Transformation is Hard Work: Lessons from TransforMED’s National Demonstration Project

1. Transformation is Hard Work: Lessons from TransforMED’s National Demonstration Project Presented by Benjamin F. Crabtree, PhD October 3, 2007

4. Center for Research in Family Medicine and Primary Care Kurt C. Stange, MD, PhD Carlos R. Jaén, MD, PhD Benjamin F. Crabtree, PhD Paul A. Nutting, MD, MSPH William L. Miller, MD, MA

6. Observation I ntervention DOPC STEP-UP IMPACT D irect O bservation of P rimary C are (1994-97) S tudy T o E nhance P revention by U nderstanding P ractice (1996-2000) Insights from Multimethod Practice Assessment of Change over Time (2001-2004) P&CD P revention & C ompeting D emands in P rimary C are (1996-99) ULTRA Using Learning Teams for Reflective Adaptation (2002-07)

10. Observation I ntervention DOPC STEP-UP IMPACT D irect O bservation of P rimary C are (1994-97) S tudy T o E nhance P revention by U nderstanding P ractice (1996-2000) Insights from Multimethod Practice Assessment of Change over Time (2001-2004) P&CD P revention & C ompeting D emands in P rimary C are (1996-99) ULTRA Using Learning Teams for Reflective Adaptation (2002-07)

11. Observation I ntervention DOPC STEP-UP IMPACT D irect O bservation of P rimary C are (1994-97) S tudy T o E nhance P revention by U nderstanding P ractice (1996-2000) Insights from Multimethod Practice Assessment of Change over Time (2001-2004) P&CD P revention & C ompeting D emands in P rimary C are (1996-99) ULTRA Using Learning Teams for Reflective Adaptation (2002-07)

12. “ All models are wrong. Some are useful.” - George Box, 1979 Box, G.E.P., Robustness in the strategy of scientific model building, in Robustness in Statistics, R.L. Launer and G.N. Wilkinson, Editors. 1979, Academic Press: New York.

13. IMPACT CHANGE MODEL

14. Change Is Challenging

16. Observation I ntervention DOPC STEP-UP IMPACT D irect O bservation of P rimary C are (1994-97) S tudy T o E nhance P revention by U nderstanding P ractice (1996-2000) Insights from Multimethod Practice Assessment of Change over Time (2001-2004) P&CD P revention & C ompeting D emands in P rimary C are (1996-99) ULTRA Using Learning Teams for Reflective Adaptation (2002-07)

17. Capacity to Change Model Reflection Action Trust Miindful Respect Heedful Diversity Social/ Task Rich/Lean STORIES Learning CULTURE Teamwork Sensemaking Improvisation Build Memory Dynamic Local Ecology Inquiry-Centered LEADERSHIP

27. National Demonstration Project Evaluation Team Center for Research in Family Medicine and Primary Care Carlos R. Jaén, MD, PhD (PI) Benjamin F. Crabtree, PhD Paul A. Nutting, MD, MSPH William L. Miller, MD, MA Kurt C. Stange, MD, PhD & Elizabeth Stewart, PhD (analyst) Reuben R. McDaniel, EdD (consultant)

31. NDP Practices 18 4 5 2 4 3 Facilitated 18 Total 4 Large (7 or more clinicians) 5 Medium (4-6 clinicians) 2 New 4 Small (3 or less clinicians) 3 Solo and Solo +1 Self-directed Number of Sites Practice Description

35. Qualitative Learning Emerging themes one year into the NDP

41. More information www.transformed.com

43. Questions?