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Physicians' Voices: What Skills and Supports Are Needed for Effective Practice in an Integrated Delivery System? A Case Study of Kaiser Permanente.

Authors
  • Chesluk, Benjamin1
  • Tollen, Laura2
  • Lewis, Joy3
  • DuPont, Samantha3
  • Klau, Marc H4
  • 1 1 American Board of Internal Medicine, Philadelphia, PA, USA.
  • 2 2 Tollen Health Policy Consulting, Larkspur, CA, USA.
  • 3 3 Kaiser Permanente Institute for Health Policy, Oakland, CA, USA.
  • 4 4 Southern California Permanente Medical Group, Pasadena, USA.
Type
Published Article
Journal
Inquiry : a journal of medical care organization, provision and financing
Publication Date
Jan 01, 2017
Volume
54
Identifiers
DOI: 10.1177/0046958017711760
PMID: 28597725
Source
Medline
Keywords
License
Unknown

Abstract

Payers are demanding that US health care become more accountable and integrated, posing new demands for physicians and the organizations that partner with them. We conducted focus groups with 30 physicians in a large integrated delivery system who had previous experience practicing in less integrated settings and asked about skills they need to succeed in this environment. Physicians identified 3 primary skills: orienting to teams and systems, engaging patients as individuals and as a panel, and integrating cost awareness into practice. Physicians also expressed a high level of trust that the system was designed to help them provide better care. This belief appeared to make the new demands and mental shifts tolerable, even welcome, standing in contrast to research showing widespread physician distrust of their institutional settings. Physicians' new skills and the system features that promote trust are described in the article and should be a focus for systems transitioning to a more integrated, accountable model.

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