Productivity and turnover in PCPs: the role of staff participation in decision-making
ABSTRACT Efforts to redesign primary care practices are beginning to address how decisions are made in the practice setting. This study contributes to these efforts by examining associations between staff participation in decision-making, productivity, and turnover in primary care practices. The study is informed by organizational theories of participation that emphasize cognitive and affective influences on employee output and behavior.
This research used data collected from primary care practices involved in a national initiative sponsored by the Robert Wood Johnson Foundation. Cross-sectional survey data on organizational structures and attributes among 49 practices were analyzed. Regression analysis was used to examine associations among practice productivity, staff participation in decision-making, and formal structures such as staff meetings. Associations between staff turnover and participative decision-making were also examined.
Staff participation in decisions regarding quality improvement, practice change, and clinical operations was positively associated with practice productivity, whereas formal structures such as staff meetings were not. In addition, higher levels of participation in decision-making were associated with reduced turnover among nonclinicians and administrative staff.
Examination of organizational features is increasingly recognized as a key to improving primary care performance. Study findings suggest that one important strategy may be implementation of a participative model emphasizing greater staff involvement in practice decisions. This may enhance information-sharing, work satisfaction, and commitment to organizational decisions, all of which can lead to beneficial outcomes such as increased productivity and stability in primary care practices.
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ABSTRACT: Making the kind of improvement changes necessary to move toward a patient-centered medical home will continue to challenge small, independent primary care practices. Here we describe further analysis of a successful program to understand the roles of coleaders of a change management process. Through an improvement collaborative we trained 2 coleaders (a physician and a non-physician) from 16 small primary care practices to institute depression care improvements. These coleaders participated in 3 learning sessions that provided depression care content as well as skills to implement a change management strategy. Qualitative data were collected by observation during the learning sessions and through in-depth interviews conducted at baseline, between each learning session, at the end of the project, 6 months after the project ended, and, finally, 26 months after the project's end. Interview results with the coleaders affirmed that a team approach is a viable strategy for practice improvement. The 2 coleaders used their complementary skills, relationships, and credibility among the practice staff to implement and sustain practice improvements. In their differing roles, they varied in how they perceived barriers to change and how they assessed their team's progress. Involving both a physician and a non-physician as coleaders enables improvement teams in small primary care practices to make progress both in the clinical content of their work and in the critical change management activities involved with creating a team, managing meetings, and coordinating work between meetings. Using a coleader structure enriches the improvement process, broadens participation in the change process, and helps to sustain these efforts over time.The Journal of the American Board of Family Medicine 09/2010; 23(5):632-9. DOI:10.3122/jabfm.2010.05.090198 · 1.98 Impact Factor
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ABSTRACT: A growing body of literature suggests that interpersonal relationships between personnel in health care organizations can have an impact on the quality of care provided. Some research recommends that the fundamental practice transformation that is being urged in this current climate of health care reform may be aided by strong interpersonal practice relationships and communication. There is much to be learned, however, about what is involved in the process of addressing and improving interpersonal relationships in primary care practices. This case study offers insights into this process by examining 1 primary care practice's efforts to address interpersonal office issues over the course of its participation in 2 back-to-back quality improvement (QI) intervention studies. Our analysis is based on extensive qualitative data on this practice (observational data, interviews, and audio-recorded QI meetings) from 2003 to 2009. By tracing common themes and patterns of interaction over an extended period of time, we identify a variety of facilitators of and barriers to addressing interpersonal issues in the practice setting. We conclude by suggesting some implications from this case for future QI research.Quality management in health care 20(1):49-61. DOI:10.1097/QMH.0b013e31820311e6