A Mixed Methods Study of Change Processes Enabling Effective Transition to Team-Based Care

Area of Science:

• Health Services Research
• Organizational Change Management
• Primary Care Transformation

Background:

• Team-based care is crucial for value in primary care, but transformation initiatives yield mixed results.
• Understanding the influence of change processes on team-based care effectiveness is essential for successful implementation.
• Previous research highlights the importance of organizational factors in healthcare reform.

Purpose of the Study:

• To explore how different change processes impact the effectiveness of transitioning to team-based care in primary care settings.
• To identify prototypical approaches to organizational change within primary care practices undergoing transformation.
• To determine the relationship between specific change strategies and the success of team-based care implementation.

Main Methods:

• Longitudinal staff survey data collected from 12 academically affiliated primary care practices.
• Qualitative interviews with practice staff to understand the nuances of practice transformation.
• Thematic analysis of qualitative data to categorize change processes and assess their impact on team effectiveness.

Main Results:

• Three distinct approaches to change were identified: functional and cultural, functional only, and cultural only.
• Practices that simultaneously pursued both functional and cultural change processes demonstrated the most effective team formation.
• This dual approach created a mutually reinforcing virtuous cycle, enhancing team-based care.

Conclusions:

• Simultaneous functional and cultural change is a critical factor for successful team-based care implementation in primary care.
• Organizational transformation efforts should integrate both operational improvements and cultural shifts for optimal results.
• Findings offer implications for designing future primary care transformation initiatives, research, and policy development.