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Innovation in Ambulatory Care: A Collaborative Approach to Redesigning the Health Care Workplace

Johnson, Paula A. MD, MPH; Bookman, Ann PhD; Bailyn, Lotte PhD; Harrington, Mona PhD, JD; Orton, Piper MBA

doi: 10.1097/ACM.0b013e318204618e
Health Care Innovations

Purpose: To improve the quality of patient care and work satisfaction of the physicians and staff at an ambulatory practice that had recently started an innovative model of clinical care for women.

Method: The authors used an inclusive process, collaborative interactive action research, to engage all physicians and staff members in assessing and redesigning their work environment. Based on key barriers to working effectively and integrating work and family identified in that process, a pilot project with new work practices and structures was developed, implemented, and evaluated.

Results: The work redesign process established cross-occupational care teams in specific clinical areas. Members of the teams built skills in assessing clinical operations in their practice areas, developed new levels of collaboration, and constructed new models of distributed leadership. The majority of participants reported an improvement in how their area functioned. Integrating work and family/personal life—particularly practices around flexible work arrangements—became an issue for team discussion and solutions, not a matter of individual accommodation by managers.

Conclusions: By engaging the workforce, collaborative interactive action research can help achieve lasting change in the health care workplace and increase physicians' and staff members' work satisfaction. This “dual agenda” may be best achieved through a collaborative process where cross-occupational teams are responsible for workflow and outcomes and where the needs of patients and providers are integrated.

Dr. Johnson is executive director, Connors Center for Women's Health and Gender Biology, and chief, Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, and associate professor of medicine, Harvard Medical School, Boston, Massachusetts.

Dr. Bookman was executive director, MIT Workplace Center, Massachusetts Institute of Technology (2001–2008), Cambridge, Massachusetts, and is a visiting scholar, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts.

Dr. Bailyn was codirector, MIT Workplace Center, and is professor of management, Sloan School of Management, Massachusetts Institute of Technology, Cambridge, Massachusetts.

Dr. Harrington was program director, MIT Workplace Center, Massachusetts Institute of Technology (2001–2008), Cambridge, Massachusetts, and has returned to research and writing.

Ms. Orton is director of programs, Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, Massachusetts.

Correspondence should be addressed to Dr. Johnson, Brigham and Women's Hospital, 75 Francis Street, PB5, Boston, MA 02115; telephone: (617) 732-8985; fax: (617) 264-5191; e-mail:

First published online December 16, 2010.

© 2011 Association of American Medical Colleges