| Using Learning Teams for Reflective Adaptation (ULTRA): insights from a team-based change management strategy in primary care. | |
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MedLine Citation:
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PMID: 20843884 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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 practice-wide 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. |
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Authors:
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Bijal A Balasubramanian; Sabrina M Chase; Paul A Nutting; Deborah J Cohen; Pamela A Ohman Strickland; Jesse C Crosson; William L Miller; Benjamin F Crabtree; |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Annals of family medicine Volume: 8 ISSN: 1544-1717 ISO Abbreviation: Ann Fam Med Publication Date: 2010 Sep-Oct |
Date Detail:
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Created Date: 2010-09-16 Completed Date: 2010-12-01 Revised Date: 2011-07-25 |
Medline Journal Info:
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Nlm Unique ID: 101167762 Medline TA: Ann Fam Med Country: United States |
Other Details:
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Languages: eng Pagination: 425-32 Citation Subset: IM |
Affiliation:
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Division of Epidemiology, Human Genetics, and Environmental Science, University of Texas School of Public, Dallas, Texas 75390, USA. bijal.a.balasubramanian@uth.tmc.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Group Practice Health Services Research / organization & administration* Humans Institutional Management Teams* Intervention Studies Organizational Culture Organizational Innovation Practice Guidelines as Topic Practice Management, Medical / organization & administration* Primary Health Care / organization & administration* Private Practice Problem Solving Qualitative Research Quality of Health Care / organization & administration* United States |
| Grant Support | |
ID/Acronym/Agency:
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K01 CA131500-04/CA/NCI NIH HHS; K05 CA140237-01/CA/NCI NIH HHS; R01 HL070800-01/HL/NHLBI NIH HHS; R01 HL70800/HL/NHLBI NIH HHS |
| Investigator | |
Investigator/Affiliation:
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Barbara DiCicco-Bloom / ; Eric Shaw / ; John Scott / ; Shawna Hudson / ; John Orzano / ; Alfred Tallia / ; Jeanne Ferrante / ; Dena O'Malley / ; Terry Falco / ; Karissa Hahn / ; Alicja Piasecki / ; Anna Looney / ; Jill Kelly / ; Brian Stello / ; Nancy Gratz / ; Kurt Stange / ; Reuben McDaniel / ; Stephen Zyzanski / ; Valerie Gilchrist / ; Christine Stroebel / ; Sonja Harris-Haywood / ; Carlos Roberto Jaén / ; Barbara Yawn / ; Leif Solberg / |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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