Table 4

Strategies for Practice Change

Recognition Level
StrategyOverall (N=249)Level 1 (n=91)Level 3a (n=158)
Use of specific strategies, % reporting that it worked well
 Changing or creating systems in the practice that make it easier to provide high-quality care86.582.289.0
 Providing information and skills training to clinicians and staffb79.070.384.1
 Designing care improvements to make the care process more beneficial to the patient78.982.476.7
 Periodically measuring care quality to assess compliance with any new approach to care76.072.278.2
 Setting goals and benchmarking rates of performance quality73.671.175.0
 Including front-line staff on quality improvement committees or teams69.165.971.0
 Removing or reducing barriers to better quality of care65.663.366.9
 Providing to those who are charged with implementing improved care the power to authorize and make the desired changesb64.955.670.3
 Delegating to nonclinician staff the responsibility to carry out aspects of care that were the responsibility of cliniciansb63.955.668.8
 Organizing people into teams focused on accomplishing the change process for improved care60.958.062.6
 Reporting measurements of individual clinician performance for comparison with peer cliniciansc60.348.966.9
 Using opinion leaders or role modeling or other strategies to encourage support for changes57.354.459.0
 Using piloting or pretesting of changes and evaluating the impact before introducing practicewide changesc51.438.259.0
 Designing care improvements to make physician participation less work than beforeb46.938.951.6
 Providing training to clinicians and staff on how to involve patients/families in quality improvement30.127.431.6
 Using formal quality improvement or efficiency approaches (eg, Lean, Plan-Do-Study-Act, rapid cycles, Six Sigma, Model for Improvement)30.526.732.9
 Including patients on quality improvement committees or teams15.512.117.5
Overall score, mean (SD)b11.5 (3.8)10.7 (4.1)11.9 (3.5)
  • Note: Pearson χ2 test for categorical variables and independent samples t tests for continuous variables.

  • a Includes practices that entered the study at Level 3 and practices that advanced from Level 1 to Level 3 during the study.

  • b P <.05, difference by level.

  • c P <.01, difference by level.

  • d Range: 0 to 18, with higher scores indicating greater use of strategies.