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Learning from implementation setbacks: Identifying and responding to contextual challenges
- Source :
- Learning Health Systems
- Publication Year :
- 2018
- Publisher :
- Wiley, 2018.
-
Abstract
- 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.
- Subjects :
- Chronic care
Process management
business.industry
030503 health policy & services
Public Health, Environmental and Occupational Health
Health Informatics
Qualitative property
Context (language use)
Population health
03 medical and health sciences
0302 clinical medicine
Health Information Management
organizational learning
Organizational learning
Health care
primary care redesign
030212 general & internal medicine
Implementation research
implementation
0305 other medical science
business
Experience Report
Productivity
Subjects
Details
- ISSN :
- 23796146
- Volume :
- 2
- Database :
- OpenAIRE
- Journal :
- Learning Health Systems
- Accession number :
- edsair.doi.dedup.....aca98396cbd718090b4c5ad8d80d4931