Physician-system relationships - Stumbling blocks and promising practices

OBJECTIVES. TO identify the barriers, facilitators, and potential better pr actices to achieving physician-system alignment. METHODS. Interviews using a semistructured, open-ended protocol were conduc ted during a total of 18 site visits, each usually 2 days in length, coveri ng multiple topics of physician group-system alignment. Interviews were con ducted with members of the target physician group, key leaders of the healt h care system, and representatives of physicians not in the target group. T he summary of the interviews for each of the site visits was analyzed to de termine barriers, facilitators, and better practices for achieving more eff ective relationships between physician groups and health care systems. RESULTS. A number of barriers to more effective relationships between physi cian groups and health systems were identified. Barriers related to environ ment, culture, and information systems were most prevalent Other major gene ral areas of barriers encountered were physician leadership, group-system r elationship, compensation and productivity, care management practices, grou p strategy, and accountability. Examples of practices that may help to reso lve some of these issues were also identified. CONCLUSIONS. Physician-system relationships can and do cause problems for i mproving health care. The evidence from the conducted site visits suggests that specific strategies may help improve these relationships but more rese arch is needed in order assess the actual impact of these strategies.