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

Abrahamson, Vanessa, Jaswal, Sabrena, Wilson, Patricia M. (2020) An evaluation of the clinical microsystems approach in general practice quality improvement. Primary Health Care Research & Development, 21 . ISSN 1463-4236. (doi:10.1017/S1463423620000158) (KAR id:81030)

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Abstract

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 dministrative 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.

Item Type: Article
DOI/Identification number: 10.1017/S1463423620000158
Uncontrolled keywords: general practice; primary healthcare; quality improvement; qualitative research; implementation science
Subjects: H Social Sciences
Divisions: Faculties > Social Sciences > School of Social Policy Sociology and Social Research > Centre for Health Services Studies
Depositing User: Vanessa Abrahamson
Date Deposited: 28 Apr 2020 12:15 UTC
Last Modified: 23 Jun 2020 09:22 UTC
Resource URI: https://kar.kent.ac.uk/id/eprint/81030 (The current URI for this page, for reference purposes)
Abrahamson, Vanessa: https://orcid.org/0000-0002-1169-9457
Jaswal, Sabrena: https://orcid.org/0000-0001-5755-0415
Wilson, Patricia M.: https://orcid.org/0000-0002-5787-9736
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