A novel perspective of Australian primary care dietetics: Insights from an exploratory study using complex adaptive systems theory

Abstract

Aims: Effective quality improvement strategies are essential to enhancing outcomes of dietetic care. Interventions informed by complex adaptive systems theory have demonstrated effectiveness in other healthcare settings. This study aimed to explore primary care dietetics practice using complex adaptive systems theory and to identify factors that individuals across the healthcare system can examine and address to improve the quality of dietetic care. Methods: Qualitative analysis of semi-structured interviews of healthcare consumers and professionals involved in the provision of dietetic care. Data collection and analysis was guided by a complexity-informed conceptual framework. The Framework Method was used to code transcripts and identify themes describing primary care dietetics. Results: Twenty-three consumers and 26 primary care professionals participated. Participants described dietetic care as being delivered by individuals organised into formal and informal systems that were influenced by the wider environment, including legal, economic, and socio-cultural systems. Dietitians described interactions with consumers as a learning opportunity and sought education, mentoring, or supervision to address knowledge and skill gaps.Relationships underpinned transfer of information between individuals. Conclusion: Complex adaptive systems theory proved to be a useful conceptual framework for primary care dietetics. Factors identified at the macro (e.g., funding), meso (e.g., professional networks), and micro (e.g., consumer education) levels should be examined and addressed to improve the quality of dietetic care.

Developing the EQUIPED approach to quality management using multi‐grounded theory

“…19 The theoretical approach was grounded in theory from the National Safety and Quality in Primary and Community Healthcare Standards, 19 the Quality in Nutrition Care Model for Dietitians, 20 and a complexity-informed model of primary care dietetics. 21 eligibility criteria to check question design and amended based on their feedback. The final survey comprised: (a) six categorical items collecting information describing the service (i.e., business age, service capacity, annual revenue, states and territories serviced, and number and types of sites serviced); and (b) seven open text items covering governance, clinical quality and safety, and working with consumers, as outlined in Table 1.…”

“…T A B L E 2 Items used in the 'theoretical matching' steps from the National Standards, 19 Quality in Nutrition Care Model for Dietitians (QUINCE-MOD) 20 and complexity-informed model of primary care dietetics 21…”

“…Items and actions were identified in ‘Instrument Development’ from the public consultation document for the National Standards 19 . The theoretical approach was grounded in theory from the National Safety and Quality in Primary and Community Healthcare Standards, 19 the Quality in Nutrition Care Model for Dietitians, 20 and a complexity‐informed model of primary care dietetics 21 …”

Developing the Quality in Nutrition Care Model for Dietitians (QUINCE‐MOD) in primary care: A mixed‐method survey of healthcare consumers and professionals

“… 10 Complexity‐informed approaches to quality improvement, which draw on the theories from complexity science, have shown promise in a variety of healthcare settings. 12 Primary care dietetics has been described as a complex adaptive system, 13 suggesting that there may be value in employing complexity‐informed approaches to improve quality in primary care dietetics.…”

Expanding perspectives on professionalism in dietetics

“…14 These capabilities are aligned with contemporary dietetics professionalism and necessitate expanding paradigms and ways of thinking, educating and being. Similarly, other papers in this issue, by Blair et al, 15 Croxford et al, 16 Kelly et al 17 and Kirkegaard et al 18 all speak to an expanding requirement to more explicitly educate graduates in the 'art' of practiceequipping nutrition and dietetics graduates for employability in diversifying roles, in navigating uncertainty and complexity, and developing the critical capabilities Boak et al 14 describe. This will require ongoing cultural change (and involve learning and unlearning), and philosophical shifts within the profession.…”