Promoters and inhibitors for quality improvement work in general practice: a qualitative analysis of 2715 free-text replies

Abstract

Background Continuous quality improvement (QI) is necessary to develop and maintain high quality general practice services. General Practitioners (GPs’) motivation is an important factor in the success of QI initiatives. We aimed to identify factors that impair or promote GPs’ motivation for and participation in QI projects.

Material and methods We analysed 2715 free-text survey replies from 2208 GPs participating in the QI intervention ‘Correct Antibiotic Use in the Municipalities’. GPs received reports detailing their individual antibiotic prescriptions for a defined period, including a comparison with a corresponding previous period. The content was discussed in peer group meetings. Each GP individually answered work-sheets on three separate time-points, including free-text questions regarding their experiences with the intervention. Data were analysed using inductive thematic analysis.

Results We identified three overarching themes in the GPs’ thoughts on inhibitors and promoters of QI work: (1) the desire to be a better doctor, (2) structural and organisational factors as both promoters and inhibitors and (3) properties related to different QI measures. The provision of individual prescription data was generally very well received. The participants stressed the importance of a safe peer group, like the Continuous Medical Education group, for discussions, and also underlined the motivating effect of working together with their practice as a whole. Lack of time was essential in GPs’ motivation for QI work. QI tools should be easily available and directly relevant in clinical work.

Conclusion The desire to be good doctor is a strong motivator for improvement, but the framework for general practice must allow for QI initiatives. QI tools must be easily obtainable and relevant for practice. Better tools for obtaining clinical data for individual GPs are needed.