Effective team-based primary care: observations from innovative practices

Wagner, Edward H.; Flinter, Margaret; Hsu, Clarissa; Cromp, De Ann; Austin, Brian T.; Etz, Rebecca; Crabtree, Benjamin F.; Ladden, Mary Joan

doi:10.1186/s12875-017-0590-8

Cited by 99 publications

(97 citation statements)

References 31 publications

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“…Selected practices included a range of geographic locations/settings, practice organizational types, and populations served. More details are available in earlier publications 64‐66 and on the internet at http://www.improvingprimarycare.org/start/about.…”

Section: Methodsmentioning

confidence: 99%

Leading Innovative Practice: Leadership Attributes in LEAP Practices

et al. 2020

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An onslaught of policies from the federal government, states, the insurance industry, and professional organizations continually requires primary care practices to make substantial changes; however, ineffective leadership at the practice level can impede the dissemination and scale‐up of these policies. The inability of primary care practice leadership to respond to ongoing policy demands has resulted in moral distress and clinician burnout. Investments are needed to develop interventions and educational opportunities that target a broad array of leadership attributes. Context Over the past several decades, health care in the United States has undergone substantial and rapid change. At the heart of this change is an assumption that a more robust primary care infrastructure helps achieve the quadruple aim of improved care, better patient experience, reduced cost, and improved work life of health care providers. Practice‐level leadership is essential to succeed in this rapidly changing environment. Complex adaptive systems theory offers a lens for understanding important leadership attributes. Methods A review of the literature on leadership from a complex adaptive system perspective identified nine leadership attributes hypothesized to support practice change: motivating others to engage in change, managing abuse of power and social influence, assuring psychological safety, enhancing communication and information sharing, generating a learning organization, instilling a collective mind, cultivating teamwork, fostering emergent leaders, and encouraging boundary spanning. Through a secondary qualitative analysis, we applied these attributes to nine practices ranking high on both a practice learning and leadership scale from the Learning from Effective Ambulatory Practice (LEAP) project to see if and how these attributes manifest in high‐performing innovative practices. Findings We found all nine attributes identified from the literature were evident and seemed important during a time of change and innovation. We identified two additional attributes—anticipating the future and developing formal processes—that we found to be important. Complexity science suggests a hypothesized developmental model in which some attributes are foundational and necessary for the emergence of others. Conclusions Successful primary care practices exhibit a diversity of strong local leadership attributes. To meet the realities of a rapidly changing health care environment, training of current and future primary care leaders needs to be more comprehensive and move beyond motivating others and developing effective teams.

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Section: Methodsmentioning

confidence: 99%

Leading Innovative Practice: Leadership Attributes in LEAP Practices

et al. 2020

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“…42 A team-based approach may also make social needs activities more scalable, consistent with other literature suggesting an important feature of high-performing, innovative primary care is expansion of the health care team. 43 Our findings are based on interviews with a limited number of salaried clinicians serving low-income populations in a single urban area and may not be generalizable. We also did not collect clinic-level measures of available social needs resources, or more comprehensive indicators of burnout levels.…”

Section: Discussionmentioning

confidence: 98%

Capacity to Address Social Needs Affects Primary Care Clinician Burnout

et al. 2019

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PURPOSE Primary care clinicians disproportionately report symptoms of burnout, threatening workforce sustainability and quality of care. Recent surveys report that these symptoms are greater when clinicians perceive fewer clinic resources to address patients' social needs. We undertook this study to better understand the relationship between burnout and clinic capacity to address social needs. METHODS We completed semistructured, in-person interviews and brief surveys with 29 primary care clinicians serving low-income populations. Interview and survey topics included burnout and clinic capacity to address social needs. We analyzed interviews using a modified grounded theory approach to qualitative research and used survey responses to contextualize our qualitative findings. RESULTS Four key themes emerged from the interview analyses: (1) burnout can affect how clinicians evaluate their clinic's resources to address social needs, with clinicians reporting high emotional exhaustion perceiving low efficacy even in when such resources are available; (2) unmet social needs affect practice by influencing clinic flow, treatment planning, and clinician emotional wellness; (3) social services embedded in primary care clinics buffer against burnout by increasing efficiency, restoring clinicians' medical roles, and improving morale; and (4) clinicians view clinic-level interventions to address patients' social needs as a necessary but insufficient strategy to address burnout. CONCLUSIONS Primary care clinicians described multiple pathways whereby increased clinic capacity to address patients' social needs mitigates burnout symptoms. These findings may inform burnout prevention strategies that strengthen the capacity to address patients' social needs in primary care clinical settings.

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“…It is essential to reflect about the quality of PHC services, considering they have a structural function in a health system responsible for the decisiveness and coordination of care throughout the service network. Innovative practices have been used to qualify actions aimed at quality improvement, as demonstrated in a US study carried out with primary care professionals, which identified the presence of an expanded team, with the work of nursing practitioners in the support for self-care, management of chronic diseases and health orientations, directing of medical activities, with autonomy and acting under protocols, working in community, among other actions (7) .…”

Section: Discussionmentioning

confidence: 99%

“…The evaluation and the use of strategies that improve the quality and decisiveness of primary care services is a concern in several countries of the world (7)(8)(9)(10) . In Brazil, where it is necessary to expand access to the health system, the PMAQ-PHC has contributed to the identification of needs and implementation of improvements (11) .…”

Section: Introductionmentioning

confidence: 99%

Influences of the program for access and quality improvement in work processes in primary care

Ferreira

Júnior

Arrigotti

et al. 2018

Rev. esc. enferm. USP

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Objective: To assess the perception of professionals of Family Health Strategy Teams on the National Program for Access and Quality Improvement in Primary Care and the possible changes in the work processes resulting from its implementation. Method: Oral history methodology conducted with members of Basic Health Units’ teams who participated in the first two cycles of the Program in São Paulo. Results: Six team members participated in the research. The professionals described the use of information to support the planning, diverged on the changes in the organization of the service and identified contributions to the direction of the teams and the control of the activities. The implementation of the Program led to changes in professional practice and favored autonomy and teamwork. The Community Health Workers stood out in the information acquisition process, and the teams found difficulties to organize the information. The collection and retrieval of information contributed to broaden the professionals’ view of the service, and the interviewees criticized the fragility of information dissemination in the Units. Conclusion: Despite its limitations, the Program led to direct improvements in the work of the teams in Primary Care.

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Effective team-based primary care: observations from innovative practices

Cited by 99 publications

References 31 publications

Leading Innovative Practice: Leadership Attributes in LEAP Practices

Leading Innovative Practice: Leadership Attributes in LEAP Practices

Capacity to Address Social Needs Affects Primary Care Clinician Burnout

Influences of the program for access and quality improvement in work processes in primary care

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