Small Primary Care Practices Face Four Hurdles--Including A Physician-Centric Mind-Set--In Becoming Medical Homes

Health Affairs (Impact Factor: 4.97). 11/2012; 31(11):2417-22. DOI: 10.1377/hlthaff.2011.0974
Source: PubMed


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.

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    • "physical environment : The physical layout of the physician practice needs to allow for team meetings and huddles . organization : Organizational issues are critical for effective patient - centered medical home teams . Research by Nutting et al . ( 2012 ) on the patient - centered medical home describes how a new ' mental model ' of physician practice organization is necessary for successful implementation of patient - centered medical home . In particular , they recommend a ' meaningful care team approach ' in which roles and contributions to the team are clearly outlined ."
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