Self-improvement culture of the practice site: Academic vs.
Community sites
Enabling elements centered on the improvement culture of the practice
site were largely elicited when respondents were asked to compare
academic and community practices. Many stated that improvement and
practice measurement were expected to a higher degree in academic
settings. One participant [P4] commented, “…In an academic
setting you are just geared to continuous education, continuous
learning, continuous improvement.”
In addition, some speculated that this was the result of more academic
training programs and credentialing. Respondents remarked that a
personal history of taking part in several elements of advanced training
may drive an increased reliance on quantitative metrics. Participant 7
explained:
“I think that there is just this kind of more of an expectation that
people in academic facilities to be measured then what would be in a
community hospital.”
Another element elicited when comparing community vs academic sites was
the perceived focus on physician performance. Some respondents suggested
that academic physicians were more driven to understand their
performance relative to their peers and therefore respond to practice
data for improvement. Some believed that the presence of performance
metrics did or could drive competition within metrics that may be more
socially valued.
“And that is why I think some people prefer to practice in academic
settings rather than community it is because they are more performance
oriented. They think that they are doing well but they always want to be
I guess challenged and driven in this way.” [P11]
Lastly, some respondents stated that self-improvement was most essential
in academic facilities due to their role as educational centers for
residents and medical students. They suggested that self-improvement may
be driven by the need to act as the best possible clinical role model
for learners.
“You are teaching, you have learners. So, you have to set an example to
those learners, and you have to be able to teach them and prepare them
for their careers. So, you want to improve yourself first before you can
do all of that.” [P9]