Collaborative Clinical Culture and Quality of Care

描述（应用摘要）：人们越来越认识到， 个别医生的行动，无论多么理想，可能不足以影响 慢性病患者的结局。凯撒永久格鲁吉亚已 彻底重组了其初级保健实践，使医生 辅以护理人员，服务可以个性化，工作人员， 包括医生在内的所有人都得到了必要的支持， 以患者为中心的变化。他们创建了卫生保健小组（HCT）， 易于管理的医生、护士和辅助人员群体， 作为半自治单位运作，在财务上有相当大的独立性， 和人事问题，并有激励措施，以病人为导向。球队 它们在采纳成为我们所说的 协作临床文化（CCC）。我们提议的项目将把措施 组织文化和劳动力特征的广泛组合， 标准化的，常规收集的护理质量指标。我们将 使用授权和协作措施，确定 医护团队实现了角色整合， 功能我们将描述和验证一个衡量员工报告的指标， "团队精神"，可用于量化HCT上的劳动力整合。我们 将描述劳动力整合对从业者满意度的影响 和士气，无论是横向还是纵向。最后我们将 估计CCC和护理质量的关联，包括跨部门 纵向。这项研究的结果将提供深入了解 HCT是否与高员工士气和高质量护理相关。

DESCRIPTION (APPLICATION ABSTRACT): It is increasingly recognized that the individual physicians' actions, however optimal, may not be adequate to affect the outcomes of patients with chronic disease. Kaiser-Permanente Georgia has completely reorganized its primary care practice so that physicians are complemented by nurse personnel, service can be personalized, and staff, including doctors, are provided with the support necessary to bring about the patient centered changes. They have created Health Care Teams (HCT), small easily manageable groups of physicians, nurses and ancillary personnel that function as semi-autonomous units, have considerable independence in financial and personnel matters, and have incentives to be patient oriented. Teams have varied in their adoption of all elements necessary to become what we term a Collaborative Clinical Culture (CCC). Our proposed project will link measures of organizational culture and workforce characteristics with an extensive set of standardized, routinely collected measures of quality of care. We will determine the degree, using measures of delegation and collaboration, to which the health care teams have achieved role integration and efficient functioning. We will describe and validate a measure of staff reported "teamness" that can be used to quantify the workforce integration on HCTs. We will describe the impact of workforce integration on practitioner satisfaction and morale, both cross-sectionally and longitudinally. Finally, we will estimate the associations of CCC and quality of care, both cross-sectionally and longitudinally. The results of this study will provide insight into whether HCTs are associated with high staff morale and high quality of care.