TY - JOUR
AU - C. Bragdon
AU - R. Siden
AU - M. Winget
AU - S. R. Harris
AU - R. Carey
AU - J. Ko
AU - A. Vyas
AU - C. Brown-Johnson
A1 - 
AB - INTRODUCTION: Stanford Medicine is working to better coordinate care across the Stanford healthcare system, as well as improve patient and provider experiences in seeking and receiving care. This study aimed to explore the complexities of moving from a fragmented to an integrated academic healthcare system and to identify and explain factors (e.g., facilitators and barriers) of the implementation of three interventions meant to improve patient experience, reduce staff burden, and integrate health care systems across faculty and community settings. METHODS: We conducted qualitative semi-structured interviews via Zoom with faculty and community physicians. Interviews were audio-recorded, professionally transcribed, and analyzed using the Consolidated Framework for Implementation Research (CFIR) and open coding. Using consensus coding approaches, researchers met regularly to discuss themes and adaptations to CFIR. RESULTS: We analyzed transcripts from interviews with physicians (n = 26). Factors impacting integration included the following: (1) physicians supported the interventions, promoting mission alignment; (2) physicians were motivated for change, reporting the existing system was intolerable; (3) physicians reported different priorities between clinics: faculty versus community and primary care versus specialty; (4) physicians prioritized interpersonal versus system solutions; (5) specialists were wary of unintended consequences of integration, specifically inappropriate bookings or patients being redirected to other clinics. Broadly speaking, facilitator factors 1-2 focused on the openness to, and tension for, change; and barrier factors 3-5 promoted or sustained variation across specialties and faculty/community clinics. CONCLUSIONS: Our results illustrate the challenges and opportunities of moving from a fragmented to an integrated healthcare system and emphasize the importance of building shared culture, collaboration, and coordinated actions across and within an integrated healthcare network.
AD - Evaluation Sciences Unit, Department of Medicine Stanford University School of Medicine, Stanford University Palo Alto California USA.; School of Social Work University of Minnesota Saint Paul Minnesota USA.; Ambulatory Services, Stanford Medicine Children's Health Stanford Medicine Palo Alto California USA.; Office of Patient Experience Stanford Health Care Palo Alto California USA.; Department of Dermatology Stanford University School of Medicine, Stanford University Palo Alto California USA.
AN - 40677602
BT - Learn Health Syst
C5 - Education & Workforce
CP - 3
DA - Jul
DO - 10.1002/lrh2.10483
DP - NLM
ET - 20250115
IS - 3
JF - Learn Health Syst
LA - eng
N2 - INTRODUCTION: Stanford Medicine is working to better coordinate care across the Stanford healthcare system, as well as improve patient and provider experiences in seeking and receiving care. This study aimed to explore the complexities of moving from a fragmented to an integrated academic healthcare system and to identify and explain factors (e.g., facilitators and barriers) of the implementation of three interventions meant to improve patient experience, reduce staff burden, and integrate health care systems across faculty and community settings. METHODS: We conducted qualitative semi-structured interviews via Zoom with faculty and community physicians. Interviews were audio-recorded, professionally transcribed, and analyzed using the Consolidated Framework for Implementation Research (CFIR) and open coding. Using consensus coding approaches, researchers met regularly to discuss themes and adaptations to CFIR. RESULTS: We analyzed transcripts from interviews with physicians (n = 26). Factors impacting integration included the following: (1) physicians supported the interventions, promoting mission alignment; (2) physicians were motivated for change, reporting the existing system was intolerable; (3) physicians reported different priorities between clinics: faculty versus community and primary care versus specialty; (4) physicians prioritized interpersonal versus system solutions; (5) specialists were wary of unintended consequences of integration, specifically inappropriate bookings or patients being redirected to other clinics. Broadly speaking, facilitator factors 1-2 focused on the openness to, and tension for, change; and barrier factors 3-5 promoted or sustained variation across specialties and faculty/community clinics. CONCLUSIONS: Our results illustrate the challenges and opportunities of moving from a fragmented to an integrated healthcare system and emphasize the importance of building shared culture, collaboration, and coordinated actions across and within an integrated healthcare network.
PY - 2025
SN - 2379-6146
SP - e10483
ST - Exploring implementation of interventions to facilitate integration in fragmented healthcare systems
T1 - Exploring implementation of interventions to facilitate integration in fragmented healthcare systems
T2 - Learn Health Syst
TI - Exploring implementation of interventions to facilitate integration in fragmented healthcare systems
U1 - Education & Workforce
U3 - 10.1002/lrh2.10483
VL - 9
VO - 2379-6146
Y1 - 2025
ER -