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. |