title: Cultivating engaged leadership through a learning collaborative: lessons from primary care renewal in Oregon safety net clinics.
abstract: OBJECTIVE
  The aim of this study was to explore how learning collaboratives cultivate leadership skills that are essential for implementing patient-centered medical homes (PCMHs).
  
  
  METHODS
  We conducted an ethnographic evaluation of a payor-incentivized PCMH implementation in Oregon safety net clinics, known as Primary Care Renewal. Analyses primarily drew on in-depth interviews with organizational leaders who were involved in the initiative. We solicited perspectives on the history, barriers, facilitators, and other noteworthy factors related to the implementation of PCMH. We reviewed and summarized transcripts and created and applied a coding dictionary to identify emergent leadership themes. We reviewed field notes from clinic site visits and observations of learning collaborative activities for additional information on the role of engaged leadership.
  
  
  RESULTS
  Interview data suggested that organizations followed a similar, sequential process of Primary Care Renewal implementation having 2 phases-inspiration and implementation-and that leaders needed and learned different leadership skills in each phase. Leaders reported that collaborative learning opportunities were critical for developing engaged leadership skills during the inspiration phase of transformation. Facilitative and modeling aspects of engaged leadership were most important for codesigning a vision and plan for change. Adaptive leadership skills became more important during the implementation phase, when specific operational and management skills were needed to foster standardization and spread of the Primary Care Renewal initiative throughout participating clinics.
  
  
  CONCLUSIONS
  The PCMH has received much attention as a way to reorganize and potentially improve primary care. Documenting steps and stages for cultivating leaders with the vision and skills to transform their organizations into PCMHs may offer a useful roadmap to other organizations considering a similar transformation.
authors.affiliation: Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon 97227, USA. carmit.mcmullen@kpchr.org
authors.forename: Carmit K
authors.initials: CK
authors.lastname: McMullen
authors.forename: Jennifer
authors.initials: J
authors.lastname: Schneider
authors.forename: Alison
authors.initials: A
authors.lastname: Firemark
authors.forename: James
authors.initials: J
authors.lastname: Davis
authors.forename: Mark
authors.initials: M
authors.lastname: Spofford
mesh_terms: D006801:Humans; D007857:Leadership; D008329:Managed Care Programs; D008484:Medicaid; D009922:Oregon; D009936:Organizational Innovation; D018802:Patient-Centered Care / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D014481:United States
keywords: engaged leadership; organizational innovation; patient-centered medical home; practice-based research; primary care; safety net clinics; transformation