(APPLICATION ABSTRACT): It is increasingly recognized that the individual physicians' actions, however optimal, may not be adequate to affect the outcomes of patients with chronic disease. Kaiser-Permanente Georgia has completely reorganized its primary care practice so that physicians are complemented by nurse personnel, service can be personalized, and staff, including doctors, are provided with the support necessary to bring about the patient centered changes. They have created Health Care Teams (HCT), small easily manageable groups of physicians, nurses and ancillary personnel that function as semi-autonomous units, have considerable independence in financial and personnel matters, and have incentives to be patient oriented. Teams have varied in their adoption of all elements necessary to become what we term a Collaborative Clinical Culture (CCC). Our proposed project will link measures of organizational culture and workforce characteristics with an extensive set of standardized, routinely collected measures of quality of care. We will determine the degree, using measures of delegation and collaboration, to which the health care teams have achieved role integration and efficient functioning. We will describe and validate a measure of staff reported """"""""teamness"""""""" that can be used to quantify the workforce integration on HCTs. We will describe the impact of workforce integration on practitioner satisfaction and morale, both cross-sectionally and longitudinally. Finally, we will estimate the associations of CCC and quality of care, both cross-sectionally and longitudinally. The results of this study will provide insight into whether HCTs are associated with high staff morale and high quality of care.
