Quality improvement (QI) system changes can produce intended changes in organizational practices without consistently improving patient outcomes.  To determine whether this is due to a failure of QI to be translated to the provider level, we developed a reliable measure (α >0.80) of specific aspects of practitioners' day-to-day work climate expected to produce improved chronic disease outcomes we call Clinical Collaborative Culture (CCC).  The 31-item measure reflects dimensions of CCC including perceptions of continuity of care, patient familiarity, staff collaboration, morale, and time pressure.  We administered the measure to 44 MDs and 22 nurse practitioners in 16 primary care health care teams (HCT) at Kaiser Permanente Georgia in 2000.  As part of a QI system change, each HCT had been granted information technology and increased managerial autonomy to develop personnel and practices to improve chronic disease care in their respective clinics.  HCT's were compared to determine how developing a high-CCC practice climate impacts diabetes patient outcomes one year later (N=7298).  Diabetes patients treated by HCT's in the top CCC quartile had significantly better glycemic and lipid control than those in other quartiles.  Practice climate should be investigated further as a missing link between system change and chronic disease outcomes.