title: Why do some primary care practices engage in practice improvement efforts whereas others do not?
abstract: OBJECTIVE
  To understand what motivates primary care practices to engage in practice improvement, identify external and internal facilitators and barriers, and refine a conceptual framework.
  
  
  METHODS
  In-depth interviews and structured telephone surveys with clinicians and practice staff (n = 51), observations, and document reviews.
  
  
  METHODS
  Comparative case study of primary care practices (n = 8) to examine aspects of the practice and environment that influence engagement in improvement activities.
  
  
  METHODS
  Three on-site visits, telephone interviews, and two surveys.
  
  
  RESULTS
  Pressures from multiple sources create conflicting forces on primary care practices' improvement efforts. Pressures include incentives and requirements, organizational relationships, and access to resources. Culture, leadership priorities, values set by the physician(s), and other factors influence whether primary care practices engage in improvement efforts.
  
  
  CONCLUSIONS
  Most primary care practices are caught in a cross fire between two groups of pressures: a set of forces that push practices to remain with the status quo, the "15-minute per patient" approach, and another set of forces that press for major transformations. Our study illuminates the elements involved in the decision to stay with the status quo or to engage in practice improvement efforts needed for transformation.
authors.affiliation: Department of Health Policy, Center for Healthcare Quality, George Washington University, Washington, DC 20037, USA. goetzdc@gwu.edu
authors.forename: Debora Goetz
authors.initials: DG
authors.lastname: Goldberg
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Mick
authors.forename: Anton J
authors.initials: AJ
authors.lastname: Kuzel
authors.forename: Lisa Bo
authors.initials: LB
authors.lastname: Feng
authors.forename: Linda E
authors.initials: LE
authors.lastname: Love
mesh_terms: D060866:Accountable Care Organizations / Q000458:organization & administration; D006302:Health Services Research; D006801:Humans; D007857:Leadership; D009042:Motivation; D015279:Organizational Culture; D009937:Organizational Objectives; D011320:Primary Health Care / Q000458:organization & administration*; D058996:Quality Improvement / Q000458:organization & administration*; D012111:Residence Characteristics