Using Learning Teams for Reflective Adaptation (ULTRA): Insights From a Team-Based Change Management Strategy in Primary Care

The Article in Brief

Using Learning Teams for Reflective Adaptation (ULTRA): Insights From a Team-Based Change Management Strategy in Primary Care

Bijal A. Balasubramanian , and colleagues

Background Changes in practice organization can contribute to improvements in health care processes and patient outcomes, but making practice-level change is complex. A study using facilitated practice improvement teams (called reflective adaptive process RAP teams) to enhance communication and decision making to improve adherence to multiple clinical guidelines failed to show significant clinical improvements. This study aimed to better understand the team-based collaborative change management strategies used and types of issues addressed by participants.

What This Study Found Although primary care practices can successfully engage in facilitated team meetings (18 of 25 practices successfully convened improvement teams despite a history of not meeting regularly), they may choose not to spend the time focusing on guideline adherence. In this study, not a single practice focused on improving adherence to specific chronic disease guidelines during the meetings. Instead, when given a choice, RAP team members focused on patient care and practice improvement issues related to communication, access to care, and access to information, brainstorming solutions, and implementing changes to address these issues.

Implications

• The authors call for additional strategies to engage practice leaders, particularly physicians, and to target issues related to guideline adherence.