Comparison of the Change Process Used for Implementing Different Models From the Perspective of the Organizational Experience of Change Implementation.
| Dimension | Advanced Access | Chronic Care Model |
|---|---|---|
| EMR = electronic medical record; CCM = Chronic Care Model. | ||
| Desired state description | Clear, simple, predefined, understandable, prescriptive— many examples of what others have done | Theoretical, complex, composite of pieces from various settings—no overall examples or models |
| Change benefits | Simplifies work of clinician, staff, and patient | Effects on stakeholders are as unclear as the model |
| Overall focus of the organization | Concentrated on this change effort | Diffused over multiple priorities |
| Leadership role | Main priority for that year with high visibility, and many dedicated resources | Many simultaneous changes and priorities, the largest being EMR implementation |
| Communication | Multiple avenues with frequent and specific messages and reports from and to leadership | Frequent from leadership, limited in explaining shifting strategies; few avenues for clinic team feedback to central leaders |
| Timeline | Clear endpoint in 1 year | Beginning of a long process without definite endpoints |
| External experts | Experienced 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 |
| Pilots | Proved in 3 sites | Unclear process and results in 3 to 4 sites |
| Testimonials | Videos of newly converted skeptics | Individual comments at meetings |
| Measurement | A few simple, visible, repeated measures of problems and progress | Difficult to develop, varied, transient, with limited connection to process changes |
| Local change management | Specified local teams with clear tasks and responsibility to tailor implementation | Largely dependent on self-organizing abilities within clinics |
| Multiclinic collaborative learning sessions | Quarterly meetings of all clinics’ teams, with follow-up through listserv and conference calls | Three meetings of clinic teams to learn latest change in strategy |
| Learning session follow-up | Listserv and conference calls have profound and immediate results, related to concrete, specific content of changes | Listserv has limited impact, related to fuzzy content of changes |
| Local accountability | Monthly reports required and each clinic’s data and status public | Periodic oral or written reports—public measures available but have limited impact |