Journal of General Internal Medicine

, Volume 25, Supplement 4, pp 581–585 | Cite as

Joy and Challenges in Improving Chronic Illness Care: Capturing Daily Experiences of Academic Primary Care Teams

  • Julie K. Johnson
  • Donna M. Woods
  • David P. Stevens
  • Judith L. Bowen
  • Lloyd P. Provost
  • Connie S. Sixta
  • Ed H. Wagner
Original Research



Two chronic care collaboratives (The National Collaborative and the California Collaborative) were convened to facilitate implementing the chronic care model (CCM) in academic medical centers and into post-graduate medical education.


We developed and implemented an electronic team survey (ETS) to elicit, in real-time, team member’s experiences in caring for people with chronic illness and the effect of the Collaborative on teams and teamwork.


The ETS is a qualitative survey based on Electronic Event Sampling Methodology. It is designed to collect meaningful information about daily experience and any event that might influence team members’ daily work and subsequent outcomes.


Forty-one residency programs from 37 teaching hospitals participated in the collaboratives and comprised faculty and resident physicians, nurses, and administrative staff.


Each team member participating in the collaboratives received an e-mail with directions to complete the ETS for four weeks during 2006 (the National Collaborative) and 2007 (the California Collaborative).


At the team level, the response rate to the ETS was 87% with team members submitting 1,145 narrative entries. Six key themes emerged from the analysis, which were consistent across all sites. Among teams that achieved better clinical outcomes on Collaborative clinical indicators, an additional key theme emerged: professional work satisfaction, or “Joy in Work”. In contrast, among teams that performed lower in collaborative measures, two key themes emerged that reflected the effect of providing care in difficult institutional environments—“lack of professional satisfaction” and awareness of “system failures”.


The ETS provided a unique perspective into team performance and the day-to-day challenges and opportunities in chronic illness care. Further research is needed to explore systematic approaches to integrating the results from this study into the design of improvement efforts for clinical teams.


chronic illness team joy in work graduate medical education ambulatory training interprofessional training 



The national staff and faculty for the Academic Chronic Care Collaboratives were supported by generous grants from the Robert Wood Johnson Foundation and the California HealthCare Foundation. The work reported in this manuscript was presented at the Academy Health Annual Research Meeting. June 28, 2009. Chicago, Illinois.

Conflict of Interest

None disclosed.


  1. 1.
    World Health Organization. Preventing Chronic Diseases: A Vital Investment: World Health Organization; 2005.Google Scholar
  2. 2.
    Bodenheimer T, Chen E, Bennett H. Confronting the growing burden of chronic disease: can the U.S. Health Care Workforce do the job? Health Aff. 2009;28(1):64–74.CrossRefGoogle Scholar
  3. 3.
    Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness: the chronic care model, Part 2. JAMA. 2002;288(15):1909–14.CrossRefPubMedGoogle Scholar
  4. 4.
    Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness. JAMA. 2002;288(14):1775–9.CrossRefPubMedGoogle Scholar
  5. 5.
    Coleman K, Austin B, Brach C, Wagner EH. Evidence on the chronic care model in the new millennium. Health Aff. 2009;28(1):75–85.CrossRefGoogle Scholar
  6. 6.
    Council on Graduate Medical Education. Physician Workforce Policy Guildelines for the United States, 2000–2020. Rockville, MD: COGME2005.Google Scholar
  7. 7.
    Wagner E, Austin B, Von Korff M. Organizing care for chronic disease. Millbank Quarterly. 1996;(74):511–44.Google Scholar
  8. 8.
    McCulloch D, Price M, Hindmarsh M, Wagner E. Improvement in diabetes care using an integrated population-based approach in a primary care setting. Dis Manag. 2000;3:75–82.CrossRefGoogle Scholar
  9. 9.
    Stevens D, Bowen J, Johnson J, DM W, Provost L, Holman H, et al. A Multi-institutional quality improvement initiative to transform chronic illness care and education in resident continuity practices. J Gen Intern Med. 2010(XX:XX–XX).Google Scholar
  10. 10.
    Braithwaite J, Westbrook J, Ranmuthugala G, Cunningham F, Plumb J, Wiley J, et al. The development, design, testing, refinement, simulation, and application of an evaluation framework for communities of practice and social-professional networks. BMC Health Serv Res. 2009;9(162).Google Scholar
  11. 11.
    Wenger E, McDermott R, Synder W. Cultivating Communities of Practice. Boston: Harvard Business School Press; 2002.Google Scholar
  12. 12.
    Bowen J, Stevens D, Sixta C, Provost L, Johnson J, DM W, et al. Developing measures of educational change for collaborative teams implementing the chronic care model in teaching practice. J Gen Intern Med. 2010(XX:XX–XX).Google Scholar
  13. 13.
    Amabile T, Whitney D, Winstock J, Miller L, Fallang C. What Really Happens in Creative Projects: Event Sampling Through Electronic Data Collection. Cambridge: Harvard University; 1997.Google Scholar
  14. 14.
    Csikszentmihalyi M, Larson R. Validity and reliability of the experience-sampling method. J Nerv Mental Dis. 1987;175:526–36.CrossRefGoogle Scholar
  15. 15.
    Larson R, Csikszentmihalyi M. The experience sampling method. New Dir Methodol Soc Behav Sci. 1983;15:41–56.Google Scholar
  16. 16.
    Amabile T, Barsade S, Mueller J, Staw B. Affect and creativity at work. Adm Sci Q. 2005;50(3):367–403.CrossRefGoogle Scholar
  17. 17.
    Scientific Software Development Company G. ATLAS.ti. Berlin, Germany.Google Scholar
  18. 18.
    Boeije H. A purposeful approach to the constant comparative method in the analysis of qualitative interviews. Qual Quant. 2002(36):3392–40.Google Scholar
  19. 19.
    Strauss A, Corbin J. Basics of Qualitative Research. 2nd ed. Thousand Oaks: Sage Publications; 1998.Google Scholar
  20. 20.
    Institute for Healthcare Improvement. Assessment Scale for Collaboratives. Boston: Institute for Healthcare Improvement; 2004.Google Scholar
  21. 21.
    Schon D. The Reflective Practitioner: How Professionals Think in Action. USA: Basic Books, Inc; 1983.Google Scholar
  22. 22.
    Csikszentmihalyi M. Creativity: Flow and the Psychology of Discovery and Invention. New York: Harper-Collins; 1996.Google Scholar
  23. 23.
    Amabile T, Hadley C, Kramer S. Creativity under the gun. Harvard Business Review. 2002;80(8):52–61.PubMedGoogle Scholar
  24. 24.
    Bakke D. Joy at Work: A Revolutionary Approach to Fun on the Job. Seattle: PVG; 2005.Google Scholar

Copyright information

© Society of General Internal Medicine 2010

Authors and Affiliations

  • Julie K. Johnson
    • 1
  • Donna M. Woods
    • 2
  • David P. Stevens
    • 3
  • Judith L. Bowen
    • 4
  • Lloyd P. Provost
    • 5
  • Connie S. Sixta
    • 6
  • Ed H. Wagner
    • 7
  1. 1.Centre for Clinical Governance Research, Faculty of MedicineUniversity of New South WalesSydneyAustralia
  2. 2.Feinberg School of MedicineNorthwestern UniversityChicagoUSA
  3. 3.The Dartmouth Institute for Health Policy and Clinical PracticeHanoverUSA
  4. 4.Oregon Health & Science UniversityPortlandUSA
  5. 5.Associates in Process ImprovementAustinUSA
  6. 6.Sixta Consulting, Inc.HoustonUSA
  7. 7.MacColl Institute for Healthcare Innovation, Group Health Center for Health StudiesSeattleUSA

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