Abstract
BackgroundPhysicians in small to moderate primary care practices in the United States (U.S.) (<25 physicians) face unique challenges in implementing quality improvement (QI) initiatives, including limited resources, small staffs, and inadequate information technology systems 23,36. This qualitative study sought to identify and understand the characteristics and organizational cultures of physicians working in smaller practices who are actively engaged in measurement and quality improvement initiatives.MethodsWe undertook a qualitative study, based on semi-structured, open-ended interviews conducted with practices (N = 39) that used performance data to drive quality improvement activities.ResultsPhysicians indicated that benefits to performing measurement and QI included greater practice efficiency, patient and staff retention, and higher staff and clinician satisfaction with practice. Internal facilitators included the designation of a practice champion, cooperation of other physicians and staff, and the involvement of practice leaders. Time constraints, cost of activities, problems with information management and or technology, lack of motivated staff, and a lack of financial incentives were commonly reported as barriers.ConclusionThese findings shed light on how physicians engage in quality improvement activities, and may help raise awareness of and aid in the implementation of future initiatives in small practices more generally.
Highlights
Physicians in small to moderate primary care practices in the United States (U.S.) (
After the Institute of Medicine (IOM) published To Err is Human,[1] numerous medical groups, health plans, and clinical organizations engaged in strategies to facilitate quality improvement (QI) in healthcare in the U.S Central to these efforts is the recognition that improvement requires performance measurement, yet measurement alone is not sufficient
This study examined the perceived benefits of utilizing QI methodologies, as well as what factors inhibited or facilitated practice improvements
Summary
Physicians in small to moderate primary care practices in the United States (U.S.) (20 physicians) are well studied, [20,21,22] and highlight the resources and approaches needed to overcome barriers to quality improvement, including a lack of staff, resources, and time [20,21,22] Despite these advances, the practical application of measurement and innovation to enhance quality in practice requires substantial motivation and resources, and may be difficult to implement and maintain, in small office settings. Physicians in small office settings may possess a limited, and highly variable, understanding of quality improvement [24]
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