Culture eats implementation for lunch: chronic care model

Stakeholders included a large university-based health system, nine individual practices, and a large electronic health record vendor. A high-tech model with patient, provider, and care manager dashboards was proposed to give relevant actionable information at the point and time of care or care planning for each team member. The Consolidated Framework for Implementation Research was used in the analysis of survey and focus group results. The tool was implemented and continually refined with the nurses’ feedback to meet their clinical needs. The clinical communications tool provides a means of documenting compliance with the patient care objectives for which the nurses were accountable and were given incentives to accomplish. The clinical tool was fully adopted by the nurses. Physicians are incredibly busy, and asking them to do additional tasks without understanding their purpose, or the new care management paradigm central to the understanding of patient and population dashboards was doomed from the start.