The Bottom Line: Effects of Practice Turnover on Primary Care Quality Improvement Implementation

Andrea Baron, MPH, ESCALATES Qualitative Team Member


Healthcare is constantly evolving and primary care practices are tasked with continuing to improve the ways in which they deliver care. For some practices this means participating in some kind of quality improvement (QI) activity. We examined the effects of practice staff turnover on a practice’s ability to both implement QI activities and also sustain the changes made from those efforts.

Useful Finding

We found turnover can limit practices’ ability to engage in QI activities in a number of ways:

  • When a staff member leaves, the remaining staff often absorb additional responsibilities and QI momentum slows as new staff are trained, or existing staff are reengaged in the QI work.
  • Turnover alters staff dynamics and can create barriers to constructive working relationships and team-building.
  • When key practice members leave, they can take with them institutional memory about QI activities’ purpose, processes, and long-term vision.

The Bottom Line

Practices should make an effort to stabilize disruption caused by turnover. Strategies such as cross-training staff to create redundancies in key positions, preserving institutional knowledge by documenting decisions and processes related to QI efforts, and creating exit processes for departing staff to ensure knowledge is transferred can all assist practices ease the transition of staff and preserve QI efforts. By understanding how turnover affects QI activities, practices may aptly plan for — and prevent — its unwanted affects.

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