A model for continuous quality improvement in small scale practices.

During the past decade new models for quality improvement in health care were developed based on experiences in industry. These models became known as total quality management or continuous quality improvement and are now widely and successfully used in larger healthcare organisations. In general practice several tools are used to improve care, such as vocational training, continuous medical education, peer review, audit, and guideline development. Although valuable, these tools usually focus more on improving professional performance than on comprehensive care provision delivered by teams. Little is known about the use of continuous quality improvement in small scale general practice. The question is whether it is possible to translate the principles of continuous quality improvement into a model for quality improvement for general practice. Simply adopting the strategies of continuous quality improvement used in hospitals or larger organisations may fail because of the specific characteristics of general practice. Most of these practices have, for example, a hierarchical structure in which the general practitioner (GP) is not only the manager but also is often the owner. In many countries general practices have a small staV who lack the time for quality improvement activities. The aim of this article is to reflect on the applicability of continuous quality improvement in small scale practices. Firstly, the characteristics of general practice will be discussed. Secondly, the essential elements of continuous quality improvement are presented by giving a short review of previous publications. Finally, these elements are translated into a framework of practical possibilities for quality improvement in general practice, which results in a model for quality improvement that may be feasible and applicable in small scale general practice. Examples from a study on quality management in general practice done in the Netherlands are used to illustrate the model. 17