This post is a two-part series on quality improvement. Check back later this month for the second part.

Quality Improvement in Primary Care

The use of quality improvement is not a new concept to the medical field as quality improvement teams are often routine in health system settings. Primary care, however, appears to have a lack of generalizable studies that support quality improvement (QI) efforts (Balasubramanian et al., 2018). Despite this lack of QI research in primary care, a recent study proposes a different type of approach that builds on the existing interactions in primary care.

QI research efforts can be strengthened using a relational-based approach that is high quality and conforms to the time parameters of primary care interactions (Bitton, 2018). This approach would help to ensure that patients’ specific needs are identified and addressed in a collaborative but efficient manner. Through this interaction a more patient-centered approach could be possible in future patient encounters (Bitton, 2018). This relationship affords practitioners and patients a rapport that is positioned to improve quality from a patient-centered perspective. The use of a patient-centered approach hopes to encourage positive and effective change throughout the system in which primary care is based. 

 

A Strategic Approach to Improvement

Approaches to quality improvement often use quantitative methods such as surveys or questionnaires to capture specific dimensions of improvement. These types of approaches can be helpful but often lead to a lack of voice from practitioners and patients. The current approach to patient-directed quality improvement could be guided by a mixed method approach using a sequential explanatory design or a concurrent triangulation design. This type of design would allow for quantitative data to be generalizable; while also supporting the development of meaning and voice from patients to identify what is working, and what improvements they would like to see for future visits. The qualitative component of this design could be comprised of brief semi-structured interviews using randomly assigned patients selected form the quantitative portion.

 

Brief Illustration of Intervention in Primary Care

In this patient-centered approach, every patient in a given time span could be given a brief survey about how they felt their visit went. This survey could be tailored to patients only receiving BHC services or every patient to encompass all services offered within the primary care setting. Once this quantitative process was completed and analyzed you could then randomly select from those who completed the survey. In this sample, you could invite them to think about a specific process in their experience. From this invitation you could ask them to focus on one of the many services offered in primary care such as nursing, BHC services, physician, or lab work and tailor your questions to that service.

After evaluating the responses to the qualitative portion of this design you could use both sets of data to develop an improvement strategy based on what is currently working for patients and what processes might need to be improved for a better patient experience. This experience has the potential to increase patient satisfaction with services and adherence to practitioner recommendations and interventions.

This emphasis on patient-centered improvement using a mixed method design is a slight shift from existing research. This shift in approach allows patients to be at the center of improvement with the hope that it improves the system and patient outcomes. This intervention would help to add patient voice to quality improvement strategies and expand the emphasis on quality improvement outside of the interprofessional system of primary care practitioners. Through this experience patients are afforded a form of systemic buy in, as their perspectives are being sought and used to improve the system that they belong to.

Alexander Young, M.A., LPC is a counseling doctoral candidate at Our Lady of the Lake University in San Antonio, Texas. He earned his master’s degree from the University of Texas at San Antonio in Counseling. He is currently completing his last practicum prior to internship at the Brady Green Clinic in San Antonio, Texas with Dr. Stacy Ogbeide.