Beyond Low-Hanging Fruit: A Systematic Approach to Assessing Quality Improvement Needs in Healthcare Practices

Quality Improvement (QI) tools abound to help clinicians improve the quality of their care. Such tools, however, assume one knows the process that needs attention. A systematic approach is thus needed for selecting the QI activities that have the greatest impact on quality. This study applies Functional Job Analysis (FJA) to systematically identify areas in preventive care most suitable for high-impact QI efforts. Seven internal medicine practice personnel served as subject matter experts (SMEs) in multiple FJA style focus groups to identify the tasks required to ensure successful execution of eight preventive-care measures. Tasks with the greatest prevalence across measures and highest human error consequence ratings were deemed most suitable for QI. SMEs generated improvement recommendations for the identified tasks via focus groups. Tasks with greatest cross-measure prevalence centered on information gathering; tasks with the greatest potential consequence of error centered on medication management, testing and test follow-up (MMTTF). SMEs reported time, space, staffing, and equipment constraints as fundamental barriers impacting all aspects of primary care. Barriers to successful information gathering included issues with front desk staff and the electronic health record. Barriers to MMTTF included lab workflow and patient-related factors. Improvement recommendations included strategic staffing, technology-based solutions, and added in-house testing capabilities. FJA successfully identified two clear, distinct clinic workflow areas that could benefit from QI initiatives. Although our work is limited by its single-site design, results are consistent with prior multi-site FJA research. Contrary to traditional, disease-specific QI approaches, our work identified a core set of processes that, if optimized, can improve care across multiple clinical conditions, and presented a novel application of a classic HR tool to make more systematic QI decisions.