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]