Developing primary care teams prepared to improve quality: a mixed-methods evaluation and lessons learned from implementing a microsystems approach
| Autor: | Elizabeth Trowbridge, Sarah Davis, Sally Kraft, Sandra Kamnetz, Steven Koslov, Stephanie Berkson, Nancy Pandhi, William Caplan |
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| Rok vydání: | 2018 |
| Předmět: |
Quality management
education Team effectiveness Qualitative property Microsystems Patient care team Health informatics Health administration 03 medical and health sciences 0302 clinical medicine Surveys and Questionnaires Health care Humans Medicine 030212 general & internal medicine Quality improvement Primary health care Medical education business.industry lcsh:Public aspects of medicine 030503 health policy & services Health Policy Nursing research lcsh:RA1-1270 Focus Groups Focus group United States Data Accuracy 3. Good health Leadership 13. Climate action 0305 other medical science business Delivery of Health Care Research Article |
| Zdroj: | BMC Health Services Research, Vol 18, Iss 1, Pp 1-10 (2018) BMC Health Services Research |
| ISSN: | 1472-6963 |
| DOI: | 10.1186/s12913-018-3650-4 |
| Popis: | Background Health systems in the United States are increasingly required to become leaders in quality to compete successfully in a value-conscious purchasing market. Doing so involves developing effective clinical teams using approaches like the clinical microsystems framework. However, there has been limited assessment of this approach within United States primary care settings. Methods This paper describes the implementation, mixed-methods evaluation results, and lessons learned from instituting a Microsystems approach across 6 years with 58 primary care teams at a large Midwestern academic health care system. The evaluation consisted of a longitudinal survey augmented by interviews and focus groups. Structured facilitated longitudinal discussions with leadership captured ongoing lessons learned. Quantitative analysis employed ordinal logistic regression and compared aggregate responses at 6-months and 12-months to those at the baseline period. Qualitative analysis used an immersion/crystallization approach. Results Survey results (N = 204) indicated improved perceptions of: organizational support, team effectiveness and cohesion, meeting and quality improvement skills, and team communication. Thematic challenges from the qualitative data included: lack of time and coverage for participation, need for technical/technology support, perceived devaluation of improvement work, difficulty aggregating or spreading learnings, tensions between team and clinic level change, a part-time workforce, team instability and difficulties incorporating a data driven improvement approach. Conclusions These findings suggest that a microsystems approach is valuable for building team relationships and quality improvement skills but is challenged in a large, diverse academic primary care context. They additionally suggest that primary care transformation will require purposeful changes implemented across the micro to macro-level including but not only focused on quality improvement training for microsystem teams. |
| Databáze: | OpenAIRE |
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