What can science contribute to quality improvement in general practice?

Abstract

Over many decades practitioners and academics working in general practice have built a strong reputation for their commitment to developing innovative approaches to improving the quality of patient care. The orientation of these initiatives has evolved over the years. Until the 1980s, providing high quality patient care was primarily reliant on the personal motivation of individual doctors to achieve explicit standards of practice.1 These standards were maintained through a commitment to education and training, and their attainment rewarded by peer recognition, for example by membership or fellowship of professional bodies. From the 1980s until the early part of this century, the emphasis shifted from individuals to teams and the narrative changed from the relatively static orientation of attaining standards to the more dynamic one of continuous improvement.2 Guidelines were developed that had to be delivered by multidisciplinary teams, multiprofessional audit was encouraged, team-based significant event analysis become common, methods of process improvement developed in the manufacturing sector were introduced into practices, and team-based financial incentives were designed and implemented at scale. Over the past decade the focus has shifted again, this time to levers for improvement that operate at a health system level and which place the locus of control more with policymakers and system leaders than with individual professionals or clinical teams. Performance management, competition, transparency, regulation, and legislation have been introduced as ways of potentiating the established professionally-led methods, or replacing them when they are deemed to be failing. In this article we describe what we see as the next phase of the ‘improvement journey’ for general practice, a phase that builds on the strengths of approaches currently being used, and attempts to address their deficiencies. We propose that this will place a stronger emphasis on the role of science — the science of improvement — …