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. 1999 Mar;8(1):36–42. doi: 10.1136/qshc.8.1.36

Setting up improvement projects in small scale primary care practices: feasibility of a model for continuous quality improvement

H Geboers, M van der Horst, H Mokkink, P van Montfort, W van den Bosch, H van den Hoogen, R Grol
PMCID: PMC2483632  PMID: 10557668

Abstract

OBJECTIVES: To evaluate the feasibility of a model for continuous quality improvement in small scale general practice and the improvement projects that practices ran after the introduction of continuous quality improvement. DESIGN: A descriptive study. SETTING: Twenty general practices in the Netherlands tested the model in an intervention period of 18 months. INTERVENTION: A model for continuous quality improvement adapted for general practice was introduced into the practices using a structured strategy. Practices were supported by trained facilitators. MAIN OUTCOME MEASURES: Acceptance at introduction and continued application of the model; the topics of improvement projects that were set up in the practices; whether the improvement projects had been completed; whether they had met the criteria (the use of the "quality cycle" and the Oxford audit score); and whether the self set objectives had been met. RESULTS: The model was introduced and accepted in all participating practices. Practices started 51 improvement projects. At the end of the study period 33 improvement projects had been completed. Practices chose a wide variety of objectives for these projects; most of them concerned medical or organisational topics. Practices started projects mainly because the topic was felt to be a problem or was causing a bottleneck in the organisation. The quality cycle was used in all projects, but practices did not always collect data and evaluate the outcomes. Fourteen projects could be discerned as "full audit". No differences existed in the quality of improvement projects among the various types of practice or between the topics addressed. At the end of the study period half of the practices continued applying the model. CONCLUSION: This study showed that the model was feasible for small scale general practice. However, application of the model tended to disintegrate after the facilitator had left the practice. Practices succeeded reasonably well in running improvement projects. Introduction of continuous quality improvement should particularly focus on this. It is suggested that intensive support is necessary to implement and maintain continuous quality improvement in small scale practices.

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Selected References

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  1. Audit and the team: an interview with the Adelaide Medical Centre team. Interview by Richard Baker. Qual Health Care. 1993 Sep;2(3):191–194. doi: 10.1136/qshc.2.3.191. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Batalden P. B., Stoltz P. K. A framework for the continual improvement of health care: building and applying professional and improvement knowledge to test changes in daily work. Jt Comm J Qual Improv. 1993 Oct;19(10):424–452. doi: 10.1016/s1070-3241(16)30025-6. [DOI] [PubMed] [Google Scholar]
  3. Berwick D. M. A primer on leading the improvement of systems. BMJ. 1996 Mar 9;312(7031):619–622. doi: 10.1136/bmj.312.7031.619. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Chambers R., Bowyer S., Campbell I. Audit activity and quality of completed audit projects in primary care in Staffordshire. Qual Health Care. 1995 Sep;4(3):178–183. doi: 10.1136/qshc.4.3.178. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Chambers R., Bowyer S., Campbell I. Audit activity and quality of completed audit projects in primary care in Staffordshire. Qual Health Care. 1995 Sep;4(3):178–183. doi: 10.1136/qshc.4.3.178. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Derry J., Lawrence M., Griew K., Anderson J., Humphreys J., Pandher K. S. Auditing audits: the method of Oxfordshire Medical Audit Advisory Group. BMJ. 1991 Nov 16;303(6812):1247–1249. doi: 10.1136/bmj.303.6812.1247. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Geboers H., Grol R., van den Bosch W., van den Hoogen H., Mokkink H., van Montfort P., Oltheten H. A model for continuous quality improvement in small scale practices. Qual Health Care. 1999 Mar;8(1):43–48. doi: 10.1136/qshc.8.1.43. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Gustafson D. H., Hundt A. S. Findings of innovation research applied to quality management principles for health care. Health Care Manage Rev. 1995 Spring;20(2):16–33. [PubMed] [Google Scholar]
  9. Lawrence M., Packwood T. Adapting total quality management for general practice: evaluation of a programme. Qual Health Care. 1996 Sep;5(3):151–158. doi: 10.1136/qshc.5.3.151. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Merry M. D. Total quality management for physicians: translating the new paradigm. QRB Qual Rev Bull. 1990 Mar;16(3):101–105. doi: 10.1016/s0097-5990(16)30350-5. [DOI] [PubMed] [Google Scholar]
  12. Shortell S. M., O'Brien J. L., Carman J. M., Foster R. W., Hughes E. F., Boerstler H., O'Connor E. J. Assessing the impact of continuous quality improvement/total quality management: concept versus implementation. Health Serv Res. 1995 Jun;30(2):377–401. [PMC free article] [PubMed] [Google Scholar]
  13. Swanson T. K., Eilers G. M. Physician and staff acceptance of continuous quality improvement. Fam Med. 1994 Oct;26(9):583–586. [PubMed] [Google Scholar]

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