title: Productivity and turnover in PCPs: the role of staff participation in decision-making.
abstract: BACKGROUND
  Efforts to redesign primary care practices are beginning to address how decisions are made in the practice setting. This study contributes to these efforts by examining associations between staff participation in decision-making, productivity, and turnover in primary care practices. The study is informed by organizational theories of participation that emphasize cognitive and affective influences on employee output and behavior.
  
  
  METHODS
  This research used data collected from primary care practices involved in a national initiative sponsored by the Robert Wood Johnson Foundation. Cross-sectional survey data on organizational structures and attributes among 49 practices were analyzed. Regression analysis was used to examine associations among practice productivity, staff participation in decision-making, and formal structures such as staff meetings. Associations between staff turnover and participative decision-making were also examined.
  
  
  RESULTS
  Staff participation in decisions regarding quality improvement, practice change, and clinical operations was positively associated with practice productivity, whereas formal structures such as staff meetings were not. In addition, higher levels of participation in decision-making were associated with reduced turnover among nonclinicians and administrative staff.
  
  
  CONCLUSIONS
  Examination of organizational features is increasingly recognized as a key to improving primary care performance. Study findings suggest that one important strategy may be implementation of a participative model emphasizing greater staff involvement in practice decisions. This may enhance information-sharing, work satisfaction, and commitment to organizational decisions, all of which can lead to beneficial outcomes such as increased productivity and stability in primary care practices.
authors.affiliation: Division of Health Policy and Management, School of Public Health, University of California-Berkeley, Berkeley, CA, USA. dh2237@columbia.edu
authors.forename: Dorothy Y
authors.initials: DY
authors.lastname: Hung
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Rundall
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Cohen
authors.forename: Alfred F
authors.initials: AF
authors.lastname: Tallia
authors.forename: Benjamin F
authors.initials: BF
authors.lastname: Crabtree
mesh_terms: D003430:Cross-Sectional Studies; D003659:Decision Making, Organizational; D017598:Efficiency, Organizational; D006801:Humans; D010563:Personnel Turnover; D011216:Practice Management, Medical / Q000458:organization & administration*; D011320:Primary Health Care; D024382:Professional Role; D012044:Regression Analysis; D014481:United States