Deciphering the Role of Organizational Culture in Patient-Centered Medical Home Implementation

Abstract

Culture--the patterns of values, norms, beliefs, and perceptions that are often the drivers of organizational members’ thinking and behavior--is recognized as an important influence on the success of organizational change. We conducted a collective care study of four primary care practices implementing the Patient-Centered Medical Home (PCMH)--an organizational change initiative that promotes the ideals of accessible, comprehensive, coordinated, patient-centered care--to examine the relationship between culture and organizational change. Interviews and surveys directly and indirectly assessed organizational members’ perceptions of culture and experiences during implementation. Reports summarizing each practice’s PCMH implementation further characterized each practice’s change efforts and progress. While some practices made more PCMH implementation progress than others, none of the practices completely achieved the PCMH ideals. The relationship between the practices and their overarching health system, practice leadership style, decision-making norms, organizationally-centered and patient-centered values were the predominant culture factors of the practices’ progress in PCMH implementation. Further research is needed to understand how culture relates to organizational change in various contexts to support health care quality improvement efforts.