title: Practice transformation in the safety net medical home initiative: a qualitative look.
abstract: BACKGROUND
  Transformation of primary care to patient-centered medical homes (PCMH) is challenging. Progress in transformation varied widely among practices involved in the Safety Net Medical Home Initiative.
  
  
  OBJECTIVE
  To study 3 successful practices to identify common characteristics and approaches.
  
  
  METHODS
  We selected 3 diverse practices based on their improvement on the PCMH-A, a self-assessment instrument measuring progress toward becoming a PCMH. We interviewed 2-3 leaders from the each of 3 practices seeking information about their motivations for transforming, the methods used to make changes, and challenges and facilitators. Interview data were coded, themes developed, and conclusions drawn using qualitative research methods.
  
  
  RESULTS
  For these successful practices, the major motivators were a desire to improve quality of care, patient experience, or provider experience. Financial incentives played a minor role. All practices had engaged, visible leaders driving change, and all ultimately developed an effective quality improvement/practice change strategy that included the provision of trusted performance data at the provider level and an explicit process change strategy. Sequencing the work of PCMH transformation was important, and developing defined provider patient panels and building effective clinical teams facilitated making improvements to access and care delivery.
  
  
  CONCLUSIONS
  Practice transformation is disruptive. To be successful, organizations need to have the will or motivation to change, explicit ideas or models on which to base change, and a culture and infrastructure that enables the execution of system changes.
authors.affiliation: *MacColl Center for Health Care Innovation, Group Health Research Institute †Department of Medicine, University of Washington School of Medicine, Seattle, WA.
authors.forename: Edward H
authors.initials: EH
authors.lastname: Wagner
authors.forename: Reshma
authors.initials: R
authors.lastname: Gupta
authors.forename: Katie
authors.initials: K
authors.lastname: Coleman
mesh_terms: D001291:Attitude of Health Personnel; D003120:Colorado; D006284:Health Plan Implementation; D006302:Health Services Research; D006801:Humans; D007061:Idaho; D017146:Models, Organizational; D009042:Motivation; D009922:Oregon; D018802:Patient-Centered Care / Q000458:organization & administration*; D011216:Practice Management, Medical / Q000639:trends*; D011320:Primary Health Care / Q000639:trends*; D016730:Program Development; D015397:Program Evaluation; D011785:Quality Assurance, Health Care; D064876:Safety-net Providers / Q000458:organization & administration*