Trust and Reflection in Primary Care Practice Redesign

Lanham, Holly J.; Palmer, Raymond F.; Leykum, Luci K.; McDaniel, Reuben R.; Nutting, Paul A.; Stange, Kurt C.; Crabtree, Benjamin F.; Miller, William L.; Jaén, Carlos Roberto

doi:10.1111/1475-6773.12415

Cited by 25 publications

(23 citation statements)

References 60 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These characteristics include aspects of practice culture and team organization, leadership structure, financial stability, and patient demographic characteristics that have also been shown to be associated with practices using QI strategies. 52,[54][55][56] Our study also showed that practices with ability to extract and use EHR clinical quality data had higher mean CPCQ strategies scores. This finding is especially relevant in light of recent research from EvidenceNOW showing that smaller practices face considerable challenges in extracting and using the EHR data needed for QI.…”

supporting

confidence: 58%

Use of Quality Improvement Strategies Among Small to Medium-Size US Primary Care Practices

et al. 2018

Self Cite

View full text Add to dashboard Cite

PURPOSE Improving primary care quality is a national priority, but little is known about the extent to which small to medium-size practices use quality improvement (QI) strategies to improve care. We examined variations in use of QI strategies among 1,181 small to medium-size primary care practices engaged in a national initiative spanning 12 US states to improve quality of care for heart health and assessed factors associated with those variations. METHODSIn this cross-sectional study, practice characteristics were assessed by surveying practice leaders. Practice use of QI strategies was measured by the validated Change Process Capability Questionnaire (CPCQ) Strategies Scale (scores range from -28 to 28, with higher scores indicating more use of QI strategies). Multivariable linear regression was used to examine the association between practice characteristics and the CPCQ strategies score. RESULTSThe mean CPCQ strategies score was 9.1 (SD = 12.2). Practices that participated in accountable care organizations and those that had someone in the practice to configure clinical quality reports from electronic health records (EHRs), had produced quality reports, or had discussed clinical quality data during meetings had higher CPCQ strategies scores. Health system-owned practices and those experiencing major disruptive changes, such as implementing a new EHR system or clinician turnover, had lower CPCQ strategies scores.CONCLUSION There is substantial variation in the use of QI strategies among small to medium-size primary care practices across 12 US states. Findings suggest that practices may need external support to strengthen their ability to do QI and to be prepared for new payment and delivery models. INTRODUCTIONH ealth care delivery is evolving in the United States, with increasing emphasis on insurance payments based on improving quality instead of merely delivering health care services. 1 This emphasis has brought a greater focus on population health management, quality measurement, and health care outcomes. Primary care practices use quality improvement (QI) strategies, such as monitoring and assessing outcomes, having skilled QI teams, and using system redesigns to improve patient and population health outcomes, system performance, and clinician experience, and to reduce health care costs.2-6 Implementing QI strategies can help practices deliver appropriate health services efficiently and improve health outcomes, [7][8][9][10] yet much of what we know about the use of QI strategies in medical care comes from surveys conducted mostly in hospitals and health systems. [11][12][13][14][15][16][17] Little is known about the use of QI strategies in small to medium-size primary care practices, where more than one-half of Americans receive care for their chronic conditions. 18 Earlier studies have lacked generalizability because of small sample sizes and limited contextual diversity. Better understanding of the prevalence and reasons for variation in use of QI strategies among smaller practices is needed...

show abstract

supporting

confidence: 58%

Use of Quality Improvement Strategies Among Small to Medium-Size US Primary Care Practices

et al. 2018

Self Cite

View full text Add to dashboard Cite

show abstract

“…In the case of the networks and communications construct, we used an additional model from Lanham and colleagues to classify the sub-constructs, since emerging subcodes aligned with characteristics of work relationships that Lanham and colleagues had previously identified [18][19][20]. CFIR defines the networks and communications construct as being about relationships: "the nature and quality of webs of social networks and the nature and quality of formal and informal communications within an organization" [13].…”

Section: Synthesis and Analysismentioning

confidence: 99%

Unpacking organizational readiness for change: an updated systematic review and content analysis of assessments

Miake-Lye

Delevan

Ganz

et al. 2020

BMC Health Serv Res

View full text Add to dashboard Cite

Background: Organizational readiness assessments have a history of being developed as important support tools for successful implementation. However, it remains unclear how best to operationalize readiness across varied projects or settings. We conducted a synthesis and content analysis of published readiness instruments to compare how investigators have operationalized the concept of organizational readiness for change. Methods:We identified readiness assessments using a systematic review and update search. We mapped individual assessment items to the Consolidated Framework for Implementation Research (CFIR), which identifies five domains affecting implementation (outer setting, inner setting, intervention characteristics, characteristics of individuals, and implementation process) and multiple constructs within each domain. Results: Of 1370 survey items, 897 (68%) mapped to the CFIR domain of inner setting, most commonly related to constructs of readiness for implementation (n = 220); networks and communication (n = 207); implementation climate (n = 204); structural characteristics (n = 139); and culture (n = 93). Two hundred forty-two items (18%) mapped to characteristics of individuals (mainly other personal attributes [n = 157] and self-efficacy [n = 52]); 80 (6%) mapped to outer setting; 51 (4%) mapped to implementation process; 40 (3%) mapped to intervention characteristics; and 60 (4%) did not map to CFIR constructs. Instruments were typically tailored to specific interventions or contexts.Discussion: Available readiness instruments predominantly focus on contextual factors within the organization and characteristics of individuals, but the specificity of most assessment items suggests a need to tailor items to the specific scenario in which an assessment is fielded. Readiness assessments must bridge the gap between measuring a theoretical construct and factors of importance to a particular implementation.

show abstract

“…When patients trust their family doctors, it is much easier for medical staff to moderate relationships with patients, to make sense to medical interventions and to teach the patients how to live with their conditions (Lanham et al, 2015). If patients trust the attending physicians and nurses in emergency department, level of anxiety decreases and specific fears become less pronounced (Jay, 1996), explaining why mistrust to hospital staff relates to increased fear of hospitalisation.…”

Section: Discussionmentioning

confidence: 99%

A rating instrument for fear of hospitalisation

Janković

Antonijevic

Vasić

et al. 2018

Journal of Clinical Nursing

View full text Add to dashboard Cite

show abstract

Trust and Reflection in Primary Care Practice Redesign

Abstract: Trust and reflection appear to play a key role in moderating relationships, sensemaking, and learning in practices undergoing practice redesign.

Cited by 25 publications

References 60 publications

Use of Quality Improvement Strategies Among Small to Medium-Size US Primary Care Practices

Use of Quality Improvement Strategies Among Small to Medium-Size US Primary Care Practices

Unpacking organizational readiness for change: an updated systematic review and content analysis of assessments

A rating instrument for fear of hospitalisation

Contact Info

Product

Resources

About