Effects of Practice Turnover on Primary Care Quality Improvement Implementation

Area of Science:

• Health Services Research
• Organizational Behavior
• Primary Care Medicine

Background:

• Primary care practices implement quality improvement (QI) to maintain standards and meet benchmarks.
• The impact of staff turnover on these QI initiatives is not well understood.

Purpose of the Study:

• To explore how staff turnover affects the ability of primary care practices to engage in quality improvement (QI) activities.
• To identify specific mechanisms through which turnover influences QI efforts.

Main Methods:

• Qualitative analysis of data collected from practice staff and external facilitators.
• Involvement in a large-scale QI initiative.

Main Results:

• Turnover can impede QI by increasing staff workload and slowing momentum due to training needs.
• It disrupts team dynamics, creating barriers to collaboration and effective working relationships.
• Departing staff may carry institutional memory regarding QI purpose, processes, and long-term goals.

Conclusions:

• Staff turnover presents significant challenges to sustained quality improvement in primary care.
• Recognizing and addressing the effects of turnover is crucial for practices and QI support organizations.
• Strategies to mitigate the disruptive impact of turnover on QI are needed.