title: Constructing a framework for quality activity in primary care.
abstract: BACKGROUND
  In 2009, the Royal New Zealand College of General Practitioners commissioned the development of a framework to facilitate quality-improvement activity in primary care settings. This paper outlines the development of the framework, which integrates concepts of quality with the reality of practice-based clinical care, and discusses its value for primary care quality improvement.
  
  
  METHODS
  Framework development involved: (1) literature review of theoretical approaches to healthcare quality; (2) field work utilising a mixed methods approach to obtain empirical data; and (3) model design.
  
  
  RESULTS
  Primary care practitioners are juggling competing priorities. Models and tools that promote quality-related activity at practice level need to take into account, and incorporate by design, day-to-day clinical and practice functions.
  
  
  CONCLUSIONS
  The quality framework identifies the components of primary care practice and locates this model within the concepts and activities necessary for quality improvement. It may be used by primary care organisations and practices to facilitate focussed quality-improvement activity and self-directed process review. The framework was developed for, and within a New Zealand primary care setting, and is applicable internationally and within other healthcare settings.
authors.affiliation: Department of the Dean, School of Medicine and Health Sciences, University of Otago, P.O. Box 7343, Wellington South, New Zealand. roshan.perera@otago.ac.nz
authors.forename: G A Roshan
authors.initials: GA
authors.lastname: Perera
authors.forename: Anthony C
authors.initials: AC
authors.lastname: Dowell
authors.forename: Caroline J
authors.initials: CJ
authors.lastname: Morris
mesh_terms: D019538:Health Care Surveys; D006270:Health Facility Administrators; D006801:Humans; D007407:Interviews as Topic; D009520:New Zealand; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards; D011785:Quality Assurance, Health Care / Q000379:methods / Q000458:organization & administration*