Table 3.

Comparison of the Change Process Used for Implementing Different Models From the Perspective of the Organizational Experience of Change Implementation.

Dimension	Advanced Access	Chronic Care Model
Desired state description	Clear, simple, predefined, understandable, prescriptive— many examples of what others have done	Theoretical, complex, composite of pieces from various settings—no overall examples or models
Change benefits	Simplifies work of clinician, staff, and patient	Effects on stakeholders are as unclear as the model
Overall focus of the organization	Concentrated on this change effort	Diffused over multiple priorities
Leadership role	Main priority for that year with high visibility, and many dedicated resources	Many simultaneous changes and priorities, the largest being EMR implementation
Communication	Multiple avenues with frequent and specific messages and reports from and to leadership	Frequent from leadership, limited in explaining shifting strategies; few avenues for clinic team feedback to central leaders
Timeline	Clear endpoint in 1 year	Beginning of a long process without definite endpoints
External experts	Experienced with many other groups, knowledgeable about specifics, and available at local collaboratives, conference calls, and an ongoing listserv (medical group also provided expertise, eg, measurement, to experts)	Primarily theoretical consultants available only to leaders; no actionable blueprint of an implemented, functional CCM available
Pilots	Proved in 3 sites	Unclear process and results in 3 to 4 sites
Testimonials	Videos of newly converted skeptics	Individual comments at meetings
Measurement	A few simple, visible, repeated measures of problems and progress	Difficult to develop, varied, transient, with limited connection to process changes
Local change management	Specified local teams with clear tasks and responsibility to tailor implementation	Largely dependent on self-organizing abilities within clinics
Multiclinic collaborative learning sessions	Quarterly meetings of all clinics’ teams, with follow-up through listserv and conference calls	Three meetings of clinic teams to learn latest change in strategy
Learning session follow-up	Listserv and conference calls have profound and immediate results, related to concrete, specific content of changes	Listserv has limited impact, related to fuzzy content of changes
Local accountability	Monthly reports required and each clinic’s data and status public	Periodic oral or written reports—public measures available but have limited impact

EMR = electronic medical record; CCM = Chronic Care Model.