AHRQ Study Identifies Conditions Leading to Quality Improvement for Primary Care

Support from executive leaders, staff participation in decision-making, and previous experience with quality improvement initiatives all helped lead to higher performance among primary care clinics that participated in quality improvement programs, according to a new AHRQ study published in Quality Management in Health Care. Additional factors that provided a receptive context for work process improvements included workplace stress, burnout and dissatisfaction with the current operations in clinics. Researchers examined clinics that employed Lean management, a process and quality improvement program that aims to eliminate waste, optimize workflows and engage workers in continuous quality improvement. Using surveys of 1,300 primary care clinicians and staff engaged in Lean-influenced redesign of clinic workflows, researchers examined conditions affecting clinics’ ability to enhance care efficiency and productivity and to increase patient satisfaction. Access the abstract.

2019 Apr/Jun;28(2):70-77. doi: 10.1097/QMH.0000000000000198.

Contextual Conditions and Performance Improvement in Primary Care.

Hung DY1, Harrison MI, Liang SY, Truong QA.

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Abstract

BACKGROUND:

Although organizational context can affect the implementation of quality initiatives, we know less about the influence of contextual conditions on quality outcomes. We examined organizational features of primary care clinics that achieved greatest performance improvements after implementing Lean redesigns.

METHODS:

We used operational data and baseline (ie, pre-Lean implementation) surveys of 1333 physicians and staff in 43 primary care clinics located across a large ambulatory care system. Segmented regression with interrupted time series analysis was used to identify clinics with highest improvements in workflow efficiency, physician productivity, and patient satisfaction following Lean redesign. We conducted independent-samples t tests to identify contextual features of clinics that showed greatest improvements in performance outcomes.

RESULTS:

Clinics with highest increases in efficiency had most prior experience with quality improvement, compared with all other clinics. Efficiency gains were also found in clinics reporting highest levels of burnout and work stress prior to redesign. Highest improvements in physician productivity were associated with a history of change, staff participation, and leadership support for redesigns. Greatest improvements in patient satisfaction occurred in least stressful environments with highest levels of teamwork, staff engagement/efficacy, and leadership support.

CONCLUSIONS:

Our findings encourage careful evaluation of clinic characteristics and capacity to effectively implement redesigns. Such evaluations may help leaders select interventions most appropriate for certain clinics, while identifying others that may need extra support with implementing change.