Insights from exemplar practices on achieving organizational structures in primary care.
OBJECTIVE
Interprofessional practice (IPP) is associated with better patient care outcomes and patient and provider satisfaction, yet little is known about the organizational structures that support effective IPP.


METHODS
We selected 9 diverse clinical practice sites with exemplary IPP and conducted site visits with nonparticipant observations and interviewed 80 physicians, nurses, pharmacists, dieticians, medical and hospital assistants, nurse practitioners, physician assistants, clinic managers, physical and occupational therapists, respiratory therapists, social workers, psychologists, and others. We independently coded field notes and interviews and identified themes and trends using a grounded theory approach. Sites were evaluated for IPP using key features identified by the 2011 Interprofessional Education Collaboration Expert Panel.


RESULTS
The primary themes at sites with high IPP were coordination of care and mutual respect. Four key organizational features were associated with these 2 themes: independent responsibilities for each professional; organizational structures for providers to learn about each other's roles; a structure and culture promoting accessible, frequent communication about patients; and strong leadership in IPP-supportive values.


CONCLUSIONS
To achieve interprofessional collaboration, practice teams require structural supports that facilitate coordination of care and mutual respect.
From the Department of Family Medicine, University of Washington School of Medicine, Seattle.
Greta
G
Tubbesing
From the Department of Family Medicine, University of Washington School of Medicine, Seattle. fchen@u.washington.edu.
Frederick M
FM
Chen
D001291:Attitude of Health Personnel; D003299:Cooperative Behavior; D006801:Humans; D007400:Interprofessional Relations; D015279:Organizational Culture; D009936:Organizational Innovation; D010348:Patient Care Team / Q000458:organization & administration*; D010820:Physicians / Q000592:standards*; D011320:Primary Health Care / Q000458:organization & administration*; D036301:Qualitative Research
Delivery of Health Care; Health Personnel; Practice Management