BACKGROUND: The 2001 Institute of Medicine (IOM) report highlighted the need for transformation of the U.S. health care system. This rigorous qualitative evaluation of transformational change for patient access in one large multispecialty group practice identifies the major issues facing organizations addressing the IOM challenge. METHODS: Semistructured depth interviews were conducted with the medical and administrative leaders at all levels, physicians, and nurses from 17 primary care clinics in one integrated medical group two years after they began to transform their approach to primary care patient appointment access. RESULTS: The mean time to third-next-available appointment was reduced by 76% during one year, from 17.8 days to 4.2 days. Nine important issues related to the change process were identified from clinic interviews. When combined with issues identified by central leaders, 13 themes stood out as lessons in transformational change. A major issue is the tension between physician autonomy and both effective organizational function and putting patients first. Physician autonomy is also diminished by the need to standardize and systematize care. CONCLUSIONS: Transformational change in care delivery is possible in large and complex group practices. Changes that directly affect care delivery and physician autonomy present particular challenges to physicians that need to be attended to if the changes are to be successful.
BACKGROUND: The 2001 Institute of Medicine (IOM) report highlighted the need for transformation of the U.S. health care system. This rigorous qualitative evaluation of transformational change for patient access in one large multispecialty group practice identifies the major issues facing organizations addressing the IOM challenge. METHODS: Semistructured depth interviews were conducted with the medical and administrative leaders at all levels, physicians, and nurses from 17 primary care clinics in one integrated medical group two years after they began to transform their approach to primary care patient appointment access. RESULTS: The mean time to third-next-available appointment was reduced by 76% during one year, from 17.8 days to 4.2 days. Nine important issues related to the change process were identified from clinic interviews. When combined with issues identified by central leaders, 13 themes stood out as lessons in transformational change. A major issue is the tension between physician autonomy and both effective organizational function and putting patients first. Physician autonomy is also diminished by the need to standardize and systematize care. CONCLUSIONS: Transformational change in care delivery is possible in large and complex group practices. Changes that directly affect care delivery and physician autonomy present particular challenges to physicians that need to be attended to if the changes are to be successful.
Authors: Benjamin F Crabtree; Paul A Nutting; William L Miller; Kurt C Stange; Elizabeth E Stewart; Carlos Roberto Jaén Journal: Ann Fam Med Date: 2010 Impact factor: 5.166
Authors: Mary C Hroscikoski; Leif I Solberg; Joann M Sperl-Hillen; Peter G Harper; Michael P McGrail; Benjamin F Crabtree Journal: Ann Fam Med Date: 2006 Jul-Aug Impact factor: 5.166
Authors: Stephen Goodall; Alan Montgomery; Jon Banks; Chris Salisbury; Fiona Sampson; Mark Pickin Journal: Br J Gen Pract Date: 2006-12 Impact factor: 5.386
Authors: Pamela A Ohman-Strickland; A John Orzano; Paul A Nutting; W Perry Dickinson; Jill Scott-Cawiezell; Karissa Hahn; Michelle Gibel; Benjamin F Crabtree Journal: Health Serv Res Date: 2007-06 Impact factor: 3.402
Authors: Benjamin F Crabtree; William L Miller; Alfred F Tallia; Deborah J Cohen; Barbara DiCicco-Bloom; Helen E McIlvain; Virginia A Aita; John G Scott; Patrice B Gregory; Kurt C Stange; Reuben R McDaniel Journal: Ann Fam Med Date: 2005 Sep-Oct Impact factor: 5.166
Authors: Daniel W Barry; Trisha V Melhado; Karen M Chacko; Rita Shi-Ming Lee; John F Steiner; Jean S Kutner Journal: J Gen Intern Med Date: 2005-12-07 Impact factor: 5.128