Physicians in almost all settings are facing extraordinary changes in the way health care is delivered, documented, evaluated, and reimbursed. While the pace of change in medicine is furious, it is not unique to health care and one need not look far for examples of successful and failed management of change in other industries.
A common theme in management books and courses on the subject is that an organization’s culture is a strong determinant of successful adaptation to change (bit.ly/Transformationefforts.) “Culture” was Merriam-Webster’s “word of the year” recently, and can be defined for the purpose of this article as “a way of thinking, behaving, or working that exists in a place or organization (such as a business).”
Physicians may not be accustomed to examining their practice culture generally or specifically as a predictor of successful change management. Moreover, the shift to value-based reimbursement and externally imposed measurement of quality is certain to bring practice culture to the forefront. If culture, then, needs to be addressed in order for a physician practice to transition successfully to fee for value, how does one get started?
Also by Dr. Dowling: How will quality be measured under MIPS?
One simple step is to measure culture with a questionnaire that has been developed by the Agency for Health Care Research and Quality (AHRQ) in the area of patient safety and health care quality. This instrument is currently free, relatively easy to administer, and standardized to permit benchmarking (bit.ly/AHRQsurvey).
The survey instrument is available together with a user guide and technical assistance from the AHRQ website (bit.ly/AHRQsurvey). Designed to be self-administered, the survey should be given to all members of a medical practice for the most accurate results—including physicians and owners of the practice, clinical staff, administrative staff, and anyone else who works in the practice. If a practice has multiple locations, the survey should be “location specific” for best results, as the culture can differ between locations.
The survey is about 50 questions and covers topics including availability of charts and results, status of medical equipment, information exchange with other providers, working environment, communication and follow-up, and questions related to governance and support from leadership. It should take no longer than 10-15 minutes to complete.