Table 1

Overarching Findings

  1. A strong foundation is needed for successful redesign

    Existing structural capacity (electronic health records, operations management, organizational size, and resources)

    Broad organizational support

    Previous experience with teams

    Financial stability

    Focus, commitment, and few distractions

  2. The process of transformation can be a long and difficult journey

    Ambitious and challenging, and requires time

    Dynamic and time intensive with ebbs and flows

    Requires deep changes in structures and systems

    Tensions and trade-offs should be expected

  3. Approaches to transformation vary

    Increased or expanded use of team-based care

    Expanded patient access and improved coordination

    Data-driven measurement and feedback

    Formal or informal learning collaboratives

  4. Visionary leadership and a supportive culture ease the way for change

    Strong leadership with vision for change at all levels

    Communication with staff and patients

    Cultural attributes (collaboration, respect, accountability)

    Alignment of incentives and rewards

    Mission-based focus

  5. Contextual factors are inextricably linked to outcome

    National, state, and local policies

    Dynamics of the health system or related systems

    Influence of the community and other stakeholders

    Financial incentives

    Staff dynamics and characteristics

    Approach to transformation