An evaluation of the clinical microsystems approach in general practice quality improvement. (23rd June 2020)

• Record Type: Journal Article
• Authors: Abrahamson, Vanessa; Jaswal, Sabrena; Wilson, Patricia M.
• Is Part Of: Primary health care research & development. Volume 21(2020)
• Publication Date: 2020-06-23
• Subjects: general practice, -- primary healthcare, -- quality improvement, -- qualitative research, -- implementation science; Family medicine -- Great Britain -- Periodicals; Primary care (Medicine) -- Great Britain -- Periodicals; 362.1094105
• DOI: 10.1017/S1463423620000158
• Languages: English
• ISSNs: 1463-4236

Abstract

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 administrative 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.