title: Innovation in ambulatory care: a collaborative approach to redesigning the health care workplace.
abstract: OBJECTIVE
  To improve the quality of patient care and work satisfaction of the physicians and staff at an ambulatory practice that had recently started an innovative model of clinical care for women.
  
  
  METHODS
  The authors used an inclusive process, collaborative interactive action research, to engage all physicians and staff members in assessing and redesigning their work environment. Based on key barriers to working effectively and integrating work and family identified in that process, a pilot project with new work practices and structures was developed, implemented, and evaluated.
  
  
  RESULTS
  The work redesign process established cross-occupational care teams in specific clinical areas. Members of the teams built skills in assessing clinical operations in their practice areas, developed new levels of collaboration, and constructed new models of distributed leadership. The majority of participants reported an improvement in how their area functioned. Integrating work and family/personal life-particularly practices around flexible work arrangements-became an issue for team discussion and solutions, not a matter of individual accommodation by managers.
  
  
  CONCLUSIONS
  By engaging the workforce, collaborative interactive action research can help achieve lasting change in the health care workplace and increase physicians' and staff members' work satisfaction. This "dual agenda" may be best achieved through a collaborative process where cross-occupational teams are responsible for workflow and outcomes and where the needs of patients and providers are integrated.
authors.affiliation: Connors Center for Women's Health and Gender Biology, Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. pajohnson@partners.org
authors.forename: Paula A
authors.initials: PA
authors.lastname: Johnson
authors.forename: Ann
authors.initials: A
authors.lastname: Bookman
authors.forename: Lotte
authors.initials: L
authors.lastname: Bailyn
authors.forename: Mona
authors.initials: M
authors.lastname: Harrington
authors.forename: Piper
authors.initials: P
authors.lastname: Orton
mesh_terms: D000553:Ambulatory Care / Q000592:standards*; D003299:Cooperative Behavior; D003695:Delivery of Health Care / Q000592:standards*; D004059:Diffusion of Innovation; D005260:Female; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D008404:Massachusetts; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team; D010865:Pilot Projects; D011787:Quality of Health Care / Q000592:standards*; D012107:Research Design / Q000592:standards*; D011795:Surveys and Questionnaires; D017132:Workplace / Q000592:standards*