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Effects of Practice Turnover on Primary Care Quality Improvement Implementation.

Authors
  • Baron, Andrea N1
  • Hemler, Jennifer R2
  • Sweeney, Shannon M2
  • Tate Woodson, Tanisha1
  • Cuthel, Allison3
  • Crabtree, Benjamin F2
  • Cohen, Deborah J1
  • 1 Oregon Health & Science University, Portland, OR.
  • 2 Rutgers University, New Brunswick, NJ.
  • 3 New York University, New York, NY.
Type
Published Article
Journal
American journal of medical quality : the official journal of the American College of Medical Quality
Publication Date
Jan 01, 2020
Volume
35
Issue
1
Pages
16–22
Identifiers
DOI: 10.1177/1062860619844001
PMID: 31030525
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Primary care practices often engage in quality improvement (QI) in order to stay current and meet quality benchmarks, but the extent to which turnover affects practices' QI ability is not well described. The authors examined qualitative data from practice staff and external facilitators participating in a large-scale QI initiative to understand the relationship between turnover and QI efforts. The examination found turnover can limit practices' ability to engage in QI activities in various ways. When a staff member leaves, remaining staff often absorb additional responsibilities, and QI momentum slows as new staff are trained or existing staff are reengaged. Turnover alters staff dynamics and can create barriers to constructive working relationships and team building. When key practice members leave, they can take with them institutional memory about QI purpose, processes, and long-term vision. Understanding how turnover affects QI may help practices, and those helping them with QI, manage the disruptive effects of turnover.

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