Caprice Knapp, Vanessa Madden, Hanny Lane, Ruth Gubernick, Steven Kairys, Cristina Pelaez-Velez, Lee Sanders and Lindsay Thompson
Objective: In the era of continuous quality improvement, practices must be ready to implement new ideas and processes. Alignment between staff and practice leadership is crucial to implementation. This study assesses the level of congruence that physician leaders and staff report about their ability to adapt to change. Methods: Survey data were collected from staff working in 20 Florida pediatric practices and a physician leader from each practice. Both surveys assessed adaptive reserve which measures the ability of the practice to adapt to change by asking questions about their willingness to make changes, problem solving skills, communication, and general team dynamics. Overall, 170 staff members completed the staff survey with a response rate of 42.6% and twenty lead physicians completed the physician leader survey for a response rate of 100%. Descriptive, bivariate, and multivariate analyses were conducted. Results: Among all staff, 30% were in high levels of agreement with their lead physician while 23.5% were in low levels of agreement with their lead physician. Practices with older staff were found to be the most aligned. Practices with one to three physicians were associated with decreased odds of congruence (Odds ratio=0.16). Staff ages 41 to 50 were associated with increased odds of congruence versus their younger counterparts (OR=5.77). Conclusions: Adaptive reserve inventory and alignment should be seen as an investment and a priority by practices, medical home facilitators, and policymakers. A team approach is essential for patient-centered medical home implementation. Staff should be considered stakeholders in the medical home transformation and their feedback should be sought throughout the process and acted on in a timely manner.
