Primary care, process improvement, and turmoil

J Ambul Care Manage. 1997 Oct;20(4):32-8. doi: 10.1097/00004479-199710000-00006.


The current health care environment in the United States is in turmoil, especially in regions that are further ahead in the transition from free-for-service to managed care. This article examines turmoil within primary care during a health-maintenance-organization-sponsored and federally funded randomized trial of using continuous quality improvement for adult clinical preventive services. The external and internal changes in structure and leadership occurring in primary care clinics are profound and prevalent. The sponsors of the project have responded to the turmoil by encouraging greater leadership involvement within the clinic and by supporting more skill building for change management.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Health Maintenance Organizations / organization & administration
  • Health Maintenance Organizations / standards*
  • Health Maintenance Organizations / trends
  • Humans
  • Leadership
  • Minnesota
  • Organizational Innovation
  • Pilot Projects
  • Preventive Health Services / organization & administration
  • Preventive Health Services / standards*
  • Primary Health Care / organization & administration
  • Primary Health Care / standards*
  • Primary Health Care / trends
  • Process Assessment, Health Care*
  • Total Quality Management / methods*
  • United States
  • United States Agency for Healthcare Research and Quality