DEVELOPMENT AND PILOT IMPLEMENTATION OF A MULTILEVEL COMPETENCY ASSESSMENT AND DEVELOPMENT SYSTEM (MSRK PMSP) BASED...

Objective, reproducible appraisal of primary healthcare (PHC) organizational maturity is essential for steering quality, safety, and sustainability. Existing approaches (e.g., accreditation, compliance audits, single-dimension scorecards) seldom provide an integrated, development-oriented view tailored to outpatient settings.

To develop a Multilevel System for Competency Development in primary healthcare organizations (MSRK PMSP) based on the Indicator Model For Outpatient Clinic Development (IMORP) model and to assess its feasibility and applicability in urban polyclinics.

The IMORP model was built on aggregated data from a six-year monitoring programme (2020-2025) covering eight urban polyclinics. The framework was designed by four public-health experts and underwent external content review by two independent experts. IMORP structures organizational maturity across seven domains (workforce, quality of care, infrastructure, innovation, digitalization, finance, managerial responsiveness) with a maximum of 155 points and four maturity tiers (basic, intermediate, advanced, expert). Descriptive statistics (mean, SD, min-max) were computed. Group comparisons used the Kruskal-Wallis test with Dunn-Bonferroni post hoc procedures where applicable (α=0.05). Temporal changes within each PHC organization were evaluated using Repeated Measures ANOVA or the Friedman test, depending on data distribution.

The model demonstrated clear managerial interpretability and domain-level diagnostic resolution. Clinic-level mean IMORP totals differed significantly (Kruskal-Wallis p<0.001), with representative ranges from approximately 60.0±3.3 to 105.3±8.1 points across facilities; domain-specific means typically fell within narrow bands (e.g., digitalization ≈14-15 points, SD minimal), whereas innovation remained uniformly low. Despite statistically significant between-clinic differences in total scores, all eight facilities were classified within the same maturity tier (Intermediate) according to predefined cut-offs, indicating structural heterogeneity without cross-tier transitions in the pilot phase.

MSRK PMSP (IMORP) offers a practical, multi-domain, maturity-levelled instrument for PHC organizations, simultaneously supporting diagnostic profiling and targeted improvement planning. A full psychometric validation is planned on a larger sample (≥35 polyclinics) to establish internal consistency, inter-rater/test-retest reliability, factor structure, and predictive validity versus clinical-economic and patient-engagement outcomes.