Quality improvement in general practice: the perspective of the primary healthcare team

Objectives To explore and describe the perceptions and attitudes of primary healthcare team members to quality improvement initiatives and to identify potential obstacles to their adoption and effective implementation. Participants Members of 17 primary healthcare teams participating in a facilitated quality improvement initiative. Design Questionnaire survey using open-ended questions to capture perceptions of confidence, benefits and anxieties related to initiating and carrying out quality improvement. Written responses were transcribed and analysed through inductive content analysis. Results Of the 327 team members surveyed, 166 responded; 56 general practitioners (GPs), 26 nurses, 25 members of professions allied to medicine and 59 managerial, administration and reception staff. Initial exploration of responses revealed generally favourable views but with conditional statements and anxieties frequently attached. Further exploration revealed deficiencies in teamwork and understanding of and involvement in the quality initiative to be evident constraints to its adoption and implementation. Concerns were raised about the impact of initiatives on individuals and teams, and anxieties expressed that quality improvement may be a waste of effort and resources. All team members, especially GPs, were concerned about time and resources. General practitioners and administrative staff expressed concern about the understanding and implementation of the quality process, whereas nurses and members of professions allied to medicine expressed more concerns about teamwork. Conclusion Primary Care Trusts face two major challenges with implementing quality improvement and clinical governance. The first is the perceived gap between their potential and what can be achieved. The second is the need to promote team understanding of and involvement in both. Failure to address either issue will prejudice the implementation of quality improvement and clinical governance in primary care.