The implementation of quality improvement facilitators in primary care settings in Quebec: a case study

Abstract

Abstract Background Quality improvement (QI) facilitators were integrated into Quebec’s university affiliated primary care practices. After an evaluation demonstrated the QI facilitators’ key role in implementing a QI culture, the Ministry of Health and Social Services decided to test the intervention in non-academic primary care practices with a one-year pilot project in one regional health organization. This study aims to understand the role and implementation of QI facilitators in non-academic primary care practices, as well as to highlight levers and barriers to their contribution. Methodology A single embedded case study was used to understand the implementation of QI facilitators. Led as an organization participatory research, the conduct of this study involved knowledge users. The Conceptual Framework for Implementation Research was used for the development of the interview guide and data analysis. We used two sources of data: 1) with the support of knowledge users, we obtained relevant documents about the QI facilitators’ role, the governance and planned implementation strategies (n = 17); 2) we conducted 19 semi-structured interviews with QI facilitators (n = 6), managers (n = 7) and physicians (n = 6) that were involved in the implementation of the pilot. Directed content analysis, triangulated writing analytics memos from documentation, was used to understand the QI facilitators’ role enactment and contribution, as well as their integration in the COVID-19 context. Results All participants had a positive perception of the QI facilitators’ role on bringing a QI culture and on the implementation of primary care projects. Three explanatory factors could explain the barriers and levers to the implementation of QI facilitators. Being decentralized was considered as enabling a more personalized approach, in which QI facilitators could better respond to their respective territory’s needs. QI facilitators worked under a co-management structure that included the clinics’ medical directors and the territorial managers. This structure was seen as an enabler to the QI facilitators’ integration and to their contributions in coordinating projects meeting provincial guidelines in the COVID-19 context. Conclusion The implementation of QI facilitators was positive for non-academic primary care practices. This study suggests elements for public institutions and managers to consider in the implementation of such QI facilitators in primary care practices.