title: The Transition of Primary Care Group Practices to Next Generation Models: Satisfaction of Staff, Clinicians, and Patients.
abstract: Restructuring primary care is essential to achieve the triple aim. This case study examines the human factors of extensive redesign on 2 midsized primary care clinics (clinics A and B) in the Midwest United States that are owned by a large health care system. The transition occurred when while the principles for patient-centered medical home were being rolled out nationally, and before the Affordable Care Act.
  
  
  
  After the transition, interviews and discussions were conducted with 5 stakeholder groups: health system leaders, clinic managers, clinicians, nurses, and reception staff. Using a culture assessment instrument, the responses of personnel at clinics A and B were compared with comparison clinics from another health system that had not undergone transition. Patient satisfaction scores are presented.
  
  
  
  Clinics A and B were similar in size and staffing. Three human factor themes emerged from interviews: responses to change, professional and personal challenges due to role redefinition, and the importance of communication. The comparison clinics had an equal or higher mean culture scores compared with the transition clinics (A and B). Patient satisfaction in improved in Clinic A.
  
  
  
  The transition took more time than expected. Health system leaders underestimated the stress and the role adjustments for clinicians and nurses. Change leaders need to anticipate the challenge of role redefinition until health profession schools graduate trainees with more experience in new models of team-based care. Incorporating experience with team based, interprofessional care into training is essential to properly prepare future health professionals.
authors.affiliation: From the Department of Family Medicine, Wright State University, Dayton, OH (TZ); Division of Health Policy and Management, University of Minnesota, Minneapolis, MN (JK, BD); Medica Research Institute, Minnetonka, MN (JK). therese.zink@wright.edu.
authors.forename: Therese
authors.initials: T
authors.lastname: Zink
authors.affiliation: From the Department of Family Medicine, Wright State University, Dayton, OH (TZ); Division of Health Policy and Management, University of Minnesota, Minneapolis, MN (JK, BD); Medica Research Institute, Minnetonka, MN (JK).
authors.forename: John
authors.initials: J
authors.lastname: Kralewski
authors.affiliation: From the Department of Family Medicine, Wright State University, Dayton, OH (TZ); Division of Health Policy and Management, University of Minnesota, Minneapolis, MN (JK, BD); Medica Research Institute, Minnetonka, MN (JK).
authors.forename: Bryan
authors.initials: B
authors.lastname: Dowd
mesh_terms: D000554:Ambulatory Care Facilities / Q000191:economics / Q000458:organization & administration; D006123:Group Practice / Q000191:economics / Q000458:organization & administration*; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D007400:Interprofessional Relations; D007857:Leadership; D010348:Patient Care Team / Q000191:economics / Q000458:organization & administration; D058991:Patient Protection and Affordable Care Act; D017060:Patient Satisfaction; D018802:Patient-Centered Care / Q000191:economics / Q000458:organization & administration*; D010549:Personal Satisfaction; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration*; D013997:Time Factors; D014481:United States
keywords: Ambulatory Care Facilities; Health Occupations; Health Personnel; Patient Protection and Affordable Care Act; Patient Satisfaction; Patient-Centered Care; Primary Health Care