Contextual antecedents of quality improvement: a comparative case study in rural, urban and Kaupapa Māori general practice
Introduction The impact of contextual factors on primary health-care quality improvement is significant. In-depth research is required to identify the key contextual factors that influence quality improvement initiatives to develop high-performing primary health-care systems. Aim This research se...
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| Format: | Article |
| Language: | English |
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CSIRO Publishing
2022-01-01
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| Series: | Journal of Primary Health Care |
| Subjects: | |
| Online Access: | https://www.publish.csiro.au/hc/pdf/HC22012 |
| _version_ | 1828161595019100160 |
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| author | Lynn McBain Paul Childerhouse Jane Cullen |
| author_facet | Lynn McBain Paul Childerhouse Jane Cullen |
| author_sort | Lynn McBain |
| collection | DOAJ |
| description |
Introduction
The impact of contextual factors on primary health-care quality improvement is significant. In-depth research is required to identify the key contextual factors that influence quality improvement initiatives to develop high-performing primary health-care systems.
Aim
This research seeks to answer two questions; what are the contextual factors influencing primary care improvement initiatives?; and how do contextual factors, the quality improvement initiative and the implementation process influence one another and the overall improvement outcomes?
Methods
A multi-case study methodology was used to explore the complexities of the phenomena in situ. Three sites where successful quality improvement had occurred were selected by purposeful theoretical sampling to provide a sample of rural, urban and Kaupapa Māori general practice settings typical of the New Zealand environment. Semi-structured interviews were conducted with team members and triangulated with secondary data provided by the organisations.
Results
The quality improvement topic and the approach taken were intrinsically linked to context. Sites reported success in achieving the desired outcomes benefitting the patients, practice and staff. Teams did not use formal improvement methods, instead relying on established relationships and elements of change management methods. The culture in all three cases was a large component of why and how these initiatives were successful.
Discussion
Intrinsic motivation was generated by community connections and networks. This combined with a learning climate generated by distributed leadership and teamwork enabled success. Iterative reflection and sensemaking processes were able to deliver quality improvement success in primary care without the use of formal improvement methods.
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| first_indexed | 2024-04-12T00:41:09Z |
| format | Article |
| id | doaj.art-e193c4ee41c84fd78a781288d3191f02 |
| institution | Directory Open Access Journal |
| issn | 1172-6156 |
| language | English |
| last_indexed | 2024-04-12T00:41:09Z |
| publishDate | 2022-01-01 |
| publisher | CSIRO Publishing |
| record_format | Article |
| series | Journal of Primary Health Care |
| spelling | doaj.art-e193c4ee41c84fd78a781288d3191f022022-12-22T03:55:00ZengCSIRO PublishingJournal of Primary Health Care1172-61562022-01-01142179186HC22012Contextual antecedents of quality improvement: a comparative case study in rural, urban and Kaupapa Māori general practiceLynn McBain0Paul Childerhouse1Jane Cullen2Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand.Massey University, Palmerston North, New Zealand; and Department of Supply Chain Management, College of Business and Law, RMIT, Melbourne, Australia.Massey University, Palmerston North, New Zealand. Introduction The impact of contextual factors on primary health-care quality improvement is significant. In-depth research is required to identify the key contextual factors that influence quality improvement initiatives to develop high-performing primary health-care systems. Aim This research seeks to answer two questions; what are the contextual factors influencing primary care improvement initiatives?; and how do contextual factors, the quality improvement initiative and the implementation process influence one another and the overall improvement outcomes? Methods A multi-case study methodology was used to explore the complexities of the phenomena in situ. Three sites where successful quality improvement had occurred were selected by purposeful theoretical sampling to provide a sample of rural, urban and Kaupapa Māori general practice settings typical of the New Zealand environment. Semi-structured interviews were conducted with team members and triangulated with secondary data provided by the organisations. Results The quality improvement topic and the approach taken were intrinsically linked to context. Sites reported success in achieving the desired outcomes benefitting the patients, practice and staff. Teams did not use formal improvement methods, instead relying on established relationships and elements of change management methods. The culture in all three cases was a large component of why and how these initiatives were successful. Discussion Intrinsic motivation was generated by community connections and networks. This combined with a learning climate generated by distributed leadership and teamwork enabled success. Iterative reflection and sensemaking processes were able to deliver quality improvement success in primary care without the use of formal improvement methods. https://www.publish.csiro.au/hc/pdf/HC22012case studycontextdistributed leadershipgeneral practiceimplementationlearning climate |
| spellingShingle | Lynn McBain Paul Childerhouse Jane Cullen Contextual antecedents of quality improvement: a comparative case study in rural, urban and Kaupapa Māori general practice Journal of Primary Health Care case study context distributed leadership general practice implementation learning climate |
| title | Contextual antecedents of quality improvement: a comparative case study in rural, urban and Kaupapa Māori general practice |
| title_full | Contextual antecedents of quality improvement: a comparative case study in rural, urban and Kaupapa Māori general practice |
| title_fullStr | Contextual antecedents of quality improvement: a comparative case study in rural, urban and Kaupapa Māori general practice |
| title_full_unstemmed | Contextual antecedents of quality improvement: a comparative case study in rural, urban and Kaupapa Māori general practice |
| title_short | Contextual antecedents of quality improvement: a comparative case study in rural, urban and Kaupapa Māori general practice |
| title_sort | contextual antecedents of quality improvement a comparative case study in rural urban and kaupapa maori general practice |
| topic | case study context distributed leadership general practice implementation learning climate |
| url | https://www.publish.csiro.au/hc/pdf/HC22012 |
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