William L Miller's research while affiliated with Lehigh Valley Health Network and other places
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Publications (101)
Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine, as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In ‘XII: Family medicine and the future of the healthcare system’, a...
Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine, as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In ‘VI: ways of being—in the office with patients’, authors address...
Population health in the United States continues to lag behind other wealthy nations. Primary care has the promise of enhancing population health; however, the implementation of a population health approach within primary care deserves further consideration. Clinicians and staff from a national sample of 10 innovative primary care practices partici...
Background The COVID-19 pandemic challenged health care delivery globally, providing unique challenges to primary care. Australia’s primary healthcare system (primarily general practices) was integral to the response. COVID-19 tested the ability of primary health care to respond to the greater urgency and magnitude than previous pandemics. Early re...
![The overall design of the IMPACT program. Adapted from Russell et al. [8]](publication/374417290/figure/fig1/AS:11431281205477454@1700279340882/The-overall-design-of-the-IMPACT-program-Adapted-from-Russell-et-al-8_Q320.jpg)
Background
Innovative Models Promoting Access to Care Transformation (IMPACT) was a five-year (2013–2018), Canadian-Australian research program that aimed to use a community-based partnership approach to transform primary health care (PHC) organizational structures to improve access to appropriate care for vulnerable populations. Local Innovation P...
Policy Points
Systems based on primary care have better population health, health equity, and health care quality, and lower health care expenditure.
Primary care can be a boundary‐spanning force to integrate and personalize the many factors from which population health emerges.
Equitably advancing population health requires understanding and suppo...
Objectives
The rapid onset and progressive course of the COVID-19 pandemic challenged primary care practices to generate rapid solutions to unique circumstances, creating a natural experiment of effectiveness, resilience, financial stability and governance across primary care models. We aimed to characterise how practices in Melbourne, Australia mo...
Introduction:
To examine the association of prior investment on the effectiveness of organizations delivering large-scale external support to improve primary care.
Methods:
Mixed-methods study of 7 EvidenceNOW grantees (henceforth, Cooperatives) and their recruited practices (n = 1720). Independent Variable: Cooperatives's experience level prior...
Introduction:
To examine the association of prior investment on the effectiveness of organizations delivering large-scale external support to improve primary care.
Methods:
Mixed-methods study of 7 EvidenceNOW grantees (henceforth, Cooperatives) and their recruited practices (n = 1720). Independent Variable: Cooperatives's experience level prior...
A new graduate medical education program in family medicine is urgently needed now. We propose an innovative plan to develop community-based, community-owned family medicine residency programs. The plan is founded on five guiding principles in which residencies will (1) transition to independent, community-owned organizations; (2) sustain comprehen...
Rationale, aims and objectives
Generalists manage a broad range of biomedical and biographical knowledge as part of each clinical encounter, often in multiple encounters over time. The sophistication of this broad integrative work is often misunderstood by those schooled in reductionist or constructivist approaches to evidence. There is a need to d...
Introduction
The COVID-19 pandemic has transformed healthcare systems worldwide. Primary care providers have been at the forefront of the pandemic response and have needed to rapidly adjust processes and routines around service delivery. The pandemic provides a unique opportunity to understand how general practices prepare for and respond to public...
The sometimes-paradoxical emergent behavior of complex systems may be explained by the interaction of simple rules. The paradox of primary care-that systems based on primary care have healthier populations, fewer health inequities, lower health care expenditures, and better system-level evidence-based disease care, despite less evidence-based care...
Purpose:
We undertook a study to identify conditions and operational changes linked to improvements in smoking and blood pressure (BP) outcomes in primary care.
Methods:
We purposively sampled and interviewed practice staff (eg, office managers, clinicians) from a subset of 104 practices participating in EvidenceNOW-a multisite cardiovascular di...
Multilevel perspectives across communities, medical systems and policy environments are needed, but few methods are available for health services researchers with limited resources. We developed a mixed methods health policy approach, the focused Rapid Assessment Process (fRAP), that is designed to uncover multilevel modifiable barriers and facilit...
Policy Points
• An onslaught of policies from the federal government, states, the insurance industry, and professional organizations continually requires primary care practices to make substantial changes; however, ineffective leadership at the practice level can impede the dissemination and scale‐up of these policies.
• The inability of primary c...
PURPOSE Despite a burgeoning population of cancer survivors and pending shortages of oncology services, clear definitions and systematic approaches for engaging primary care in cancer survivorship are lacking. We sought to understand how primary care clinicians perceive their role in delivering care to cancer survivors.
METHODS We conducted digita...
Background:
Management of care transitions from primary care into and out of oncology is critical for optimal care of cancer patients and cancer survivors. There is limited understanding of existing primary care-oncology relationships within the context of the changing health care environment.
Methods:
Through a comparative case study of 14 inno...
Observers of the past 10 to 15 years have witnessed the simultaneous growth of dramatic changes in the practice of primary care and the emergence of a new field of dissemination and implementation science (D&I). Most current implementation science research in primary care assumes practices are not meeting externally derived standards and need exter...
Purpose:
We assessed differences in structural characteristics, quality improvement processes, and cardiovascular preventive care by ownership type among 989 small to medium primary care practices.
Methods:
This cross-sectional analysis used electronic health record and survey data collected between September 2015 and April 2017 as part of an ev...
80
Background: Improvements in the management of care transitions between primary care and oncology are critical for achieving optimal care quality and outcomes for cancer patients and survivors. We examine relationships between innovative PC practices and oncologists to inform and strengthen PC-oncology interfaces in diverse healthcare settings. M...
Background
Burnout among primary care physicians, advanced practice clinicians (nurse practitioners and physician assistants [APCs]), and staff is common and associated with negative consequences for patient care, but the association of burnout with characteristics of primary care practices is unknown.
Objective
To examine the association between...
Objective:
To learn from the experiences of innovative primary care practices that have successfully developed care teams.
Research design:
A 2½-day working conference was convened with representatives from 10 innovative primary care practices, content experts, and researchers to discuss experiences of developing care teams. Qualitative data inc...
Purpose:
Improving primary care quality is a national priority, but little is known about the extent to which small to medium-size practices use quality improvement (QI) strategies to improve care. We examined variations in use of QI strategies among 1,181 small to medium-size primary care practices engaged in a national initiative spanning 12 US...
Health care extension is an approach to providing external support to primary care practices with the aim of diffusing innovation. EvidenceNOW was launched to rapidly disseminate and implement evidence-based guidelines for cardiovascular preventive care in the primary care setting. Seven regional grantee cooperatives provided the foundational eleme...
Background:
Most Western nations have sought primary care (PC) reform due to the rising costs of health care and the need to manage long-term health conditions. A common reform-the introduction of inter-professional teams into traditional PC settings-has been difficult to implement despite financial investment and enthusiasm.
Objective:
To synth...
Background:
Meta-analysis and meta-synthesis have been developed to synthesize results across published studies; however, they are still largely grounded in what is already published, missing the tacit 'between the lines' knowledge generated during many research projects that are not intrinsic to the main objectives of studies.
Objective:
To dev...
Importance: Despite a decade of effort by national stakeholders to bring cancer survivorship to the forefront of primary care, there is little evidence to suggest that primary care has begun to integrate comprehensive services to manage the care of long-term cancer survivors.
Objective: To explain why primary care has not begun to integrate compre...
Introduction:
Patient-centered medical homes (PCHMs) aspire to transform today's challenged primary care services. However, it is unclear which PCMH characteristics produce specific outcomes of interest for care delivery. This study tested a novel typology of PCMH practice transformation, the PCMH framing typology, and evaluated measurable outcome...
Family physicians hunger in a time of excess. This article reviews the importance of healing relationships in the craft of family medicine and several of the forces that have undermined the ability to achieve effective healing relationships. Several directions forward are recommended and a promise shared.
Background
The Agency for Healthcare Research and Quality (AHRQ) launched the EvidenceNOW Initiative to rapidly disseminate and implement evidence-based cardiovascular disease (CVD) preventive care in smaller primary care practices. AHRQ funded eight grantees (seven regional Cooperatives and one independent national evaluation) to participate in Ev...
Background:
Culture is transmitted through language and reflects a group's values, yet much of the current language used to describe the new patient-centered medical home (PCMH) is a carryover from the traditional, physician-centric model of care. This language creates a subtle yet powerful force that can perpetuate the status quo, despite transfo...
Context
A key aim of reforms to primary health care (PHC) in many countries has been to enhance interprofessional teamwork. However, the impact of these changes on practitioners has not been well understood.
Objective
To assess the impact of reform policies and interventions that have aimed to create or enhance teamwork on professional communicati...
Person-centered care is a burgeoning social movement and a mission statement for modern healthcare. However, it is not a new idea. Often called the father of modern medicine, William Osler said, “The good physician treats the disease; the great physician treats the patient who has the disease.”1 Social movements typically begin with common issues b...
In healthcare change interventions, on-the-ground learning about the implementation process is often lost because of a primary focus on outcome improvements. This paper describes the Learning Evaluation, a methodological approach that blends quality improvement and implementation research methods to study healthcare innovations.
Learning Evaluation...
Objective:
To test a conceptual model of relationships, reflection, sensemaking, and learning in primary care practices transitioning to patient-centered medical homes (PCMH).
Data sources/study setting:
Primary data were collected as part of the American Academy of Family Physicians' National Demonstration Project of the PCMH.
Study design:
W...
Purpose:
To provide empirical evidence on key organizing constructs shaping practical, real-world integration of behavior health and primary care to comprehensively address patients' medical, emotional, and behavioral health needs.
Methods:
In a comparative case study using an immersion-crystallization approach, a multidisciplinary team analyzed...
Purpose:
This study sought to describe features of the physical space in which practices integrating primary care and behavioral health care work and to identify the arrangements that enable integration of care.
Methods:
We conducted an observational study of 19 diverse practices located across the United States. Practice-level data included fie...
Purpose:
To identify how organizations prepare clinicians to work together to integrate behavioral health and primary care.
Methods:
Observational cross-case comparison study of 19 U.S. practices, 11 participating in Advancing Care Together, and 8 from the Integration Workforce Study. Practices varied in size, ownership, geographic location, and...
The Patient-Centered Medical Home (PCMH) is proposed as a vehicle to deliver primary health care to older adults. The PCMH has the ability to improve the quality of care and reduce unnecessary expenditures while fostering functional independence and improving quality of life. Steps to develop a PCMH for older adults include clarity of purpose, team...
The application of complexity science to understanding healthcare system improvement highlights the need to consider interdependencies within the system. One important aspect of the interdependencies in healthcare delivery systems is how individuals relate to each other. However, results from our observational and interventional studies focusing on...
Background:
Current research on primary care practice redesign suggests that outside facilitation can be an important source of support for achieving substantial change.
Objectives:
To analyse the specific sequence of strategies used by a successful practice facilitator during the American Academy of Family Physicians' (AAFP) National Demonstrat...
Disruption, uncertainty, fear, promise, change, frustration, and energy all bundle together uncomfortably in our current unstable and unpredictable climate of health care reform and turbulence. The troubled landscape of family medicine and primary care offers stark evidence of this, and the patient-centered medical home (PCMH) represents an excitin...
Metrics focus attention on what is important. Balanced metrics of primary health care inform purpose and aspiration as well as performance. Purpose in primary health care is about improving the health of people and populations in their community contexts. It is informed by metrics that include long-term, meaning- and relationship-focused perspectiv...
Innovative workforce models are being developed and implemented to meet the changing demands of primary care. A literature review was conducted to construct a typology of workforce models used by primary care practices.
Ovid Medline, CINAHL, and PsycInfo were used to identify published descriptions of the primary care workforce that deviated from w...
Serious shortcomings remain in clinical care in the United States despite widespread use of improvement strategies for enhancing clinical performance based on knowledge transfer approaches. Recent calls to transform primary care practice to a patient-centered medical home present even greater challenges and require more effective approaches.
Our re...
Incorporating quality improvement (QI) into resident education and clinical care is challenging. This report explores key characteristics shaping the relative success or failure of QI efforts in seven primary care practices serving as family medicine residency training sites.
The authors used data from the 2002-2008 Using Learning Teams for Reflect...
Many commentators view the conversion of small, independent primary care practices into patient-centered medical homes as a vital step in creating a better-performing health care system. The country's first national medical home demonstration, which ran from June 1, 2006, to May 31, 2008, and involved thirty-six practices, showed that this transfor...
The renewal of primary care waits just ahead. The patient-centered medical home (PCMH) movement and a refreshing breeze of collaboration signal its arrival with demonstration projects and pilots appearing across the country. An early message from this work suggests that the development of collaborative, cross-disciplinary teams may be essential for...
The patient-centered medical home (PCMH) has become a widely cited solution to the deficiencies in primary care delivery in the United States. To achieve the magnitude of change being called for in primary care, quality improvement interventions must focus on whole-system redesign, and not just isolated parts of medical practices.
Investigators par...
The Using Learning Teams for Reflective Adaptation (ULTRA) study used facilitated reflective adaptive process (RAP) teams to enhance communication and decision making in hopes of improving adherence to multiple clinical guidelines; however, the study failed to show significant clinical improvements. The purpose of this study was to examine qualitat...
Numerous primary care practice development efforts, many related to the patient-centered medical home (PCMH), are emerging across the United States with few guides available to inform them. This article presents a relationship-centered practice development approach to understand practice and to aid in fostering practice development to advance key a...
This article introduces a journal supplement evaluating the country's first national demonstration of the patient-centered medical home (PCMH) concept. The PCMH is touted by some as a linchpin for renewing the foundering US health care system and its primary care foundation. The National Demonstration Project (NDP) tested a new model of care and co...
We provide an overall description of the National Demonstration Project (NDP) intervention to transform family practices into patient-centered medical homes.
An independent evaluation team used multiple data sources and methods to describe the design and implementation of the NDP. These included direct observation of the implementation team and pro...
The objective of this study was to elucidate the effect of facilitation on practice outcomes in the 2-year patient-centered medical home (PCMH) National Demonstration Project (NDP) intervention, and to describe practices' experience in implementing different components of the NDP model of the PCMH.
Thirty-six family practices were randomized to a f...
We describe the experience of practices in transitioning toward patient-centered medical homes (PCMHs) in the National Demonstration Project (NDP).
The NDP was launched in June 2006 as the first national test of a model of the PCMH in a diverse sample of 36 family practices, randomized to facilitated and self-directed intervention groups. An indepe...
This article summarizes findings from the National Demonstration Project (NDP) and makes recommendations for policy makers and those implementing patient-centered medical homes (PCMHs) based on these findings and an understanding of diverse efforts to transform primary care. The NDP was launched in June 2006 as the first national test of a particul...
Understanding the transformation of primary care practices to patient-centered medical homes (PCMHs) requires making sense of the change process, multilevel outcomes, and context. We describe the methods used to evaluate the country's first national demonstration project of the PCMH concept, with an emphasis on the quantitative measures and lessons...
The purpose of this study was to evaluate patient outcomes in the National Demonstration Project (NDP) of practices' transition to patient-centered medical homes (PCMHs).
In 2006, a total of 36 family practices were randomized to facilitated or self-directed intervention groups. Progress toward the PCMH was measured by independent assessments of ho...
The patient-centered medical home (PCMH) is four things: 1) the fundamental tenets of primary care: first contact access, comprehensiveness, integration/coordination, and relationships involving sustained partnership; 2) new ways of organizing practice; 3) development of practices’ internal capabilities, and 4) related health care system and reimbu...
Around the world, growing pressures are raising apprehension about the sustainability of the health care enterprise. These pressures include aging populations; increasing illness and multimorbidity mediated by behavioral, social, and environmental factors; and glaring and subtle inequities. These factors and advancing technologies are increasing th...
Understanding the role of relationships health care organizations (HCOs) offers opportunities for shaping health care delivery. When quality is treated as a property arising from the relationships within HCOs, then different contributors of quality can be investigated and more effective strategies for improvement can be developed.
Data were drawn f...
Building strong relationships among physicians and staff improves the practice's ability to deal with the uncertainties of a rapidly changing environment. Interacting proactively with the economic, social, political, and cultural environment-the practice landscape-provides opportunities for adaptation and ongoing learning.
The dominant unspoken philosophical basis of medical care in the United States is a form of Cartesian reductionism that views the body as a machine and medical professionals as technicians whose job is to repair that machine. The purpose of this paper is to advocate for an alternative philosophy of medicine based on the concept of healing relations...
Brainstorming helped identify recurrent problemsAs the RAP meetings progressed, it became clear that despite the close quarters, each part of the practice was isolated from the others and all team members were frustrated by their inability to influence the lead physician, Dr. Cope. Over time, the RAP meetings changed the relationship patterns and t...
The patient-centered medical home (PCMH) is emerging as a potential catalyst for multiple health care reform efforts. Demonstration projects are beginning in nearly every state, with a broad base of support from employers, insurers, state and federal agencies, and professional organizations. A sense of urgency to show the feasibility of the PCMH, a...
Those attempting to implement changes in health care settings often find that intervention efforts do not progress as expected. Unexpected outcomes are often attributed to variation and/or error in implementation processes. We argue that some unanticipated variation in intervention outcomes arises because unexpected conversations emerge during inte...
Clinicians often have an intuitive understanding of how their relationships with patients foster healing. Yet we know little empirically about the experience of healing and how it occurs between clinicians and patients. Our purpose was to create a model that identifies how healing relationships are developed and maintained.
Primary care clinicians...
In the context of the current health care payer system, quality of care standards, financial incentives and consumer choice are not well aligned, yet competition for increased admissions has become a matter of survival. Satisfaction and loyalty are two constructs that are the most meaningful measures in the context of sustaining and increasing admi...
This study aimed to elucidate how clinical preventive services are delivered in family practices and how this information might inform improvement efforts.
We used a comparative case study design to observe clinical preventive service delivery in 18 purposefully selected Midwestern family medicine offices from 1997 to 1999. Medical records, observa...
Quality improvement processes have sometimes met with limited success in small, independent primary care settings. The theoretical framework for these processes uses an implied understanding of organizations as predictable with potentially controllable components. However, most organizations are not accurately described using this framework. Comple...
At this second anniversary of the Annals of Family Medicine, we sought to characterize primary care research and to identify opportunities for new directions by analyzing the content of the first and second volumes of the Annals.
Using an a priori classification scheme, 2 editors independently categorized each research article and essay published i...
Healing can be both an intensely personal and a social and community event that often surprises us when it emerges from the landscape of everyday life. This observation raises at least three questions that serve as the focus for this paper's reflections about creating optimal healing places. Who are patients? What relationships and features of thos...
Learning and teaching the complex craft of relationship-centered care in the context of the competing demands of clinical family medicine can be challenging. The "Clinical Hand" is an educational aid, which serves as a curricular map specifying what content and skills are important for relationship centered care. The Clinical Hand illuminates seven...
Faced with a rapidly changing healthcare environment, primary care practices often have to change how they practice medicine. Yet change is difficult, and the process by which practice improvement can be understood and facilitated has not been well elucidated. Therefore, we developed a model of practice change using data from a quality improvement...
A call for reform has occurred across medical disciplines to counteract the isolation and overemphasis on cognitive competency that characterizes residency education. This article describes an experiment in creating an alternative residency culture-one that encourages self-reflection, a sense of belonging, and positive identity-to support the resid...
This paper charts a course for assessing the impact of healing relationships in clinical medicine. The system of healing relationships is multidimensional, longitudinal, contextual, and emergent. In a new conceptual model, healing relationships are identified in terms of the conditions of healing intention, motivation, and information transfer, and...
Comments on the articles by R. M. Epstein (see records
2003-02684-001 and
2003-02684-002) that discuss mindfulness and mindful practice in medicine. The commentators add their thoughts to this discussion and highlight the different ways that they can apply Epstein's ideas. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
During the past decade, many hospitals experienced difficulty integrating primary care practices into their health systems. We hypothesized that this difficulty may be, in part, a result of limited understanding of practice organizational designs. The structure and function of practices have not been well studied. In this article, we answer the fol...
During the past decade, many hospitals experienced difficulty integrating primary care practices into their health systems. We hypothesized that this difficulty may be in part, a result of limited understanding of practice organizational designs. The structure and function of practices have not been well studied. In this article, we answer the foll...
Style of physician-patient interaction has been shown to have an impact on patient outcomes. Although many different interaction styles have been proposed, few have been empirically tested. This study was conducted to empirically derive physician interaction styles and to explore the association of style with patient reports of specific attributes...
Comments on the article by J. Borkan, S. Reis, and J. Medalie (see record
2008-06034-001) which advocated for a narrative approach in family medicine. Borkan and colleagues presented a refreshing and practical approach for healing and living and the assessment of quality of care. Examine your own life. It is quickly apparent that reason is not the...
Foreword - Larry Culpepper Introduction - William L Miller and Benjamin F Crabtree PART ONE: OVERVIEW OF QUALITATIVE RESEARCH METHODS Primary Care Research - William L Miller and Benjamin F Crabtree A Multimethod Typology and Qualitative Roadmap PART TWO: DISCOVERY: DATA COLLECTION STRATEGIES Sampling in Qualitative Inquiry - Anton J Kuzel Particip...
presents a road map of research methods to facilitate the development of a multimethod approach to [primary care research] / five styles of inquiry are identified and described / research aims and analysis objectives are then matched with these styles / the research styles are also connected with three different paradigms / this information is used...
Reviews the book,
Basics of qualitative research by Anselm Strauss and Juliet Corbin (see record
1990-98829-000). In this book, Strauss and Corbin detail only one approach to analyzing qualitative data. Their approach is specifically designed to build social and social psychological theory--thus the name grounded theory. One of the major goals of...
listening, along with seeing and touching, is one of the primary sources of information about the world / as a data collection tool, the interview represents an attempt to "standardize" listening in the interest of scientific knowing / details the Long Interview as an example of a semistructured in-depth interview approach to collecting data in pri...
qualitative research [in primary care] is examined from three different perspectives / Stephen Zyzanski looks at qualitative research through the eyes of family systems theory, psychometrics, and the dominant research paradigm / Ian McWhinney shares his perspective as a family physician, academic leader, and visionary / Robert Blake reveals his per...
Citations
... This is a considerable challenge, but the importance and impact of family medicine fully justifies this effort. [13][14][15][16][17][18] From the Subdivision of Family Medicine and Atención Familiar, we call on all actors related to this crucial medical discipline to join efforts so that more family physicians and related personnel can learn about and join the snii, to promote research, and development of new medical practices. Collaboration between educational, health, and governmental institutions, and associations is crucial to achieve this objective. ...
... It has been previously reported that the Mexican flu and Ebola and dengue epidemics contained chaotic patterns (Speakman and Sharpley 2012;Mangiarotti et al. 2016;Agusto and Khan 2018). Additionally, it is also possible to see new studies in the literature supporting that the Covid-19 pandemic has chaotic spreading dynamics (Jones and Strigul 2021;Borah et al. 2022;Abbes et al. 2023;Russell et al. 2023;Mashuri et al. 2023;Wang et al. 2023;Debbouche et al. 2022;Sapkota et al. 2021;Gonçalves 2022). ...
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... We believe that a national primary care extension program could play a vital role in humanizing primary care for providers and recipients of care. 40 Looking ahead, we see an expanded role for a primary care extension service in supporting primary care as a common good, further building the pathway to high-quality primary care and improved health equity, as described in the 2021 NASEM report. 2 This would entail helping practices and their community partners further understand the perspectives, priorities, and needs of their patients and communities, and respond to those needs by improving or adding appropriate services (for example, behavioral health and social care services). 41 Support of this type could also enhance the well-being of primary care clinicians and staff, by linking practice improvement more directly to what matters to them-providing high-quality care that helps patients live longer, healthier lives. ...
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... 22), Tylicz (no. 23), and Zielonki Parcele (no. 24), representing villages. ...
... Facilitation in healthcare settings (also referred to as practice facilitation or implementation facilitation, and henceforth referred to as healthcare facilitation) is an implementation strategy [1,2] that supports people in health services organizations develop the means to change the structure and processes within settings to help reduce the gap between evidence and practice [3][4][5][6][7]. Healthcare facilitation has been described as a cyclical, dynamic learning process in which facilitators apply diverse strategies through interactive problem-solving in a supportive relationship among healthcare employees that may lead to performance improvement [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. ...
... 3,8 Unlike other specialties, family medicine residency training primarily occurs in community-based programs. 9 Community-based programs have less infrastructural and support staff to train family medicine residents, requiring core faculty to perform additional administrative duties. 10 We sought to describe the allocation, disbursement, and use of nonclinical administrative FTE for family medicine residency core faculty at academic-based and communitybased residency programs, as well as perceived barriers to allocation of nonclinical FTE. ...
... [36] Valueinformed 'integrative wisdom' , a defining feature of generalist care, is likely to be helpful in addressing this space through its tolerance of uncertainty, awareness of complexity and ability to integrate dynamic and diverse forms of knowledge to inform practice. [37]. ...
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... Therefore, a balanced number of specialists and generalists is crucial. Generalists complement a health care system by dealing with a wide range of health problems, the capacity to prioritize, and providing person-centered care 6 . ...
... The multiple case study approach allows a detailed, intensive exploration of individuals and organisations in context (Patton 2002), and the prospective structure allowed assessment of changes over time. Our methodology is detailed elsewhere (Russell et al. 2021). This secondary analysis investigating the role of practice leadership in the pandemic was informed by Crabtree et al.'s leadership model (Crabtree et al. 2020), which we saw as a valuable lens for data analysis, given its identification of leadership characteristics promoting change. ...
... However, small-size clinics do not necessarily demonstrate a poor outcome. The Evidence NOW Initiative to promote evidencebased cardiovascular disease in Primary Care found that small-size and clinician-owned practices contributed to better blood pressure outcomes and tobacco cessation in primary care clinics [31]. It is suggested that if the clinician considers and tailors operational expectations to the practice setting, they can rapidly reach meaningful improvement. ...
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