Using Learning Teams for Reflective Adaptation (ULTRA): Insights From a Team-Based Change Management Strategy in Primary Care
Using Learning Teams for Reflective Adaptation (ULTRA): Insights From a Team-Based Change Management Strategy in Primary Care
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DOI：
10.1370/afm.1159
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发表时间：
2010-09-01
影响因子：
4.4
通讯作者：
Crabtree, Benjamin F.
中科院分区：
文献类型：
--
作者：
Balasubramanian, Bijal A.;Chase, Sabrina M.;Crabtree, Benjamin F.
使用学习团队进行反思适应（ULTRA）研究使用促进反思适应过程（RAP）团队来加强沟通和决策，希望提高对多种临床指南的依从性;然而，该研究未能显示出显着的临床改善。本研究的目的是检查定性数据从25干预的做法，以了解他们如何在一个团队为基础的合作变革管理战略和类型的问题，他们addressed.METHODS我们分析了现场笔记和采访的多方法的做法评估，以及现场笔记和录音记录从RAP会议，使用迭代的小组过程和沉浸结晶的方法。结果尽管没有定期开会的历史，25个实践中有18个成功地召集了改进团队。有证据表明，在这些做法中，有12个做法的全行业沟通有所改善。在后续行动中，8个做法继续RAP会议，并发现这一过程在解决问题和决策方面很有价值。7个业务未能参与区域行动方案，主要原因是主要领导人主导会议议程或工作人员在会议上不愿发言。虽然改进目标的数量差异很大，但大多数RAP团队都针对患者护理相关问题或实践层面的组织改进问题。没有一个单一的做法集中在坚持临床护理guidelines.CONCLUSION初级保健的做法可以成功地从事促进团队会议，但是，领导人必须参与的过程。需要采取额外的策略来吸引实践领导者，特别是医生，并针对与遵守指南有关的问题。
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 practice-wide 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.