CONTINUOUS QUALITY IMPROVEMENT IN PRIMARY-CARE - WHATS HAPPENING

OBJECTIVES. Despite much health care interest in quality and Continuou s Quality Improvement, there is little quantitative information about it. The purpose of this study was to measure the attitudes, activities , and organizational cultures concerning Continuous Quality Improvemen t in a group of Midwestern primary care clinics. METHODS. Three survey s of the clinicians, nurses, and other staff in 44 primary care clinic s in the metropolitan area of Minneapolis and St. Paul were conducted. These surveys assessed: (1) attitudes about quality improvement, (2) previous efforts in these clinics to use process improvement teams, an d (3) the extent to which the clinics' organizational cultures were pe rceived as supporting quality. The Provider Attitude Survey was comple ted by clinicians and nurses; the Process Improvement Progress was com pleted by members of the best Continuous Quality Improvement teams, if any; and the Quality Systems Inventory was completed by all personnel . RESULTS. Most Of the clinical personnel reported support for various Continuous Quality Improvement concepts, but their understanding and experience were limited. Only 20 (45%) clinics had had at least one Co ntinuous Quality Improvement team in the past, only five of the 12 tea ms with adequate information had completed an improvement cycle, and o nly seven reported improving a process with it. The mean clinic scores for quality culture were no better than those in other types of organ izations. CONCLUSIONS. Despite relatively favorable attitudes and some Continuous Quality Improvement activities, there appears to be a need to help clinics build skill and experience for the required care impr ovements.