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

BACKGROUND: Changes to the general practice (GP) contract in England (April 2019) introduced a new quality improvement (QI) domain. The clinical microsystems programme is an approach to QI with limited evidence in primary care. AIM: To explore experiences of GP staff participating in a clinical micr...

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Detalles Bibliográficos
Autores principales: Abrahamson, Vanessa, Jaswal, Sabrena, Wilson, Patricia M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cambridge University Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7327435/
https://www.ncbi.nlm.nih.gov/pubmed/32638688
http://dx.doi.org/10.1017/S1463423620000158
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author Abrahamson, Vanessa
Jaswal, Sabrena
Wilson, Patricia M.
author_facet Abrahamson, Vanessa
Jaswal, Sabrena
Wilson, Patricia M.
author_sort Abrahamson, Vanessa
collection PubMed
description BACKGROUND: Changes to the general practice (GP) contract in England (April 2019) introduced a new quality improvement (QI) domain. The clinical microsystems programme is an approach to QI with limited evidence in primary care. AIM: To explore experiences of GP staff participating in a clinical microsystems programme. DESIGN AND SETTING: GPs within one clinical commissioning group (CCG) in South East England. Normalisation process theory informed qualitative approach. METHOD: Review of all CCG clinical microsystems projects using pre-existing data. The Diffusion of Innovation Cycle was used to inform the sampling frame and GPs were invited to participate in interviews or focus groups. Ten practices participated; 11 coaches and 16 staff were interviewed. RESULTS: The majority of projects were process-driven activities related to administrative systems. Projects directly related to health outputs were fewer and related to externally imposed targets. Four key elements facilitated practices to engage: feeling in control; receiving enhanced service payment; having a senior staff member championing the approach; and good practice–coach relationship. There appeared to be three key benefits in addition to project-specific ones: improved working relationships between CCG and practice; more cohesive practice team; and time to reflect. CONCLUSION: Small projects with clear parameters were more successful than larger ones or those spanning organisations. However, there was little evidence suggesting the key benefits were unique attributes of the microsystems approach and sustainability was problematic. Future research should focus on cross-organisational approaches to QI and identify what, if any, added value the approach provides.
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spelling pubmed-73274352020-07-09 An evaluation of the clinical microsystems approach in general practice quality improvement Abrahamson, Vanessa Jaswal, Sabrena Wilson, Patricia M. Prim Health Care Res Dev Development BACKGROUND: Changes to the general practice (GP) contract in England (April 2019) introduced a new quality improvement (QI) domain. The clinical microsystems programme is an approach to QI with limited evidence in primary care. AIM: To explore experiences of GP staff participating in a clinical microsystems programme. DESIGN AND SETTING: GPs within one clinical commissioning group (CCG) in South East England. Normalisation process theory informed qualitative approach. METHOD: Review of all CCG clinical microsystems projects using pre-existing data. The Diffusion of Innovation Cycle was used to inform the sampling frame and GPs were invited to participate in interviews or focus groups. Ten practices participated; 11 coaches and 16 staff were interviewed. RESULTS: The majority of projects were process-driven activities related to administrative systems. Projects directly related to health outputs were fewer and related to externally imposed targets. Four key elements facilitated practices to engage: feeling in control; receiving enhanced service payment; having a senior staff member championing the approach; and good practice–coach relationship. There appeared to be three key benefits in addition to project-specific ones: improved working relationships between CCG and practice; more cohesive practice team; and time to reflect. CONCLUSION: Small projects with clear parameters were more successful than larger ones or those spanning organisations. However, there was little evidence suggesting the key benefits were unique attributes of the microsystems approach and sustainability was problematic. Future research should focus on cross-organisational approaches to QI and identify what, if any, added value the approach provides. Cambridge University Press 2020-06-23 /pmc/articles/PMC7327435/ /pubmed/32638688 http://dx.doi.org/10.1017/S1463423620000158 Text en © Cambridge University Press 2020 http://creativecommons.org/licenses/by/4.0/ This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Development
Abrahamson, Vanessa
Jaswal, Sabrena
Wilson, Patricia M.
An evaluation of the clinical microsystems approach in general practice quality improvement
title An evaluation of the clinical microsystems approach in general practice quality improvement
title_full An evaluation of the clinical microsystems approach in general practice quality improvement
title_fullStr An evaluation of the clinical microsystems approach in general practice quality improvement
title_full_unstemmed An evaluation of the clinical microsystems approach in general practice quality improvement
title_short An evaluation of the clinical microsystems approach in general practice quality improvement
title_sort evaluation of the clinical microsystems approach in general practice quality improvement
topic Development
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7327435/
https://www.ncbi.nlm.nih.gov/pubmed/32638688
http://dx.doi.org/10.1017/S1463423620000158
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