Constructing a framework for quality activity in primary care

Abstract

Introduction. In 2009, the Royal New Zealand College of General Practitioners commissioned the development of a framework to facilitate quality-improvement activity in primary care settings. This paper outlines the development of the framework, which integrates concepts of quality with the reality of practice-based clinical care, and discusses its value for primary care quality improvement. Method. Framework development involved: (1) literature review of theoretical approaches to healthcare quality; (2) field work utilising a mixed methods approach to obtain empirical data; and (3) model design. Results. Primary care practitioners are juggling competing priorities. Models and tools that promote quality-related activity at practice level need to take into account, and incorporate by design, day-to-day clinical and practice functions. Conclusions. The quality framework identifies the components of primary care practice and locates this model within the concepts and activities necessary for quality improvement. It may be used by primary care organisations and practices to facilitate focussed quality-improvement activity and self-directed process review. The framework was developed for, and within a New Zealand primary care setting, and is applicable internationally and within other healthcare settings. What is known about the topic? Primary care practitioners are frequently juggling competing priorities while participating in an array of professional development, quality assurance, and improvement activities, some perceived to be of little relevance to day-to-day clinical care. What does this paper add? The framework integrates concepts of quality with the reality of practice-based clinical care. The function of the framework is to ensure all relevant aspects of practice are considered in a systematic and comprehensive manner to obtain quality improvement. What are the implications for practitioners? The framework is a practical tool that can guide practices and organisational stakeholders to continually deconstruct, examine and reassemble any practice-based clinical care activity. Practices wishing to undertake quality-improvement activity within the context of clinical care may use the framework to guide critical thinking at practice level.