Understanding Factors Influencing Quality Improvement Capacity among Ambulatory Care Practices across the MidSouth Region: An Exploratory Qualitative Study

Background and Objective: Success in choosing and implementing quality metrics, necessary in a value-based care model, depends on quality improvement (QI) capacity - the shared knowledge, understanding, and commitment to continuous improvement. We set out to explore factors influencing QI capacity among ambulatory care practices in the MidSouth Practice Transformation Network. Methods: As part of network participation, 82 practices submitted a plan for implementing self-selected quality metrics. This plan asked practices to identify factors that would assist or impede successful implementation of interventions to meet metric targets. We used a qualitative thematic analysis approach to explore barriers and facilitators to developing QI capacity among ambulatory care practices. Results: Recurrent facilitators included external change agents, protected time for QI, a framework for improvement, and infrastructure including electronic health record (EHR) capabilities. Frequent barriers included lack of QI knowledge, lack of time, frequent staff turnover, inadequate EHR capabilities, lack of an internal change agent, and a belief that performance was outside of the practice's control. Conclusion: These findings provide insight into factors influencing the adoption and implementation of QI metrics across a diverse group of ambulatory care practices and suggest that targeting the Inner Setting of practices may be an appropriate approach for developing practice-level QI capacity, which is necessary for success in a value-based care model.