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Practice Management Program
Primary Care Networks Program Management Office
Toward Optimized Practice

The Evolution of Change Agents Supporting PMH and HN Transformation in Alberta

For almost two decades there has been a growing commitment to transform Alberta’s primary health care system and to optimize its integration within the broader health neighbourhood. Transformation in Alberta began with a handful of clinics, dispersed across the province testing different ways of delivering care to their patients.  At the same time, international evidence continues to emerge demonstrating results that improving quality of care, patient outcomes, and patient satisfaction can be achieved via implementation of the Patient’s Medical Home.

In Alberta, there have been several successful implementation demonstrations of PMH elements, indicating that adoption of the PMH model is possible in our province. In addition, significant uptake of panel identification and preventative screening initiatives validates that spread and scale of PMH work is achievable. 

These successes are the result of clinical teams mobilizing to change the way they deliver care to their patients.  However, most of the improvements have not been organic, but the result of many change agents working tirelessly to promote and support a new way of delivering primary care.  These change agents can be found at all levels of the healthcare system and include:

  • Clinic level change agents such as clinic managers, clinical staff, and patients
  • The health transformation workforce level – practice facilitators and PMH physician champions supporting clinics to transform
  • Enablers of change such as PCN strategic leaders (e.g., PCN Board and Governance Committee members) and PCN staff (e.g., executive directors, PCN communications Personnel, evaluation personnel) typically positions who operate a step or two removed from the clinic level
  • System level supports, partner programs and organizations supporting the optimizations of health care delivery

The AMA Accelerating Change Transformation Team (ACTT), and its predecessor organizations[i], , have been supporting structures and roles for primary care reform efforts since 2003 including support to PCN boards, PCN business processes, and clinical process experts.  In 2018, Alberta Health Services (AHS) launched the Primary Health Care Integration Network (PHCIN), a Strategic Clinic Network focused on coordination of services across the health care system.  ACTT is actively partnering with the PHCIN with the focus on the integration of primary and community specialty services. 

As the complexity and scale of implementing PMH and the health neighbourhood increases, the need to organize and optimize supports has also increased. This Blueprint has been created to organize the supports, to identify gaps, and to enable ACTT to continue to optimize the supports.  Its structure was created to be applied to a variety of change agents supporting the implementation of the PMH in the health neighbourhood. 

[i] In 2016 the support programs of Practice Management Program, Toward Optimized Practice, and PCN Program Management Office began work together to better integrate the support and change services offered. These programs officially merged on November 1, 2018 and were renamed Accelerating Change Transformation Team or ACTT.

Diagram:  The Evolution of Change Agents Supporting Primary Care Transformation in Alberta:

The change agent role and its support is not a new concept in Alberta. Near the turn of the millennium small pockets of physician innovators began the work of changing how primary and community specialty care is delivered. Many were looking at new ways that they could approach care delivery in their practices, a few also worked with system partners to enhance care where it intersects with the broader health care system.  They looked at what other health care systems across the world were doing then adopted and adapted promising practices to fit their context.  It was these innovators who drove both the early quality improvement initiatives and set the vision for the new structures to drive change, including the development of the PCNs (Primary Care Networks).  In addition to the physician champions, over time, small numbers of other change agent roles evolved, such as the practice facilitator (PFF.  The PF role developed in organizations like Toward Optimized Practice (TOP), Alberta Health Service (AHS) and in PCNs to support community-based quality improvement (QI) initiatives such as Alberta AIM[1], Health Screen in Action[2], TRACII[3], and pcnACT[4].  The data collected from these projects demonstrated that the interventions were successful, however, the initiatives did not spread beyond a few innovators and early adopter practices, eluding impact at the system level. 

In 2013, Alberta Screening & Prevention (ASaP) initiative launched.  This initiative was purposefully designed to engage several hundred physicians across the province.  What set this initiative apart from previous ones (i.e., that had not gone to scale) was the strategic investment by PCNs in change agents, beginning with physician champions and practice facilitators.  Other roles supporting change at the practice level emerged as the initiative ramped up; the panel manager supporting panel identification, maintenance, and management; and the EMR specialist role, experts who support other change agents or the clinic directly with their EMR expertise for clinical care improvements.  Within the first two years, ASaP delivered on demonstrating impact at the provincial level, both in physician uptake and statistically significant improvements in screening rates. 

Through the same period as the ASaP initiative was in full swing, Alberta adopted the College of Family Physicians Canada (CFPC) A Vision for Canada:  Family Practice - The Patient's Medical Home as the provincial vision and adapted the Safety Net Medical Home Initiative Implementation Elements (2011) as the Alberta roadmap to achieve the vision.  (This document has since been updated:  A New Vision for Canada – Family Practice – The Patient's Medical Home 2019.)  The first goal set forth with this work was to support primary care physicians to work on panel processes. Once again change agents were central and engaged physicians and their teams in the work and to successfully scale the uptake of panel processes across the province to almost 70% in under four years. These change agents have been critical in the ability for practices to engage in other improvement initiatives such as Choosing Wisely Alberta and other PCN-level PMH initiatives. 

Guided by both the international evidence for change agents in primary care system transformation and the Alberta experience of reaching scale with improvement initiatives, supports for change agents were built to help change agents to connect, share, and learn from one another.  These supports include, but are not limited to: 

The change agent roles are continuing to evolve internationally and within Alberta.  Through this Blueprint, the AMA is organizing its plan to support change agents through their journey of helping clinics implement PMH and HN, as well as other PCN priorities as they arise. 


[1] Alberta AIM

[2] Health Screen in Action


[4] pcnACT