Successful task delegation in general practice – a way to maintain primary health care in the future

Riisgaard, Helle; Nexøe, Jørgen

doi:10.1080/02813432.2017.1335056

Cited by 10 publications

(12 citation statements)

References 8 publications

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“…Organisational virtuousness creates self-reinforcing positive spirals, together with a buffering function towards negative challenges to the organisation [23,24]. It is essential for organisations in primary care to work to enhance their cultural core values, especially if optimal performance includes task delegation, but also to acknowledge that changing a culture demands time and resources [25]. Several of the explored HWE indicators relate to factors associated with the development and support of organisational virtuousness such as fostering respect, integrity, gratitude, compassion, forgiveness, inspiration, and meaningful work [23].…”

Section: Discussionmentioning

confidence: 99%

“…Joy at work was common and based on experiences of personal mastery and feelings of meaningfulness but was also described as enjoyment of the positive and inspiring social culture in the workplace. Intrinsic motivation is connected to feelings of accomplishment and joy at doing well at work [35], and job-satisfaction is also related to a high degree of task delegation and good quality care [25]. Previous research has shown that intrinsic motivation decreased after the implementation of governance structure reforms in primary care [3], indicating that the well-functioning PCUs had other qualities that supported intrinsic motivation and joy at work.…”

Section: Discussionmentioning

confidence: 99%

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Workers’ experiences of healthy work environment indicators at well-functioning primary care units in Sweden: a qualitative study

Josefsson

Avby

Bäck

et al. 2018

Scandinavian Journal of Primary Health Care

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Objective: Staff experiences of healthy work environment (HWE) indicators at primary care units can assist in understanding why some primary care units function better than others. The aim of the study was to create increased understanding of how workers experienced HWE indicators at well-functioning primary care units. Design: Fifty in-depth interviews with staff at six primary care units in Sweden were analysed with deductive content analysis, revisiting a systematic review of HWE indicators. Results: The study presents additional perspectives on staff experiences of HWE indicators at well-functioning primary care units. The included primary care units (PCU) shared a similar pattern of work environment indicators, with unique solutions and strategies to meet shared challenges. Staff at the included PCUs were encouraged to work to create and sustain a HWE, but each domain (indicator) also provided challenges that the staff and organisation needed to meet. The results suggest that useful approaches for a healthy work environment could be to address issues of organisational virtuousness, employee commitment and joy at work. Conclusions: Both managers and staff are encouraged to actively work not only to create and sustain an HWE but also to promote organisational virtuousness, employee commitment, joy at work and to increase the performance at work, which is of benefit to staff, patients and society. Key Points Staff at well-functioning primary care units (PCUs) experienced healthy work environments The included PCUs shared a similar pattern of work environment indicators, with unique solutions and strategies to meet shared challenges. Staff at the included PCUs were encouraged to work to create and sustain a healthy work environment, but each domain (indicator) also provided challenges that the staff and organisation needed to meet. The results suggest that useful approaches for a healthy work environment could be to address issues of organisational virtuousness, employee commitment and joy at work.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Workers’ experiences of healthy work environment indicators at well-functioning primary care units in Sweden: a qualitative study

Josefsson

Avby

Bäck

et al. 2018

Scandinavian Journal of Primary Health Care

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“…In Norway, only physician-led care is eligible for reimbursement in general practice, whilst collaborating healthcare professionals (cHCPs), such as nurses, medical secretaries and dietitians lack the authority to bill for their services independently and are directly employed by practices. Hence, compared to some other countries [24,26], multi-professional team-based care is not common in Norwegian primary care.…”

Section: Introductionmentioning

confidence: 91%

The roles of healthcare professionals in diabetes care: a qualitative study in Norwegian general practice

Sørensen

Groven

Gjelsvik

et al. 2020

Scandinavian Journal of Primary Health Care

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Objective: To explore the experiences of general practitioners (GPs), nurses and medical secretaries in providing multi-professional diabetes care and their perceptions of professional roles. Design, setting and subjects: Semi-structured interviews were conducted with six GPs, three nurses and two medical secretaries from five purposively sampled diabetes teams. Interviews were analysed thematically. Main outcome measures: Healthcare professionals' (HCPs') experiences of multi-professional diabetes care in general practice. Results: The involvement of nurses and medical secretaries (collaborating health care professionals) was mainly motivated by GPs' time pressure and their perception of diabetes care as easy to standardize. GPs reported that diabetes care had become more structured and continuous after the involvement of collaborating health care professionals (cHCPs). cHCPs defined their role differently from GPs, emphasizing that their approach included acknowledging patients' need for diabetes education, listening to their stories and meeting their need for emotional support. GPs appeared less involved in patients' emotional concerns and more focused on the biomedical aspects of illness. There was little emphasis on teamwork among GPs and cHCPs, and none of the practices used care plans to involve patients in decisions or unify treatment among professionals. Participants stated that institutional structures including a discriminatory remuneration system, lack of role descriptions and missing procedures for collaborative approaches were an obstacle to MPC. Conclusions: cHCPs worked independently under delegated leadership of the GPs. Although cHCPs had a complementary role, HCPs in general practice may not take full advantage of the potential of sharing patient responsibility and learning with, from and about each other. Contextual barriers for team-based care approaches should be addressed in future research.

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“…A potential explanation for these findings is that nurses follow guidelines more precisely than physicians and that it influences the quality of care positively. However, a substantial variation in the degree to which GPs choose to delegate tasks to their staff has previously been found [13], and research shows that variation is still present – especially with regard to the complexity of the tasks which the GPs are willing to delegate [14]. Consequently, based on the literature in the area, we hypothesize that higher degrees of task delegation are associated with a higher adherence to guidelines when treating patients with chronic disease.…”

Section: Introductionmentioning

confidence: 97%

Associations between degrees of task delegation and adherence to COPD guidelines on spirometry testing in general practice - a national cross-sectional study

Riisgaard

Søndergaard

et al. 2019

BMC Health Serv Res

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Background The healthcare systems in the western world have in recent years faced major challenges caused by demographic changes and altered patterns of diseases as well as political decisions influencing the organisation of healthcare provisions. General practitioners are encouraged to delegate more clinical tasks to their staff in order to respond to the changing circumstances. Nevertheless, the degree of task delegation varies substantially between general practices, and how these different degrees affect the quality of care for the patients is currently not known. Using chronic obstructive pulmonary disease (COPD) as our case scenario, the aim of the study was to investigate associations between degrees of task delegation in general practice and spirometry testing as a measure of quality of care. Methods We carried out a cross-sectional study comprising all general practices in Denmark and patients suffering from chronic obstructive pulmonary disease. General practitioners (GPs) were invited to participate in a survey investigating degrees of task delegation in their clinics. Data were linked to national registers on spirometry testing among patients with COPD. We investigated associations using multilevel mixed-effects logit models and adjusted for practice and patient characteristics. Results GPs from 895 practices with staff managing COPD-related tasks responded, and 61,223 COPD patients were linked to these practices. Hereof, 24,685 (40.3%) had a spirometry performed within a year. Patients had a statistically significant higher odds ratio (OR) of having an annual spirometry performed in practices with medium or maximal degrees of task delegation compared to practices with a minimal degree (OR = 1.27 and OR = 1.33, respectively). Conclusion Delegating more complex tasks to practice staff implies that COPD-patients are more likely to be treated according to evidence-based recommendations on spirometry testing. Electronic supplementary material The online version of this article (10.1186/s12913-019-4270-3) contains supplementary material, which is available to authorized users.

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Successful task delegation in general practice – a way to maintain primary health care in the future

Cited by 10 publications

References 8 publications

Workers’ experiences of healthy work environment indicators at well-functioning primary care units in Sweden: a qualitative study

Workers’ experiences of healthy work environment indicators at well-functioning primary care units in Sweden: a qualitative study

The roles of healthcare professionals in diabetes care: a qualitative study in Norwegian general practice

Associations between degrees of task delegation and adherence to COPD guidelines on spirometry testing in general practice - a national cross-sectional study

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