Table 3.

Comparison of the Change Process Used for Implementing Different Models From the Perspective of the Organizational Experience of Change Implementation.

DimensionAdvanced AccessChronic Care Model
EMR = electronic medical record; CCM = Chronic Care Model.
Desired state descriptionClear, simple, predefined, understandable, prescriptive— many examples of what others have doneTheoretical, complex, composite of pieces from various settings—no overall examples or models
Change benefitsSimplifies work of clinician, staff, and patientEffects on stakeholders are as unclear as the model
Overall focus of the organizationConcentrated on this change effortDiffused over multiple priorities
Leadership roleMain priority for that year with high visibility, and many dedicated resourcesMany simultaneous changes and priorities, the largest being EMR implementation
CommunicationMultiple avenues with frequent and specific messages and reports from and to leadershipFrequent from leadership, limited in explaining shifting strategies; few avenues for clinic team feedback to central leaders
TimelineClear endpoint in 1 yearBeginning of a long process without definite endpoints
External expertsExperienced with many other groups, knowledgeable about specifics, and available at local collaboratives, conference calls, and an ongoing listserv (medical group also provided expertise, eg, measurement, to experts)Primarily theoretical consultants available only to leaders; no actionable blueprint of an implemented, functional CCM available
PilotsProved in 3 sitesUnclear process and results in 3 to 4 sites
TestimonialsVideos of newly converted skepticsIndividual comments at meetings
MeasurementA few simple, visible, repeated measures of problems and progressDifficult to develop, varied, transient, with limited connection to process changes
Local change managementSpecified local teams with clear tasks and responsibility to tailor implementationLargely dependent on self-organizing abilities within clinics
Multiclinic collaborative learning sessionsQuarterly meetings of all clinics’ teams, with follow-up through listserv and conference callsThree meetings of clinic teams to learn latest change in strategy
Learning session follow-upListserv and conference calls have profound and immediate results, related to concrete, specific content of changesListserv has limited impact, related to fuzzy content of changes
Local accountabilityMonthly reports required and each clinic’s data and status publicPeriodic oral or written reports—public measures available but have limited impact