Patient Safety/Quality of Care

Quality assurance programs are more likely to be adopted if they are compatible with the culture of the medical group practice

Developing quality assurance programs that are compatible with the culture of a medical group practice is important for gaining program buy-in by clinicians, according to Amer Kaissi, Ph.D., of Trinity University and John Kralewski, Ph.D., of the University of Minnesota. In a study supported by the Agency for Healthcare Research and Quality (T32 HS13828 and HS10055), Drs. Kaissi and Kralewski and their colleagues surveyed primary care physicians in 88 Midwest medical group practices using a cultural instrument developed by Dr. Kralewski and the Medical Group Management Association. Their findings suggest that the culture of medical group practices influences the types of programs the practices implement to ensure quality of care.

For example, practices with cultures that emphasize information tended to favor electronic data systems and formal programs that provide comparative or evidence-based data to enhance clinical practice. Those with a quality/patient-centered culture appeared to prefer patient satisfaction surveys to assess the quality of their care. Practices that were more business-oriented relied on bureaucratic strategies such as benchmarking and physician profiling.

On the other hand, cultures that emphasized the autonomy of physician practice were negatively associated with all of the programs studied, suggesting that most quality improvement programs were seen as an attempt to interfere with physicians' practices. Similarly, practices with a highly collegial culture were less likely to use any of these programs, apparently relying on informal peer review mechanisms to ensure quality of care.

See "How does the culture of medical group practices influence the types of programs used to assure quality of care?" by Drs. Kaissi and Kralewski, Ann Curoe, M.D., M.P.H., and others, in the April 2004 Health Care Management Review 29(2), pp. 129-138.

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