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BMC Health Serv Res. 2018 Nov 9;18(1):847. doi: 10.1186/s12913-018-3650-4.

Developing primary care teams prepared to improve quality: a mixed-methods evaluation and lessons learned from implementing a microsystems approach.

Author information

1
Department of Family and Community Medicine, University of New Mexico School of Medicine, MSC 09 5040, 1 University of New Mexico, Albuquerque, NM, 87131, USA. npandhi@salud.unm.edu.
2
Population Health at Geisel School of Medicine at Dartmouth College, 1 Rope Ferry Rd, Hanover, NH, 03755, USA.
3
Primary Care Academics Transforming Healthcare Collaborative, Madison, WI, USA.
4
Planning and Business Development, UW Health, Madison, WI, USA.
5
University of Wisconsin Law School, Madison, WI, USA.
6
Center for Patient Partnerships, Madison, WI, USA.
7
Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
8
Department of Pediatric and Adolescent Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
9
General Internal Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.

Abstract

BACKGROUND:

Health systems in the United States are increasingly required to become leaders in quality to compete successfully in a value-conscious purchasing market. Doing so involves developing effective clinical teams using approaches like the clinical microsystems framework. However, there has been limited assessment of this approach within United States primary care settings.

METHODS:

This paper describes the implementation, mixed-methods evaluation results, and lessons learned from instituting a Microsystems approach across 6 years with 58 primary care teams at a large Midwestern academic health care system. The evaluation consisted of a longitudinal survey augmented by interviews and focus groups. Structured facilitated longitudinal discussions with leadership captured ongoing lessons learned. Quantitative analysis employed ordinal logistic regression and compared aggregate responses at 6-months and 12-months to those at the baseline period. Qualitative analysis used an immersion/crystallization approach.

RESULTS:

Survey results (N = 204) indicated improved perceptions of: organizational support, team effectiveness and cohesion, meeting and quality improvement skills, and team communication. Thematic challenges from the qualitative data included: lack of time and coverage for participation, need for technical/technology support, perceived devaluation of improvement work, difficulty aggregating or spreading learnings, tensions between team and clinic level change, a part-time workforce, team instability and difficulties incorporating a data driven improvement approach.

CONCLUSIONS:

These findings suggest that a microsystems approach is valuable for building team relationships and quality improvement skills but is challenged in a large, diverse academic primary care context. They additionally suggest that primary care transformation will require purposeful changes implemented across the micro to macro-level including but not only focused on quality improvement training for microsystem teams.

KEYWORDS:

Microsystems; Patient care team; Primary health care; Quality improvement

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