From David Rees PhD dissertation "Developing a Theory of Implementation for Better Chronic Health Management" Health Services Research Centre, Victoria University of Wellington, New Zealand
The goal is effective management of chronic conditions
Effective management results from linking clinical engagement to effective action
Data on performance reinforces clinical engagement, a reinforcing performance feedback loop (R1).
Data can improve the understanding of the impact of CCM on the primary care practice population and improve the quality of the effort, another reinforcing loop (R2).
Data can also improve the understanding of how clinical care processes impact on clinical outcomes and improve the quality of processes, another reinforcing loop (R3)
Effort to engage patients and enhance self-management skills improves adherence and results in more effective CCM. This is the self management reinforcing loop (R4)
Data on performance levels enhances community understanding of health issues and community support for CCM through support of patient self-management. This is the community engagement reinforcing loop (R5)
Data on performance enhances the belief that change is possible, improving clinical engagement and CCM actions. This is the self-efficacy reinforcing loop (R6).
All these potential reinforcing loops are constrained by the resources demanded to instill the belief that change is possible. This is the Resource Demand balancing loop (B1).
Self management demands resources in the short term but adds additional resources in the long term, reducing resource demand after a delay
To overcome these initial constraints requires additional resource capacity
Additional influences on the community and patient self management are patient skills and community resources.
Clinical leadership leads the belief in change and contributes to detailed understanding of context, process and outcome.
Enablers of clinical leadership and practice support contribute to the clinical leadership role.