Defense Date


Document Type


Degree Name

Doctor of Philosophy


Health Related Sciences

First Advisor

Stephen S. Mick


Family medicine practices are currently threatened by factors such as poor reimbursement, physician stress, shortage of providers, and difficulties in providing prompt access and reliable continuity of care. The external environment faced by family medicine practices is extremely complex and characterized by high pressure from regulatory sources, decreasing reimbursement levels, an increasing rate of change in technologies and care delivery processes, and increasing patient and community expectations. Over the last several years there have been many efforts in family medicine to respond to the challenges presented by the external environment. The majority of these efforts focus on redesigning the delivery of health care services and improving business functionality at the practice level. These innovations include incorporating a patient-centered team approach to providing care, increasing use of advanced technologies, improving functional office space, emphasizing quality and outcomes, and enhancing practice finances.

This study explored innovations in family medicine practices to redesign the delivery of health care services and improve business functionality. This research also examined whether environmental factors and organizational characteristics influence strategies to redesign the practice of family medicine. The study employed an integrated set of theoretical frameworks from organizational sociology in evaluating the environmental influences on innovative efforts. Institutional theory was used to provide a conceptual framework to explain the connection between innovations in family medicine practices and three institutional forces within the environment: coercive forces, mimetic forces, and normative forces. Resource dependency theory was used to explain physician practice motivators for change based on a dependence on scarce financial, human, and information resources.

The study utilized multiple secondary data sets to define the external environment and an organizational survey of family medicine practices to understand the utilization of innovations and environmental influences. Descriptive statistics and multivariate analysis were used to reveal innovations and to determine the impact of environmental factors on the implementation of redesign strategies. The study results provide essential information on innovations undertaken by family medicine practices in Virginia and how environmental factors and organizational characteristics influence efforts to redesign.


Scanned, with permission from the author, from the original print version, which resides in University Archives.


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