A complexity perspective on health care improvement and reform in general practice and primary health care

2010 ◽  
Vol 16 (1) ◽  
pp. 29 ◽  
Author(s):  
Barbara J. Booth ◽  
Nicholas Zwar ◽  
Mark Harris
Keyword(s):  
Health Care ◽  
General Practice ◽  
Primary Health Care ◽  
Organisational Change ◽  
Alternative View ◽  
Policy Makers ◽  
Complex Processes ◽  
Primary Health ◽  
Health Care Improvement ◽  
Care Improvement

Health care improvement is always on the planning agenda but can prove frustrating when ‘the system’ seems to have a life of its own and responds in unpredictable ways to reform initiatives. Looking back over 20 years of general practice and primary health care in Australia, there has been plenty of planning and plenty of change, but not always a direct cause and effect relationship between the two. This article explores in detail an alternative view to the current orthodoxy of design, control and predictability in organisational change. The language of complexity is increasingly fashionable in talking about the dynamics of organisational behaviour and health care improvement, but its popular use often ignores challenging implications. However, when interpreted through human sociology and psychology, a complexity perspective offers a better match with everyday human experience of change. As such, it offers some suggestions for leaders, policy makers and managers in health care: that uncertainty and paradox are inherent in organisational change; that health care reform must pay attention to the constraints and politics of the everyday; and that change in health systems results from the complex processes of relating among those involved and that neither ‘the system’ nor a few individuals can be accountable for overall performance and outcomes.

Understanding the general practice nursing workforce in New Zealand: an overview of characteristics 2015–19

2021 ◽  
Vol 27 (1) ◽  
pp. 22
Author(s):  
Sarah L. Hewitt ◽  
Nicolette F. Sheridan ◽  
Karen Hoare ◽  
Jane E. Mills
Keyword(s):  
Health Care ◽  
General Practice ◽  
Primary Health Care ◽  
New Zealand ◽  
Survey Data ◽  
Nursing Workforce ◽  
Roles And Responsibilities ◽  
Primary Health ◽  
Part Time ◽  
Role Confusion

Limited knowledge about the nursing workforce in New Zealand general practice inhibits the optimal use of nurses in this increasingly complex setting. Using workforce survey data published biennially by the Nursing Council of New Zealand, this study describes the characteristics of nurses in general practice and contrasts them with the greater nursing workforce, including consideration of changes in the profiles between 2015 and 2019. The findings suggest the general practice nursing workforce is older, less diverse, more predominately New Zealand trained and very much more likely to work part-time than other nurses. There is evidence that nurses in general practice are increasingly primary health care focused, as they take on expanded roles and responsibilities. However, ambiguity about terminology and the inability to track individuals in the data are limitations of this study. Therefore, it was not possible to identify and describe cohorts of nurses in general practice by important characteristics, such as prescribing authority, regionality and rurality. A greater national focus on defining and tracking this pivotal workforce is called for to overcome role confusion and better facilitate the use of nursing scopes of practice.

Community Health and General Practice: The Impact of Different Cultures on the Integration of Primary Care

2001 ◽  
Vol 7 (1) ◽  
pp. 65 ◽  
Author(s):  
Hal Swerissen ◽  
Jenny Macmillan ◽  
Catuscia Biuso ◽  
Linda Tilgner
Keyword(s):  
Primary Care ◽  
Health Care ◽  
General Practice ◽  
Primary Health Care ◽  
Community Health ◽  
Community Health Centres ◽  
Care Services ◽  
Primary Health ◽  
Health Centres ◽  
The Relationship

This study examined the existing relationship between community health centres and General Practice Divisions in the State of Victoria, including the nature of joint working arrangements and the identification of barriers to greater collaboration. Improved integration of primary health care services has been advocated to improve consumer and population health outcomes and to reduce inappropriate use of acute and extended care services. General practitioners (GPs) and community health centres are two key providers of primary health care with potential for greater integration. The current study conducted telephone interviews with 20 community health centre CEOs and 18 Executive Officers of divisions, which were matched according to catchment boundaries. Results suggest, while some joint planning is occurring, especially on committees, working parties and projects, there is an overall low level of satisfaction with the relationship between community health centres and GPs and GP divisions. Major barriers to greater integration are the financial or business interests of GPs and misunderstanding and differences in perceived roles and ideology between GPs and community health centres. Improved communication, greater contact and referral and follow-up procedures are identified as a means of improving the relationship between GPs, GP divisions and community health centres. Community health centres and general practitioners (GPs) are key providers of primary care (Australian Community Health Association, 1990).

scholarly journals Why are there gaps in our management of those with high cardiovascular risk?

2012 ◽  
Vol 4 (1) ◽  
pp. 21 ◽  
Author(s):  
Fiona Doolan-Noble ◽  
Jocelyn Tracey ◽  
Stewart Mann
Keyword(s):  
Health Care ◽  
General Practice ◽  
Primary Health Care ◽  
Cardiovascular Risk ◽  
New Zealand ◽  
Barriers And Facilitators ◽  
Care Providers ◽  
High Cardiovascular Risk ◽  
Text Data ◽  
Primary Health

INTRODUCTION: Multiple New Zealand and other international studies have identified gaps in the management of those identified at high risk of a future cardiovascular (CV) event. This study sought to explore the views of health professionals about the barriers and facilitators present within the current primary health care system to the optimal management of those at high CV risk. METHODS: This qualitative study utilised a focus group methodology to examine the barriers and facilitators within primary health care (PHC), and employed a general inductive approach to analyse the text data. FINDINGS: The analysis of text data resulted in the emergence of interrelated themes, underpinned by subthemes. The patient, their circumstances and their characteristics and perceptions provided the first key theme and subthemes. The next key theme was primary health care providers, with subthemes of communication and values and beliefs. The general practice was the third theme and included multiple subthemes: implementation planning and pathway development, time and workload and roles and responsibilities. The final main theme was the health system with the subthemes linking to funding and leadership. CONCLUSION: This study determined the factors that act as barriers and facilitators to the effective management of those at high CV risk within the New Zealand PHC sector. General practice has a pivotal role in preventive health care, but to succeed there needs to be a refocusing of the PHC sector, requiring support from policy makers, District Health Boards and Primary Health Organisations, as well as those working in the sector. KEYWORDS: Primary health care; high cardiovascular risk management; general practitioners; practice nurses; barriers; facilitators

scholarly journals Caring for refugees in general practice: perspectives from the coalface

2014 ◽  
Vol 20 (1) ◽  
pp. 85 ◽  
Author(s):  
Rebecca Farley ◽  
Deborah Askew ◽  
Margaret Kay
Keyword(s):  
Health Care ◽  
General Practice ◽  
Primary Health Care ◽  
Health Care Providers ◽  
Minority Groups ◽  
Health Care Systems ◽  
Refugee Health ◽  
Care Providers ◽  
Structured Interviews ◽  
Primary Health

This qualitative research project explored the experiences of primary health care providers working with newly arrived refugees in Brisbane. Data from 36 participants (20 general practitioners, five practice nurses and 11 administrative staff) involved in five focus groups and four semi-structured interviews were analysed. The results indicated that despite difficulties, providers are committed and enthusiastic about working with refugees. The flexibility of the general practice setting enables innovative approaches. The establishment of a specialised refugee health service in Brisbane has improved providers’ capacity to deliver refugee health care. However, most practices continue to feel isolated as they search for solutions, and the need for greater supports and a more coordinated approach to care were emphasised. The themes of communication, knowledge and practice and health care systems encapsulated the factors that influence health care providers’ ability to care for refugees and provide a framework for improving available supports. Australian primary health care is currently undergoing great change, which provides an opportunity to make significant gains in the provision of care for refugees and other minority groups within our community. As health care reforms are implemented it is essential that they are responsive to the expressed needs of health care providers working in these areas.

Positioning Nurses in Primary Health Care in Bhutan

2018 ◽  
Vol 4 (1) ◽  
pp. 33-41
Author(s):  
Diki Wangmo ◽  
Carol Windosr ◽  
Michele Clark
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Nursing Education ◽  
Central Place ◽  
Policy Makers ◽  
Primary Health ◽  
Auxiliary Nurse ◽  
Nurses Role ◽  
The 1960S

Introduction: Nursing in Bhutan had its beginning in the early 1960s, approximately 20 years prior to the Alma Ata Conference. From basic nursing care and housekeeping roles, Bhutanese nurses have now occupied central place in nursing service, administration and management and education. Nursing education has progressed from certificate level in the 1960s to bachelor, master and PhD levels in 2014. Although nurses have been closely associated with Primary Health Care development in Bhutan, apart from the role of the Auxiliary Nurse Midwives, nurses have rarely been explicitly associated with this area of practice. Therefore, the objective of this study was to find out the role of Bhutanese Nurses in PHC. Methods: qualitative case study method was used to carry out focus group and in-depth interviews with 66 respondents that included policy makers, planners, educators, regulators and implementers. Data were analyzed through manifest and latent content analysis. Results: The centrality of the nursing role in the area of PHC has not been realized. Discharge of the PHC role was identified more in terms of the place of work and by title or designation of the nurses. Primary Health Care momentum appeared to have slowed down and nurses differed in their understanding of PHC concept. Conclusion: Although Nursing in Bhutan has made much progress, the uneven development of the nurses’ role in PHC in Bhutan and globally suggests a need to identify and implement strategies such as standardizing, role profiling, curricula review and leadership improvement to ensure progress in this area.

scholarly journals Patient safety challenges in primary health care: a scoping review

2020 ◽  
Vol 73 (5) ◽  
Author(s):  
Carlise Rigon Dalla Nora ◽  
Mariur Gomes Beghetto
Keyword(s):  
Health Care ◽  
Patient Safety ◽  
Primary Health Care ◽  
Scoping Review ◽  
Health Professionals ◽  
Health Care Professionals ◽  
Improve Patient Safety ◽  
Policy Makers ◽  
Primary Health ◽  
Enhancing Resources

ABSTRACT Objectives: to identify the patient safety challenges described by health professionals in Primary Health Care. Methods: a scoping review was conducted on the LILACS, MEDLINE, IBECS, BDENF, and CINAHL databases, and on the Cochrane, SciELO, Pubmed, and Web of Science libraries in January 2019. Original articles on patient safety in the context of Primary Health Care by health professionals were included. Results: the review included 26 studies published between 2002 and 2019. Four categories resulted from the analysis: challenges of health professionals, administration challenges of health services, challenges with the patient and family, and the potential enhancing resources for patient safety. Conclusions: patient safety challenges for Primary Care professionals are multiple and complex. This study provides insight into resources to improve patient safety for health care professionals, patients, administrators, policy makers, educators, and researchers.

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