The Article in Brief

Different Paths to High-Quality Care: Three Archetypes of Top-Performing Practice Sites

Chris Feifer, DrPH , and colleagues

Background This study looks at 9 medical practices that have been successful in improving the quality of medical care they deliver.

What This Study Found The practices in this study, which are successful in improving quality of care, can be described by 3 models or archetypes. The Technophile archetype describes practices that quickly adopt and consistently use an electronic medical record and its tools, such as automated guides to help clinicians and staff perform and document routine tasks. Each of these practices has a doctor who is committed to finding new ways to use the electronic medical record. Practices in the Motivated Team archetype look for new ways to use existing resources to improve quality. They involve the entire practice by sharing information, holding practice meetings, involving and motivating staff, and setting aside time for improvement efforts. Practices in the Care Enterprise archetype select clinical areas that they want to improve and design systems to do so, involving staff if needed. They take a customer-service approach to provide care that meets the needs of patients and doctors and is consistent with recommended guidelines.

Implications

• No single approach creates success in improving quality of care. Practices in this study use many common strategies, with different approaches for organizing their practice change efforts.
• Practices that succeeded in improving quality in this study had someone in the practice who was a "champion" for the improvement effort.
• Medical practices do not have to start out with a focus on technology to improve quality.