ORIGINAL ARTICLE: PDF OnlyPrimary Care, Process Improvement, and TurmoilMagnan, Sanne MD, PhD; Solberg, Leif I. MD; Giles, Katherine MBA, BSN; Kottke, Thomas E. MD; Wheeler, John W. MDAuthor Information Associate Medical Director, Blue Plus, an affiliate of Blue Cross Blue Shield of Minnesota, St. Paul, Minnesota Clinical Director of Research, Group Health Foundation/HealthPartners, Minneapolis, Minnesota Project Coordinator, Group Health Foundation/HealthPartners, Minneapolis, Minnesota Professor of Medicine, Mayo Clinic and Foundation, Rochester, Minnesota Project Physician Liaison, Group Health Foundation/HealthPartners, Minneapolis, Minnesota Journal of Ambulatory Care Management: October 1997 - Volume 20 - Issue 4 - p 32-38 Buy Abstract The current health care environment in the United States is in turmoil, especially in regions that are further ahead in the transition from fee-for-service to managed care. This article examines turmoil within primary care during a health-maintenance-organization-sponsored and federally funded randomized trial of using continuous quality improvement for adult clinical preventive services. The external and internal changes in structure and leadership occurring in primary care clinics are profound and prevalent. The sponsors of the project have responded to the turmoil by encouraging greater leadership involvement within the clinic and by supporting more skill building for change management. © Williams & Wilkins 1997. All Rights Reserved.