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The Cultural Complexity of Medical Groups



The Issue

To adapt to new models of care, like the patient-centered medical home, some medical groups will need to alter their practice culture to make it more collaborative and patient-centered. Such a transformation requires an understanding of the different types of cultures that are present in physician groups and how those varying cultures influence performance.


What the Study Found

Commonwealth Fund–supported researchers studied eight multispecialty medical practices, looking for evidence of seven culture types: group, which emphasizes teamwork and strong staff relationships; hierarchical, which values stability through adherence to rules, policies, and procedures; rational, which prioritizes productivity, efficiency, and achievement; developmental, which stresses growth, change, and flexibility; quality-oriented, which focuses on evidence-based care; patient-centered, which emphasizes responsiveness to patient preferences; and physician-centered, which seeks to preserve physician preferences and authority over clinical decisions.

The researchers found that:

  • All of the medical groups had a blend of at least five of the seven types, with a dominance of patient-centered, physician-centered, rational, and quality-oriented cultures. Group, developmental, and hierarchical cultures were the least emphasized in all the practices examined.
  • Cultural types can coexist and be positively or negatively reinforcing. For instance, developmental cultures facilitated rational and quality-oriented cultures, while rational and quality-oriented cultures hindered or negatively reinforced one another.
  • Six factors influenced medical group culture: financial issues, staffing, leadership styles, organizational structure, hiring processes and professional development activities, and external requirements like public reporting.



The researchers conclude that it is important for managers is to assess the culture types present in their groups and examine whether those cultures are consistent with the groups' goals.

Publication Details



I. M. Nembhard, S. J. Singer, S. M. Shortell et al., "The Cultural Complexity of Medical Groups," Health Care Management Review, July–Sept. 2012 37(3):200–13.