Strategies for achieving whole-practice engagement and buy-in to the patient-centered medical home.
OBJECTIVE
The current model of primary care in the United States limits physicians' ability to offer high-quality care. The patient-centered medical home (PCMH) shows promise in addressing provision of high-quality care, but achieving a PCMH practice model often requires comprehensive organizational change. Guided by Solberg's conceptual framework for practice improvement, which argues for shared prioritization of improvement and change, we describe strategies for obtaining organizational buy-in to and whole-staff engagement of PCMH transformation and practice improvement.


METHODS
Semistructured interviews with 136 individuals and 7 focus groups involving 48 individuals were conducted in 20 small- to mid-sized medical practices in Pennsylvania during the first regional rollout of a statewide PCMH initiative. For this study, we analyzed interview transcripts, monthly narrative reports, and observer notes from site visits to identify discourse pertaining to organizational buy-in and strategies for securing buy-in from personnel. Using a consensual qualitative research approach, data were reduced, synthesized, and managed using qualitative data management and analysis software.


RESULTS
We identified 13 distinct strategies used to obtain practice buy-in, reflecting 3 overarching lessons that facilitate practice buy-in: (1) effective communication and internal PCMH campaigns, (2) effective resource utilization, and (3) creation of a team environment.


CONCLUSIONS
Our study provides a list of strategies useful for facilitating PCMH transformation in primary care. These strategies can be investigated empirically in future research, used to guide medical practices undergoing or considering PCMH transformation, and used to inform health care policy makers. Our study findings also extend Solberg's conceptual framework for practice improvement to include buy-in as a necessary condition across all elements of the change process.
Department of Health Policy and Administration, Pennsylvania State University, University Park, Pennsylvania.
William K
WK
Bleser
Michelle
M
Miller-Day
Dana
D
Naughton
Patricia L
PL
Bricker
Peter F
PF
Cronholm
Robert A
RA
Gabbay
D000288:Administrative Personnel; D001291:Attitude of Health Personnel; D017144:Focus Groups; D006801:Humans; D017146:Models, Organizational; D009722:Nurse Practitioners; D009726:Nurses; D009936:Organizational Innovation; D018802:Patient-Centered Care / Q000458:organization & administration*; D010414:Pennsylvania; D010820:Physicians; D011320:Primary Health Care / Q000458:organization & administration*; D036301:Qualitative Research
organizational innovation (organizational change); patient-centered care (medical home); primary health care; qualitative research