title: Teaching quality improvement in the midst of performance measurement pressures: mixed messages?
abstract: BACKGROUND
  While the importance of teaching quality improvement (QI) is recognized, formal opportunities to teach it are limited and are not always successful at getting physician trainee buy-in. We summarize findings that emerged from a QI curriculum designed to promote physician trainee insights into the evaluation and improvement of quality of care.
  
  
  METHODS
  Grounded-theory approaches to thematic coding of responses from 24 trainees to open-ended items about aspects of a QI curriculum. The 24 trainees were subsequently divided into 9 teams that provided group responses to open-ended items about assessing quality care. Coding was also informed by notes from group discussions.
  
  
  RESULTS
  Successes associated with QI projects reflected several aspects of optimizing care such as approaches to improving processes and enabling providers. Counterproductive themes included aspects of compromising care such as creating blinders and complicating care delivery. Themes about assessing care included absolute versus process trade-offs, time frame, documentation completeness, and the underrecognized role of the patient/provider dynamic.
  
  
  CONCLUSIONS
  Our mapping of the themes provides a useful summary of issues and ways to approach the potential lack of buy-in from physician trainees about the value of QI and the "mixed-messages" regarding inconsistencies in the application of presumed objective performance measures.
authors.affiliation: Department of Medicine, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio 44106, USA. brook.watts@med.va.gov
authors.forename: Brook
authors.initials: B
authors.lastname: Watts
authors.forename: Sarah
authors.initials: S
authors.lastname: Augustine
authors.forename: Renée H
authors.initials: RH
authors.lastname: Lawrence
mesh_terms: D003479:Curriculum; D004501:Education, Medical; D006801:Humans; D011785:Quality Assurance, Health Care / Q000592:standards*; D013337:Students, Medical / Q000523:psychology*; D011795:Surveys and Questionnaires