title: The practice perspective on transformation: experience and learning from the frontlines.
abstract: BACKGROUND
  The transition of a primary care practice to a patient-centered medical home can be arduous. It requires time and resources from staff and leaders. Evidence to date suggests that not all medical homes are equally successful and that there is a substantial difference between the achievement of medical home recognition and meaningful transformation. However, little information is available to help a practice understand which approaches or strategies it might employ to prepare itself for successful transformation.
  
  
  OBJECTIVE
  Leaders in 2 very different primary care practices that participated in the Safety Net Medical Home Initiative (SNMHI) offer their impressions, contextualizing the experience of practice transformation from the perspective of the medical practice and providing insight on approaches that may support success.
  
  
  METHODS
  The authors self-identified a set of shared approaches they believe allowed their organizations to successfully implement and sustain changes consistent with the PCMH Model of Care.
  
  
  RESULTS
  The approaches are: (1) harness the power of meaning; (2) approach PCMH implementation as a large-scale cultural transformation; (3) engage frontline staff and patients in the change process; (4) develop leadership's capacity to manage and support the change process; (5) consider sustainability from the beginning.
authors.affiliation: *Cambridge Health Alliance and the Harvard Medical School Center for Primary Care, Somerville, MA †Portneuf Health Care Foundation, Pocatello, ID.
authors.forename: Somava
authors.initials: S
authors.lastname: Stout
authors.forename: Stephen
authors.initials: S
authors.lastname: Weeg
mesh_terms: D001291:Attitude of Health Personnel; D006284:Health Plan Implementation; D006302:Health Services Research; D006801:Humans; D007061:Idaho; D007407:Interviews as Topic; D007857:Leadership; D008404:Massachusetts; D017146:Models, Organizational; D009042:Motivation; 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*