Department of Health Policy and Administration, Pennsylvania State University, University Park, Pennsylvania.
Ann Fam Med. 2014 Jan-Feb;12(1):37-45. doi: 10.1370/afm.1564.
The current model of primary care in the United States limits physicians' ability to offer high-quality care. The patient-centered medical home (PCMH) shows promise in addressing provision of high-quality care, but achieving a PCMH practice model often requires comprehensive organizational change. Guided by Solberg's conceptual framework for practice improvement, which argues for shared prioritization of improvement and change, we describe strategies for obtaining organizational buy-in to and whole-staff engagement of PCMH transformation and practice improvement.
Semistructured interviews with 136 individuals and 7 focus groups involving 48 individuals were conducted in 20 small- to mid-sized medical practices in Pennsylvania during the first regional rollout of a statewide PCMH initiative. For this study, we analyzed interview transcripts, monthly narrative reports, and observer notes from site visits to identify discourse pertaining to organizational buy-in and strategies for securing buy-in from personnel. Using a consensual qualitative research approach, data were reduced, synthesized, and managed using qualitative data management and analysis software.
We identified 13 distinct strategies used to obtain practice buy-in, reflecting 3 overarching lessons that facilitate practice buy-in: (1) effective communication and internal PCMH campaigns, (2) effective resource utilization, and (3) creation of a team environment.
Our study provides a list of strategies useful for facilitating PCMH transformation in primary care. These strategies can be investigated empirically in future research, used to guide medical practices undergoing or considering PCMH transformation, and used to inform health care policy makers. Our study findings also extend Solberg's conceptual framework for practice improvement to include buy-in as a necessary condition across all elements of the change process.
美国目前的初级保健模式限制了医生提供高质量医疗服务的能力。以患者为中心的医疗之家（PCMH）在提供高质量医疗服务方面显示出了希望，但要实现 PCMH 实践模式通常需要全面的组织变革。我们以 Solberg 的实践改进概念框架为指导，该框架主张共同优先考虑改进和变革，描述了获得组织认同和全体员工参与 PCMH 转型和实践改进的策略。
在宾夕法尼亚州进行全州范围内的 PCMH 倡议的首次区域推广期间，对 20 家中小型医疗实践中的 136 个人和 7 个焦点小组中的 48 个人进行了半结构化访谈。在这项研究中，我们分析了访谈记录、每月的叙述报告和现场访问的观察员笔记，以确定与组织认同和从人员那里获得认同的策略相关的话语。使用共识定性研究方法，使用定性数据管理和分析软件对数据进行了减少、综合和管理。
我们确定了 13 种用于获得实践认同的独特策略，反映了促进实践认同的 3 个总体经验教训：（1）有效的沟通和内部 PCMH 活动，（2）有效的资源利用，以及（3）创建团队环境。
我们的研究提供了一组在初级保健中促进 PCMH 转型的有用策略。这些策略可以在未来的研究中进行实证研究，用于指导正在经历或考虑 PCMH 转型的医疗实践，以及为医疗保健政策制定者提供信息。我们的研究结果还扩展了 Solberg 的实践改进概念框架，将认同作为变革过程所有要素的必要条件。
