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Learning from implementation setbacks: Identifying and responding to contextual challenges

INTRODUCTION: We address organizational learning about implementation context during setbacks to primary care redesign in an ambulatory system. The redesign expanded care teams and added a medical assistant assigned administrative and coordination tasks. The redesign was expected to improve care eff...

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Autores principales: Harrison, Michael I., Grantham, Susan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6508762/
https://www.ncbi.nlm.nih.gov/pubmed/31245592
http://dx.doi.org/10.1002/lrh2.10068
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author Harrison, Michael I.
Grantham, Susan
author_facet Harrison, Michael I.
Grantham, Susan
author_sort Harrison, Michael I.
collection PubMed
description INTRODUCTION: We address organizational learning about implementation context during setbacks to primary care redesign in an ambulatory system. The redesign expanded care teams and added a medical assistant assigned administrative and coordination tasks. The redesign was expected to improve care efficiency, prevention, and continuity. In response to setbacks, redesign and system leaders used understanding of context to plan system‐wide changes, as well as program adjustments. Doing so enhanced the redesign's prospects and contributed to system learning. METHODS: We conducted a 33‐month, mixed‐methods study. Qualitative data included quarterly calls with the redesign leaders and 63 activity log entries. There were three site visits; 73 interviews with practice leaders, providers, and medical assistants. Data analysis used categories from an implementation research framework; these were refined and then expanded inductively using log reports, debriefings with change leaders, and documents. Quantitative analysis used system operational data on chronic care, prevention, efficiency, productivity, and patient access. RESULTS: Redesigned teams were not implemented as widely or rapidly as anticipated and did not deliver hoped‐for gains in operational metrics. Interviews reported that team redesign was leading to improvements in chronic care and prevention and eased provider burden. Besides making small adjustments to cope with setbacks, redesign and system leaders engaged in more thorough organizational learning. They examined contextual challenges underlying setbacks and posing risks to the delivery system as a whole. Their responses to challenges helped strengthen the redesign's prospects, improved the delivery system's position in its labor market, and helped the system prepare to meet emerging requirements for value‐based care and population health. CONCLUSIONS: This case points to benefits for both health care researchers and change practitioners of paying closer attention to how context affects implementation of organizational change, and to opportunities and conditions for learning from setbacks during change.
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spelling pubmed-65087622019-06-26 Learning from implementation setbacks: Identifying and responding to contextual challenges Harrison, Michael I. Grantham, Susan Learn Health Syst Experience Report INTRODUCTION: We address organizational learning about implementation context during setbacks to primary care redesign in an ambulatory system. The redesign expanded care teams and added a medical assistant assigned administrative and coordination tasks. The redesign was expected to improve care efficiency, prevention, and continuity. In response to setbacks, redesign and system leaders used understanding of context to plan system‐wide changes, as well as program adjustments. Doing so enhanced the redesign's prospects and contributed to system learning. METHODS: We conducted a 33‐month, mixed‐methods study. Qualitative data included quarterly calls with the redesign leaders and 63 activity log entries. There were three site visits; 73 interviews with practice leaders, providers, and medical assistants. Data analysis used categories from an implementation research framework; these were refined and then expanded inductively using log reports, debriefings with change leaders, and documents. Quantitative analysis used system operational data on chronic care, prevention, efficiency, productivity, and patient access. RESULTS: Redesigned teams were not implemented as widely or rapidly as anticipated and did not deliver hoped‐for gains in operational metrics. Interviews reported that team redesign was leading to improvements in chronic care and prevention and eased provider burden. Besides making small adjustments to cope with setbacks, redesign and system leaders engaged in more thorough organizational learning. They examined contextual challenges underlying setbacks and posing risks to the delivery system as a whole. Their responses to challenges helped strengthen the redesign's prospects, improved the delivery system's position in its labor market, and helped the system prepare to meet emerging requirements for value‐based care and population health. CONCLUSIONS: This case points to benefits for both health care researchers and change practitioners of paying closer attention to how context affects implementation of organizational change, and to opportunities and conditions for learning from setbacks during change. John Wiley and Sons Inc. 2018-09-26 /pmc/articles/PMC6508762/ /pubmed/31245592 http://dx.doi.org/10.1002/lrh2.10068 Text en © 2018 The Authors. Learning Health Systems published by Wiley Periodicals, Inc. on behalf of the University of Michigan This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Experience Report
Harrison, Michael I.
Grantham, Susan
Learning from implementation setbacks: Identifying and responding to contextual challenges
title Learning from implementation setbacks: Identifying and responding to contextual challenges
title_full Learning from implementation setbacks: Identifying and responding to contextual challenges
title_fullStr Learning from implementation setbacks: Identifying and responding to contextual challenges
title_full_unstemmed Learning from implementation setbacks: Identifying and responding to contextual challenges
title_short Learning from implementation setbacks: Identifying and responding to contextual challenges
title_sort learning from implementation setbacks: identifying and responding to contextual challenges
topic Experience Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6508762/
https://www.ncbi.nlm.nih.gov/pubmed/31245592
http://dx.doi.org/10.1002/lrh2.10068
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