What attributions do Australian high-performing general practices make for their success? Applying the clinical microsystems framework: a qualitative study

OBJECTIVES: To identify the success attributions of high-performing Australian general practices and the enablers and barriers they envisage for practices wishing to emulate them. DESIGN: Qualitative study using semi-structured interviews and content analysis of the data. Responses were recorded, transcribed verbatim and coded according to success characteristics of high-performing clinical microsystems. SETTING: Primary healthcare with the participating general practices representing all Australian states and territories, and representing metropolitan and rural locations. PARTICIPANTS: Twenty-two general practices identified as high performing via a number of success criteria. The 52 participants were 19 general practitioners, 18 practice managers and 15 practice nurses. RESULTS: Participants most frequently attributed success to the interdependence of the team members, patient-focused care and leadership of the practice. They most often signalled practice leadership, team interdependence and staff focus as enablers that other organisations would need to emulate their success. They most frequently identified barriers that might be encountered in the form of potential deficits or limitations in practice leadership, staff focus and mesosystem support. CONCLUSIONS: Practice leaders need to empower their teams to take action through providing inclusive leadership that facilitates team interdependence. Mesosystem support for quality improvement in general practice should focus on enabling this leadership and team building, thereby ensuring improvement efforts are converted into effective healthcare provision.