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

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

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

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

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