Merging existing practices with new ones: the adjustment of organizational routines to using cancer patient pathways in primary healthcare

Abstract Background The introduction of new tools can bring unintended consequences for organizational routines. Cancer Patient Pathways (CPP) were introduced into the Swedish healthcare system in 2015 to shorten time to diagnosis and treatment. Primary healthcare (PHC) plays a central role since cancer diagnosis often begins in PHC units. Our study aimed to understand how PHC units adjusted organizational routines to utilizing CPPs. Method Six PHC units of varied size from both urban and rural areas in northern Sweden were included. Grounded theory method was used to collect and analyse group interviews at each unit. Nine group interviews with nurses and physicians, for a total of 41 participants, were performed between March and November 2019. The interviews focused on CPPs as tools, the PHC units’ routines and providers’ experiences with using CPPs in their daily work. Results Our analysis captured how PHC units adjusted organizational routines to utilizing CPPs by fusing existing practices with new practices to offer better quality of care. Specifically, three overarching organizational routines within the PHC units were identified. First, Manoeuvring diverse patient needs with easier patient flow, the PHC units handled the diverse needs of the population while simultaneously drawing upon CPPs to ease the patient flow within the healthcare system. Second, (Dis) integrating internal know-how, the PHC units drew upon internal competence even when PHC know-how was not taken into account by those driving the CPP initiative. Third, Coping with unequal relationships toward secondary care, the PHC units dealt with being in an unequal position while adopting CPPs instead further decreased possibilities to influence decision-making between care-levels. Conclusion Adopting CPPs as a tool within PHC units brought various unintended consequences in organizational routines. Our study from northern Sweden illustrates that the PHC know-how needs to be integrated into the healthcare system to improve the use of new tools as CPP. Further, the relationships between different levels of care should be taken in account when introducing new tools for healthcare. Also, when adopting innovations, unintended consequences need to be further explored empirically in diverse healthcare contexts internationally in order to generate deeper knowledge in the research area.

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Negotiating bodily sensations between patients and GPs in the context of standardized cancer patient pathways – an observational study in primary care

BMC Health Services Research ◽

10.1186/s12913-020-4893-4 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 2

Author(s):

Cecilia Hultstrand ◽

Anna-Britt Coe ◽

Mikael Lilja ◽

Senada Hajdarevic

Keyword(s):

Primary Care ◽

Cancer Patient ◽

Primary Healthcare ◽

Social Processes ◽

Diagnostic Process ◽

Care Seeking ◽

Cancer Symptoms ◽

Grounded Theory Method ◽

Patient Pathways ◽

Bodily Sensations

Abstract Background How interactions during patient-provider encounters in Swedish primary care construct access to further care is rarely explored. This is especially relevant nowadays since Standardized Cancer Patient Pathways have been implemented as an organizational tool for standardizing the diagnostic process and increase equity in access. Most patients with symptoms indicating serious illness as cancer initially start their diagnostic trajectory in primary care. Furthermore, cancer symptoms are diverse and puts high demands on general practitioners (GPs). Hence, we aim to explore how presentation of bodily sensations were constructed and legitimized in primary care encounters within the context of Standardized Cancer Patient Pathways (CPPs). Methods Participant observations of patient-provider encounters (n = 18, on 18 unique patients and 13 GPs) were carried out at primary healthcare centres in one county in northern Sweden. Participants were consecutively sampled and inclusion criteria were i) patients (≥18 years) seeking care for sensations/symptoms that could indicate cancer, or had worries about cancer, Swedish speaking and with no cognitive disabilities, and ii) GPs who met with these patients during the encounter. A constructivist approach of grounded theory method guided the data collection and was used as a method for analysis, and the COREQ-checklist for qualitative studies (Equator guidelines) were employed. Results One conceptual model emerged from the analysis, consisting of one core category Negotiating bodily sensations to legitimize access, and four categories i) Justifying care-seeking, ii) Transmitting credibility, iii) Seeking and giving recognition, and iv) Balancing expectations with needs. We interpret the four categories as social processes that the patient and GP constructed interactively using different strategies to negotiate. Combined, these four processes illuminate how access was legitimized by negotiating bodily sensations. Conclusions Patients and GPs seem to be mutually dependent on each other and both patients’ expertise and GPs’ medical expertise need to be reconciled during the encounter. The four social processes reported in this study acknowledge the challenging task which both patients and primary healthcare face. Namely, negotiating sensations signaling possible cancer and further identifying and matching them with the best pathway for investigations corresponding as well to patients’ needs as to standardized routines as CPPs.

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CN59 A meeting between existing practices and new ones in primary healthcare: How nurses adjust work routines to using cancer patient pathways

Annals of Oncology ◽

10.1016/j.annonc.2021.08.688 ◽

2021 ◽

Vol 32 ◽

pp. S1277

Author(s):

P. Fjällström ◽

S. Hajdarevic ◽

A-B. Coe ◽

M. Lilja

Keyword(s):

Cancer Patient ◽

Primary Healthcare ◽

Patient Pathways ◽

Work Routines

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Encountering suicide in primary healthcare rehabilitation: the experiences of physiotherapists

BMC Psychiatry ◽

10.1186/s12888-020-03004-1 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Åse Lundin ◽

Anna Bergenheim

Keyword(s):

At Risk ◽

Healthcare System ◽

Primary Healthcare ◽

Qualitative Content Analysis ◽

Western Hemisphere ◽

Mental Wellbeing ◽

Healthcare Personnel ◽

Public Health Issue ◽

Structured Interviews ◽

Patients At Risk

Abstract Background Suicide is a serious public health issue and one of the most common causes of death globally. Suicide has long-lasting impact on personal, relational, community and societal levels. Research has shown that patients often seek help in the primary healthcare system preceding a suicide. Studies exploring the experiences of encountering patients at risk for suicide have been performed among various categories of healthcare personnel, such as nurses and psychiatry residents as well as emergency room staff. There is a lack of research regarding primary healthcare rehabilitation staff, despite the fact that physiotherapists are the third largest health profession in the Western hemisphere and often work with patients experiencing mental health symptoms. The aim of this study was to explore the experiences of encountering patients at risk for suicide among physiotherapists working in a primary healthcare rehabilitation setting. Methods Semi-structured interviews were conducted with 13 physiotherapists working in primary healthcare rehabilitation clinics in the Gothenburg area, Sweden. The interviews were recorded on audio and transcribed into written text. A qualitative content analysis was performed on the material collected. Results The analysis of the material revealed an overarching theme, Through barriers and taboos – the physiotherapist finds a way, with five main categories: possibilities for identification, obstacles in meeting suicide, workplace environment matters, where does the patient belong? and education and experience are keys. Conclusions The present study indicates that physiotherapists in the primary healthcare system encounter patients experiencing suicidality, and they expressed a strong desire to care for both the physical and mental wellbeing of the patients. Despite reporting many barriers, the physiotherapists often found a way to form a meaningful therapeutic alliance with the patient and to ask about possible suicidality in their clinical practice. The result suggests that physiotherapists could play a larger role in working with patients experiencing suicidality in a primary healthcare setting and that they could be viewed as possible gatekeepers in identification as well as referral of these patients into other parts of the healthcare system.

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Cross-sector pre-registration pharmacist placements in general practice in England: lessons from a national evaluation

International Journal of Pharmacy Practice ◽

10.1093/ijpp/riab015.049 ◽

2021 ◽

Vol 29 (Supplement_1) ◽

pp. i40-i41

Author(s):

A Hindi ◽

S Willis ◽

S Jacobs ◽

E Schafheutle

Keyword(s):

General Practice ◽

Wide Spectrum ◽

Geographical Location ◽

Unintended Consequences ◽

Final Report ◽

Contributing Factors ◽

Training Experience ◽

Good Communication ◽

Patient Pathways ◽

Study Sites

Abstract Introduction In 2019/2020, the Pharmacy Integration Fund commissioned delivery of cross-sector pre-registration pharmacist training incorporating 3–6 month placements in general practice (GP). GP placements were managed by Health Education England (HEE) and organised as one (or more) blocks, or as spilt weeks/days across base sector (hospital/community) and GP. Trainees had a pharmacist tutor at base and in GP. Aim to evaluate the implementation of cross-sector pre-registration pharmacy placements in GP in England, and to identify barriers and enablers of a successful placement. Methods A qualitative approach was taken, with case study sites purposively sampled for maximum variation: pharmacy base (hospital/community), number of pre-registration pharmacist trainees in base doing GP placement, length of GP placement, organisation of GP placement and geographical location. With consent, trainees and tutors identified as meeting sampling criteria were emailed invitation letters and participant information sheets. Where the trainee and their tutor(s) agreed to participate, semi-structured telephone interviews were conducted January - July 2020. Questions developed from literature(1, 2) and the HEE handbook were tailored to understanding trainees’ and tutors’ views on the implementation of pre-registration pharmacist placements in GP, including benefits, unintended consequences and impacts. Thematic analysis across sites was undertaken with a focus on exploring inter and intra group themes. Results Thirty-four interviews were completed in 11 study sites (5 GP/hospital; 6 GP/community pharmacy). Trainees and tutors considered GP placements had been successful. Contributing factors were: placement planning (induction, contingency arrangements for cover should GP tutor be unavailable); tutors working together (good communication and collaboration); GP tutor support (regular contact, reflection; identifying learning needs; opportunities for learning); integration of GP placements within training year (specific learning/training activities at base during GP placement); and GP tutors having backing of their organisation to supervise effectively. A lack of these impacted negatively. Trainees completed a wide spectrum of activities and gradually moved from administrative to clinical tasks. They built up confidence to undertake patient-facing activities, with more direct supervision at the beginning moving to indirect supervision using debriefing. Thirteen weeks in GP was considered an appropriate minimum duration by all trainees and tutors; those based in community felt that 26 weeks in GP provided more opportunities for clinical and consultation skills learning. Cross-sector experience facilitated a better understanding of patient pathways and the importance of holistic patient care. All trainees considered working in GP in future but highlighted the lack of a cross-sector GP foundation programme. Base tutors felt the time commitment was comparable to single sector placements. Base and GP tutors felt that a clear set of competencies for GP placements and a broader governance framework would ensure standards and consistency. Conclusion This is the first national evaluation of cross-sector pre-registration pharmacists in general practice placements in England. Sampling as case studies enabled data triangulation and generated a multi-faceted understanding on factors impacting GP placements. A key limitation was the volunteer bias associated with recruitment. Key attributes of a successful pre-registration cross-sector training experience are highlighted and can inform policy reforms including change from pre-registration to foundation year training. References 1. Gray N. Review of Experience of Pre-registration Pharmacist Placements in the General Practice Setting – Final Report. 2019. 2. Jee SD, Schafheutle EI, Noyce PR. Is pharmacist pre-registration training equitable and robust? Higher Education, Skills and Work-Based Learning. 2019;9(3):347–58.

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Covid-19 pandemic and The Nigerian primary healthcare system: The leadership question

Cogent Arts and Humanities ◽

10.1080/23311983.2020.1859075 ◽

2021 ◽

Vol 8 (1) ◽

pp. 1859075

Author(s):

Ngozika Anthonia Obi-Ani ◽

Dominic Obinna Ezeaku ◽

Ogechi Ikem ◽

Mathias Chukwudi Isiani ◽

Paul Obi-Ani ◽

...

Keyword(s):

Healthcare System ◽

Primary Healthcare

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A baseline survey of the Primary Healthcare System in South Eastern Nigeria

Health Policy ◽

10.1016/j.healthpol.2005.07.006 ◽

2006 ◽

Vol 77 (2) ◽

pp. 182-201 ◽

Cited By ~ 15

Author(s):

Chinyere Mercellina Chukwuani ◽

Akindeji Olugboji ◽

Edward Erdorga Akuto ◽

Akim Odebunmi ◽

Ezenta Ezeilo ◽

...

Keyword(s):

Healthcare System ◽

Primary Healthcare ◽

Baseline Survey ◽

South Eastern

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Implementing standardized cancer patient pathways (CPPs) – a qualitative study exploring the perspectives of health care professionals

BMC Health Services Research ◽

10.1186/s12913-019-4413-6 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Sara Delilovic ◽

Henna Hasson ◽

Mårten Åhström ◽

Mia von Knorring

Keyword(s):

Health Care ◽

Qualitative Study ◽

Cancer Patient ◽

Health Care Professionals ◽

Patient Pathways

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Perceptions of registered nurses regarding factors influencing service delivery in expanding programmes in a primary healthcare setting

Health SA Gesondheid ◽

10.4102/hsag.v17i1.535 ◽

2012 ◽

Vol 17 (1) ◽

Cited By ~ 4

Author(s):

Nnoi. A. Xaba ◽

Mmapheko D. Peu ◽

Salaminah S. Phiri

Keyword(s):

Service Delivery ◽

Registered Nurses ◽

Primary Healthcare ◽

Healthcare Setting ◽

Qualitative Approach ◽

Focus Group Interviews ◽

Enabling Factors ◽

Related Factors ◽

Factors Influencing ◽

Group Interviews

The aim of this study was to explore and describe the perceptions of registered nurses regarding factors influencing service delivery regarding expansion programmes in a primary healthcare setting, using a qualitative approach. The registered nurses, who have been working in the clinics for more than two years and have been exposed to the expansion programmes there, were purposively sampled. Two focus group interviews were conducted in a neutral place and the data collected by the researcher Nnoi A. Xaba (N.A.X.). Data were analysed by the researcher and an independent co-coder using the Tesch method. Categories, subcategories and themes were identified; those that formed the basis of discussion were disabling factors, enabling factors, client-related factors, service-related factors and solutions to problems. It is recommended that integration of programmes and coordination be done at a provincial level and planned together with the training centres in order to alleviate problems in service delivery. Training on expansion programmes in the form of in-service education should be carried out continually in the region.Die doel van die studie was om die persepsie van geregistreerde verpleegkundiges met betrekking tot die faktore wat dienslewering van die uitbreidingsprogramme in ‘n primêre gesondheid opset beinvloed; te eksploreer en te beskryf. ‘n Kwalitatiewe benadering is gevolg in die iutvoering van die studie. ‘n Doelgerigte steekproef is uitgevoer vanuit geregistreerde verpleegkundiges wat vir langer as twee jaar in die klinieke werksaam was en blootgestel is aan die uitbreiding programme. Twee fokus groep onderhoude is deur die navorser Nnoi A. Xaba (N.A.X.) in ‘n neutrale opset uitgevoer. Data is deur die navorser en ŉ onafhanklike kodeerder ontleed volgens Tesch se metode van analise. Kategorieë, sub-kategorieë en temas was geidentifiseer. Die kategorieë fundamenteel tot die bespreking behels: remmende faktore, bydraende faktore, kliënt-verwante faktore, diens-verwante faktore, en oplossing van probleme. Daar word aanbeveel dat die integrasie en koordinasie van programme op provisiale vlak beplan word in samewerking met opleidings instansies om die dienslewerings probleem te verlig. In die streek behoort opleiding met betrekking tot die uitbreidingsprogramme deurlopend deur middel van indiensopleiding gedoen word.

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