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Electronic letters published:
![[Read Comment]](/icons/misc/sectionDOWN.gif){kind=icon}
Lessons For Every Practice In Exemplary Medical Group
Organizational Culture and Exemplary Practices
Nurture AND Nature
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Brian Stello, Allentown, PA Lehigh Valley Hospital
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In the article, "Transforming Medical Care: Case Study of an Exemplary, Small Medical Group," (Solberg, et.al.) the practice analyzed, "Patient First Medical Group," maintains its business and clinical versatility through a progressive management style. At a time when Family Medicine practices feel assaulted by changes in reiumbursement, by a growing consumerist perspective, and by a rapidly evolving clinical environment, the practice represented in the article has been able to maintain an approach that leads to clinical and business success. The modern Family Practice needs business savvy as much as clinical expertise to maintain itself. While strict adaptation of PFMG's model may not fit every practice, there are several principles applicable to any practice wishing to survive and thrive. 1. Leadership that is able to focus on a clear mission and vision in both business and clinical activities. 2. Ability to allow unit managers to manage with support but without micro-management. 3. Two-way communication among all levels of the office staff. 4. Development of a unified team model among the staff. 5. Maintaining the practice-patient relationship as critical to success. Furthermore, the authors imply that the time has come for Family Medicine practices to accept the need for heightened business acumen that supports a strong organizational change model to maintain a practice. Too often, I meet with colleagues who struggle with change and assume a reactive posture to the current environment. As our practice and business environments will inevitably change again, the time has come for practices to develop progressive, proactive management styles. Competing interests: None declared |
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Frederic C. Craigie, PhD, Augusta, Maine, USA Psychologist/Faculty, Maine-Dartmouth Family Practice Residency
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Dr. Solberg and colleagues are to be commended for an excellent exploration of the organizational-culture underpinnings of a highly- successful small medical group practice. Their observations are strikingly similar to the findings of my 2004 study (with Dr. Rick Hobbs) of the organizational cultures of two exemplary community health center practices (http://www.stfm.org/fmhub/fm2004/November/Frederic733.pdf ). We also found support for the observations of the present study of the importance of a shared understanding of mission, vision and values, the importance of strong and consistent leadership (in our practices, the leadership of the non-physician practice managers was as important as the leadership of the physicians), an egalitarian spirit in the work environment that invited participation and ownership of all of the staff in the change process, and of the openness of the organization to conversations about change rather than retreating from them. We also found a very significant influence of affective, relationship and community aspects of the work culture… perhaps along the lines of “pride and joy” in the present study… many of our professional and support staff used the word “family” to describe a culture of caring for and supporting and enjoying one another. I think that exemplary practice research (another good example is the work at Dartmouth Medical School on clinical microsystems*) is important for us in Family Medicine to pursue as we seek to move forward with the Future of Family Medicine vision and recommendations. As Solberg et al say well, “We believe that these unrecognized attributes of its organizational culture are what has allowed PFMG to create a practice that meets so many of the design recommendations of national bodies and might even be required as a foundation for achieving those recommendations.” Exemplary practice research gives us information and, frankly, gives us hope. Part of my work involves conversations with mid-career physicians about organizational culture. I find a very common observation or assumption… so much so that it is often considered a “given,” that humane and soulful organizational culture is incompatible with objective parameters of organizational function and success. Work like that of Dr. Solberg and colleagues helps us to create and sustain an alternative vision. * Nelson EC, Batalden PB, Huber TP, Mohr JJ, Godfrey MM, Headrick LA, Wasson JH. Microsystems in health care: Part 1. Learning from high- performing front-line clinical units. Jt Comm J Qual Improv. 2002 Sep;28(9):472-93. Competing interests: None declared |
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Dennis F. Saver, Vero Beach, FL, USA Board Chair, FAFP
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This anthropologic descriptive study of the culture of a highly successful practice is welcome and overdue. The perceptive analysis shows that shared vision with consistant leadership and comprehensive followup creates a winning culture. It is the (previously missing) counterpoint to the FFM report, which had descibed the external structure of the New Model of Care--all of the externally visable attributes which the patient will see, as expressed from the base pairs of FFM DNA. The "invisible" internal culture of this practice CREATED ITS OWN SUSTAINABLE SYSTEM by nurture, before the "nature" of the FFM DNA was published. This article shows a great example of How to Get To The Goal Line. I'm impressed, and more than a little envious. The combination of nature AND nurture is dynamite. Competing interests: None declared |
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