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

• Published in: Medical care research and review Vol. 78; no. 4; pp. 326 - 337
• Main Authors: Kyle, Michael Anne, Aveling, Emma-Louise, Singer, Sara
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-08-2021; SAGE PUBLICATIONS, INC
• Subjects: Capacity building approach; Capacity development; Collaborative learning; Cultural change; Empirical Research; Mixed methods research; Primary care; Prioritizing; Qualitative analysis; Quality control; Quality management; Teams; Transformation; Transformations; team-based care; primary care; transformation; change
• ISSN: 1077-5587; 1552-6801
• DOI: 10.1177/1077558719881854

Team-based care is considered central to achieving value in primary care, yet results of large-scale primary care transformation initiatives have been mixed. We explore how underlying change processes influence the effectiveness of transition to team-based care. We studied 12 academically affiliated primary care practices participating in a learning collaborative, using longitudinal staff survey data to measure progress toward team-based care and qualitative interviews with practice staff to understand practice transformation. Transformation efforts focused on team formation and capacity building for quality improvement. Using thematic analysis, we explored types of change processes undertaken and the relationship between change processes and effective team-based care. We identified three prototypical approaches to change: pursuing functional and cultural change processes, functional only, and cultural only. Practice sites prioritizing both change processes formed the most effective teams: simultaneous functional and cultural change spurred a mutually reinforcing virtuous cycle. We describe implications for research, practice, and policy.