title: Coaching strategies for enhancing practice transformation.
abstract: BACKGROUND
  Current research on primary care practice redesign suggests that outside facilitation can be an important source of support for achieving substantial change.
  
  
  OBJECTIVE
  To analyse the specific sequence of strategies used by a successful practice facilitator during the American Academy of Family Physicians' (AAFP) National Demonstration Project (NDP).
  
  
  METHODS
  This secondary analysis describes a sequence of strategies used to produce change in family medicine practices attempting to adopt a new model of care. The authors analysed qualitative data generated by one facilitator and six practices by coding facilitator field notes, site visit reports, qualitative summaries, depth interviews and email strings.
  
  
  RESULTS
  The facilitator utilized practice member coaching in addition to consulting, negotiating and connecting approaches. Coaching strategies encouraged: (i) expansive, multi-directional, attentive styles of communication; (ii) solving practical problems together; (iii) modelling facilitative leadership and (iv) encouraging an expanded vision of care. Practice members who received consistent coaching reported internal shifts and new ways of conceptualizing work, not just success at implementing model components. They indicated that their facilitator had helped them think and behave in new ways while helping them achieve benchmarks.
  
  
  CONCLUSIONS
  It was once believed that the transition from traditional models of family medicine practice to new models of care meant implementing new technological components, suggesting that outside facilitators should act as technological and care delivery consultants. However, coaches may be especially useful in helpful in practices undertake substantial changes.
authors.affiliation: Rutgers School of Nursing, Rutgers Biomedical and Health Sciences, Rutgers University, Newark, NJ, sabrina.m.chase@rutgers.edu.
authors.forename: Sabrina M
authors.initials: SM
authors.lastname: Chase
authors.affiliation: Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
authors.forename: Benjamin F
authors.initials: BF
authors.lastname: Crabtree
authors.affiliation: Sunflower Foundation: Health Care for Kansans, Topeka, KS.
authors.forename: Elizabeth E
authors.initials: EE
authors.lastname: Stewart
authors.affiliation: Department of Family Medicine, University of Colorado Health Sciences Center, Denver, CO.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Nutting
authors.affiliation: Department of Family Medicine, Lehigh Valley Health Network, Allentown, PA.
authors.forename: William L
authors.initials: WL
authors.lastname: Miller
authors.affiliation: Family Medicine and Community Health, Epidemiology and Biostatistics, Sociology, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland Clinical and Translational Science Collaborative, Cleveland, OH and.
authors.forename: Kurt C
authors.initials: KC
authors.lastname: Stange
authors.affiliation: Departments of Family and Community Medicine and Epidemiology and Biostatistics, Research to Address Community Health (REACH) Center, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
authors.forename: Carlos R
authors.initials: CR
authors.lastname: Jaén
mesh_terms: D001291:Attitude of Health Personnel; D003253:Consultants; D005194:Family Practice / Q000458:organization & administration*; D006801:Humans; D007400:Interprofessional Relations; D007857:Leadership; D017146:Models, Organizational; D011216:Practice Management, Medical / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D011340:Problem Solving; D036301:Qualitative Research; D014481:United States
keywords: Attitude of health personnel; family practice/methods; models; organizational innovation; physician practice patterns/organization and administration; primary health care/organization and administration; qualitative research.