Leadership for Quality Improvement in Group Practices

OBJECTIVES: The authors studied influence of physician leaders on their colleagues' performance using data from a randomized, controlled trial of quality assurance interventions in 16 primary care practices. METHODS: The authors examined whether leaders performed better than their colleagues and looked for evidence of leaders' influence on their colleagues before intervention. As behavioral indicators of each leader's influence for improvement in response to quality assurance interventions, the authors (1) change in the leader's performance score and (2) an index of leader commitment derived from the leader's participation in quality assurance interventions; these indicators were used as covariates in a comparison in experimental practice sites of leaders' and colleagues' mean case performance scores before and after intervention. RESULTS: Leaders did not outscore their colleagues or influence their colleagues' performance scores before intervention. In response to quality assurance interventions, a leader's change in performance score significantly improved colleagues' score if the leader improved. A positive leader commitment index predicted colleagues' improvement independently of the leader change score. CONCLUSIONS: As hypothesized, physician leaders, by the example of their behavior, influenced colleagues' performance. However, leaders exerted their influence only after receiving external stimulation for quality improvement.