Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

3016 — The Chronic Care Model as a Tool for Organizational Transformation

Cramer IE (Center for Organization, Leadership and Management Research) , Holmes SK (Center for Organization, Leadership and Management Research), Cohen AB (Boston University Health Policy Institute), Restuccia J (Boston University School of Management), Shwartz M (Boston University School of Management), Van Deusen Lukas C (Center for Organization, Leadership and Management Research), Lerner B (Center for Organization, Leadership and Management Research), Tabor L (Center for Organization, Leadership and Management Research), Charns MP (Center for Organization, Leadership and Management Research)

Objectives:
Implementation of the Chronic Care Model (CCM) in VA would address needs of a large portion of the veteran population. However, CCM implementation is challenging because sustainable change requires full organizational transformation rather than incremental efforts. We report findings from a study of organizational transformation in 12 healthcare organizations in which we identified factors critical to CCM implementation and transformation.

Methods:
Beginning in 2001, the Robert Wood Johnson Foundation funded seven healthcare organizations to pursue perfect care, an effort requiring dramatic improvement through system redesign and organizational transformation. Several sites used the CCM/planned care model as a construct on which to build transformation. Using a case-study approach, we examined change at seven grantee and five other sites. Over four years, we conducted more than 750 semi-structured interviews with approximately 1,000 employees. With site visits generally occurring at six-month intervals, we observed organizations’ new initiatives as well as ongoing transformation journeys. Detailed site visit notes were coded into broad themes suggested by the data, literature, and research team discussions.

Results:
We identified factors critical to CCM implementation and its relationship to transformation efforts. In the context of a patient-centered focus, these include: (1) organizational commitment to and alignment with change objectives; (2) improvement initiatives that engage staff across disciplines at all levels in meaningful problem solving; (3) evidence-based, data-driven efforts that create impetus and momentum for change; (4) infrastructure that supports the organization’s new work; and (5) structures and processes that facilitate integration across organizational boundaries. Using these factors, we developed a conceptual model of organizational transformation that incorporates the CCM. Although sites differed in their approaches, explicit focus on the CCM resulted in broad-based change within organizations.

Implications:
Patient care quality improvement gains often are limited in impact and ultimately cannot be sustained. From observations in 12 sites, we conclude that the CCM provides leverage for major organizational change because it uniquely engages people in fundamentally changed work processes that, in turn, support shifts in culture, values, and behavior required for transformation.

Impacts:
Study results may guide implementation of the CCM as well as further research about its role in organizational transformation.