An evaluation of the clinical microsystems approach in general practice quality improvement

Abrahamson, Vanessa; Jaswal, Sabrena K.; Wilson, Patricia M.

doi:10.1017/s1463423620000158

Cited by 6 publications

(22 citation statements)

References 29 publications

(42 reference statements)

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“…Staffing was reported as a key element in 11 studies 30,32,34,[36][37][38][39]41,44,46,47 . Flexibility in the team structure was described as an effective way to adapt to local resource constraints 41,[44][45][46]48,49 . The need for flexibility was balanced with the importance of role clarity 37,38,41,44,45,47 .…”

Section: Deployment Of Resourcesmentioning

confidence: 99%

Section: Culture Of Changementioning

confidence: 99%

“…A cultural change of practice was described in 11 papers 30,[41][42][43][44][45][46][47][49][50][51] and included changes in values, perspectives and working processes. The identification of practice members who would act as a "champion of change" was mentioned in four studies 30,46,49,50 . These individuals would celebrate positive achievements and use practice data to demonstrate improved health outcomes for patients to motivate participating GPs and sustain the implementation of micro-teams in the long term.…”

Section: Culture Of Changementioning

confidence: 99%

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Primary care micro-teams: an international systematic review of patient and healthcare professional perspectives

et al. 2023

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Background: There has been a recent trend, both in the UK and internationally, towards creating larger primary care practices with the assumption that interdisciplinary teams can increase patient accessibility and provide more cost-effective, efficient services. Micro-teams have been proposed to mitigate some of the potential challenges with practice expansion, including continuity of care. Aim: Review the available literature to examine how micro-teams are described and the opportunities which primary care micro-teams can provide for practice staff and patients and limitations to their introduction and implementation. Design and setting: International Systematic review of studies published in English. Method: A Framework analysis was used to synthesise the literature. Databases and grey literature were searched. Studies were included if they provided evidence regarding the implementation of micro-teams in primary care. We worked with a PPI co-author and conducted stakeholder discussions to those with and without experience in micro-team implementation. Results: The majority of the 24 included studies discussed empirical data from healthcare professionals, describing the implementation of micro-teams. Results include the characteristics of the literature; how micro-teams have been described; the range of ways micro-teams have been implemented; reported outcomes and experiences of patients and staff. Conclusion: The organisation of primary care has the potential to impact the nature and quality of patient care, safety and outcomes. This review contributes to current debates surrounding care delivery and how this can impact the experiences and outcomes of patients and staff. The analysis identifies several key opportunities and challenges for future research, policy and practice.

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Section: Deployment Of Resourcesmentioning

confidence: 99%

Section: Culture Of Changementioning

confidence: 99%

Section: Culture Of Changementioning

confidence: 99%

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Primary care micro-teams: an international systematic review of patient and healthcare professional perspectives

et al. 2023

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“…A systematic review of 35 studies evaluating clinical microsystems, of which 18 described general practice clinics, found that implementation of these care models helped develop a patient-centered approach; promoted interdisciplinarity and quality improvement skills; and increased clinical efficiency, patient safety, and patient and clinician satisfaction [ 17 ]. A recent UK-based qualitative study of general practitioners practicing in micropractice settings found that, while this care model increased clinician satisfaction, quality improvement efforts focused more on administrative or process metrics than health outcome-focused metrics, and, as such, the value of this approach in improving patient outcomes remains unclear [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Empowering Patients Through Virtual Care Delivery: Qualitative Study With Micropractice Clinic Patients and Health Care Providers

Burton¹,

Rush²,

Smith³

et al. 2022

JMIR Form Res

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Background Prior to the wider adoption of digital health technologies during the COVID-19 pandemic, applications of virtual care were largely limited to specialist visits and remote care using telehealth (phone or video) applications. Data sharing approaches using tethered patient portals were mostly built around hospitals and larger care systems. These portals offer opportunities for improved communication, but despite a belief that care has improved, they have so far shown few outcome improvements beyond medication adherence. Less is known about use of virtual care and related tools in the outpatient context and particularly in rural community contexts. Objective This study aims to reflect on the opportunities and barriers for sustainable virtual care through an example of a digitally enabled rural micropractice, which has provided 10%-15% virtual care since 2016 and 70% virtual care since March 2020. Methods Three focus groups, 1 with providers (physician and medical office manager) and 2 with a total of 8 patients from a rural micropractice in British Columbia, were conducted in November 2020 and December 2020. Virtual care delivery was explored through the topics of communication approach, mixing virtual and in-person care, the practice team’s journey in developing these approaches, and provider and patient satisfaction with the care model. Interviews were transcribed, checked for accuracy against recordings, and thematically analyzed. Results Both patients and providers reported ease of communication and high satisfaction. Either could initiate communication, and patients found the ability to share health information asynchronously through the portal allowed time to reflect and prepare their thoughts. Patients were highly engaged and reported feeling empowered and true partners in their health care, although they noted limited care coordination with specialists. The mix of virtual and in-person visits was highly regarded by patients and providers, and patients reported feeling safe and cared for 24/7, although both expressed concern about work spilling into the provider’s home life. The physician worried about missed diagnoses with virtual care. With respect to establishing the micropractice, solutions took about 5 years to optimize, with providers noting a learning curve requiring technical support for both themselves and their patients and a willingness to respond to patient feedback to identify the best solutions. Despite a mature virtual practice, patients reported deferred care due to COVID-19. Conclusions The micropractice’s hybrid care model encouraged patients to be true partners in their care and resulted in high patient engagement and satisfaction; yet, success may rely on the patient population being willing to engage and being comfortable with technology. Barriers lie in gaps in care coordination and provider fear that signs or symptoms more evident with an in-person exam could be missed. Even in this setting, deferral of care in light of COVID-19 was present, and opportunities to address care gaps should be sought.

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“…While PUTZ had a focused objective of pressure ulcer reduction, MS required participants to identify areas of improvement and implement change. Previous research suggests that while improving quality through clinical microsystems, sustainability can be challenging and smaller projects with clear parameters tend to be more successful than larger ones [ 22 ]. Our results also showed that some teams in MS struggled with selecting appropriate projects.…”

Section: Discussionmentioning

confidence: 99%

Factors influencing measurement for improvement skills in healthcare staff: trainee, and trainer perspectives

2022

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Background Measurement for improvement is an integral component of quality improvement (QI) trainings and demonstrates whether a change resulted in an improvement. Despite its critical role, the development of measurement for improvement skills for QI is relatively under-explored. Purpose To explore the training, curricular and contextual factors that influence the development of measurement for improvement skills in healthcare professionals. Methods This is a retrospective, qualitative, multiple case study design, based on two QI collaboratives. Trainees and trainers from these programmes participated in semi-structured interviews. A framework drawing on the Kirkpatrick’s evaluation model and the Model for Understanding Success in Quality (MUSIQ) model was developed. The interviews were analysed based on a three-step qualitative thematic analysis method. Results A total of 21 participants were interviewed (15 trainees and 6 trainers). Six themes emerged in the analysis of trainee interviewees: impact of differences in job role and hierarchical levels, narrow conception of QI, knowledge disparity between trained and untrained staff, balancing the benefits and burdens of measurement, early adopters of QI driving change and supportive and engaged leadership. Themes in trainer perspectives were knowledge and understanding of measurement, application of PDSA approach to programme design, balancing consistency with adaptation to context, and attributes of sites receptive to change as predictors of development of measurement for improvement skills in staff. Conclusion Training alone does not determine the development, sustainability and spread of measurement and QI skills. Instead, it is influenced by a combination of curricular, training, and contextual support structures. Training programmes should be aware of the impact of job role and hierarchy, increased knowledge disparity between trained and untrained staff and trainees equating QI to bundle implementation while designing programmes. Similarly, organisational support through leaders, encouraging staff who have an interest in measurement and a culture receptive to QI also supports development of measurement skills. The study highlights the need for trainees, trainers, and organisations to work together in balancing the benefits and burdens of measurement, leading to sustainable skill development in line with international best practices.

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An evaluation of the clinical microsystems approach in general practice quality improvement

Cited by 6 publications

References 29 publications

Primary care micro-teams: an international systematic review of patient and healthcare professional perspectives

Primary care micro-teams: an international systematic review of patient and healthcare professional perspectives

Empowering Patients Through Virtual Care Delivery: Qualitative Study With Micropractice Clinic Patients and Health Care Providers

Factors influencing measurement for improvement skills in healthcare staff: trainee, and trainer perspectives

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