Open Access Open Badges Research article

Triggering change in diabetes care delivery in general practice: a qualitative evaluation approach using the clinical microsystem framework

Tina Janamian1, Lisa J Crossland1*, Claire Jackson1 and Jenny Morcom2

Author Affiliations

1 Centre for Research Excellence in Primary Health Care Microsystems, University of Queensland, Level 8, Health Sciences Building, Building 16/910, Royal Brisbane Hospital, Herston, Brisbane, Queensland, 4006, Australia

2 Focus Health Network, 7 The Esplanade Cotton Tree, Maroochydore, Queensland, Australia

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BMC Family Practice 2014, 15:32  doi:10.1186/1471-2296-15-32

Published: 13 February 2014



In 2008, the Sunshine Coast Division of General Practice (SCDGP) in Queensland, Australia initiated a highly successful Improved Diabetes Management (IDM) program with general practices in a regional area. The IDM program was evaluated against the 10 elements of a high functioning clinical microsystem framework as identified by Nelson et al. (2007) in order to determine key factors contributing to the successful adoption and uptake of the program in participating general practices.


The evaluation focussed on in-depth key informant interviews with 10 SCDGP staff and general practitioners (GPs) involved in the IDM program. A thematic analysis was undertaken and common emergent themes were reviewed against the 10 elements of high performing clinical microsystem.


While all aspects of the clinical microsystem approach appeared effective in the design, implementation and adoption of the IDM program, several characteristics were crucial. The identification of champions of change in both the division and participating practices, the celebration of positive achievements and the use ‘real data’ from practices to demonstrate improved health outcomes for patients from the practice were instrumental in motivating participating GPs to both implement and sustain changes in their diabetes care delivery.


In designing and redesigning health care, the clinical microsystems approach offers a pathway for the effective uptake of innovation in Australian primary health care; a means of integrating structure, process and outcomes of a care framework for reviewing improvements in the health care delivery process and could lead to improvements in patient health outcomes.

Clinical microsystems; Quality improvement; Diabetes mellitus, Chronic disease management; Health services research