title: Continuous quality improvement in primary care: what's happening?
abstract: OBJECTIVE
  Despite much health care interest in quality and Continuous Quality Improvement, there is little quantitative information about it. The purpose of this study was to measure the attitudes, activities, and organizational cultures concerning Continuous Quality Improvement in a group of Midwestern primary care clinics.
  
  
  METHODS
  Three surveys of the clinicians, nurses, and other staff in 44 primary care clinics in the metropolitan area of Minneapolis and St. Paul were conducted. These surveys assessed: (1) attitudes about quality improvement, (2) previous efforts in these clinics to use process improvement teams, and (3) the extent to which the clinics' organizational cultures were perceived as supporting quality. The Provider Attitude Survey was completed by clinicians and nurses; the Process Improvement Progress was completed by members of the best Continuous Quality Improvement teams, if any; and the Quality Systems Inventory was completed by all personnel.
  
  
  RESULTS
  Most of the clinical personnel reported support for various Continuous Quality Improvement concepts, but their understanding and experience were limited. Only 20 (45%) clinics had had at least one Continuous Quality Improvement team in the past, only five of the 12 teams with adequate information had completed an improvement cycle, and only seven reported improving a process with it. The mean clinic scores for quality culture were no better than those in other types of organizations.
  
  
  CONCLUSIONS
  Despite relatively favorable attitudes and some Continuous Quality Improvement activities, there appears to be a need to help clinics build skill and experience for the required care improvements.
authors.affiliation: Health Partners Research Foundation, Minneapolis, Minnesota 55440-1309, USA. leif.i.solberg@healthpartners.com
authors.forename: L I
authors.initials: LI
authors.lastname: Solberg
authors.forename: M L
authors.initials: ML
authors.lastname: Brekke
authors.forename: T E
authors.initials: TE
authors.lastname: Kottke
authors.forename: R P
authors.initials: RP
authors.lastname: Steel
mesh_terms: D001291:Attitude of Health Personnel; D007722:Health Knowledge, Attitudes, Practice; D008910:Minnesota; D011159:Population Surveillance; D017410:Practice Guidelines as Topic; D011314:Preventive Health Services / Q000592:standards; D011320:Primary Health Care / Q000592:standards*; D017064:Process Assessment, Health Care; D011795:Surveys and Questionnaires; D017749:Total Quality Management