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The purpose of this article is to identify and test the effectiveness of work strategies employed by regional implementation teams to attain high quality care for diabetes patients.

The study was conducted in a major health maintenance organization (HMO) that provides care for 70 per cent of Israel's diabetes patients. A sequential mixed model design, combining qualitative and quantitative methods was employed. In‐depth interviews were conducted with members of six regional implementation teams, each responsible for the care of 25,000‐34,000 diabetic patients. Content analysis of the interviews revealed that teams employed four key strategies: task‐interdependence, goal‐interdependence, reliance on top‐down standardised processes and team‐learning. These strategies were used to predict the mean percentage performance of eight evidence‐based indicators of diabetes care: percentage of patients with HbA1c < 7 per cent, blood pressure ≤ 130/80 and cholesterol≤100; and performance of: HbA1c tests, LDL cholesterol tests, blood pressure measurements, urine protein tests, and ophthalmic examinations.

Teams were found to vary in their use of the four strategies. Mixed linear models analysis indicated that type of indicator (simple process, compound process, and outcome) and goal interdependence were significantly linked to team effectiveness. For simple‐process indicators, reliance on top‐down standardised processes led to team effectiveness, but for outcome measures this strategy was ineffective, and even counter‐effective. For outcome measures, team‐learning was more beneficial.

The findings have implications for the management of chronic diseases.

The advantage of allowing team members flexibility in the choice of the best work strategy to attain high quality diabetes care is attested.

The Maturity Matrix is a tool designed in the UK to assess family practice organisational development and to stimulate quality improvement. It is practice‐led, formative and undertaken by a practice team with the help of trained facilitators. The aim of this study is to assess the Maturity Matrix as a tool and an organisational development measure in European family practice settings.

Using a convenience sample of 153 practices and 11 facilitators based in the UK, Germany, The Netherlands, Switzerland and Slovenia, feasibility was assessed against six criteria: completion; coverage; distribution; scaling; translation; and missing data. Information sources were responses to evaluation questionnaires by facilitators and completed Maturity Matrix profiles.

All practices taking part completed the Maturity Matrix sessions successfully. The Netherlands, the UK and Germany site staff suggested including additional dimensions: interface between primary and secondary care; access; and management of expendable materials. Maturity Matrix scores were normally distributed in each country. Scaling properties, translation and missing data suggested that the following dimensions are most robust across the participating countries: clinical performance audit; prescribing; meetings; and continuing professional development. Practice size did not make a significant difference to the Maturity Matrix profile scores.

The study suggests that the Maturity Matrix is a feasible and valuable tool, helping practices to review organisational development as it relates to healthcare quality. Future research should focus on developing dimensions that are generic across European primary care settings.