Protecting the culture of a patient-centered medical home

Objective: This study describes and categorizes the cultural frictions and conflicts within a successfully implemented Internal Medicine Patient-Centered Medical Home (PCMH) clinic at the National Naval Medical Center, and provides lessons learned for combating these concerns. Methods: A semistructured interview protocol was developed, focusing on unique tenets of the PCMH, benefits of the model, and perceived obstacles to practicing medicine within this delivery system. The interviews included questions regarding efforts to foster team cohesion and impediments within the PCMH, as well as unique influences of the larger organization and the patient population, and lingering concerns about threats to the PCMH's viability. Key Results: Cultural tensions were revealed in four areas: perceived competing values within PCMH, individual resistance to PCMH values, within-team conflicts threatening the acculturation of PCMH values, and threats to the culture from external stakeholders. Conclusions: Recommendations for addressing these areas include values clarification and empowerment, training for socialization, realistic job previews, selective personnel retention, team building and conflict resolution mechanisms, and increased senior managerial support.