Factors influencing family physician engagement in practice-based quality improvement Qualitative study

Objective To explore the experiences of family physicians leading quality improvement (QI) efforts and to better understand facilitators and barriers related to advancing QI in family practice. Design Qualitative descriptive study. Setting The Department of Family and Community Medicine at the University of Toronto in Ontario. The department launched a quality and innovation program in 2011 with the dual goals of teaching QI skills to learners and supporting faculty in leading QI efforts in practice. Participants Family physician faculty who held QI leadership roles at any of the department's 14 teaching units between 2011 and 2018. Methods Fifteen semistructured telephone interviews were conducted over 3 months in 2018. Analysis was informed by a qualitative descriptive approach. Consistency of responses across the interviews was suggestive of thematic saturation. Main findings Substantial variation was found in the level of engagement with QI in practice settings despite the common training, forms of support, and curriculum the department provided. Four factors influenced the uptake of QI. First, committed leadership across the organization was fundamental to developing an effective QI culture. Second, external drivers such as mandatory QI plans sometimes motivated engagement in QI but sometimes were barriers, particularly when internal priorities conflicted with external demands. Third, at many practices, QI was widely perceived as extra work rather than as a way to enable better patient care. Finally, physicians described lack of time and resources as a challenge, particularly in community practices, and advocated for practice facilitation as a mechanism to support QI efforts. Conclusion Advancing QI in primary care practice will require committed leaders, a clear understanding among physicians of the potential benefits of QI, alignment of external demands with internal drivers for improvement, and dedicated time for QI work along with support such as practice facilitation.