title: Quality improvement in small office settings: an examination of successful practices.
abstract: BACKGROUND
  Physicians in small to moderate primary care practices in the United States (U.S.) (<25 physicians) face unique challenges in implementing quality improvement (QI) initiatives, including limited resources, small staffs, and inadequate information technology systems 23,36. This qualitative study sought to identify and understand the characteristics and organizational cultures of physicians working in smaller practices who are actively engaged in measurement and quality improvement initiatives.
  
  
  METHODS
  We undertook a qualitative study, based on semi-structured, open-ended interviews conducted with practices (N = 39) that used performance data to drive quality improvement activities.
  
  
  RESULTS
  Physicians indicated that benefits to performing measurement and QI included greater practice efficiency, patient and staff retention, and higher staff and clinician satisfaction with practice. Internal facilitators included the designation of a practice champion, cooperation of other physicians and staff, and the involvement of practice leaders. Time constraints, cost of activities, problems with information management and or technology, lack of motivated staff, and a lack of financial incentives were commonly reported as barriers.
  
  
  CONCLUSIONS
  These findings shed light on how physicians engage in quality improvement activities, and may help raise awareness of and aid in the implementation of future initiatives in small practices more generally.
authors.affiliation: Quality Research, American Board of Internal Medicine, Philadelphia, PA, USA. dwolfson@abim.org
authors.forename: Daniel
authors.initials: D
authors.lastname: Wolfson
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Bernabeo
authors.forename: Brian
authors.initials: B
authors.lastname: Leas
authors.forename: Shoshanna
authors.initials: S
authors.lastname: Sofaer
authors.forename: Gregory
authors.initials: G
authors.lastname: Pawlson
authors.forename: Donna
authors.initials: D
authors.lastname: Pillittere
mesh_terms: D006123:Group Practice / Q000592:standards*; D006801:Humans; D010824:Physicians' Offices; D011786:Quality Control; D014481:United States