A Focus on Patient-Centered Care and Office Practice Management:
••Fall 2003/Vol. 7, No. 4

Editorial Comments

Successful Practices in the Physician's Work Environment
Three Regions: Three Levels of Development | pdf >>

Foundational Linkage Research
In 1998, The Permanente Journal (TPJ) published an article defining the value of linking performance measures from two different satisfaction surveys: employee and member.¹ The "Linkage" subgroup of the interregional Care Experience Council (CEC) explored the relationship between highly satisfied employees and highly satisfied members. They identified the employee survey questions that correlated with member satisfaction survey questions and then identified and interviewed those high-performing teams.² This information can be used to improve aspects of the work environment by focusing on activities that have the greatest potential return on investment.

Application of Research
As a refinement and follow-up process, the "MD Work Environment" subgroup of the CEC explored the linkage between physician and patient satisfaction. The key drivers of physician satisfaction were identified and found to be consistent with the key drivers of employee satisfaction. High-performing teams were again identified and interviewed. In 2002, TPJ published the research findings.³ A summary of the key findings can be found in the sidebar below, "Summary of Successful Practice Findings," and the contrasting practices of the high-rated vs the medium- and low-rated teams are listed in Table 1.

Summary of Successful Practice Findingsa The teams with the highest morale and patient satisfaction were characterized by: · The use of principles to guide behavior · Leadership by example · Team development · Generous recognition, and · Goal-setting within the team's sphere of influence The medium- and low-teams did well on some of the practice categories but hadn't consistently addressed others. There were multiple routes to success--Each high-performing team found its own way to accomplish these five categories of successful practices.

Transfer of Successful Practices
To begin to transfer these successful practices, the Care Experience Council, in partnership with four regions, sponsored a workshop at the 2003 National Primary Care Conference, at which high-performing physician team leaders and team members discussed, in interactive sessions, their team development, processes, and tools. Three of those teams present summaries of their work in four articles in this issue. Hawaii pediatrician Bill Pfeiffer, MD, describes early multidisciplinary team development, and Cynthia Copp, ARPN, reviews the Hawaii team's processes. Georgia internist James Hipkens, MD, recounts sustaining a high-performing team in the face of losing the founding team leader; and Southern California internist Darla Holland, MD, describes facilitywide implementation of improving efficiency and support in office practice.

This series of articles represents the culmination of linkage research leading to identifying key drivers of physician and employee satisfaction, leading to identification of high-performing teams, leading to team descriptions of processes and tools for high performance, leading to transfer of those practices. The two modes of transfer include interactive presentations at a national educational conference and publication in The Permanente Journal to communicate these practices to all clinicians. We hope this will stimulate clinicians to seek out these teams, and possibly visit them, as a way to transfer the successful practices that can produce both highly satisfied physicians and employees and highly satisfied patients, as we contribute to creating the highest value and the highest health care quality for KP members.

 

^a Reprinted from Tallman K, Steinbruegge J, Hatzis M. Successful practices in the physician work environment: We work together. Perm J 2002 Fall;6(4):39-42.

References

1. Kam SM, Brooks SM. Touching the customer by understanding employees: preliminary linkage research findings from four regions of Kaiser Permanente. Perm J 1998 Spring;2(2):47-54.
2. Janisse T, Tallman K. Care Experience physician work environment update: physician key drivers [presentation]. Care Experience Council, Oakland, CA, Nov 2001.
3. Tallman K, Steinbruegge J, Hatzis M. Successful practices in the physician work environment: we work together. Perm J 2002 Fall;6(4):39-42.

 

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