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Improving Medical Practice: A Conceptual Framework

HealthPartners Research Foundation, Minneapolis, Minn

CORRESPONDING AUTHOR: Leif I. Solberg, MD, HealthPartners Research Foundation, PO Box 1524, MS21111R, Minneapolis, MN 55440, leif.i.solberg{at}healthpartners.com

PURPOSE The purpose of this article is to produce a relatively simple conceptual framework for guiding and studying practice improvement.

METHODS I summarize the lessons from my experience with a variety of quality improvement research studies during the last 30 years, supplemented with relevant literature from both medicine and other industries about the issues associated with successful quality improvement.

RESULTS My experience suggests that organizational leadership with an urgent vision for change, ability to manage the change process, and selection of systematic changes capable of fulfilling the vision are each critical for successful quality improvement. Published literature from other industries emphasizes the importance of a goal-directed change process managed by leaders who recognize the need to engage their employees and other leaders in a disciplined but flexible way that accommodates external and internal factors and uses teams and group learning. It also suggests the importance of organizational context and the level of external and internal barriers and facilitators for change. The resulting model proposes that priority, change process, and care process content are necessary for measurable improvements in quality of care and patient outcomes, although internal and external barriers must also be attended to and addressed.

CONCLUSION This framework may provide a guide to those in the front lines of care who would like to make the care transformations that are needed to greatly improve care. It may also be helpful to those who are developing or testing interventions and recruiting medical practices for such change efforts.

Key Words: Chronic disease • delivery of health care • disease management • models, organizational • quality of health care • physician’s practice patterns • health services research

This article has been cited by other articles:

				L. I. Solberg, S. E. Asche, K. L. Margolis, and R. R. Whitebird Measuring an Organization's Ability to Manage Change: The Change Process Capability Questionnaire and Its Use for Improving Depression Care American Journal of Medical Quality, June 1, 2008; 23(3): 193 - 200. [Abstract] [PDF]

				K. C. Stange In This Issue: New Concepts for Diabetes and Chronic Disease Management Ann. Fam. Med, May 1, 2007; 5(3): 194 - 195. [Full Text] [PDF]

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