It Takes Two: Using Coleaders to Champion Improvements in Small Primary Care Practices

Kaia Gallagher; Paul A. Nutting; Donald E. Nease; Deborah G. Graham; Aaron J. Bonham; W. Perry Dickinson; Deborah S. Main

doi:10.3122/jabfm.2010.05.090198

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Table 1.

Principles that Define the Reflective–Adaptive Process (RAP)

RAP Principle	Application in the Current Study
Each practice setting is assumed to be unique in terms of mission, underlying priorities, history, relationships, and overall practice context.	Practice champions were individually selected by the participating practices and included a physician and non-physician who, in turn, were charged with shepherding change within their practices.
All staff members within a practice are seen as interconnected and interdependent in terms of relationships and functions. Relationships among practice staff are critical to practice effectiveness.	Improvement teams were recruited by the practice champions and included staff with varying responsibilities and positions within the practice.
The “health” of a practice can be characterized by its ability to change adaptively in response to a wide variety of environmental challenges.	The improvement teams were presented with a specific menu of depression change options, but chose for themselves the types of improvements that would be considered.
Tension and conflict are normal parts of the change process.	Conflict resolution skills were conveyed to the practice champions during 3 learning sessions organized during the course of the initiative.
Dividing change into a series of smaller bites is likely to result in greater success as compared with trying to change too much too suddenly.	Practice champions were trained to develop action plans that focused on a sequential series of changes that could be implemented during a series of improvement team meetings.

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Table 2.

Division of Tasks among Non-Physicians and Physicians by Number of Practices* (n = 14)

	Physician Coleader	Shared by Physician and Nonphysician Coleaders	Nonphysician Coleader
Recruiting team members	2	6	6
Arranging for meeting times and logistics	2	2	10
Setting priorities for issues the improvement team would address	5	7	2
Acting as the facilitator during meetings	6	2	6
Coordinating the work of the improvement team between meetings		3	11
Follow up on any actions that needed to be taken between the meetings		5	9