Case studies from Project IMPROVE, the first randomized controlled trial to evaluate the effectiveness of continuous quality improvement (CQI) in primary care, were subjected to a qualitative analysis.
Three questions were addresses : How does change in the health care environment affect a quality improvement (QI) process ?
How does clinic organization influence a QI process ? and What is the impact of a QI process on clinic organization ?
Case studies were conducted in 6 clinics that had been randomly selected from the 22 clinics participating in the IMPROVE intervention.
The case study data consisted of observations of CQI team meetings, open-ended interviews with 30 informants (team members plus others in the clinics), interviews with IMPROVE consultants, and documentation from the project.
The data were analyzed to identify themes and generate concepts, assess and compare the informants'experiences, and develop a conceptual framework stimulated by research and theory literature.
Change and uncertaintly in the health care environment both complicated the QI process and motivated participation in improvement.
The smaller clinics appeared to have more difficulty with the QI process because of limited resources and lack of compatibility between the QI approach and their clinic organization. (...)
Mots-clés Pascal : Soin, Relation professionnelle, Travail, Hôpital, Secteur privé, Entretien, Processus, Méthodologie, Nursing, Prévention, Qualité, Condition travail, Organisation
Mots-clés Pascal anglais : Care, Professional relation, Work, Hospital, Private sector, Interview, Process, Methodology, Nursing, Prevention, Quality, Working condition, Organization
Notice produite par :
ORS Auvergne - Observatoire Régional de la Santé d'Auvergne
Code Inist : 002B30A11. Création : 19/02/1999.