Transforming small independent practices to patient-centered medical homes is widely believed to be a critical step in reforming the US health care system. Our team has conducted research on improving primary care practices for more than fifteen years. We have found four characteristics of small primary care practices that seriously inhibit their ability to make the transformation to this new care model. We found that small practices were extremely physician-centric, lacked meaningful communication among physicians, were dominated by authoritarian leadership behavior, and were underserved by midlevel clinicians who had been cast into unimaginative roles. Our analysis suggests that in addition to payment reform, a shift in the mind-set of primary care physicians is needed. Unless primary care physicians can adopt new mental models and think in new ways about themselves and their practices, it will be very difficult for them and their practices to create innovative care teams, become learning organizations, and act as good citizens within the health care neighborhood.

译文

:人们普遍认为,将小规模的独立实践转变为以患者为中心的医疗之家,是改革美国医疗保健体系的关键步骤。我们的团队针对改善初级保健实践进行了十五年的研究。我们发现小型初级保健实践的四个特征严重阻碍了他们向这种新的保健模式转变的能力。我们发现,小规模的实践非常以医师为中心,在医师之间缺乏有意义的沟通,被专制的领导行为所主导,并且被中庸的临床医师所忽视,而这些医师被赋予了难以想象的作用。我们的分析表明,除了支付改革之外,还需要改变基层医疗医生的思维方式。除非初级保健医生可以采用新的心理模式并以新的方式思考自己和他们的做法,否则他们和他们的做法将很难创建创新的保健团队,成为学习型组织并在保健邻里中扮演好公民的角色。 。

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