Continuous quality improvement in small general medical practices: the attitudes of general practitioners and other practice staff

Objectives. Continuous quality improvement (CQI) offers opportunities to im prove care in small-scale office-based practice. Little is yet known about the implementation of CQI in small primary care practices. We studied the a ttitudes of physicians and staff in small family practices to a model of CQ I tailored to office-based practice setting. Practices and design. An exploratory study in 20 family practices in The Ne therlands. Practices were stimulated to adopt the model for continuous qual ity improvement. Main outcome measures. The use of the model at the end of the study period, the perception of the physicians and staff of their success with adopting the model, their view of its usefulness, their willingness to continue and personal and practical obstacles. Measurements were made using written ques tionnaires. Results. The rate of implementation of the model varied between practices. Participants rated their success in performing improvement projects, holdin g regular quality meetings and setting targets and priorities. They were po sitive about the usefulness of the model and they were generally willing to continue to use it. Barriers included the size of workload and the tendenc y to postpone actions until external support by an outreach visitor was pro vided. Physician and staff attitudes were homogeneous at a practice level. Conclusion. Our findings stress the importance of starting CQI with small, easy-to-handle projects. Workload reduction might be an important issue to focus on. Personal obstacles should be addressed throughout the introductio n. We found attitudes in small-scale practices to be homogeneous, so that i t was important to pay explicit attention to commitment to CQI from the sta rt of the introduction.