Implementation of a transformative learning collaborative training for family doctor teams and managers: a description of participant process and perception

Abstract

Background: The Health Commission of Wuhou reformed its primary care system by implementing a Transformative Learning Collaborative (TLC): a structure that supports shared learning and rapid change among a group of providers or organisations. This paper examines the adaptation of a district TLC to implement, disseminate, and scale up the principles of a District Model for family doctor teams and managers of Community Health Centres (CHCs) in China. We describe TLC as a means of informing training content and evaluated the implementation through participant feedback. Methods: A district TLC was implemented to disseminate a District Model, which included six quality improvement principles and was developed to reform the primary care delivery process. Family doctor teams (n=26, 52 family doctor individuals) and managers (n=13) from thirteen CHCs in a Chinese district participated in the TLC organisation. The TLC process was described, and survey data served to assess the activities and resource usefulness. The perceived implementation enablers and inhibitors were also descriptively analysed. Results: The purpose, content, and process of TLC were described. The implementation included four steps: structure establishment, participants identification, activities implementation, and setting up a feedback system. The survey findings captured family doctors’ and managers’ feedback with regard to preference, needs, concerns, and problems in implementing TLC training. In general, most family doctors and managers indicated that TLC was necessary. All the successfully implemented Plan-Do-Study-Action cycles (77.6%) were applied to the model. Family doctors and managers agreed that coaches, a programme director, and data analysts were useful resources. The top three enablers for successful TLC implementation were managers’ support (93.9%); improvements in self-ability and team-based ability and impacts on participants’ career goals (89.8%), and support from family doctor teams (87.8%). Conclusions: This study offered a guided process for running TLC in the primary care system of China and provided valuable feedback from family doctors and managers regarding TLC training. Challenges were also found for future research and consideration. Our findings suggest that manager support is necessary for collaboration in family doctor teams and that participants play an important role by evaluating learning sessions and providing recommendations for future learning.