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Effective teamwork in primary healthcare through a structured patient-sorting system - a qualitative study on staff members' conceptions.

Maun A, Engström M, Frantz A, Brämberg EB, Thorn J - BMC Fam Pract (2014)

Bottom Line: Reorganization and team development can improve quality and performance but projects in primary care frequently do not attain the targeted results.By developing and introducing a structured patient-sorting system a primary healthcare centre in Western Sweden increased its access rate significantly and employed its medical professionals more efficiently.Knowledge from this study can be used to assist and improve future implementations in primary healthcare centres.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Primary healthcare meets increased demands from an aging population concerning quality and availability while concurrently dealing with a growing shortage of general practitioners and imperfect efficiency in healthcare processes. Reorganization and team development can improve quality and performance but projects in primary care frequently do not attain the targeted results. By developing and introducing a structured patient-sorting system a primary healthcare centre in Western Sweden increased its access rate significantly and employed its medical professionals more efficiently. The aim of this study was to explore staff members' conceptions of the structured patient-sorting system in order to gain an inside perspective on this project.

Methods: In this qualitative study 16 interviews were conducted over a period of two years and data was analysed using a phenomenographic approach to identify the various conceptions of the eleven participants.

Results: Three categories of description were identified: The system was conceptualized as 1) a framework for the development of patient-centred processes that were clear and consistent, 2) a promotor of professional development and a shared ideal of cooperative practice and 3) a common denominator and catalyst in conflict management.

Conclusions: This study demonstrates that the introduction of a structured patient-sorting system makes it possible for several important change processes to take place concurrently: improvement of healthcare processes, empowerment of professionals and team development. It therefore indicates the importance of an appropriate, contextualized framework to support multiple concomitant quality improvement processes. Knowledge from this study can be used to assist and improve future implementations in primary healthcare centres.

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Iterative development cycle. The structured patient-sorting system was developed through iterative development cycles inspired by the Plan-Do-Study-Act model.
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Fig1: Iterative development cycle. The structured patient-sorting system was developed through iterative development cycles inspired by the Plan-Do-Study-Act model.

Mentions: The primary care centre in Western Sweden where the structured patient-sorting system was developed and introduced in 2008 was purposely chosen for this study in order to gain a deeper understanding of the conceptions of the actively involved participants. The system was developed through iterative development cycles inspired by the Plan-Do-Study-Act model (Figure 1). All staff members participated regularly in interdisciplinary work-groups where the possible causes of the low access rate were assessed. Sorting algorithms and alterations of daily processes were developed, tested in small scale and evaluated before they where implemented for the whole primary care centre. As a result of this process nurses triaged all patients to the appropriate primary care professionals according to the symptoms described (Figure 2) in contrast to the earlier routine where most patients were initially sent to a General Practitioner. A special sorting manual was developed for this purpose in order to standardize the procedure and physiotherapists, psychologists and occupational therapists started to treat patients with certain conditions triaged directly to them by the nurses without a referral from a general practitioner [15]. Follow-up studies showed that the structured patient-sorting system seemed to satisfy the patient’s wish and need for quick access to a psychologist and that long-term healthcare consumption decreased for patients initially seeing physiotherapists [18,19]. The structured patient-sorting system has been adopted by a number of primary care centres in Sweden.Figure 1


Effective teamwork in primary healthcare through a structured patient-sorting system - a qualitative study on staff members' conceptions.

Maun A, Engström M, Frantz A, Brämberg EB, Thorn J - BMC Fam Pract (2014)

Iterative development cycle. The structured patient-sorting system was developed through iterative development cycles inspired by the Plan-Do-Study-Act model.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4260211&req=5

Fig1: Iterative development cycle. The structured patient-sorting system was developed through iterative development cycles inspired by the Plan-Do-Study-Act model.
Mentions: The primary care centre in Western Sweden where the structured patient-sorting system was developed and introduced in 2008 was purposely chosen for this study in order to gain a deeper understanding of the conceptions of the actively involved participants. The system was developed through iterative development cycles inspired by the Plan-Do-Study-Act model (Figure 1). All staff members participated regularly in interdisciplinary work-groups where the possible causes of the low access rate were assessed. Sorting algorithms and alterations of daily processes were developed, tested in small scale and evaluated before they where implemented for the whole primary care centre. As a result of this process nurses triaged all patients to the appropriate primary care professionals according to the symptoms described (Figure 2) in contrast to the earlier routine where most patients were initially sent to a General Practitioner. A special sorting manual was developed for this purpose in order to standardize the procedure and physiotherapists, psychologists and occupational therapists started to treat patients with certain conditions triaged directly to them by the nurses without a referral from a general practitioner [15]. Follow-up studies showed that the structured patient-sorting system seemed to satisfy the patient’s wish and need for quick access to a psychologist and that long-term healthcare consumption decreased for patients initially seeing physiotherapists [18,19]. The structured patient-sorting system has been adopted by a number of primary care centres in Sweden.Figure 1

Bottom Line: Reorganization and team development can improve quality and performance but projects in primary care frequently do not attain the targeted results.By developing and introducing a structured patient-sorting system a primary healthcare centre in Western Sweden increased its access rate significantly and employed its medical professionals more efficiently.Knowledge from this study can be used to assist and improve future implementations in primary healthcare centres.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Primary healthcare meets increased demands from an aging population concerning quality and availability while concurrently dealing with a growing shortage of general practitioners and imperfect efficiency in healthcare processes. Reorganization and team development can improve quality and performance but projects in primary care frequently do not attain the targeted results. By developing and introducing a structured patient-sorting system a primary healthcare centre in Western Sweden increased its access rate significantly and employed its medical professionals more efficiently. The aim of this study was to explore staff members' conceptions of the structured patient-sorting system in order to gain an inside perspective on this project.

Methods: In this qualitative study 16 interviews were conducted over a period of two years and data was analysed using a phenomenographic approach to identify the various conceptions of the eleven participants.

Results: Three categories of description were identified: The system was conceptualized as 1) a framework for the development of patient-centred processes that were clear and consistent, 2) a promotor of professional development and a shared ideal of cooperative practice and 3) a common denominator and catalyst in conflict management.

Conclusions: This study demonstrates that the introduction of a structured patient-sorting system makes it possible for several important change processes to take place concurrently: improvement of healthcare processes, empowerment of professionals and team development. It therefore indicates the importance of an appropriate, contextualized framework to support multiple concomitant quality improvement processes. Knowledge from this study can be used to assist and improve future implementations in primary healthcare centres.

Show MeSH