Date of Award


Document Type


Degree Name

Doctor of Education (EdD)


Executive Leadership

First Supervisor

Theresa Pulos

Second Supervisor

Anastasia Urtz


Healthcare in the US has been in an extended state of accelerated change since the passing of the Affordable Care Act in 2010. Sweeping policies designed to reduce cost per capita, improve the patient experience of care (including quality and satisfaction), and improve the health of populations are being implemented at the macro and micro levels of healthcare services. Chronic illness is a leading factor in the rising costs of healthcare. This issue is driving more patient care from the hospital to the outpatient setting, such as physician practices, to reduce costs. Additionally, this paradigm shift is transitioning the patient from one of consumer of services to a co-manager of their own health. Managing chronic illness is a team endeavor with multiple healthcare players and support staff in concert with the patient. The ensuing relationship is a key element of success to the goal of living well. This qualitative constructivist grounded theory study of 11 patients with chronic illness explains their perceptions of organizational climate in physician office practices and conceptualizes perspectives of developing the patient-staff relationship. The major thematic construct is a model which demonstrates how chronically ill patients’ perceive the significance of the patient-staff relationship as proxy to their physicians. This emerging model informs healthcare leaders and practitioners how organizational climate influences patients’ perceptions and their health behaviors, and the significance placed on their patient-staff relationships.

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