Table 5.

Vignettes of Two Practices Showing Examples of Each Relationship Characteristic^*

Characteristic	Practice Alpha	Practice Beta
Trust	“She [the administrator] asked me [office clerk] what I thought about it and I told her and the next week she did just that.” “When the managers are away from the office, we pretty much run the clinic.”	“We don’t have any say in the decisions around here.” “They never ask our input.” “They do ask our input and don’t use it.”
Mindfulness	“I like to sit with front office staff when they are learning something new so that I can learn, too.” “I rely on my employees to tell me what they think so we can do better.”	“That’s not the way we do it here.” “I can’t think of a situation that there’s not a procedure for.”
Heedfulness	“Before I make a new policy or change an existing one I talk with everyone to see how it would impact their day.” “I think we should spend more time with people in different roles so that we can see how what we do impacts others.”	“I don’t have a good feel for how my work fits in back there [the clinical side]” “We’re so busy back here that we don’t have time to check how we impact each other.”
Respectful Interaction	Every morning, clinic members hold a “huddle” where people openly participate and share ideas about the day before and the day ahead. “I encourage people to speak up and share their thoughts so that we can all improve and learn.”	“I don’t feel comfortable sharing my opinion about things here.” “People here don’t take my ideas seriously so why should I speak up?” “When people try to make improvements here, they are seen as a negative thing.”
Diversity	“We need people who think differently from the rest of us. If they weren’t here, we’d probably be doing the bunny hop down the hallway.” “Each nursing unit had one person that stood out from the rest in terms of how they approached their work and how they got work done.”	“It’s a shame that those two were broken up. They worked really well together and were doing really interesting, new things.” “We can’t have each of our care teams doing different things.” “If we do things differently here, we are penalized.”
Social/Task Relatedness	A mixture of social and task relatedness was observed. We observed that people in Alpha were open with each other in discussing personal/social matters.	Very little social relating was observed; high task relatedness. “When we get too close, we are separated.” “People here view this as a job…that’s it.”
Rich/Lean Communication	People tended to use face-to-face communication when they had questions or need a nonroutine problem solved Depending on the issue, people used a telephone, overhead pager, and/or face-to-face meetings to address problems.	“I often miss important messages because I hear about them over e-mail—I hear nothing about it until I need to know and then it’s too late.” “It’s a waste of time to sit in meetings and be given information that’s not relevant to my job.”
Practice Relationships Profile Summary	At Alpha, all practice members were given the responsibility and authority to do the work of the practice. Practice member input was seen as necessary for getting the work of Alpha done well. This culture was palpable in the front office and back office alike. Members of Alpha talked about mistakes. They freely self-organized around the work and were encouraged to do so as long as the work was accomplished well. People at Alpha used humor to relate with each other and to do their work. Alpha’s relationship system enabled a positive practice environment and facilitated high-quality health care.	Standardization of care delivery was an overarching goal for Beta. Beta management worked to dampen self-organization that did not fit with the formal rules, structures, and procedures of Beta. Nursing staff were regularly asked to rotate through teams to discourage ways of doing things that deviated from the way things were normally done at Beta. Because people at Beta could not self-organize openly, they found different, sometimes destructive, ways to self-organize. Beta’s push for standardization created an environment of care where practice relationships were lost and quality of care suffered.

^*These vignettes represent composites of typical behaviors in the primary care practices that were examined in the DOPC, P&CD, STEP-UP, and ULTRA Studies (see Table 3). The Alpha and Beta practices are both fictional, Alpha representing an idealized example of a practice with good relationships and Beta an example of a practice with relationships that need improvement.