title: The cultural complexity of medical groups.
abstract: BACKGROUND
  Organizational culture is an important driver of organizational performance. However, little is known about the cultures of medical groups, which play an important role in health care.
  
  
  OBJECTIVE
  We sought to characterize the cultures of medical groups and identify factors that influence these cultures.
  
  
  METHODS
  We conducted a qualitative study of the organizational cultures of 8 U.S. multispecialty medical groups, using data collected during site visits and in-depth interviews with clinical and administrative staff (N = 69). Groups were randomly selected from those that participated in the second National Study of Physician Organizations using stratified sampling along three dimensions (i.e., ownership type, use of care management practices, and outcome performance). We analyzed the data to assess the presence of seven culture types-group, hierarchical, rational, developmental, quality oriented, patient centered, and physician centered-using the constant comparative method.
  
  
  RESULTS
  We found that a multiplicity and diversity of cultures exist within and across multispecialty medical groups, with a dominance of patient-centered, physician-centered, rational, or quality-oriented cultures and less emphasis on group, developmental, and hierarchical cultures. Culture types that may seem antithetical, for example, patient-centered and physician-centered cultures, often coexisted within the same group. Across culture types, we found that six factors influenced medical group culture: financial, people, leadership, structural, processes, and environmental.
  
  
  CONCLUSIONS
  As medical groups adapt to changes under health care reform, their success likely depends on their having cultures that facilitate collaboration with other organizations (e.g., hospitals) that possess different cultures and adaptation to changes in payment and regulation. Our study suggests that some groups may not have the developmental and group cultures needed to adapt. Our study identifies six categories of levers they can use to alter their culture as desired.
authors.affiliation: Yale School of Public Health and Yale School of Management, Yale University, New Haven, CT, USA. ingrid.nembhard@yale.edu
authors.forename: Ingrid M
authors.initials: IM
authors.lastname: Nembhard
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Singer
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Shortell
authors.forename: Diane
authors.initials: D
authors.lastname: Rittenhouse
authors.forename: Lawrence P
authors.initials: LP
authors.lastname: Casalino
mesh_terms: D000288:Administrative Personnel / Q000523:psychology; D001291:Attitude of Health Personnel; D018864:Cultural Diversity; D019317:Evidence-Based Medicine; D006123:Group Practice / Q000706:statistics & numerical data; D006801:Humans; D007400:Interprofessional Relations; D007857:Leadership; D015279:Organizational Culture; D009936:Organizational Innovation; D016134:Organizational Policy; D010043:Outcome and Process Assessment, Health Care; D018802:Patient-Centered Care; D011594:Psychometrics; D036301:Qualitative Research; D013038:Specialization / Q000706:statistics & numerical data; D014481:United States