Implementation of management innovation at primary care health centers: qualitative assessments

This article describes the implementation of innovations at health centers participating in The Robert Wood Johnson Foundation Program to Strengthen Primary Care Health Centers. Relatively successful approaches to management innovation are described and common obstacles to innovation are considered. Key issues include poor physician retention, inadequate or inappropriate space, the complexities of automation, difficulty in the recruitment of staff and consultants (particularly in rural areas), and disruptions caused by internal promotions.