Doctoral Dissertation Research: Quality Improvement and Assurance in the Provisioning of Rural Primary Medical Care

In the United States, health policy advocates allege a growing quality crisis, as public health experts consistently report that the US population pays significantly more for healthcare than other nations, with worse outcomes. The rhetoric of quality and its moral mandate to ensure and improve medical services is now a central part of health policies globally.

Yet little is known about how the idea of quality itself is conceptualized in clinical care spaces, how these conceptions might differ according to the characteristics of the individuals and organizations who attempt to provide quality care, and how these conceptions frame the types of actions individuals and organizations implement in pursuit of quality improvement. This doctoral dissertation research investigates if and how the rhetoric of quality improvement and assurance impacts the provision of medicine in an isolated rural medical setting.

In addition to providing training for a graduate student, this work will be disseminated widely to academic and non-academic audiences. Findings also inform ongoing development of a regional social science and medicine curriculum for family medicine residents.

Through an ethnographic study with health administrators, physicians, nurse practitioners, physician assistants, and clinical staff, researchers analyze the process of creating quality health services within the medical center as well as values, perceptions, and organizational dynamics that influence how quality is conceptualized and enacted across multiple care settings. The researchers use participant observation of the daily activities at a medical center and observe administrative and clinical practice across each care setting.

Data will be collected using focal follows, observation, interviews, methods from cognitive anthropology, and archival research. The research findings expand understanding of local and national attempts to influence biomedical practice and make significant contributions to the anthropology of policy, medical anthropology, the anthropology of institutions, quality improvement, and implementation science.

This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.