Table 1

Danish version of the Maturity Matrix used

	Clinical data	Audit	Use of guidelines	Access to clinical information	Prescribing	Human resource management	CME	Practice meetings	Sharing information with patients	Significant events	Handling of emergencies	Learning from patients
1	All notes and external data (discharge letters, etc) are registered on computer	No clinical audit	No policy for following guidelines	No system for storage and locating clinical information is available	No audit data on prescribing is available	Not relevant (single-handed practice with no staff)	No CME arrangements exists for GPs and staff	Practice team meetings are not arranged	No written patient information available	Significant events are recorded	No resuscitation equipment or acute box is available	No system for collecting feedback from patients	1
2	As above and non-digitalised correspondences are scanned or registered on computer	Data collection exercises conducted but incomplete audit cycles	The practice team adapts clinical guidelines for use in the practice	Textbooks and peer-reviewed journals and guidelines at limited locations	An analysis of prescribing is available	Practice staff has written contracts	CME arrangements for GPs and staff are in place	Practice team meetings occur infrequently and at irregularly	Patient information available, but unsystematic and random	Significant events are reviewed at team meetings occasionally	A written formulary guides practice teams' handling of medical disasters	Informal arrangements exists to collect feedback from patients	2
3	Lab data registered on computer	Occasional audit cycles	The practice team takes steps to implement the use of guidelines in the practice	As above and renewed regularly	Prescribing data are discussed by the practice team	Wages are in accordance with labour marked contracts	Budgets are allocated for CME for GPs and staff	Practice team meetings occur regularly	Patient information in waiting areas on general health topics	Significant events are reviewed at team meetings regularly	Resuscitation equipment (oxygen) and an acute box with relevant medications is easily available	Formal arrangements exists to collect feedback from patients	3
4	As above and all consultations are ICPC-coded but only on chosen diagnoses or incompletely	Regular audit cycles completed, but only for a few chronic conditions	Clinical guidelines are integrated into daily clinical practice	As above and used during consultations	A local formulary guides prescribing and renewals	Practice staff receives induction training	GPs spend their annual allowance and staff make use of their four annual days for CME	Practice team meetings occur regularly and are well organised	Patient information in waiting areas on various clinical conditions	Significant events generate organisational changes from time to time	A practice team member takes on responsibility for maintenance of the resuscitation equipment and relevant medications	Feedback from patients is reviewed at practice meetings	4
5	As above and external material ICPC coded but only on chosen diagnoses or incompletely	Regular complete audit for a wide range of chronic conditions performed regularly	Use of guidelines on a few chronic conditions are reviewed by clinical audit	As above and internet based information available at limited locations	Prescribing patterns is regularly reviewed by practice team and result in changes to policies	Practice staff has job descriptions	Practice team discuss the learning subjects most valuable for the team members personally and the practice as an organisation	Regular, agenda led practice meetings with agreed minutes and action points	Patient information quality assurance is conducted	Significant events are analysed clinically and organisationally	All practice team members are familiar with the written resuscitation formulary	Feedback from patients results in organisational changes	5
6	As above and all consultations ICPC coded on all diagnoses	Regular complete audit for a wide range of chronic conditions performed regularly	Use of guidelines on a wide range of chronic conditions performed regularly	Internet based information available at the clinical desktop	As above for all major drug types	Practice staff has annual appraisals	As above and linked to the practice development plan	As above, plus arrangements that ensures that action points are fulfilled are in place	Clinical information systems capable of providing a range of patient information	As above, and analysis is discussed at staff meetings	A practice team member takes on responsibility for induction training of resuscitation to new team members	The practice involves patients in planning services	6
7	As above and external material is always ICPC coded	As above and data send to an external database	As above and data reviewed by an external agency	All clinicians use internet based information during consultations	Prescribing specialists provides practice specific advice on practice prescribing data	Staff appraisals are formalised	Arrangements that ensures that knowledge achieved by GPs and staff through CME is shared with practice team	As above plus involvement of extended team of community-based healthcare staff	Electronic information resources available for patients in waiting areas	As above and analysis generate organisational changes	The practice team perform training exercises in resuscitation at least annually	Patient-led organisational changes are evaluated	7
8	Results of all investigations, including x-rays available on computer	Systematic audits are shared with the public	As above and data are shared with the public	All clinicians are skilled at using the internet to find information during consultations	Prescribing specialists provides practice specific case-based advice on specific ordinations	Practice development plan is discussed with practice staff	All team members receive external support in order to plan their CME	As above plus collaboration with social care services	Individually tailored information provided to patients about harms and benefits	The impact of a significant event analysis is evaluated	Resuscitation procedures are quality-assured	Patient feedback systems are integrated into the performance of the organisation	8

CME, Continuing Medical Education.