Creating a physician compact that drives group success.

A physician compact is the unwritten understanding of what an organization and its employees owe one another. When expectations clash about job security, salary, hours and the like, the practice--and its patients--suffer. Outdated expectations of the physician compact can hamper an organization from functioning smoothly and delivering optimal care. Rewriting a compact should involve all of a group's physicians, and should be endorsed and promoted by practice leadership. A satisfactory compact develops a shared sense of strategic imperatives and helps a practice reach its potential.

How can IDSs integrate conflicting cultures?

Many integrated delivery systems (IDSs) perform poorly because of cultural differences of their constituents. To reconcile such differences and start to develop one unifying culture, IDSs need to promote a set of cultural values and expectations that support the entire enterprise. Creating a unified, functional culture is a complex process that ranges from identifying the organization's strategic aims and assessing current cultures in light of those aims, to being courageous and consistent in demonstrating the organization's values.

The HMO physician as team player.

For HMOs to function most effectively, physicians and support staff need to work together as teams. Successful teamwork requires a high degree of communication and coordination, attributes that are often lacking unless the HMO has decentralized authority and nurtures effective teamwork. This article describes barriers that impede teamwork, and focuses on specific steps that can be taken to enhance the team environment in a prepaid group practice.

Acceptance of preventive measures by individuals, institutions and communities.

The acceptance by individuals, institutions and communities of preventive measures for controlling the two most prevalent dental diseases, dental caries and periodontal disease, is limited. A wide gap exists between available preventive methods and their appropriate application. Adoption of preventive dental self-care (tooth brushing, flossing diet modification) is organized around five categories of determinants influencing oral health behaviours: psychological factors; face-to-face interactions between people; broad societal influences; information and the immediate surroundings; and reinforcement schemes. While each of these five categories of determinants influences adoption of the desired behaviours, altering any single factor does not usually result in sustained behaviour change. Institutions (e.g. schools and workplaces) and communities are sites where the determinants of individual behaviours can be altered and preventive services can be delivered. Very little research has been conducted to improve our understanding of the variables which explain why dental health prevention programmes are accepted or rejected by institutions or communities. When programmes are adopted, little is known about the accuracy of their administration or about barriers to, and problems in, their implementation and maintenance. To achieve optimal oral health throughout life, a combination of passive measures (e.g. water fluoridation, school-based fluoride programmes) and active personal behaviours (e.g. oral hygiene, diet control) is required. Therefore, it is essential that researchers and practitioners improve their understanding of the acceptance of passive measures by institutions and communities as well as their understanding of the adoption of active measures by individuals.

Planning the educational component of a hypertension control program: a case study.

The failure to plan the health education component of a health service program together with the total planning effort has severely limited the contribution education could make to program goals. This case study illustrates the use of the systematic observation of behavior to identify factors which facilitated or hindered the development of a hypertension control program in ambulatory facilities and boards of health. The relationship of these factors to the planning process is discussed. Although this project deals with hypertension, the factors identified as facilitating or hindering change are applicable to any public health program.