Cultivating Engaged Leadership Through a Learning Collaborative: Lessons From Primary Care Renewal in Oregon Safety Net Clinics

Abstract

PURPOSE The aim of this study was to explore how learning collaboratives cultivate leadership skills that are essential for implementing patient-centered medical homes (PCMHs). METHODSWe conducted an ethnographic evaluation of a payor-incentivized PCMH implementation in Oregon safety net clinics, known as Primary Care Renewal. Analyses primarily drew on in-depth interviews with organizational leaders who were involved in the initiative. We solicited perspectives on the history, barriers, facilitators, and other noteworthy factors related to the implementation of PCMH. We reviewed and summarized transcripts and created and applied a coding dictionary to identify emergent leadership themes. We reviewed fi eld notes from clinic site visits and observations of learning collaborative activities for additional information on the role of engaged leadership. RESULTSInterview data suggested that organizations followed a similar, sequential process of Primary Care Renewal implementation having 2 phases-inspiration and implementation-and that leaders needed and learned different leadership skills in each phase. Leaders reported that collaborative learning opportunities were critical for developing engaged leadership skills during the inspiration phase of transformation. Facilitative and modeling aspects of engaged leadership were most important for codesigning a vision and plan for change. Adaptive leadership skills became more important during the implementation phase, when specifi c operational and management skills were needed to foster standardization and spread of the Primary Care Renewal initiative throughout participating clinics. CONCLUSIONSThe PCMH has received much attention as a way to reorganize and potentially improve primary care. Documenting steps and stages for cultivating leaders with the vision and skills to transform their organizations into PCMHs may offer a useful roadmap to other organizations considering a similar transformation.

Minnesota’s Early Experience with Medical Home Implementation: Viewpoints from the Front Lines

“…This unsustainable business model should be addressed by payment reform legislation or health system policies. 26,27 Similar to findings from other studies, 14,15,18 clinical and administrative leadership proved a crucial facilitator at the clinic level and higher. Our interviewees universally endorsed the need for leaders who were 1) inspiring and 2) able to effect fundamental operational changes.…”

“…Our interviewees universally endorsed the need for leaders who were 1) inspiring and 2) able to effect fundamental operational changes. 14 The importance of facilitative leadership fits well with the concept of adaptive reserve (i.e., combination of healthy relationship infrastructure, alignment of management systems, and leadership), which Nutting et al observed as critical to managing practice change. 28 Minnesota has a high penetration of EMRs in primary care.…”

“…[4][5][6][7][8][9][10][11] Facilitators and barriers to the creation of a successful PCMH have been explored in a limited number of heterogeneous settings, including small practices, large group practices, high-performing practices, and safety net clinics. [12][13][14][15][16][17] To date, significant challenges have been identified; specifically, the investment of resources for infrastructure changes and the leadership skills needed to guide an organization through paradigm-shifting cultural change. 5,14,18 Common facilitators have included valuing innovation, quality improvement, and patient-centeredness.…”

“…[12][13][14][15][16][17] To date, significant challenges have been identified; specifically, the investment of resources for infrastructure changes and the leadership skills needed to guide an organization through paradigm-shifting cultural change. 5,14,18 Common facilitators have included valuing innovation, quality improvement, and patient-centeredness. 12,13,16 We sought to augment the literature on motivations, barriers, and facilitators to PCMH implementation by describing a large-scale initiative with some unique features.…”

Lessons Learned from Applying a Modified Learning Collaborative Model to Promote Change in Regional and Statewide HIV Care Systems

“…LCs have most often been used to address challenges in ambulatory care settings or to address specific clinical topics, e.g. management of diabetes [1][2][3][4][5][6][7][8]. Antonini et al describes the use of a LC to address challenges faced in the integration of substance use diagnosis and treatment into primary health care and identify successful models and processes that minimize common barriers of documentation and privacy, financing and partnering with primary care providers [1].…”