Developing primary care teams prepared to improve quality: a mixed-methods evaluation and lessons learned from...

Area of Science:

• Healthcare Management
• Quality Improvement Science
• Primary Care Research

Background:

• Healthcare systems face pressure to lead in quality for market competitiveness.
• The clinical microsystems framework is a key strategy for developing effective clinical teams.
• Limited research exists on applying the microsystems approach in US primary care.

Purpose of the Study:

• To evaluate the implementation and impact of a Microsystems approach in a large academic health system.
• To identify lessons learned from a 6-year initiative involving 58 primary care teams.
• To assess changes in team perceptions and identify implementation challenges.

Main Methods:

• A mixed-methods evaluation combining longitudinal surveys, interviews, and focus groups.
• Quantitative analysis using ordinal logistic regression to compare survey responses over time.
• Qualitative analysis employing an immersion/crystallization approach and facilitated leadership discussions.

Main Results:

• Improved perceptions of organizational support, team effectiveness, cohesion, quality improvement skills, and communication.
• Identified challenges including lack of time, need for technical support, and difficulties with data-driven improvement.
• Observed tensions between team-level and clinic-level change initiatives.

Conclusions:

• The microsystems approach benefits team relationships and quality improvement skills in primary care.
• Successful primary care transformation requires addressing challenges within the microsystems approach.
• System-level changes, beyond team-focused training, are essential for broader transformation.