Open Access Highly Accessed Research article

Quality improvement in small office settings: an examination of successful practices

Daniel Wolfson1, Elizabeth Bernabeo2*, Brian Leas3, Shoshanna Sofaer4, Gregory Pawlson5 and Donna Pillittere5

Author Affiliations

1 American Board of Internal Medicine Foundation, Philadelphia, PA, USA

2 Quality Research, American Board of Internal Medicine, Philadelphia, PA, USA

3 Department of Health Policy, Thomas Jefferson University, Philadelphia, PA, USA

4 School of Public Affairs, Baruch College, New York, NY, USA

5 National Committee for Quality Assurance, Washington, DC, USA

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BMC Family Practice 2009, 10:14  doi:10.1186/1471-2296-10-14

Published: 9 February 2009



Physicians in small to moderate primary care practices in the United States (U.S.) (<25 physicians) face unique challenges in implementing quality improvement (QI) initiatives, including limited resources, small staffs, and inadequate information technology systems 23,36. This qualitative study sought to identify and understand the characteristics and organizational cultures of physicians working in smaller practices who are actively engaged in measurement and quality improvement initiatives.


We undertook a qualitative study, based on semi-structured, open-ended interviews conducted with practices (N = 39) that used performance data to drive quality improvement activities.


Physicians indicated that benefits to performing measurement and QI included greater practice efficiency, patient and staff retention, and higher staff and clinician satisfaction with practice. Internal facilitators included the designation of a practice champion, cooperation of other physicians and staff, and the involvement of practice leaders. Time constraints, cost of activities, problems with information management and or technology, lack of motivated staff, and a lack of financial incentives were commonly reported as barriers.


These findings shed light on how physicians engage in quality improvement activities, and may help raise awareness of and aid in the implementation of future initiatives in small practices more generally.