Strategies for Practice Change
| Recognition Level | |||
|---|---|---|---|
| Strategy | Overall (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 care | 86.5 | 82.2 | 89.0 |
| Providing information and skills training to clinicians and staffb | 79.0 | 70.3 | 84.1 |
| Designing care improvements to make the care process more beneficial to the patient | 78.9 | 82.4 | 76.7 |
| Periodically measuring care quality to assess compliance with any new approach to care | 76.0 | 72.2 | 78.2 |
| Setting goals and benchmarking rates of performance quality | 73.6 | 71.1 | 75.0 |
| Including front-line staff on quality improvement committees or teams | 69.1 | 65.9 | 71.0 |
| Removing or reducing barriers to better quality of care | 65.6 | 63.3 | 66.9 |
| Providing to those who are charged with implementing improved care the power to authorize and make the desired changesb | 64.9 | 55.6 | 70.3 |
| Delegating to nonclinician staff the responsibility to carry out aspects of care that were the responsibility of cliniciansb | 63.9 | 55.6 | 68.8 |
| Organizing people into teams focused on accomplishing the change process for improved care | 60.9 | 58.0 | 62.6 |
| Reporting measurements of individual clinician performance for comparison with peer cliniciansc | 60.3 | 48.9 | 66.9 |
| Using opinion leaders or role modeling or other strategies to encourage support for changes | 57.3 | 54.4 | 59.0 |
| Using piloting or pretesting of changes and evaluating the impact before introducing practicewide changesc | 51.4 | 38.2 | 59.0 |
| Designing care improvements to make physician participation less work than beforeb | 46.9 | 38.9 | 51.6 |
| Providing training to clinicians and staff on how to involve patients/families in quality improvement | 30.1 | 27.4 | 31.6 |
| Using formal quality improvement or efficiency approaches (eg, Lean, Plan-Do-Study-Act, rapid cycles, Six Sigma, Model for Improvement) | 30.5 | 26.7 | 32.9 |
| Including patients on quality improvement committees or teams | 15.5 | 12.1 | 17.5 |
| Overall score, mean (SD)b | 11.5 (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.