TY - JOUR
T1 - Making sense of primary care practices' capacity for change
AU - Litaker, David
AU - Ruhe, Mary
AU - Flocke, Susan
N1 - Funding Information:
Supported by grants 2R01 CA80862, 4R01 CA80862, and R25T-CA111898 from the National Cancer Institute; Grant IIR 06-091 from the VA Health Services Research and Development Services; and Grants 053768 and 065213 from the Robert Wood Johnson Foundation.
PY - 2008/11
Y1 - 2008/11
N2 - A deeper understanding of the forces that shape the motivation and willingness of primary care practices to adopt and implement new procedures-their "capacity for change"-may better guide development of interventions to foster adoption and implementation of evidence-based care. This study applies and evaluates the utility of a previously described framework for making sense of this complex construct in a diverse sample of primary care practices. A multidisciplinary team of 3 analysts examined ethnographic field notes that describe 15 single-physician or multiphysician practices in different organizational settings. Examples of the 4 components within the framework (ie, staff motivations, resources, opportunities for change, and external influences) and their interactions were identified. Cross-practice comparisons identified emerging themes relevant to capacity for change. Not surprisingly, variation among examples of individual components of change capacity across practices was present. Patterns among these components, however, seemed less informative in making sense of practices' capacity for change than patterns across component interactions. For example, the ability of practice members to recognize and act on opportunities for change seemed to be shaped by the extent to which motivations were broadly shared within the practice and by tangible and intangible resources (eg, leadership style, relationships among practice members, and financial resources of the practice). Revised operational definitions for framework components and careful reflection on the nature of their interactions helped make sense of practices' capacity for change in our sample and will enable future hypothesis testing to refine our understanding of factors that influence the translation of scientific knowledge in primary care settings.
AB - A deeper understanding of the forces that shape the motivation and willingness of primary care practices to adopt and implement new procedures-their "capacity for change"-may better guide development of interventions to foster adoption and implementation of evidence-based care. This study applies and evaluates the utility of a previously described framework for making sense of this complex construct in a diverse sample of primary care practices. A multidisciplinary team of 3 analysts examined ethnographic field notes that describe 15 single-physician or multiphysician practices in different organizational settings. Examples of the 4 components within the framework (ie, staff motivations, resources, opportunities for change, and external influences) and their interactions were identified. Cross-practice comparisons identified emerging themes relevant to capacity for change. Not surprisingly, variation among examples of individual components of change capacity across practices was present. Patterns among these components, however, seemed less informative in making sense of practices' capacity for change than patterns across component interactions. For example, the ability of practice members to recognize and act on opportunities for change seemed to be shaped by the extent to which motivations were broadly shared within the practice and by tangible and intangible resources (eg, leadership style, relationships among practice members, and financial resources of the practice). Revised operational definitions for framework components and careful reflection on the nature of their interactions helped make sense of practices' capacity for change in our sample and will enable future hypothesis testing to refine our understanding of factors that influence the translation of scientific knowledge in primary care settings.
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U2 - 10.1016/j.trsl.2008.09.005
DO - 10.1016/j.trsl.2008.09.005
M3 - Article
C2 - 19010296
AN - SCOPUS:57649106563
SN - 1931-5244
VL - 152
SP - 245
EP - 253
JO - Translational Research
JF - Translational Research
IS - 5
ER -