Physician-system relationships: stumbling blocks and promising practices.
OBJECTIVE
To identify the barriers, facilitators, and potential better practices to achieving physician-system alignment.


METHODS
Interviews using a semi-structured, open-ended protocol were conducted during a total of 18 site visits, each usually 2 days in length, covering multiple topics of physician group-system alignment. Interviews were conducted with members of the target physician group, key leaders of the health care system, and representatives of physicians not in the target group. The summary of the interviews for each of the site visits was analyzed to determine barriers, facilitators, and better practices for achieving more effective relationships between physician groups and health care systems.


RESULTS
A number of barriers to more effective relationships between physician groups and health systems were identified. Barriers related to environment, culture, and information systems were most prevalent. Other major general areas of barriers encountered were physician leadership, group-system relationship, compensation and productivity, care management practices, group strategy, and accountability. Examples of practices that may help to resolve some of these issues were also identified.


CONCLUSIONS
Physician-system relationships can and do cause problems for improving health care. The evidence from the conducted site visits suggests that specific strategies may help improve these relationships but more research is needed in order assess the actual impact of these strategies.
Gillies
R R
RR
School of Public Health, University of California, Berkeley, 94720-7360, USA. gillies@uclink4.berkeley.edu
Zuckerman
H S
HS
Burns
L R
LR
Shortell
S M
SM
Alexander
J A
JA
Budetti
P P
PP
Waters
T M
TM
D019033:Delivery of Health Care, Integrated; D005260:Female; D006801:Humans; D007400:Interprofessional Relations; D007407:Interviews as Topic; D008297:Male; D008329:Managed Care Programs; D008875:Middle Aged; D010820:Physicians; D014481:United States; D017132:Workplace