Capabilities and experience

The MacColl Center for Health Care Innovation ( drives health system change in four ways:

Conceptual work and model-building

Successful systems change begins with a strong conceptual framework grounded in scientific evidence and clinical experience. The MacColl Center’s most noteworthy product in this area has been the Chronic Care Model, developed in the mid-1990s through an evidence review of the chronic disease literature and MacColl’s experience with Group Health’s own quality improvement initiatives. The Chronic Care Model was born as an attempt to understand the necessary elements to support productive interactions between patients and health care providers. Over the next 15 years, it has become one of the most frequently used and adapted paradigms for understanding and improving ambulatory care nationally and internationally.

A more recent example of such conceptual work is the MacColl Center’s Framework for Creating a Regional Healthcare System, to be used for broad-based, geographically focused improvements to communities’ health care infrastructures. Funded by the California HealthCare Foundation, the MacColl team studied large, successful health systems and coalitions to distill common lessons relevant to the rest of American health care. The resulting framework served as an organizing model for the Robert Wood Johnson Foundation’s subsequent national effort, Aligning Forces for Quality.

Similar work is now underway with a program called Primary Care Team: Learning from Effective Ambulatory Practices (LEAP). Also funded by the Robert Wood Johnson Foundation, LEAP is studying high-functioning primary-care practices nationwide to identify the best workforce model innovations so they can be replicated and adopted widely.


Technical assistance

Whether the MacColl Center is working with a single-physician practice in rural Washington state or a complex system with hundreds of clinics nationwide, our staff understands that change can be both exhilarating and difficult. Two decades of experience, through programs such as Improving Chronic Illness Care and the Safety Net Medical Home Initiative, has shown that providing people with proven training models, resources, and tools can help their teams move confidently forward, knowing that changes underway will reliably benefit their organizations and the patients they serve.

We offer technical assistance with the development and implementation of a variety of training options, depending on the complexity of the changes needed and the size of the client organization.

One familiar example is the large-scale “collaborative”—a series of workshops where interdisciplinary teams rapidly design, test, and implement sustainable changes in workflow.

MacColl also has a longstanding interest in practice coaches—i.e., individuals who help and advise practices for a limited time to accomplish the myriad changes required for system transformation. The Commonwealth Fund currently funds MacColl to create a national curriculum to equip practice coaches to teach the principles of the patient-centered medical home.

Additional offerings range from traditional classroom-based training sessions to webinars and online toolkits, including coaching and implementation guides.

Programs may be geared to policy development, administrative leadership, or clinical care. Curricula may be designed to “train the trainer” for large-scale organizational reach, or to teach individual contributors new skills they’ll use in their own jobs.


Hypothesis-driven research and implementation science

Through our work designing, implementing, and evaluating changes in clinical practice, the MacColl Center staff contributes to hypothesis-driven research in health services and the burgeoning field of implementation science.

The MacColl Center bridges the gap between science and practice by helping to ensure that evidence-based practices validated in demonstration projects and pilot programs can be replicated and taken to scale. One current example is the MacColl Center’s involvement in evaluating Group Health’s patient-centered medical home pilot of primary care. After proving that the model improved care and reduced costs at one medical center, Group Health spread the model to all its 25 other medical centers. Evaluation of Group Health’s system-wide implementation can be used to learn what’s being done well and how to make it better.

See the MacColl Center publications page for examples of our ongoing contributions to peer-reviewed literature.


Education, training, and dissemination

The MacColl Center is committed to building the field of chronic illness care improvement by training individuals as tomorrow’s leaders.

To this end, the Center has hosted many Commonwealth Fund Harkness Fellows in Health Care Policy and Practice since 2000. The Harkness fellowships provide a unique opportunity for mid-career health services researchers and practitioners from select international locations to spend up to a year in the United States, conducting original research and working with leading health policy experts.

In addition, the MacColl Center has worked with the Association of American Medical Colleges to conduct a collaborative to help academic medical centers to adopt the Chronic Care Model.

The MacColl Center has also had a longstanding relationship with the California HealthCare Foundation’s chronic disease program, serving as faculty at their networking conferences and as advisers to their ongoing California Improvement Network effort.