Assessing the applicability of the Model for Understanding Success in Quality (MUSIQ) for primary care: a multi-case mixed methods analysis.

Abstract

Introduction: Effective quality improvement (QI) is vital to improve healthcare quality and outcomes. The context surrounding QI has a dynamic relationship that impacts QI efforts over time. Developing an understanding of context may provide opportunities to address barriers to success. Most studies into contextual influences have been conducted in secondary care. Primary care is key to improving population health, equity and value. The Model for Understanding Success in Quality (MUSIQ) is a commonly used context assessment tool that was developed in large, mainly secondary care organisations, and questions have been raised as to its applicability in primary care.

Aim: This study aims to assess the applicability of the MUSIQ in primary care settings and suggest adaptations for primary care.

Methods: A multi-case mixed methods approach was followed with quantitative data from the MUSIQ survey tool, compared with qualitative data from Aotearoa New Zealand primary care interviews. The Consolidated Framework for Implementation Research (CFIR) guided qualitative data collection and analysis.

Results: Scores were duplicated between common microsystem and organisational factors. External motivation created mixed reactions and scores depending on interpretation, but consistent themes of community responsibility and network relationships were identified as strengths. A lack of QI infrastructure and triggering events were consistent findings.

Discussion: Total MUSIQ scores were impacted by scores given for factors at different MUSIQ levels that are combined in many primary care organisations. A primary care adaptation of MUSIQ is proposed that removes the duplicated levels and adds key primary care contextual factors not included in MUSIQ.