Organizational characteristics associated with sustained participation in internal quality improvement: Findings from two waves of a national sample of physician practices in the United States

Abstract

Background and purpose

Engagement in internal quality improvement (QI) within physician practices is a key avenue by which to deliver evidence-based and patient-centered care, but it can be difficult to sustain such engagement. Consequently, research is needed that identifies organizational factors associated with sustained internal QI. We utilized two waves of a national survey of physician practices to explore whether organizational innovation characteristics including organizational culture, health information technology (HIT) capacity, and Accountable Care Organization (ACO) affiliation distinguish physician practices that sustain their engagement in internal QI from those that do not.

Methods

We linked two waves of the National Survey of Healthcare Organizations and Systems (NSHOS) fielded between 2017-2018 and 2022–2023 among physician practices in the United States to assess organizational characteristics associated with sustained engagement in QI (n = 714 practices). Our final regression models incorporate survey and nonresponse weights and control for practice size and ownership.

Results

We found that higher innovative culture scores were associated with almost three times the odds of sustained QI (OR = 2.91, p < 0.001). Although high HIT capacity was also associated with greater odds of sustained versus non-sustained QI across both survey waves, this finding was not statistically significant (OR = 1.11, p > 0.05). We did not find statistically significant support for our final hypothesis that ACO affiliation (whether commercial, Medicare, or Medicaid) was associated with sustained internal QI (OR = 1.26, p > 0.05).

Conclusions

Our study is the first to our knowledge to underscore the critical importance of innovative organizational culture to sustaining internal QI among physician practices. Although ACO affiliation may signal willingness to participate in QI as a means to advance evidence- and value-based care and HIT capacity may facilitate improvement activities, these characteristics may not assure sustained internal QI engagement without an organizational culture aligned with QI.

Practice implications

Policies that advance organizational capacity to develop a learning-oriented innovative culture could enable sustained QI engagement at the physician practice level.