Using practice genograms to understand and describe practice configurations.
BACKGROUND
Demands for change in medical practices are coming from multiple sources. Since interventions to change clinical practice continue to have limited success, understanding the functional structure of primary care practices and the dynamics of providing care have become increasingly important.


METHODS
To portray and understand the primary care office system, we developed "practice genograms" that describe practice participants and their relationships with each other. Formal organizational structure is evaluated using family systems theory and family of origin genogram techniques.


RESULTS
Practice genograms provided a more dynamic, relational model than the organizational chart and promoted identification of relationship strengths and weaknesses within a practice the same way that family genograms identify these characteristics in a family system.


CONCLUSIONS
Research implications for the use of the practice genogram include enhanced data gathering, increased understanding of the complexity of practices as adaptive systems, and increased understanding of current and potential approaches to changing practices.
Department of Family Medicine, University of Nebraska Medical Center, Omaha, USA. hmcilva@unmc.edu
H
H
McIlvain
B
B
Crabtree
J
J
Medder
K C
KC
Stange
W L
WL
Miller
D005194:Family Practice / Q000193:education*; D006801:Humans; D007400:Interprofessional Relations; D009329:Nebraska; D009820:Ohio; D011320:Primary Health Care / Q000458:organization & administration*; D011364:Professional Practice / Q000458:organization & administration*; D012189:Retrospective Studies