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Study shows the culture of medical group practice changes as practices become larger and more complex

The culture of medical group practice is considered one of the most important organizational factors influencing the costs and quality of health care. A recent study that was supported by the Agency for Healthcare Research and Quality (HS10055 and T32 HS13828) shows that practice culture changes as group practices become larger and more complex through diversification into multispecialty practices or as they become part of larger health care systems.

Ann Curoe, M.D., M.P.H., John Kralewski, Ph.D., and Amer Kaissi, M.P.H., of the University of Minnesota School of Public Health, sent a survey to 1,223 physicians in 191 clinics in the upper Midwest. Clinics ranged from 3 to over 21 physicians, from single to multispecialty, physician-owned to system-owned, and rural to urban. The survey addressed nine dimensions of medical group practice culture: collegiality, information emphasis, quality emphasis, organizational identity, cohesiveness, business emphasis, organizational trust, innovativeness, and autonomy.

Physician responses indicated that collegiality, quality emphasis, organizational identity, cohesiveness, and organizational trust all decreased as clinic size increased with system ownership and multi-specialty practices. All except quality emphasis decreased with system ownership. Cohesiveness decreased in rural clinics. Autonomy decreased with system ownership but was not affected by clinic size, location, or specialty.

There was no difference in information emphasis, business emphasis, and innovativeness due to clinic size, ownership, location, or specialty. However, these three cultural dimensions varied a great deal within the various organizational forms, indicating that there are important cultural differences among the group practices within each practice form. Thus, the culture of medical group practices varies both between and within organizational forms. The authors conclude that the culture survey instrument used in this study can be a useful tool in assessing group practice cultures and managing those cultures effectively.

More details are in "Assessing the cultures of medical group practices," by Drs. Curoe and Kralewski, and Amer Kaissi, M.P.H., in the September 2003 Journal of the American Board of Family Practice 16, pp. 394-398.

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