Discussion
This review identified multiple barriers and facilitators
of implementing the CCM across various primary care
settings. The major emerging themes were those related
to the inner setting of the organization, the process of
implementation and characteristics of the individual
healthcare providers. These included: culture of the
organization, its structural characteristics, networks and
communication, implementation climate and readiness,
supportive leadership, and provider attitudes and beliefs.
Every primary care organization possesses its own cultural
norms, practices and leadership. It is impossible to
achieve change without adopting an approach that considers
the individual and the team of providers, the
organization setting and the greater system within which
it is embedded [54]. Wolfson and colleagues attributed
the success of QI in different primary care practices to
facilitators in various levels of the organization including:
presence of an initiative champion; physician, staff
and patient cooperation; leadership investment; team
practice and progress tracking [55]. The uptake of CCM
elements in the studies required a primary care culture
supporting willingness to change and quality improvement
at the individual clinician, team and organizational
levels. Implementation was most successful when there
was a shared vision and a recognized need across the
organization for new care change approaches to promote
effective execution of the CCM