Journal of General Internal Medicine

, Volume 23, Issue 11, pp 1778–1783 | Cite as

Providers’ Experience with an Organizational Redesign Initiative to Promote Patient-Centered Access: A Qualitative Study

  • James T. Tufano
  • James D. Ralston
  • Diane P. Martin
Original Article

Abstract

Background

Patient-centered access is a philosophy and a method that supports efforts to redesign health-care delivery systems to deliver higher quality care and to better meet the needs and preferences of patients. Since mid-2000, Group Health Cooperative has pursued an ensemble of strategic initiatives aimed at promoting patient-centered access, referred to as the Access Initiative. In support of this strategy, Group Health has also engaged in enterprise implementation of an electronic medical record and clinical information system that is integrated with their patient Web site, MyGroupHealth.

Objective

To elicit, describe, and characterize providers’ perceptions of the effects of the Access Initiative, an information technology-enabled organizational redesign initiative intended to promote patient-centered access.

Design

Thematic analysis of semi-structured in-depth interviews.

Participants

Twenty-two care providers representing 14 primary care, medical, and surgical specialties at Group Health Cooperative, an integrated health-care system based in Seattle, Washington.

Findings

Analyses of the interview transcripts revealed nine emergent themes, five of which have particular relevance for health-care organizations pursuing patient-centered access: the Access Initiative improved patient satisfaction, improved the quality of encounter-based care, compromised providers’ focus on population health, created additional work for providers, and decreased job satisfaction for primary care providers and some medical specialists.

Conclusions

Providers like that the Access Initiative is mostly good for their patients, but dislike the negative effects on their own quality of life – especially in primary care. These reforms may not be sustainable under current models of organization and financing.

KEY WORDS

patient-centered access information technology qualitative evaluation organizational redesign informatics 

Notes

Acknowledgments and Conflicts of Interest

This study was funded by a grant from the Robert Wood Johnson Foundation. All study activities and protocols were reviewed and approved by the Group Health Cooperative Center for Health Studies’ Institutional Review Board. While Mr. Tufano and Dr. Ralston are currently employed by the Group Health Cooperative Center for Health Studies, they retained full independence in the conduct of this research. Dr. Martin reports no potential conflict of interest related to this endeavor.

References

  1. 1.
    Woolf SH. Patient safety is not enough: targeting quality improvements to optimize the health of the population. Ann Intern Med. 2004;143:33–36.Google Scholar
  2. 2.
    Berry LL, Selders K, Wilder SS. Innovations in access to care: a patient-centered approach. Ann Int Med. 2003;139:568–574.PubMedGoogle Scholar
  3. 3.
    Berg M. Patient care information systems and health care work: a sociotechnical approach. Int J Med Inform. 1999;55:87–101.PubMedCrossRefGoogle Scholar
  4. 4.
    Hartswood M, Proctor R, Rouncefield M, Slack R. Making a case in medical work: implications for the electronic medical record. Comput Support Coop Work. 2003;12:241–266.CrossRefGoogle Scholar
  5. 5.
    Ash JS, Berg M, Coiera E. Some unintended consequences of information technology in healthcare: the nature of patient care information system-related errors. J Am Med Inform Assoc. 2004;11:104–112.PubMedCrossRefGoogle Scholar
  6. 6.
    Scott JT, Rundall TG, Vogt TM, Hsu J. Kaiser Permanente’s experience of implementing an electronic medical record: a qualitative study. BMJ. 2005;331:1313–1316.PubMedCrossRefGoogle Scholar
  7. 7.
    Ornstein C. Hospital heeds doctors, suspends use of software: Cedars-Sinai physicians entered prescriptions and other orders in it, but called it unsafe. Los Angeles Times. January 22, 2003:B1.Google Scholar
  8. 8.
    Ralston JD. Group Health Cooperative’s transformation to patient-centered access. Managed Care Interface. (in press).Google Scholar
  9. 9.
    Ralston JD, Carrell D, Reid R, Anderson M, Moran M, Hereford J. Patient web services integrated with a shared medical record: patient use and satisfaction. J Am Med Inform Assoc. 2007;14:798–806.PubMedCrossRefGoogle Scholar
  10. 10.
    U.S. Centers for Disease Control & Prevention (CDC) website accessed July 25, 2008 http://www.cdc.gov/hiv/software/answr.htm
  11. 11.
    Bradley EH, Curry LA, Devers KJ. Qualitative data analysis for health services research: Developing taxonomy, themes, and theory. Health Serv Res. 2007;42:1758–1772.PubMedCrossRefGoogle Scholar
  12. 12.
    Cooper RA, Gretzen TE, McKee HJ, Laud P. Economic and demographic trends signal an impending physician shortage. Health Aff. 2002;21:140–54.CrossRefGoogle Scholar
  13. 13.
    Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Qtrly. 2005;83:457–502.CrossRefGoogle Scholar
  14. 14.
    Garibaldi RA, Popkave C, Bylsma W. Career plans for trainees in internal medicine residency programs. Academic Med. 2005;142:715–724.Google Scholar
  15. 15.
    Schwartz MD, Basco WT Jr, Grey MR, Elmore JG, Rubenstein A. Rekindling student interest in generalist careers. Ann Intern Med. 2005;142:715–724.PubMedGoogle Scholar
  16. 16.
    Blue Ribbon Panel of the Society of General Internal Medicine. Redesigning the practice model for general internal medicine. A proposal for coordinated care: a policy monograph of the Society of General Internal Medicine. J Gen Intern Med. 2007;22:400–409.CrossRefGoogle Scholar
  17. 17.
    American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, American Osteopathic Association. Joint principles of the patient-centered medical home. February 2007. Website accessed 8/5/08 http://www.medicalhomeinfo.org/Joint%20Statement.pdf

Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • James T. Tufano
    • 1
    • 2
  • James D. Ralston
    • 2
  • Diane P. Martin
    • 3
  1. 1.National Library of Medicine Informatics Research Fellow and Doctoral Candidate, Division of Biomedical and Health Informatics, School of MedicineUniversity of WashingtonSeattleUSA
  2. 2.Group Health CooperativeCenter for Health StudiesSeattleUSA
  3. 3.Department of Health Services, School of Public Health and Community MedicineUniversity of WashingtonSeattleUSA

Personalised recommendations