Transforming Medical Care: Case Study of an Exemplary, Small Medical Group

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