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 Cohen, Pamela A. Ohman Strickland, Jesse C. Crosson, William L. Miller, Benjamin F. Crabtree

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

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
Volume8
Issue number5
DOIs
StatePublished - Sep 2010
Externally publishedYes

Fingerprint

Primary Health Care
Learning
Decision Making
Communication
Guidelines
Guideline Adherence
Patient Care Team
Group Processes
Immersion
Crystallization
Interviews
Physicians
Practice (Psychology)

Keywords

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

ASJC Scopus subject areas

  • Family Practice

Cite this

Balasubramanian, B. A., Chase, S. M., Nutting, P. A., Cohen, D., Ohman Strickland, P. A., Crosson, J. C., ... Crabtree, B. F. (2010). Using learning teams for reflective adaptation (ULTRA): Insights from a team-based change management strategy in primary care. Annals of Family Medicine, 8(5), 425-432. https://doi.org/10.1370/afm.1159

Using learning teams for reflective adaptation (ULTRA) : Insights from a team-based change management strategy in primary care. / Balasubramanian, Bijal A.; Chase, Sabrina M.; Nutting, Paul A.; Cohen, Deborah; Ohman Strickland, Pamela A.; Crosson, Jesse C.; Miller, William L.; Crabtree, Benjamin F.

In: Annals of Family Medicine, Vol. 8, No. 5, 09.2010, p. 425-432.

Research output: Contribution to journalArticle

Balasubramanian, BA, Chase, SM, Nutting, PA, Cohen, D, Ohman Strickland, PA, Crosson, JC, Miller, WL & Crabtree, BF 2010, 'Using learning teams for reflective adaptation (ULTRA): Insights from a team-based change management strategy in primary care', Annals of Family Medicine, vol. 8, no. 5, pp. 425-432. https://doi.org/10.1370/afm.1159
Balasubramanian, Bijal A. ; Chase, Sabrina M. ; Nutting, Paul A. ; Cohen, Deborah ; Ohman Strickland, Pamela A. ; Crosson, Jesse C. ; Miller, William L. ; Crabtree, Benjamin F. / Using learning teams for reflective adaptation (ULTRA) : Insights from a team-based change management strategy in primary care. In: Annals of Family Medicine. 2010 ; Vol. 8, No. 5. pp. 425-432.
@article{472a229795d34334858272c0a16bbce7,
title = "Using learning teams for reflective adaptation (ULTRA): Insights from a team-based change management strategy in primary care",
abstract = "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.",
keywords = "Chronic disease, Group meetings, Organizational change, Primary care, Qualitative research, Quality improvement",
author = "Balasubramanian, {Bijal A.} and Chase, {Sabrina M.} and Nutting, {Paul A.} and Deborah Cohen and {Ohman Strickland}, {Pamela A.} and Crosson, {Jesse C.} and Miller, {William L.} and Crabtree, {Benjamin F.}",
year = "2010",
month = "9",
doi = "10.1370/afm.1159",
language = "English (US)",
volume = "8",
pages = "425--432",
journal = "Annals of Family Medicine",
issn = "1544-1709",
publisher = "Annals of Family Medicine, Inc",
number = "5",

}

TY - JOUR

T1 - Using learning teams for reflective adaptation (ULTRA)

T2 - Insights from a team-based change management strategy in primary care

AU - Balasubramanian, Bijal A.

AU - Chase, Sabrina M.

AU - Nutting, Paul A.

AU - Cohen, Deborah

AU - Ohman Strickland, Pamela A.

AU - Crosson, Jesse C.

AU - Miller, William L.

AU - Crabtree, Benjamin F.

PY - 2010/9

Y1 - 2010/9

N2 - 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.

AB - 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.

KW - Chronic disease

KW - Group meetings

KW - Organizational change

KW - Primary care

KW - Qualitative research

KW - Quality improvement

UR - http://www.scopus.com/inward/record.url?scp=77957727784&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77957727784&partnerID=8YFLogxK

U2 - 10.1370/afm.1159

DO - 10.1370/afm.1159

M3 - Article

C2 - 20843884

AN - SCOPUS:77957727784

VL - 8

SP - 425

EP - 432

JO - Annals of Family Medicine

JF - Annals of Family Medicine

SN - 1544-1709

IS - 5

ER -