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APHA Scientific Session and Event Listing

Recorded presentation

Dorothy Hung, PhD, MA, MPH¹, Tom Rundall, PhD², Deborah Cohen, PhD³, Alfred Tallia, MD, MPH³, and Benjamin Crabtree, PhD³. (1) Sociomedical Sciences, Columbia University Mailman School of Public Health, 722 W. 168th Street, Suite 526B, New York, NY 10032, 212.342.0154, dh2237@columbia.edu, (2) School of Public Health, University of California, Berkeley, 416 Warren Hall, Berkeley, CA 94720, (3) Family Medicine, UMDNJ-Robert Wood Johnson Medical School, 1 World's Fair Drive, Somerset, NJ 08873

Efforts to redesign healthcare organizations are beginning to address how decisions are made in the practice setting. This study contributes to these efforts by examining associations between staff participation in decision making, productivity, and turnover in primary care practices. The study is informed by organizational theories of participation that emphasize human resources and human relations effects on employee output and behavior. This research used data collected from primary care practices involved in a national initiative sponsored by the Robert Wood Johnson Foundation. Cross-sectional survey data on organizational structures and attributes among 49 practices were analyzed. Regression analysis was used to examine associations between practice productivity, staff participation in decision making, and formal structures such as staff meetings. Associations between staff turnover and participative decision making were also examined. Staff participation in decisions regarding quality improvement, practice change, and clinical operations was positively associated with productivity (p<0.05), whereas formal structures such as staff meetings were not. In addition, higher levels of participation in decision making were associated with reduced turnover among non-clinicians and administrative staff (p<0.05). Examination of organizational features is increasingly recognized as a key to improving primary care performance. These study findings have general policy and practice implications for the implementation of a participative model emphasizing greater staff involvement in decision making. Participation may enhance information sharing, work satisfaction, and commitment to organizational decisions, all of which can lead to beneficial outcomes such as increased productivity and stability in primary care practices.

Learning Objectives: Readers will be able to

• articulate important aspects of human resources and human relations management models;
• apply organizational theories to issues faced by primary care practices, such as productivity and staff turnover; and
• assess the need for participative organizational designs that emphasize staff involvement in practice decisions.

Keywords: Decision-Making, Primary Care

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation