title: Trust and Reflection in Primary Care Practice Redesign.
abstract: To test a conceptual model of relationships, reflection, sensemaking, and learning in primary care practices transitioning to patient-centered medical homes (PCMH).
  
  
  
  Primary data were collected as part of the American Academy of Family Physicians' National Demonstration Project of the PCMH.
  
  
  
  We conducted a cross-sectional survey of clinicians and staff from 36 family medicine practices across the United States. Surveys measured seven characteristics of practice relationships (trust, diversity, mindfulness, heedful interrelation, respectful interaction, social/task relatedness, and rich and lean communication) and three organizational attributes (reflection, sensemaking, and learning) of practices.
  
  
  
  We surveyed 396 clinicians and practice staff. We performed a multigroup path analysis of the data. Parameter estimates were calculated using a Bayesian estimation method.
  
  
  
  Trust and reflection were important in explaining the characteristics of practice relationships and their associations with sensemaking and learning. The strongest associations between relationships, sensemaking, and learning were found under conditions of high trust and reflection. The weakest associations were found under conditions of low trust and reflection.
  
  
  
  Trust and reflection appear to play a key role in moderating relationships, sensemaking, and learning in practices undergoing practice redesign.
authors.affiliation: Department of Medicine/Hospital Medicine & Department of Family and Community Medicine, The University of Texas Health Science Center, San Antonio, TX.|South Texas Veterans Health Care System, San Antonio, TX.|Department of Information, Risk and Operations Management, McCombs School of Business, The University of Texas at Austin, San Antonio, TX.
authors.forename: Holly Jordan
authors.initials: HJ
authors.lastname: Lanham
authors.affiliation: Department of Family and Community Medicine, The University of Texas Health Science Center, San Antonio, TX.
authors.forename: Raymond F
authors.initials: RF
authors.lastname: Palmer
authors.affiliation: South Texas Veterans Health Care System, San Antonio, TX.|Department of Information, Risk and Operations Management, McCombs School of Business, The University of Texas at Austin, San Antonio, TX.|Department of Medicine/Hospital Medicine, The University of Texas Health Science Center, San Antonio, TX.
authors.forename: Luci K
authors.initials: LK
authors.lastname: Leykum
authors.affiliation: Department of Information, Risk and Operations Management, McCombs School of Business, The University of Texas at Austin, San Antonio, TX.
authors.forename: Reuben R
authors.initials: RR
authors.lastname: McDaniel
authors.affiliation: Center for Research Strategies, Denver, CO.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Nutting
authors.affiliation: Departments of Family Medicine, Epidemiology and Biostatistics, and Sociology, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH.
authors.forename: Kurt C
authors.initials: KC
authors.lastname: Stange
authors.affiliation: Department of Family Medicine & Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
authors.forename: Benjamin F
authors.initials: BF
authors.lastname: Crabtree
authors.affiliation: Department of Family Medicine, Lehigh Valley Health Network, Allentown, PA.
authors.forename: William L
authors.initials: WL
authors.lastname: Miller
authors.affiliation: Departments of Family & Community Medicine, and Epidemiology and Biostatistics, Research to Advance Community Health Center, The University of Texas Health Sciences Center, San Antonio, TX.
authors.forename: Carlos Roberto
authors.initials: CR
authors.lastname: Jaén
mesh_terms: D001291:Attitude of Health Personnel; D001499:Bayes Theorem; D003430:Cross-Sectional Studies; D006801:Humans; D009936:Organizational Innovation; D018802:Patient-Centered Care / Q000458:organization & administration* / Q000592:standards; D011320:Primary Health Care / Q000458:organization & administration*; D011787:Quality of Health Care / Q000458:organization & administration; D035502:Trust; D014481:United States
keywords: Practice redesign; learning; reflection; relationships; sensemaking