Introducing a quality improvement programme to primary healthcare teams.
OBJECTIVE
To evaluate a programme in which quality improvement was facilitated, based on principles of total quality management, in primary healthcare teams, and to determine its feasibility, acceptability, effectiveness, and the duration of its effect.


METHODS
Primary healthcare teams in Leicestershire (n = 147) were invited to take part in the facilitated programme. The programme comprised seven team meetings, led by a researcher, plus up to two facilitated meetings of quality improvement subgroups, appointed by each team to consider specific quality issues.


METHODS
To assess the effect and feasibility of the programme on improving the quality of care provided, the individual quality improvement projects undertaken by the teams were documented and opportunities for improvement were noted at each session by the facilitator. The programme's acceptability was assessed with questionnaires issued in the final session to each participant. To assess the long term impact on teams, interviews with team members were conducted 3 years after the programme ended.


RESULTS
10 of the 27 teams that initially expressed interest in the programme agreed to take part, and six started the programme. Of these, five completed their quality improvement projects and used several different quality tools, and three completed all seven sessions of the programme. The programme was assessed as appropriate and acceptable by the participants. Three years later, the changes made during the programme were still in place in three of the six teams. Four teams had decided to undertake the local quality monitoring programme, resourced and supported by the Health Authority.


CONCLUSIONS
The facilitated programme was feasible, acceptable, and effective for a few primary healthcare teams. The outcomes of the programme can be sustained. Research is needed on the characteristics of teams likely to be successful in the introduction and maintenance of quality improvement programmes.
Hearnshaw
H
H
Eli Lilly National Clinical Audit Centre, Department of General Practice and Primary Health Care, University of Leicester, Leicester General Hospital, UK.
Reddish
S
S
Carlyle
D
D
Baker
R
R
Robertson
N
N
D003659:Decision Making, Organizational; D006126:Group Processes; D006302:Health Services Research; D008332:Management Quality Circles; D015279:Organizational Culture; D010348:Patient Care Team / Q000592:standards*; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards*; D015397:Program Evaluation; D011795:Surveys and Questionnaires; D017749:Total Quality Management / Q000458:organization & administration*; D006113:United Kingdom