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Research ArticleTheory

Primary Care Practice Development: A Relationship-Centered Approach

William L. Miller, Benjamin F. Crabtree, Paul A. Nutting, Kurt C. Stange and Carlos Roberto Jaén
The Annals of Family Medicine May 2010, 8 (Suppl 1) S68-S79; DOI: https://doi.org/10.1370/afm.1089
William L. Miller
MD, MA
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Benjamin F. Crabtree
PhD
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Paul A. Nutting
MD, MSPH
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Kurt C. Stange
MD, PhD
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Carlos Roberto Jaén
MD, PhD
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  • Figure 1.
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    Figure 1.

    Relationship-centered practice core model.

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    Figure 2.

    Relationship-centered practice adaptive reserve model.

    Relationship Characteristics

    Mindfulness = Openness to new ideas and different perspectives; continuous creation of new categories.

    Respectful Interaction = Honest, tactful, and mutually valuing interchange where each person brings meaning and value to the other.

    Heedful Interrelating = Interaction where individuals are especially sensitive to the way their role and others fit into the larger group and its goals.

    Channel Effectiveness = Appropriate use and mix of rich (eg, face-to-face) and lean (eg, e-mail) communications where rich channels are used when messages are highly ambiguous, complicated, or emotionally charged and lean channels are used when messages are clear, simple, and emotionally neutral.

    Mix of Social and Task Relatedness = Social relatedness includes non–work-related conversations and activities that are often based on friendships and family, whereas task relatedness consists of work-related conversations and activities.

    Diversity = Differences in mental models and in age, sex, and ethnicity.

    Trust = Belief that you can depend on the other and the associated willingness to be vulnerable to another.

  • Figure 3.
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    Figure 3.

    Practice Change and Development model.

  • Figure 4.
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    Figure 4.

    Developmental pathway of change and transformation.

Tables

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    Table 1.

    Elements of Practice Core and Adaptive Reserve

    FeatureElement
    Core
        ResourcesMaterial
    Human
        Organizational structureLeadership, compensation, reward, and accountability systems
    Management model
        Functional processesClinical care
    Operations
    Finance
    Adaptive reserveAction and reflection cycles
    Facilitative leadership
    Learning culture
    Improvisational ability
    Stories of change
    Sensemaking
    Relationships and communication
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    Table 2.

    Typology of Practice Development Conversations

    Type of ConversationExamples
    ProjectPlan-Do-Study-Act (PDSA) cycles
    Project management
    Capability building
        Skill buildingLearning collaborative workshops
    Coaching
        System buildingReflection-action process (RAP) teams75
    Appreciative inquiry76,77
    Dialogue78
        FireproofingCrucial conversations79
    Mindfulness meditation80
    Whole system
        PossibilityWorld Café81
    Future Search82
        ActionKaizen events83
    Open Space84

Additional Files

  • Figures
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  • Supplemental Appendix

    Supplemental Appendix. Overview of Complexity Theory Concepts

    Files in this Data Supplement:

    • Supplemental data: Appendix - PDF file, 2 pages, 98KB
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The Annals of Family Medicine: 8 (Suppl 1)
The Annals of Family Medicine: 8 (Suppl 1)
Vol. 8, Issue Suppl 1
1 May 2010
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Primary Care Practice Development: A Relationship-Centered Approach
William L. Miller, Benjamin F. Crabtree, Paul A. Nutting, Kurt C. Stange, Carlos Roberto Jaén
The Annals of Family Medicine May 2010, 8 (Suppl 1) S68-S79; DOI: 10.1370/afm.1089

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Primary Care Practice Development: A Relationship-Centered Approach
William L. Miller, Benjamin F. Crabtree, Paul A. Nutting, Kurt C. Stange, Carlos Roberto Jaén
The Annals of Family Medicine May 2010, 8 (Suppl 1) S68-S79; DOI: 10.1370/afm.1089
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  • Article
    • Abstract
    • INTRODUCTION
    • UNDERSTANDING PRIMARY CARE PRACTICES WITH INTENT TO ENHANCE VALUE
    • PLANNING AND IMPLEMENTING PRIMARY CARE PRACTICE DEVELOPMENT
    • CONCLUSION
    • Acknowledgments
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