TY - JOUR
T1 - Using learning teams for reflective adaptation (ULTRA)
T2 - Insights from a team-based change management strategy in primary care
AU - Balasubramanian, Bijal A.
AU - Chase, Sabrina M.
AU - Nutting, Paul A.
AU - Cohen, Deborah J.
AU - Ohman Strickland, Pamela A.
AU - Crosson, Jesse C.
AU - Miller, William L.
AU - Crabtree, Benjamin F.
AU - DiCicco-Bloom, Barbara
AU - Shaw, Eric
AU - Scott, John
AU - Hudson, Shawna
AU - Orzano, John
AU - Tallia, Alfred
AU - Ferrante, Jeanne
AU - O'Malley, Dena
AU - Falco, Terry
AU - Hahn, Karissa
AU - Piasecki, Alicja
AU - Looney, Anna
AU - Kelly, Jill
AU - Stello, Brian
AU - Gratz, Nancy
AU - Stange, Kurt
AU - McDaniel, Reuben
AU - Zyzanski, Stephen
AU - Gilchrist, Valerie
AU - Stroebel, Christine
AU - Harris-Haywood, Sonja
AU - Jaén, Carlos Roberto
AU - Yawn, Barbara
AU - Solberg, Leif
N1 - Funding Information:
Funding support: Data collection and analysis grant support from the National Heart, Lung, and Blood Institute (R01 HL70800) and an AAFP Research Center Grant. This research was also supported by the Cancer Institute of New Jersey's Primary Care Research shared resource.
PY - 2010/9/1
Y1 - 2010/9/1
N2 - PURPOSE The Using Learning Teams for Reflective Adaptation (ULTRA) study used facilitated reflective adaptive process (RAP) teams to enhance communication and decision making in hopes of improving adherence to multiple clinical guidelines; however, the study failed to show significant clinical improvements. The purpose of this study was to examine qualitative data from 25 intervention practices to understand how they engaged in a team-based collaborative change management strategy and the types of issues they addressed. METHODS We analyzed field notes and interviews from a multimethod practice assessment, as well as field notes and audio-taped recordings from RAP meetings, using an iterative group process and an immersion-crystallization approach. RESULTS Despite a history of not meeting regularly, 18 of 25 practices successfully convened improvement teams. There was evidence of improved practicewide communication in 12 of these practices. At follow-up, 8 practices continued RAP meetings and found the process valuable in problem solving and decision making. Seven practices failed to engage in RAP primarily because of key leaders dominating the meeting agenda or staff members hesitating to speak up in meetings. Although the number of improvement targets varied considerably, most RAP teams targeted patient care-related issues or practice-level organizational improvement issues. Not a single practice focused on adherence to clinical care guidelines. CONCLUSION Primary care practices can successfully engage in facilitated team meetings; however, leaders must be engaged in the process. Additional strategies are needed to engage practice leaders, particularly physicians, and to target issues related to guideline adherence.
AB - PURPOSE The Using Learning Teams for Reflective Adaptation (ULTRA) study used facilitated reflective adaptive process (RAP) teams to enhance communication and decision making in hopes of improving adherence to multiple clinical guidelines; however, the study failed to show significant clinical improvements. The purpose of this study was to examine qualitative data from 25 intervention practices to understand how they engaged in a team-based collaborative change management strategy and the types of issues they addressed. METHODS We analyzed field notes and interviews from a multimethod practice assessment, as well as field notes and audio-taped recordings from RAP meetings, using an iterative group process and an immersion-crystallization approach. RESULTS Despite a history of not meeting regularly, 18 of 25 practices successfully convened improvement teams. There was evidence of improved practicewide communication in 12 of these practices. At follow-up, 8 practices continued RAP meetings and found the process valuable in problem solving and decision making. Seven practices failed to engage in RAP primarily because of key leaders dominating the meeting agenda or staff members hesitating to speak up in meetings. Although the number of improvement targets varied considerably, most RAP teams targeted patient care-related issues or practice-level organizational improvement issues. Not a single practice focused on adherence to clinical care guidelines. CONCLUSION Primary care practices can successfully engage in facilitated team meetings; however, leaders must be engaged in the process. Additional strategies are needed to engage practice leaders, particularly physicians, and to target issues related to guideline adherence.
KW - Chronic disease
KW - Group meetings
KW - Organizational change
KW - Primary care
KW - Qualitative research
KW - Quality improvement
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U2 - 10.1370/afm.1159
DO - 10.1370/afm.1159
M3 - Article
C2 - 20843884
AN - SCOPUS:77957727784
SN - 1544-1709
VL - 8
SP - 425
EP - 432
JO - Annals of family medicine
JF - Annals of family medicine
IS - 5
ER -