Quality improvement in primary care clinics.

L. R. Fischer, L. I. Solberg, T. E. Kottke

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


BACKGROUND: Case studies from Project IMPROVE, the first randomized controlled trial to evaluate the effectiveness of continuous quality improvement (CQI) in primary care, were subjected to a qualitative analysis. Three questions were addressed: How does change in the health care environment affect a quality improvement (QI) process? How does clinic organization influence a QI process? and What is the impact of a QI process on clinic organization? METHOD: Case studies were conducted in 6 clinics that had been randomly selected from the 22 clinics participating in the IMPROVE intervention. The case study data consisted of observations of CQI team meetings, open-ended interviews with 30 informants (team members plus others in the clinics), interviews with IMPROVE consultants, and documentation from the project. The data were analyzed to identify themes and generate concepts, assess and compare the informants' experiences, and develop a conceptual framework stimulated by research and theory literature. RESULTS: Change and uncertainty in the health care environment both complicated the QI process and motivated participation in improvement. The smaller clinics appeared to have more difficulty with the QI process because of limited resources and lack of compatibility between the QI approach and their clinic organization. Project IMPROVE had two qualitative effects on clinics: increased awareness of preventive services and application of the CQI method to other problems and issues. CONCLUSION: QI initiatives can help clinics adapt to a changing health care environment and create functioning teams or groups that can address a variety of organization problems and tasks. The process should be flexible to accommodate varying organization structures and cultures.

Original languageEnglish (US)
Pages (from-to)361-370
Number of pages10
JournalThe Joint Commission Journal on Quality Improvement
Issue number7
StatePublished - Jul 1998

Bibliographical note

Funding Information:
Lucy Rose Fischer, PhD, is Senior Research Investigator, and Leif I. Solberg, MD, is Clinical Director of Research, Healthpartners Research Foundation, Minneapolis, and a member of The Joint Commission Journal on Quality Improvement j Editorial Advisory Board Thomas E. Kot-tke, MD, MSPH, is Professor of Medicine, Mayo Clinic, Rochester, Minnesota. This project was supported by giants Jiom Group Health Foundation and the Blue Cross and Blue Shield Foundation. We express our thanks to the six clinics that aped to be part of the case studies and to the team members and other staf who were interviewed and shared their perspectives. Project IMPROE was successfilly implemented in primary care clinics because of the commitment and hard work of many dedicated profesod in each clinic that partz'n'pated in the IMPROE demonstration. We are gmtej%l for insights Jiom a number of others, including thef i k i n g researchers: Sanne


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