Organizational factors influencing successful primary care and public health collaboration

Valaitis, Ruta; Meagher‐Stewart, Donna; Martin-Misener, Ruth; Wong, Sabrina T.; MacDonald, Marjorie; O’Mara, Linda

doi:10.1186/s12913-018-3194-7

Cited by 53 publications

(63 citation statements)

References 34 publications

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“…Implementing changes related to program integration can introduce challenges with bringing together divergent priorities, joining unique information processes and systems, removing overlap in various areas of operations, and restructuring roles of organizational members [4][5][6][7]. These changes can face resistance, making implementation of program integration difficult.…”

Section: Introductionmentioning

confidence: 99%

Examining health care providers’ and middle-level managers’ readiness for change: a qualitative study

Austin

Chreim

Grudniewicz

2020

BMC Health Serv Res

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Background: Readiness is a critical precursor of successful change; it denotes whether those involved in the change are motivated and empowered to participate in the change. Research on readiness tends to focus on frontline providers or individuals in non-managerial positions and offers limited attention to individuals in middle management positions who are expected to lead frontline providers in change implementation. Yet middle-level managers are also recipients of changes that are planned and decreed by those in higher positions. This study sought to examine both frontline provider and middle manager readiness for change in the context of primary care program integration. Methods: Using a qualitative case study approach, we examined how frontline providers and middle managers experienced six readiness factors: discrepancy, appropriateness, valence, efficacy, fairness and trust in management. Data were collected through documents, meeting observation and semi-structured interviews with frontline providers and middle managers involved in the change. Results: The findings highlighted similarities and differences in readiness experiences of frontline providers and middle managers. Across both types of participants, we found that the notion of valence should be expanded to consider individuals' evaluation of benefits to patients and the health system; efficacy applies to both content and process of change; fairness and trust in management findings require further exploration to determine their appropriateness to be incorporated in models of readiness for change; and trust in management (or lack of trust) has a cascading influence across the levels in the organization. Conclusions: Our study makes a contribution by nuancing and extending conceptualizations of individual readiness factors, and by highlighting the central role of middle manager readiness for change. Implications of the study include the need to consider readiness factors prior to the implementation of change and the importance of fostering readiness throughout all levels of the organization.

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Section: Introductionmentioning

confidence: 99%

Examining health care providers’ and middle-level managers’ readiness for change: a qualitative study

Austin

Chreim

Grudniewicz

2020

BMC Health Serv Res

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“…Perhaps the message is to consider more appropriately other influences in which PC-PH collaborations are formed and operate. Researchers on this team have developed an ecological framework depicting different levels of influence (intra-personal, intrapersonal, organizational, and systemic) on PC-PH collaborations [36][37][38][39]. Barriers and enablers to collaboration organized under these levels of influence were identified in the cases presented and align with those identified in our ecological framework thereby providing further evidence to support the framework.…”

Section: Discussionmentioning

confidence: 73%

“…We selected cases that were brought to our attention through reports and key informants involved in a qualitative study [37][38][39]. Collaborations with less positive experiences could have been included although these were difficult to identify.…”

Section: Discussionmentioning

confidence: 99%

Addressing quadruple aims through primary care and public health collaboration: ten Canadian case studies

et al. 2020

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Background: Health systems in Canada and elsewhere are at a crossroads of reform in response to rising economic and societal pressures. The Quadruple Aim advocates for: improving patient experience, reducing cost, advancing population health and improving the provider experience. It is at the forefront of Canadian reform debates aimed to improve a complex and often-fragmented health care system. Concurrently, collaboration between primary care and public health has been the focus of current research, looking for integrated community-based primary health care models that best suit the health needs of communities and address health equity. This study aimed to explore the nature of Canadian primary care-public health collaborations, their aims, motivations, activities, collaboration barriers and enablers, and perceived outcomes. Methods: Ten case studies were conducted in three provinces (Nova Scotia, Ontario, and British Columbia) to elucidate experiences of primary care and public health collaboration in different settings, contexts, populations and forms. Data sources included a survey using the Partnership Self-Assessment Tool, focus groups, and document analysis. This provided an opportunity to explore how primary care and public health collaboration could serve in transforming community-based primary health care with the potential to address the Quadruple Aims. Results: Aims of collaborations included: provider capacity building, regional vaccine/immunization management, community-based health promotion programming, and, outreach to increase access to care. Common precipitators were having a shared vision and/or community concern. Barriers and enablers differed among cases. Perceived barriers included ineffective communication processes, inadequate time for collaboration, geographic challenges, lack of resources, and varying organizational goals and mandates. Enablers included clear goals, trusting and inclusive relationships, role clarity, strong leadership, strong coordination and communication, and optimal use of resources. Cases achieved outcomes addressing the Q-Aims such as improving access to services, addressing population health through outreach to at-risk populations, reducing costs through efficiencies, and improving provider experience through capacity building.

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“…(1,2) Transformation here can be understood in a number of ways, but key among them is the idea that primary care practice becomes less focused on diagnosing and curing disease and more focused on supporting health, wellness, and the effective management of chronic conditions. (3,4) This can be summed up as a shift from primary care to primary health care (PHC), with a resulting emphasis on population health, prevention, and service delivery integration (3,5,6) that promises to bend the cost curve as it moves care upstream from hospitals. (7,8) Among other positive effects, recent studies have linked reductions in Emergency Department utilization and hospital admissions to PHC-focused statelevel investments in primary care.…”

Section: Introductionmentioning

confidence: 99%

An Implementation History of Primary Health Care Transformation: Alberta’s Primary Care Networks and the People, Time and Culture of change

Leslie

Khayatzadeh‐Mahani

Birdsell

et al. 2020

Preprint

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Background: Primary care, and its transformation into Primary Health Care (PHC), hasbecome an area of intense policy interest around the world. As part of this trendAlberta, Canada, has implemented Primary Care Networks (PCNs). These aredecentralized organizations, mandated with supporting the delivery of PHC, fundedthrough capitation, and operating as partnerships between the province’s healthcareadministration system and family physicians. This paper provides an implementationhistory of the PCNs, giving a detailed account of how people, time, and culturehave interacted to implement bottom up, incremental change in a predominantly Fee-For-Service (FFS) environment.Methods: Our implementation history is built out of an analysis of policy documentsand qualitative interviews. We conducted an interpretive analysis of relevant policydocuments (n=20) published since the first PCN was established. We then grounded12 semi-structured interviews in that initial policy analysis. These interviews explored11 key stakeholders’ perceptions of PHC transformation in Alberta generally, and theformation and evolution of the PCNs specifically. The data from the policy review andthe interviews were coded inductively, with participants checking our emerginganalyses.Results: Over time, the PCNs have shifted from an initial Frontier Era thatemphasized local solutions to local problems and featured few rules, to a present Eraof Accountability that features central demands for standardized measures,governance, and co-planning with other elements of the health system. A core groupof people – clinician and administration leaders – emerged to create the PCNs and,over time , to develop a long-term Quality Improvement (QI) vision and governanceplan for them as organizations. The continuing willingness of both these groups towork at understanding and aligning one another’s cultures to achieve thetransformation towards PHC has been central to the PCNs’ survival and success.Conclusions: Generalizable lessons from the implementation history of this emergingpolicy experiment include: The need for flexibility within a broad commitment toimproving quality. The importance of time for individuals and organizations to learnabout: quality improvement; one another’s cultures; and how best to support thetransformation of a system while delivering care locally.

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Organizational factors influencing successful primary care and public health collaboration

Cited by 53 publications

References 34 publications

Examining health care providers’ and middle-level managers’ readiness for change: a qualitative study

Examining health care providers’ and middle-level managers’ readiness for change: a qualitative study

Addressing quadruple aims through primary care and public health collaboration: ten Canadian case studies

An Implementation History of Primary Health Care Transformation: Alberta’s Primary Care Networks and the People, Time and Culture of change

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