Care delivery and compensation system changes: a case study of organizational readiness within a large dental care practice organization in the United States

BMC Oral Health

Research Article

Gary Allen¹  Jeanne Dysert¹  R. Mike Shirtcliff¹  Sharity Ludwig¹  Melissa Mitchell¹  Joana Cunha-Cruz²  Peter Milgrom²  Colleen E. Huebner³  JoAnna Scott⁴ 

[1] Advantage Dental Services LLC, Redmond, OR, USA;Northwest Center to Reduce Oral Health Disparities, Department of Oral Health Sciences, School of Dentistry, University of Washington, Box 357475, 98195-7475, Seattle, WA, USA;Northwest Center to Reduce Oral Health Disparities, Department of Oral Health Sciences, School of Dentistry, and Department of Health Services, School of Public Health University of Washington, Seattle, WA, USA;UMKC School of Dentistry, Kansas City, MO, USA;

关键词: Organizational innovation;    Quality improvement;    healthcare reform;    Dental care/manpower;    patient care team;    United States;   

DOI  :  10.1186/s12903-017-0448-4

 received in 2017-05-25, accepted in 2017-12-07,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundDental care delivery systems in the United States are consolidating and large practice organizations are becoming more common. At the same time, greater accountability for addressing disparities in access to care is being demanded when public funds are used to pay for care. As change occurs within these new practice structures, attempts to implement change in the delivery system may be hampered by failure to understand the organizational climate or fail to prepare employees to accommodate new goals or processes. Studies of organizational behavior within oral health care are sparse and have not addressed consolidation of current delivery systems. The objective of this case study was to assess organizational readiness for implementing change in a large dental care organization consisting of staff model clinics and affiliated dental practices and test associations of readiness with workforce characteristics and work environment.MethodsA dental care organization implemented a multifaceted quality improvement program, called PREDICT, in which community-based mobile and clinic-based dental services were integrated and the team compensated based in part on meeting performance targets. Dental care providers and supporting staff members (N = 181) were surveyed before program implementation and organizational readiness for implementing change (ORIC) was assessed by two 5-point scales: change commitment and efficacy.ResultsProviders and staff demonstrated high organizational readiness for change. Median change commitment was 3.8 (Interquartile range [IQR]: 3.3-4.3) and change efficacy was 3.8 (IQR: 3.0-4.2). In the adjusted regression model, change commitment was associated with organizational climate, support for methods to arrest tooth decay and was inversely related to office chaos. Change efficacy was associated with organizational climate, support for the company’s mission and was inversely related to burnout. Each unit increase in the organizational climate scale predicted 0.45 and 0.8-unit increases in change commitment and change efficacy.ConclusionsThe survey identified positive readiness for change and highlighted weaknesses that are important cautions for this organization and others initiating change. Future studies will examine how organizational readiness to change, workforce characteristics and work environment influenced successful implementation within this organization.

【 授权许可】

CC BY   
© The Author(s). 2017