This article addresses organizational learning about implementation context during set backs to primary care redesign in an ambulatory system. The redesign expanded care teams and added a medical assistant assigned administrative and coordination tasks. It was expected to improve care efficiency, prevention and continuity through system-wide changes and program adjustments.
It was found that redesigned teams were not implemented as widely or rapidly as anticipated and did not deliver hoped-for gains in operational metrics. Team redesign did lead to improvements in chronic care and prevention, eased provider burden and helped to support more organization learning. They examined contextual challenges underlying setbacks and posing risks to the delivery system as a whole. Their responses to challenges helped strengthen the redesign's prospects, improved the delivery system's position in its labor market, and helped the system prepare to meet emerging requirements for value-based care and population health. This case points to benefits for both healthcare researchers and change practitioners of paying closer attention to how context for learning from setbacks during change.
Authors: Michael I. Harrison and Sue Grantham.
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