Using learning teams for reflective adaptation (ULTRA): Insights from a team-based change management strategy in primary care

Bijal A. Balasubramanian, Sabrina M. Chase, Paul A. Nutting, Deborah J. Cohen, Pamela A. Ohman Strickland, Jesse C. Crosson, William L. Miller, Benjamin F. Crabtree, Barbara DiCicco-Bloom, Eric Shaw, John Scott, Shawna Hudson, John Orzano, Alfred Tallia, Jeanne Ferrante, Dena O'Malley, Terry Falco, Karissa Hahn, Alicja Piasecki, Anna LooneyJill Kelly, Brian Stello, Nancy Gratz, Kurt Stange, Reuben McDaniel, Stephen Zyzanski, Valerie Gilchrist, Christine Stroebel, Sonja Harris-Haywood, Carlos Roberto Jaén, Barbara Yawn, Leif Solberg

Research output: Contribution to journalArticlepeer-review

46 Scopus citations


PURPOSE The Using Learning Teams for Reflective Adaptation (ULTRA) study used facilitated reflective adaptive process (RAP) teams to enhance communication and decision making in hopes of improving adherence to multiple clinical guidelines; however, the study failed to show significant clinical improvements. The purpose of this study was to examine qualitative data from 25 intervention practices to understand how they engaged in a team-based collaborative change management strategy and the types of issues they addressed. METHODS We analyzed field notes and interviews from a multimethod practice assessment, as well as field notes and audio-taped recordings from RAP meetings, using an iterative group process and an immersion-crystallization approach. RESULTS Despite a history of not meeting regularly, 18 of 25 practices successfully convened improvement teams. There was evidence of improved practicewide communication in 12 of these practices. At follow-up, 8 practices continued RAP meetings and found the process valuable in problem solving and decision making. Seven practices failed to engage in RAP primarily because of key leaders dominating the meeting agenda or staff members hesitating to speak up in meetings. Although the number of improvement targets varied considerably, most RAP teams targeted patient care-related issues or practice-level organizational improvement issues. Not a single practice focused on adherence to clinical care guidelines. CONCLUSION Primary care practices can successfully engage in facilitated team meetings; however, leaders must be engaged in the process. Additional strategies are needed to engage practice leaders, particularly physicians, and to target issues related to guideline adherence.

Original languageEnglish (US)
Pages (from-to)425-432
Number of pages8
JournalAnnals of family medicine
Issue number5
StatePublished - Sep 1 2010
Externally publishedYes


  • Chronic disease
  • Group meetings
  • Organizational change
  • Primary care
  • Qualitative research
  • Quality improvement

ASJC Scopus subject areas

  • Family Practice


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