Introducing quality clusters in general practice – a qualitative study of the experiences of cluster coordinators

Abstract

Background In 2018, the concept of clusters was introduced as a new model for data-driven quality improvement in general practice in Denmark. However, there is little research on the development and implementation of general practice clusters. The study explores how the cluster coordinators responsible for leading the clusters forward enacted and experienced their role during the early years of the clusters with attention to the challenges and enablers perceived in the process. Methods Qualitative, semi-structured interviews with 25 cluster coordinators from clusters that had carried out at least two meetings on a specific professional topic. The coordinators represented clusters of varying sizes and different geographic locations. Key topics in the interview guide were the development and structure of the cluster, the role of the coordinator, obtainment of data for the meetings, the role of external support, the form and content of the meetings, the participation and engagement of the members. A thematic analysis – shaped by the original aims and categories of the study while also being open to emerging themes – was performed on the transcribed interview material. Results Important enablers in the process of developing the clusters included the positive engagement of the GPs, the support offered by regional quality units and a national quality organisation for general practice, and the funding provided by the formal cluster framework. Challenges initially included setting up the clusters administratively and translating the open cluster concept into a local, workable model; and later obtaining relevant data for the cluster meetings and facilitating peer discussions about the data. Conclusion The coordinators generally experienced that the development of the clusters had progressed relatively fast with engagement from most of the participating GPs. Still, challenges with data obtainment, data analysis, and facilitation will have to be addressed ongoingly. Future research should investigate learning processes at the cluster meetings and how the clusters impact clinical practice and collaborative relations between general practice and other health care providers.

Data driven or data informed? How general practitioners use data to evaluate their own and colleagues’ clinical work in clusters

“…They said it led to changes in behaviour, which they themselves associated with higher quality. This positive embrace is in line with existing studies of the cluster concept where 70% of the GPs considered the cluster moderately or highly useful, as well as the fact that 98% chose a cluster instead of accreditation (Bundgaard et al., 2022; Kousgaard et al., 2022; Madsen et al., 2022). The cluster concept has almost from the start changed the GPs’ perception of quality improvement from something externally dictated and potentially unfair to something internally initiated and beneficial.…”

“…The GPs highlighted one particular actor whom they feared would get their data: the Danish Patient Safety Authority (DPSA). In recent years, individual doctors as well as the Danish Medical Association have stated their mistrust to this authority's ability to assess doctors' clinical work, which includes several open letters from the Danish Medical Association to the Danish minister of Health (Boston Consulting Group et al, 2022;Jessen, 2021). The GPs in our interviews described DPSA with strong metaphors, such as KGB and Stasi-the former security agencies for the Soviet Union and East Germany.…”

“…The cluster concept exists in different forms in various countries (Kousgaard et al., 2022; Stanciu et al., 2020). In Denmark, clusters replaced a mandatory GP accreditation program, which may have increased the resources GPs invest in quality improvement, but it was criticised by the GPs for being too externally controlling, bureaucratic and negatively affecting their job enthusiasm (Pedersen et al., 2018; Waldorff et al., 2016).…”

“…In a qualitative study by Kousgaard et al. (2022, p. 8), the cluster’s coordinators considered that ‘[e]asy access to relevant and comprehensible data is crucial if the visions of data driven quality improvement in the clusters are to be realised’. A final evaluation report summarising the quantitative and qualitative studies, concludes that data ‘contribute to insights into the GPs' own behaviour compared to other doctors in the cluster and help to open a conversation about different approaches to patient treatment’ (Madsen et al., 2022, p. 6, our translation).…”

“…In so‐called clusters, ‘all GPs must work with data‐driven quality improvement’ (RLNT and PLO, 2022, p. 143, our translation). By sharing data from their own clinic with each other, the GPs evaluate their own and colleagues’ clinical work and quality (Kousgaard et al., 2022). The national central quality organisation, Quality in General Practice (KiAP), supports the cluster concept.…”