Descriptive

5.2.1. Dependent variables

Overall, HDC implementation effectiveness was rated as suboptimal: On average, middle managers rated community linkages and self-management support implementation as

moderate, but only five middle managers indicated that community linkages were fully implemented in their health centers, and only three middle managers indicated that self- management support was fully implemented in their health centers. The majority of middle managers (74 percent) rated delivery system design implementation in their health centers as poor-to-moderate, and only three middle managers rated it as fully implemented.

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Middle managers’ commitment to innovation implementation varied. On average, commitment to innovation implementation was moderate; however, less than 12 percent of middle managers “agreed” or “strongly agreed” that they regularly engaged in HDC implementation activities.

5.2.2. Independent variables

Overall, middle managers rated their access to IP&Ps as moderate-to-poor. For example, although half of middle managers in the sample reported that they received “a moderate amount,” “quite a bit” or “a great deal” of incentives related to HDC implementation, nearly a third of middle managers in the study sample indicated that they received “a little” or no incentives. And only a minority of middle managers (36 percent) “agreed” or “strongly agreed” that employee performance reviews addressed HDC performance; most middle managers either reported that they “neither agreed nor disagreed” or “disagreed” that employee performance reviews addressed their HDC-related performance. Nearly half of middle managers indicated that they received “a little” or “no” access to financial resources. Access to human resources was better than access to other IP&Ps: Only four middle

managers indicated that administrative human resources “refused to participate” or “grudgingly participated,” whereas more than half of middle managers reported that administrative human resources “support[ed] activities with words and actions” or were “actively involved and/or [got] people excited about participating in the collaborative.” Similarly, only two middle managers indicated that clinical human resources “refused to participate” or “grudgingly participated,” and more than half of middle managers reported that clinical human resources “support[ed] activities with words and actions” or were

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“actively involved and/or [got] people excited about participating in the collaborative.” Like access to human resources, access to training resources was better than access to most other IP&Ps: More than half of middle managers indicated that access to training in changing health center systems and encouraging providers to correctly use HDC tools was more than adequate; less than 12 percent of middle managers indicated that their access to training resources was inadequate or nonexistent. Local social network involvement was also limited: Most of middle managers’ health centers were comprised of just one facility, and middle managers’ health centers were comprised of 4 facilities on average; only 7 middle managers worked in health centers with 10 or more facilities. Top managers’ support for innovation implementation was lacking: Top managers’ support for an environment that encourages innovation implementation was moderate-to-poor in most middle managers’ health centers; just 10 percent of middle managers indicated that they received “a great deal” of support from top managers for an environment that encourages innovation implementation, and more than 40 percent received only “a little” or no support from top managers for an environment that encourages innovation implementation. On average, middle managers rated top

managers’ support in the form of technology as moderate; however, almost half of middle managers reported that they received only “a little” or no support from top managers in the form of technology.

5.2.3. Control variables Health center variables

At the time of the survey, more than three quarters of middle managers’ health centers had participated in the HDC for three or more years, and almost a quarter had participated

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since the beginning of the HDC in 1998. Middle managers’ health centers served as few as 500 unduplicated patients per year and as many as 58,000; on average, they saw 14,000 unduplicated patients per year. At the time of the survey, more than half of middle managers were the only middle manager who had served as team leader at their health center. A minority (16 percent) of middle managers had been preceded by three or more team leaders in their health center. Half (52 percent) of middle managers’ health centers were in rural locations.

Middle manager variables

Middle managers had worked at their health center for an average of 7 years. Almost a quarter of middle managers had worked at their health center for 10 or more years. At the time of the survey, middle managers had been the team leader in their health center for an average of 2.7 years at. Most (34 percent) middle managers were clinicians (such as social workers, diabetes educators, or registered nurses); 20 percent were providers (such as physicians, nurse practitioners or physician assistants); and 28 percent were administrators (such as community education coordinators or chronic care coordinators). Three middle managers reported that they were both clinicians and providers; eight reported that they were both providers and administrators; and 27 reported that they were both clinicians and

administrators.