TY - JOUR
T1 - Trust and Reflection in Primary Care Practice Redesign
AU - Lanham, Holly Jordan
AU - Palmer, Raymond F.
AU - Leykum, Luci K.
AU - McDaniel, Reuben R.
AU - Nutting, Paul A.
AU - Stange, Kurt C.
AU - Crabtree, Benjamin F.
AU - Miller, William L.
AU - Jaén, Carlos Roberto
N1 - Funding Information:
Joint Acknowledgment/Disclosure Statement: The authors express their appreciation for the cooperation and dedication of the physicians and staff of the family practices that participated in the NDP. We also thank the anonymous reviewers for their comments and insights. The American Academy of Family Physicians provided funding support for this evaluation, including a Research Center grant. The evaluation was also partially supported by the Commonwealth Fund, a national, private foundation based in New York City that supports independent research on health care issues and makes grants to improve health care practice and policy. LKL was supported by the Department of Veterans Affairs, Veterans Health Administration, and Health Services Research and Development Service (CDA 07-022) and her investigator salary support is provided through this funding and through the South Texas Veterans Health Care System. RMD receives support from the Charles and Elizabeth Prothro Chair in Health Care Management, the University of Texas at Austin. KCS was supported in part by the Harry and Elsa Jiler American Cancer Society Clinical Research Professorship. BFC was supported in part by a National Cancer Institute K05 Senior Investigator Award (K05 CA140237). Disclaimer: The views presented here are those of the authors and not necessarily those of the Commonwealth Fund, its directors, officers, or staff or the position or policy of the Department of Veterans Affairs. Disclosures: None.
Publisher Copyright:
© Health Research and Educational Trust
PY - 2016/8/1
Y1 - 2016/8/1
N2 - Objective: To test a conceptual model of relationships, reflection, sensemaking, and learning in primary care practices transitioning to patient-centered medical homes (PCMH). Data Sources/Study Setting: Primary data were collected as part of the American Academy of Family Physicians' National Demonstration Project of the PCMH. Study Design: We conducted a cross-sectional survey of clinicians and staff from 36 family medicine practices across the United States. Surveys measured seven characteristics of practice relationships (trust, diversity, mindfulness, heedful interrelation, respectful interaction, social/task relatedness, and rich and lean communication) and three organizational attributes (reflection, sensemaking, and learning) of practices. Data Collection/Extraction Methods: We surveyed 396 clinicians and practice staff. We performed a multigroup path analysis of the data. Parameter estimates were calculated using a Bayesian estimation method. Principal Findings: Trust and reflection were important in explaining the characteristics of practice relationships and their associations with sensemaking and learning. The strongest associations between relationships, sensemaking, and learning were found under conditions of high trust and reflection. The weakest associations were found under conditions of low trust and reflection. Conclusions: Trust and reflection appear to play a key role in moderating relationships, sensemaking, and learning in practices undergoing practice redesign.
AB - Objective: To test a conceptual model of relationships, reflection, sensemaking, and learning in primary care practices transitioning to patient-centered medical homes (PCMH). Data Sources/Study Setting: Primary data were collected as part of the American Academy of Family Physicians' National Demonstration Project of the PCMH. Study Design: We conducted a cross-sectional survey of clinicians and staff from 36 family medicine practices across the United States. Surveys measured seven characteristics of practice relationships (trust, diversity, mindfulness, heedful interrelation, respectful interaction, social/task relatedness, and rich and lean communication) and three organizational attributes (reflection, sensemaking, and learning) of practices. Data Collection/Extraction Methods: We surveyed 396 clinicians and practice staff. We performed a multigroup path analysis of the data. Parameter estimates were calculated using a Bayesian estimation method. Principal Findings: Trust and reflection were important in explaining the characteristics of practice relationships and their associations with sensemaking and learning. The strongest associations between relationships, sensemaking, and learning were found under conditions of high trust and reflection. The weakest associations were found under conditions of low trust and reflection. Conclusions: Trust and reflection appear to play a key role in moderating relationships, sensemaking, and learning in practices undergoing practice redesign.
KW - Practice redesign
KW - learning
KW - reflection
KW - relationships
KW - sensemaking
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U2 - 10.1111/1475-6773.12415
DO - 10.1111/1475-6773.12415
M3 - Article
C2 - 26611650
AN - SCOPUS:84978225133
SN - 0017-9124
VL - 51
SP - 1489
EP - 1514
JO - Health Services Research
JF - Health Services Research
IS - 4
ER -