Diffusion of a collaborative care model in primary care: a longitudinal qualitative study
1 Solidage, McGill University - Université de Montréal Research Group on Frailty and Aging - Lady Davis Institute, Jewish General Hospital, H466, 3755, Ch. Côte Ste Catherine, Montreal, Québec H3T 1E2, Canada
2 Santé Vieillissement research group, Versailles St Quentin University, 49 rue Mirabeau, Paris, 75016, France
3 Management Institute, Ecole des Hautes Etudes en Santé Publique, Avenue du Professeur Léon-Bernard - CS 74312, Rennes cedex, 35043, France
4 Department of Family Medicine, McGill University, 515-517 av. des Pins Ouest, Montreal, Quebec, H2W 1S4, Canada
5 Desautels Faculty of Management, McGill University, 1001 Sherbrooke St. West, Montreal, Quebec, H3A 1G5, Canada
BMC Family Practice 2013, 14:3 doi:10.1186/1471-2296-14-3Published: 4 January 2013
Although collaborative team models (CTM) improve care processes and health outcomes, their diffusion poses challenges related to difficulties in securing their adoption by primary care clinicians (PCPs). The objectives of this study are to understand: (1) how the perceived characteristics of a CTM influenced clinicians' decision to adopt -or not- the model; and (2) the model's diffusion process.
We conducted a longitudinal case study based on the Diffusion of Innovations Theory. First, diffusion curves were developed for all 175 PCPs and 59 nurses practicing in one borough of Paris. Second, semi-structured interviews were conducted with a representative sample of 40 PCPs and 15 nurses to better understand the implementation dynamics.
Diffusion curves showed that 3.5 years after the start of the implementation, 100% of nurses and over 80% of PCPs had adopted the CTM. The dynamics of the CTM's diffusion were different between the PCPs and the nurses. The slopes of the two curves are also distinctly different. Among the nurses, the critical mass of adopters was attained faster, since they adopted the CTM earlier and more quickly than the PCPs. Results of the semi-structured interviews showed that these differences in diffusion dynamics were mostly founded in differences between the PCPs' and the nurses' perceptions of the CTM's compatibility with norms, values and practices and its relative advantage (impact on patient management and work practices). Opinion leaders played a key role in the diffusion of the CTM among PCPs.
CTM diffusion is a social phenomenon that requires a major commitment by clinicians and a willingness to take risks; the role of opinion leaders is key. Paying attention to the notion of a critical mass of adopters is essential to developing implementation strategies that will accelerate the adoption process by clinicians.