Changing primary care performance measurement by getting started

This action research study was conducted as part of an ongoing performance measurement initiative in an association of primary care teams in Ontario, Canada. The problem addressed was the challenge of increasing participation in performance measurement. The research question addressed was: What happens when a novel approach to measuring quality/ demonstrating value is introduced in my organization? My view in this action research considered change as a continuous phenomenon. This is consistent with my operational mandate as a scholar-practitioner and my own orientation as a reluctant constructionist. The literature informed the development of a framework to guide the analysis of data in this study. This action research was based on a developmental evaluation using qualitative tools for data capture and analysis. It ensured a critical perspective by orienting around the reflective questions: “What, So What, Now What”. The study unfolded in a cyclical way starting with the launch of the artifact, the experience with the first iterations, reflection on the experience to generate recommendations for action, the experience with implementing the actions (or not, as events unfolded) and finally reflections and general considerations for next steps with the initiative. The data sources included: results of surveys, minutes and materials for governance committees, email conversations between staff, members and stakeholders of the organization, my own observations and performance reports generated by the ongoing measurement initiative. Data were analysed using template analysis. The artifact in this study was Data to Decisions (D2D) a multifaceted initiative that involves member engagement, supporting materials, a performance report and communication. The study showed that participation in D2D was high and that the initiative was generally considered to be successful. The key themes emerging from the experience with D2D were: a focus on relationships; a dynamic of help-seeking and self-reliant behaviour, a range of perceptions of priority and a clear intent and ability to “get started” with measurement. Reflections on these themes generated actions, the fate of which was described and reflected on in the final phases of the action research study. Implications of the data were presented for consideration by the organization as the ongoing measurement work continues, independent of this action research study. In this way, the study contributed to the organization’s ability to support ongoing measurement and improvement of performance. The observation that relationships are more important in participation in performance measurement than the actual indicators being measured is a useful contribution to professional knowledge regarding performance measurement in primary care. The thesis concludes with a reflexive moment in which I described the purpose and nature of reflexivity involved in my action research and summarize my role as a scholar-practitioner and my reflections on the project as a whole