"Nobody was showing up to meetings," Weiner says. "There were no department meetings in adult primary care. There was just a disengagement across the organization, and any attempt to change or do anything different was met with resistance and resentment and frustration."
She then began to delve deeper into the situation.
"You need to find out what is going on in your organization, because it can vary from department to department. You really have to use your diagnostic skills to figure it out, and then you have to do an intervention based on what you found."
Part of the issue may have been what attracted Weiner to Oregon Medical Group in the first place: a large degree of physician independence. They had the autonomy to train their medical assistants as they saw fit, to set up their patient templates the way they wanted, and to see patients at their own pace.
Yet, as healthcare changed, the group struggled to come together.
"In the late 2000s, we started to feel some of the pressures of the changes in healthcare, of some of the health plans expecting us to improve quality," Weiner says. "They were giving us feedback and measuring, and we didn't quite know what to do with it."
The organization reached its tipping point in 2011 with the implementation of its electronic medical record.
"It really highlighted the lack of standards that we had. Everybody practiced differently, and everybody collected data differently. That created a lot of frustration," she says. "We have 140 intelligent clinicians who went about figuring out how to collect data and put it in the EMR in 140 different ways."
The results of Weiner's 2012 assessment of the organization was proof things needed to change.
"It was a way to make the case that we can't stay here anymore. That this was unsustainable, that we needed to change, and we needed to do something different," she says.
Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.