Quality improvement in community health centres: the role of microsystem characteristics in the implementation of a diabetes prevention initiative.
OBJECTIVE
To examine the role of microsystem characteristics in the translation of an evidence-based intervention (the Diabetes Prevention Initiative (DPI)) into practice in a community-health centre (CHC).


METHODS
Case study.


METHODS
Constant comparative method of qualitative analysis.


METHODS
Community-health centre in a mid-sized city in the USA.


METHODS
27 administrators, clinicians and staff of a community-health centre implementing a DPI.


METHODS
Perceptions of microsystem characteristics that influence the implementation of this initiative.


RESULTS
Five characteristics of high-performing microsystems were reflected, but not maximised, in the implementation of the DPI. First, there was no universally shared definition of the desired purpose of the DPI. Second, investment in quality improvement (QI) was strong, yet sustainability remained a concern, since efforts were dependent upon external grant support. Third, lack of cohesiveness between the initiative planning team and the rest of the organisation served to both facilitate and constrain implementation. Fourth, administrators showed both support for new initiatives and a lack of strategic vision for QI. Fifth, this initiative substantially strained already-stretched role definitions.


CONCLUSIONS
Translation of the DPI in this CHC was constrained by the lack of a cohesive QI infrastructure and incomplete alignment with characteristics of high-performing microsystems. The findings suggest an important role for microsystem characteristics in the process of implementing evidence-based interventions. Enhancing the level of microsystem performance of CHCs is essential to informing efforts to improve quality of care in this critical safety-net system.
Santana
Calie
C
Division of General Internal Medicine, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10463, USA. casantan@montefiore.org
Nunez-Smith
Marcella
M
Camp
Anne
A
Ruppe
Erin
E
Berg
David
D
Curry
Leslie
L
D001291:Attitude of Health Personnel; D003151:Community Health Centers / Q000145:classification / Q000592:standards; D003299:Cooperative Behavior; D003920:Diabetes Mellitus / Q000517:prevention & control*; D055317:Evidence-Based Practice; D006284:Health Plan Implementation; D006801:Humans; D009937:Organizational Objectives; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team; D061214:Patient Safety; D010934:Planning Techniques; D036301:Qualitative Research; D058996:Quality Improvement; D014481:United States