Buch Martin Sandberg, Edwards Adrian, Eriksson Tina
Danish Institute for Health Services Research, Dampfaergevej 27-29, Copenhagen Ø, Denmark.
Qual Prim Care. 2009;17(5):311-22.
The Maturity Matrix is a group-based formative self-evaluation tool aimed at assessing the degree of organisational development in general practice and providing a starting point for local quality improvement. Earlier studies of the Maturity Matrix have shown that participants find the method a useful way of assessing their practice's organisational development. However, little is known about participants' views on the resulting efforts to implement intended changes.
To explore users' perspectives on the Maturity Matrix method, the facilitation process, and drivers and barriers for implementation of intended changes.
Observation of two facilitated practice meetings, 17 semi-structured interviews with participating general practitioners (GPs) or their staff, and mapping of reasons for continuing or quitting the project.
General practices in Denmark Main outcomes: Successful change was associated with: a clearly identified anchor person within the practice, a shared and regular meeting structure, and an external facilitator who provides support and counselling during the implementation process. Failure to implement change was associated with: a high patient-related workload, staff or GP turnover (that seemed to affect small practices more), no clearly identified anchor person or anchor persons who did not do anything, no continuous support from an external facilitator, and no formal commitment to working with agreed changes.
Future attempts to improve the impact of the Maturity Matrix, and similar tools for quality improvement, could include: (a) attention to matters of variation caused by practice size, (b) systematic counselling on barriers to implementation and support to structure the change processes, (c) a commitment from participants that goes beyond participation in two-yearly assessments, and (d) an anchor person for each identified goal who takes on the responsibility for improvement in practice.
成熟度矩阵是一种基于小组的形成性自我评估工具，旨在评估全科医疗中的组织发展程度，并为地方质量改进提供一个起点。早期对成熟度矩阵的研究表明，参与者认为该方法是评估其实践组织发展的一种有用方式。然而，对于参与者对实施预期变革所做努力的看法却知之甚少。
探讨用户对成熟度矩阵方法、促进过程以及实施预期变革的驱动因素和障碍的看法。
观察两次有促进作用的实践会议，对参与的全科医生（GP）或其工作人员进行17次半结构化访谈，并梳理继续或退出该项目的原因。
丹麦的全科医疗
成功的变革与以下因素相关：实践中有明确确定的核心人物、共享且定期的会议结构，以及在实施过程中提供支持和咨询的外部促进者。变革未实施与以下因素相关：与患者相关的工作量大、工作人员或全科医生流动（似乎对小型实践影响更大）、没有明确确定的核心人物或核心人物无所作为、没有外部促进者的持续支持，以及没有对按照商定的变革开展工作的正式承诺。
未来提高成熟度矩阵以及类似质量改进工具影响力的尝试可包括：（a）关注实践规模导致的差异问题；（b）就实施障碍进行系统咨询，并为变革过程的构建提供支持；（c）参与者做出超越参与两年一次评估的承诺；（d）为每个确定的目标指定一名承担实践改进责任的核心人物。
