A Mixed Methods Study of Change Processes Enabling Effective Transition to Team-Based Care.

Michael Anne Kyle,Emma-Louise Aveling,Sara Singer

doi:10.1177/1077558719881854

Michael Anne Kyle, Emma-Louise Aveling + Show 1 more

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https://doi.org/10.1177/1077558719881854

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Abstract

Team-based care is considered central to achieving value in primary care, yet results of large-scale primary care transformation initiatives have been mixed. We explore how underlying change processes influence the effectiveness of transition to team-based care. We studied 12 academically affiliated primary care practices participating in a learning collaborative, using longitudinal staff survey data to measure progress toward team-based care and qualitative interviews with practice staff to understand practice transformation. Transformation efforts focused on team formation and capacity building for quality improvement. Using thematic analysis, we explored types of change processes undertaken and the relationship between change processes and effective team-based care. We identified three prototypical approaches to change: pursuing functional and cultural change processes, functional only, and cultural only. Practice sites prioritizing both change processes formed the most effective teams: simultaneous functional and cultural change spurred a mutually reinforcing virtuous cycle. We describe implications for research, practice, and policy.

Highlights

Multidisciplinary care teams are viewed as the basic operating unit of a learning health care system capable of generating ongoing improvements in quality and efficiency (American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, & American Osteopathic Association [AAFP], 2007; BielaszkaDuVernay, 2011; Schottenfeld et al, 2016)
Teambased care is a cornerstone of most primary care practice transformation initiatives and a requirement for credentials like the Patient-Centered Medical Homes (PCMH; AAFP, 2007; Bloniarz & Smalley, 2014; Bodenheimer, 2007; Grumbach & Bodenheimer, 2004; Iglehart, 2008; Mitchell et al, 2012; Naylor et al, 2010; Wagner, Coleman, Reid, Phillips, & Sugarman, 2012)
We studied 12 academic primary care practices participating in a multiyear learning collaborative, which had as a central focus establishing team-based care and building capacity for continuous improvement (Bitton et al, 2014)

Summary

Introduction

Multidisciplinary care teams are viewed as the basic operating unit of a learning health care system capable of generating ongoing improvements in quality and efficiency (American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, & American Osteopathic Association [AAFP], 2007; BielaszkaDuVernay, 2011; Schottenfeld et al, 2016). Despite widespread optimism about the transformative potential of team-based care, in practice medical home models have delivered mixed results (Sinaiko et al, 2017). Theoretical and empirical literature suggests that effective primary care teams can improve outcomes of great interest, such as care coordination, quality, and efficiency (Alexander et al, 2005; Reiss-Brennan et al, 2016). Teambased care has been associated with better continuity, access, and satisfaction for patients (Grumbach & Bodenheimer, 2004), while team structures can enhance capacity for shared learning and improvement (Provost, Lanham, Leykum, McDaniel, & Pugh, 2015; Valentine & Edmondson, 2015).

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