The Patient Centered Medical Home: Mental Models and Practice Culture Driving the Transformation Process
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The Patient-Centered Medical Home (PCMH) has become a dominant model of primary care re-design. The PCMH model is a departure from more traditional models of healthcare delivery and requires significant transformation to be realized.
To describe factors shaping mental models and practice culture driving the PCMH transformation process in a large multi-payer PCMH demonstration project.
Individual interviews were conducted at 17 primary care practices in South Eastern Pennsylvania.
A total of 118 individual interviews were conducted with clinicians (N = 47), patient educators (N = 4), office administrators (N = 12), medical assistants (N = 26), front office staff (N = 7), nurses (N = 4), care managers (N = 11), social workers (N = 4), and other stakeholders (N = 3). A multi-disciplinary research team used a grounded theory approach to develop the key constructs describing factors shaping successful practice transformation.
Three central themes emerged from the data related to changes in practice culture and mental models necessary for PCMH practice transformation: 1) shifting practice perspectives towards proactive, population-oriented care based in practice–patient partnerships; 2) creating a culture of self-examination; and 3) challenges to developing new roles within the practice through distribution of responsibilities and team-based care. The most tension in shifting the required mental models was displayed between clinician and medical assistant participants, revealing significant barriers towards moving away from clinician-centric care.
Key factors driving the PCMH transformation process require shifting mental models at the individual level and culture change at the practice level. Transformation is based upon structural and process changes that support orientation of practice mental models towards perceptions of population health, self-assessment, and the development of shared decision-making. Staff buy-in to the new roles and responsibilities driving PCMH transformation was described as central to making sustainable change at the practice level; however, key barriers related to clinician autonomy appeared to interfere with the formation of team-based care.
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- The Patient Centered Medical Home: Mental Models and Practice Culture Driving the Transformation Process
Journal of General Internal Medicine
Volume 28, Issue 9 , pp 1195-1201
- Cover Date
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- Online ISSN
- Springer US
- Additional Links
- patient-centered care
- primary health care
- delivery of health care
- program evaluation
- Industry Sectors
- Author Affiliations
- 1. Department of Family Medicine and Community Health, The University of Pennsylvania, 141 Anatomy & Chemistry Building, 3620 Hamilton Walk, Philadelphia, PA, 19104, USA
- 2. Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, PA, USA
- 3. Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- 4. Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA
- 5. Philadelphia VA Medical Center, Philadelphia, PA, USA
- 6. Department of Communication Studies, Chapman University, Orange, CA, USA
- 7. Department of Biomedical Informatics & Medical Education, University of Washington School of Medicine, Seattle, WA, USA
- 8. Department of Family Medicine and Community Health, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- 9. Penn State Hershey Diabetes Institute, Penn State College of Medicine, Diabetes Program, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA