Effects of Practice Turnover on Primary Care Quality Improvement Implementation

Abstract

Primary care practices often engage in quality improvement (QI) in order to stay current and meet quality benchmarks, but the extent to which turnover affects practices’ QI ability is not well described. The authors examined qualitative data from practice staff and external facilitators participating in a large-scale QI initiative to understand the relationship between turnover and QI efforts. The examination found turnover can limit practices’ ability to engage in QI activities in various ways. When a staff member leaves, remaining staff often absorb additional responsibilities, and QI momentum slows as new staff are trained or existing staff are reengaged. Turnover alters staff dynamics and can create barriers to constructive working relationships and team building. When key practice members leave, they can take with them institutional memory about QI purpose, processes, and long-term vision. Understanding how turnover affects QI may help practices, and those helping them with QI, manage the disruptive effects of turnover.

The LEAP Program: Quality Improvement Training to Address Team Readiness Gaps Identified by Implementation Science Findings

“…Health system leaders are putting increasing attention and urgency on engaging frontline teams in QI to provide greater participation and control over clinical processes, and as a potential antidote for clinician burnout. 51 , 52 System leaders, however, continue to struggle to accomplish this 34 – 36 , 53 though there are pockets of success. 52 , 54 , 55 More organizations are recognizing that investing in QI is “an enlightened strategy, not an expense; 52 , p51 ” LEAP can help engage teams in QI and increase readiness for implementing change in a constantly changing environment.…”

OUP accepted manuscript

“…Discontinuity or ‘gaps in care’ related to failures in communication and care coordination can cause distress and dysfunctional use of healthcare ( 16 ). In primary care, discontinuity limits quality initiatives ( 34 ) and may have organizational effects on patient safety. When key practitioners leave, they may take with them institutional memory and visions of quality development ( 34 ).…”

“…In primary care, discontinuity limits quality initiatives ( 34 ) and may have organizational effects on patient safety. When key practitioners leave, they may take with them institutional memory and visions of quality development ( 34 ). From a theoretical perspective, the organization suffers by losing stored ‘human capital’, generating human resource costs ( 35 ).…”

Barriers and Facilitators in the Recruitment and Retention of More Than 250 Small Independent Primary Care Practices for EvidenceNOW

“…This training series was an attempt to maintain QI momentum and minimize loss of institutional memory. 40 Finally, factors that facilitated recruitment overlapped and were synergistic with those that fostered retention. This is important to highlight.…”