Learning from implementation setbacks: Identifying and responding to contextual challenges

Abstract

Introduction We address organizational learning about implementation context during setbacks to primary care redesign in an ambulatory system. The redesign expanded care teams and added a medical assistant assigned administrative and coordination tasks. The redesign was expected to improve care efficiency, prevention, and continuity. In response to setbacks, redesign and system leaders used understanding of context to plan system‐wide changes, as well as program adjustments. Doing so enhanced the redesign's prospects and contributed to system learning. Methods We conducted a 33‐month, mixed‐methods study. Qualitative data included quarterly calls with the redesign leaders and 63 activity log entries. There were three site visits; 73 interviews with practice leaders, providers, and medical assistants. Data analysis used categories from an implementation research framework; these were refined and then expanded inductively using log reports, debriefings with change leaders, and documents. Quantitative analysis used system operational data on chronic care, prevention, efficiency, productivity, and patient access. Results Redesigned teams were not implemented as widely or rapidly as anticipated and did not deliver hoped‐for gains in operational metrics. Interviews reported that team redesign was leading to improvements in chronic care and prevention and eased provider burden. Besides making small adjustments to cope with setbacks, redesign and system leaders engaged in more thorough organizational learning. They examined contextual challenges underlying setbacks and posing risks to the delivery system as a whole. Their responses to challenges helped strengthen the redesign's prospects, improved the delivery system's position in its labor market, and helped the system prepare to meet emerging requirements for value‐based care and population health. Conclusions This case points to benefits for both health care researchers and change practitioners of paying closer attention to how context affects implementation of organizational change, and to opportunities and conditions for learning from setbacks during change.

Referral to digital parent training in primary care: Facilitators and barriers.

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Capacity-Building for Collecting Patient-Reported Outcomes and Experiences (PRO) Data Across Hospitals

“…The target for the Policies/IRB capacity is to have CBEX data included in routine hospital QI activities. Suggested frameworks for learning health systems indicate that QI is a fundamental activity, and that research should be integrated into clinical practice (Damschroeder et al, 2009;Harrison & Grantham, 2018). Folding the collection of PRO data into routine QI activities would ease the burden of implementation (LeRouge et al, 2020), especially given that the risks from such data collection are minimal (Whicher et al, 2015).…”

Harmonizing Qualitative Data Across Multiple Health Systems to Identify Quality Improvement Interventions: A Methodological Framework Using PROSPR II Cervical Research Center Data as Exemplar

“…We attend to both the context and the broader applicability of findings, and offer data sampling, collection, and analytic tools and techniques for strengthening qualitative claims. By sharing our framework, we advance use of qualitative methodology in implementation science, (National Cancer Institute, 2018) where assessing the role of context is key to responding to organizational challenges and shaping implementation strategies across multiple healthcare systems (Harrison & Grantham, 2018; Nilsen & Bernhardsson, 2019). We illustrate how harmonized data enables the production of aggregate findings and site-specific insights to inform system-level quality improvement across diverse healthcare systems.…”