When Management Works: An Organizational Culture That Facilitates Learning to Self-Manage Type 2 Diabetes

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Abstract
This study describes women's perspectives of provider and setting factors that support their ability to be effective self-managers of type 2 diabetes. A qualitative approach with focus-group interviews and document review was used The 17 women in this study had been nominated as exemplars in self-management by experts from a diabetes treatment and research center in the Midwest. Data generated from four structured focus group sessions, investigator fieldnotes, and clinic records of participants yielded the following themes: (I) turning points facilitated the management experience along with certain obstacles and barriers, (2) an organizational culture of caring facilitated learning selfmanagement (3) major shifts in provider-patient relationships accompanied a phasic process of learning management and (4) a set of personal characteristics most likely influenced the learning process. The knowledge and skills obtained through diabetes education are essential for initiating the self-management process. However, becoming an effective self-manager requires an organizational culture that supports elements of a role reversal in which patients can be experts and providers can be mentors.