A Mixed Methods Study of Change Processes Enabling Effective Transition to Team-based Care

Michael Anne  Kyle; Emma-Louise  Aveling; Sara J. Singer

Article | Medical Care Research and Review | Forthcoming

A Mixed Methods Study of Change Processes Enabling Effective Transition to Team-based Care

by Michael Anne Kyle, Emma-Louise Aveling and Sara J. Singer

Abstract

Team-based care is considered central to achieving value in primary care, yet results of large-scale primary care transformation initiatives have been mixed. We explore how underlying change processes influence the effectiveness of transition to team-based care. We studied 12 academically affiliated primary care practices participating in a learning collaborative, using longitudinal staff survey data to measure progress toward team-based care and qualitative interviews with practice staff to understand practice transformation. Transformation efforts focused on team formation and capacity building for quality improvement. Using thematic analysis, we explored types of change processes undertaken and the relationship between change processes and effective team-based care. We identified three prototypical approaches to change: pursuing functional and cultural change processes, functional only, and cultural only. Practice sites prioritizing both change processes formed the most effective teams: simultaneous functional and cultural change spurred a mutually reinforcing virtuous cycle. We describe implications for research, practice, and policy.

Keywords: team-based care; Primary Care; Health Care and Treatment; Transformation; Groups and Teams; Change Management;

Format: Print

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Citation:

Kyle, Michael Anne, Emma-Louise Aveling, and Sara J. Singer. "A Mixed Methods Study of Change Processes Enabling Effective Transition to Team-based Care." Medical Care Research and Review (forthcoming). (Pre-published online October 15, 2019.)

Effective teams can be significant drivers of innovations that enable broader quality improvements and efficiency gains across organizations. But despite the wealth of research and managerial expertise describing characteristics of effective teams, people and organizations still struggle to deploy teams that achieve their potential, regardless of individual effort and good intentions. More puzzling is that teams following the same template of best practices can achieve different results. We studied new team formation to understand why some teams work and others struggle. Our research suggests that transitioning to effective teams depends on mutually reinforcing functional and cultural change processes. The way in which organizations combine these two key change processes is critical for success.

OBJECTIVES: Understanding variation in spending across organizations, rather than across geographic areas, is important because care is delivered by organizations and interventions increasingly focus on organizations. Accountable care organizations (ACOs) are particularly important to study given their incentives to reduce spending. Analyzing spending differences across ACOs may help identify cost savings opportunities. STUDY DESIGN: Cross-sectional analysis of Medicare claims. METHODS: We stratified ACOs into quartiles based on the deviation between each ACO’s risk-adjusted spending and average risk-adjusted fee-for-service spending in the same market (hospital referral region). We compared spending between top- and bottom-quartile ACOs on each of 7 major service categories and 10 clinical condition groups to identify areas of potential savings. We simulated spending reductions if ACOs with high adjusted spending reduced spending to the levels of lower-spending ACOs. RESULTS: In 2016, geographically adjusted and risk-adjusted total per-beneficiary spending for the highest-spending quartile of ACOs was 14% higher than for ACOs in the lowest quartile. Variation between high- and low-spending ACOs was greatest, at 27%, in the use of skilled nursing facilities—a service category in which ACOs have reduced spending by the greatest percentage. Inpatient care was the largest driver of absolute dollar differences in spending, however, accounting for 37% of the total spread. If spending in ACOs above median adjusted spending were brought down to the median, savings would be 3% to 4%. CONCLUSIONS: By extending the variations literature to focus on ACOs, we illustrated that meaningful further savings opportunities exist both within and across markets.

Article | Milbank Quarterly

Toward a Corporate Culture of Health: Results of a National Survey

Michael Anne Kyle, Lumumba Seegars, John M. Benson, Robert J. Blendon, Robert S. Huckman and Sara J. Singer

Context: The private sector has a large potential role in advancing health and well-being, but attention to corporate practices around health tends to focus on a narrow range of issues and on large businesses. Systematically describing private sector engagement in health and well-being is a necessary step toward understanding the current state of the field and developing an agenda for businesses going forward.
Methods: We conducted a national survey of 1,017 private sector organizations to assess current levels of engagement in what we term a culture of health (CoH). We measured corporate CoH along four dimensions, which assess the extent to which businesses promote employee, environmental, consumer, and community health and well-being. We also explored potential explanations for the number of health-related actions taken in each dimension.
Findings: On average, businesses took 38% of health-related actions included in our survey. For each dimension, we found variation among businesses in the number of actions taken (on average, there were almost fourfold differences between the bottom and top quartiles of businesses in terms of actions taken). Mentioning health and well-being in the corporate mission, having a strategic plan for CoH, and perceiving a positive return on CoH investments were all associated with businesses’ actions taken. Fewer than half of businesses, however, perceived a positive return on their CoH investments.
Conclusions: Overall, the private sector is taking steps to foster health and well-being. However, there remains substantial variation among businesses and opportunity for growth, even among those currently taking the most action. Strengthening the business case for a corporate CoH may increase private sector investments in health and well-being. Actions taken by individual businesses, business groups, industries, and regulators have the potential to improve corporate engagement and impact.

Keywords: Corporate Health; social determinants of health; Health Policy; public health; Organizations; Health; Policy; Surveys;

Citation:

Kyle, Michael Anne, Lumumba Seegars, John M. Benson, Robert J. Blendon, Robert S. Huckman, and Sara J. Singer. "Toward a Corporate Culture of Health: Results of a National Survey." Milbank Quarterly 97, no. 4 (December 2019): 954–977. View Details

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A Mixed Methods Study of Change Processes Enabling Effective Transition to Team-based Care

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