积极提高 PCP 的临床工作满意度。
19 个哈佛附属的初级保健实践场所参加了 2012-2016 年的学术创新合作，旨在建立以团队为基础的护理并提高患者安全性。2015 年向 854 名 PCP 进行了全员调查。该调查衡量了提供者对团队动态、提供者感知的安全文化、PCP 之间的患者护理协调以及提供者的临床工作满意度的体验。我们进行了定性比较分析，以确定“食谱”，即增强 PCP 临床工作满意度的必要和充分条件的组合。
强有力的提供者感知的安全文化和有效的团队动态是充分条件，在实践中存在这些条件可以最好地支持 PCP 实现更大的临床工作满意度。
我们的研究结果表明，在初级保健实践中创造和维持强大的安全文化以及建立和实施高效的团队对于提高 PCP 的临床工作满意度和提供安全、高质量的护理非常重要。
进行定性比较分析为告知初级保健并鼓励初级保健实践为提高 PCP 的临床工作满意度和提供安全、高质量的护理而追求战略重点提供了新的视角。
