Abstract
Background/Aims We examined the extent to which relational dynamics among primary care providers and clinic staff impacts clinic quality and efficiency from the patients’ perspective. Relational dynamics, measured by team communication (frequency, timeliness, accuracy, problem-solving) and relationships (shared goals, shared knowledge, mutual respect), has been associated with better performance in hospital settings through better communication and coordination of tasks among providers; however, the impact in primary care has received more limited attention in the literature. We take advantage of the natural variation in practice culture that occurred in 13 family medicine and 13 internal medicine departments in a large multispecialty practice in California.
Methods We conducted a cross sectional study using data from a relational dynamics survey completed by providers (142 physicians; 96 medical assistants; 46% response rate), Press Ganey patient satisfaction data (n = 13,076; 21% response rate), and EHR from July 2011 to June 2012. Relational dynamics was measured by 7 reliable items of team interaction (Cronbach’s alpha = 0.90), scored 1 (lowest) to 5 (highest). Department averages were constructed and matched to 8 patient satisfaction measures of clinic quality and efficiency, scored as the % of “very satisfied” respondents. Relevant patient case-mix, physician, and department characteristics were included in multilevel models with random effects at the department level.
Results Relational dynamics varied across the 26 departments ranging from 3.57 to 4.52 (mean = 4.17; SD = 0.25). A one SD increase in relational dynamics was associated with an increase in the % of patients “very satisfied” with scheduling appointments (1.61, P <0.05), getting the clinic on the phone (1.46,P <0.05), returning phone calls (2.19,P <0.01), returning emails (2.23,P <0.05), wait times (3.71,P <0.01), and the likelihood of recommending the practice (1.53,P <0.01). However, there was no relationship with the ease of obtaining referrals and the sensitivity to patients’ needs.
Conclusions The relational dynamics in primary care departments are associated with improvements in patient satisfaction with clinic performance. These findings support establishing formal procedures to enhance the communication and relationships among primary care providers and clinic staff in order to improve the patient experience with care.
