The effects of residency practice redesign on providers and staff.

BACKGROUND AND OBJECTIVES Practice redesign is one of the core principles of the Patient-centered Medical Home. Little is known about how such large-scale changes in a residency practice affect the providers and staff involved. METHODS Focus groups were conducted with residents, faculty, and medical support staff of a redesigned practice to determine the factors that contributed to the success of a practice redesign experiment. RESULTS Challenges included obtaining sufficient buy-in for the process, ineffective communication from practice leadership, and insufficient staff training. Facilitating factors included involving staff in developing solutions, enhanced responsibility, and team cohesion over time. Residents involved in the redesign effort felt that it enhanced their practice experience. CONCLUSIONS Practice redesign can be a challenging task for residency practices to complete successfully. Committed leadership and planning, with attention to the impact that such a change will have on those involved, can greatly impact the likelihood of success.