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，都可能不足以影响 慢性病患者的转归。凯撒-永久佐治亚州 彻底重组其初级保健业务，以便医生 辅以护士人员，服务可以个性化，工作人员， 包括医生在内，都得到了必要的支持，以实现 以病人为中心的改变。他们创建了健康护理团队(HCT)，规模很小 易于管理的医生、护士和辅助人员团队 作为半自治单位，在财务上有相当的独立性 和人事问题，并有激励以耐心为导向。球队已经有了 他们采用了所有必要的元素，成为我们所说的 协作临床文化(CCC)。我们提议的项目将把各项措施联系起来 具有广泛的组织文化和员工特征 由标准化的、常规收集的护理质量衡量标准组成。我们会 使用授权和协作措施确定以下程度 医疗团队实现了角色整合和高效 功能正常。我们将描述和验证报告的员工的衡量标准 “团队精神”，可以用来量化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，我们会 评估CCC和护理质量的关联，两者都是横断面的 而且是纵向的。这项研究的结果将为我们提供关于 HCT是否与高涨的员工士气和高质量的护理有关。

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.