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Engaging primary care physicians in system change – an interpretive qualitative study in a remote and rural health region in Northern British Columbia, Canada
OBJECTIVES: To describe how physicians were engaged in primary healthcare system change in a remote and rural Canadian health authority. DESIGN: A qualitative interpretive study based on a hermeneutic approach. METHODS: 34 transcribed in-depth interviews with physicians and administrators relevant t...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6549631/ https://www.ncbi.nlm.nih.gov/pubmed/31142534 http://dx.doi.org/10.1136/bmjopen-2018-028395 |
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author | Snadden, David Reay, Trish Hanlon, Neil MacLeod, Martha |
author_facet | Snadden, David Reay, Trish Hanlon, Neil MacLeod, Martha |
author_sort | Snadden, David |
collection | PubMed |
description | OBJECTIVES: To describe how physicians were engaged in primary healthcare system change in a remote and rural Canadian health authority. DESIGN: A qualitative interpretive study based on a hermeneutic approach. METHODS: 34 transcribed in-depth interviews with physicians and administrators relevant to physician engagement were purposively sampled from a larger data set of 239 interviews gathered over a 3-year period from seven communities engaged in primary healthcare transformation. Interviews were coded and analysed interpretively to develop common themes. SETTING: This research is part of a larger study, Partnering for Change I, which investigated the efforts of Northern Health, a rural regional health authority in British Columbia, to transform its healthcare system to one grounded in primary care with a focus on interdisciplinary teams. It reports how physician engagement was accomplished during the first 3 years of the study. PARTICIPANTS: Interviews with 34 individuals with direct involvement and experience in the processes of physician engagement. These included 10 physicians, three Regional Executives, 18 Primary Healthcare coordinators and three Division of Family Practice leads. RESULTS: Three major interconnected themes that depicted the process of engagement were identified: working through tensions constructively, drawing on structures for engagement and facilitating relationships. CONCLUSIONS: Physician engagement was recognised as a priority by Northern Health in its efforts to create system change. This was facilitated by the creation of Divisions of Family Practice that provided a structure for dialogue and facilitated a common voice for physicians. Divisions helped to build trust between various groups through allowing constructive conversations to surface and deal with tensions. Local context mattered. Flexibility in working from local priorities was a critical part of developing relationships that facilitated the design and implementation of system reform. |
format | Online Article Text |
id | pubmed-6549631 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-65496312019-06-21 Engaging primary care physicians in system change – an interpretive qualitative study in a remote and rural health region in Northern British Columbia, Canada Snadden, David Reay, Trish Hanlon, Neil MacLeod, Martha BMJ Open General practice / Family practice OBJECTIVES: To describe how physicians were engaged in primary healthcare system change in a remote and rural Canadian health authority. DESIGN: A qualitative interpretive study based on a hermeneutic approach. METHODS: 34 transcribed in-depth interviews with physicians and administrators relevant to physician engagement were purposively sampled from a larger data set of 239 interviews gathered over a 3-year period from seven communities engaged in primary healthcare transformation. Interviews were coded and analysed interpretively to develop common themes. SETTING: This research is part of a larger study, Partnering for Change I, which investigated the efforts of Northern Health, a rural regional health authority in British Columbia, to transform its healthcare system to one grounded in primary care with a focus on interdisciplinary teams. It reports how physician engagement was accomplished during the first 3 years of the study. PARTICIPANTS: Interviews with 34 individuals with direct involvement and experience in the processes of physician engagement. These included 10 physicians, three Regional Executives, 18 Primary Healthcare coordinators and three Division of Family Practice leads. RESULTS: Three major interconnected themes that depicted the process of engagement were identified: working through tensions constructively, drawing on structures for engagement and facilitating relationships. CONCLUSIONS: Physician engagement was recognised as a priority by Northern Health in its efforts to create system change. This was facilitated by the creation of Divisions of Family Practice that provided a structure for dialogue and facilitated a common voice for physicians. Divisions helped to build trust between various groups through allowing constructive conversations to surface and deal with tensions. Local context mattered. Flexibility in working from local priorities was a critical part of developing relationships that facilitated the design and implementation of system reform. BMJ Publishing Group 2019-05-28 /pmc/articles/PMC6549631/ /pubmed/31142534 http://dx.doi.org/10.1136/bmjopen-2018-028395 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. |
spellingShingle | General practice / Family practice Snadden, David Reay, Trish Hanlon, Neil MacLeod, Martha Engaging primary care physicians in system change – an interpretive qualitative study in a remote and rural health region in Northern British Columbia, Canada |
title | Engaging primary care physicians in system change – an interpretive qualitative study in a remote and rural health region in Northern British Columbia, Canada |
title_full | Engaging primary care physicians in system change – an interpretive qualitative study in a remote and rural health region in Northern British Columbia, Canada |
title_fullStr | Engaging primary care physicians in system change – an interpretive qualitative study in a remote and rural health region in Northern British Columbia, Canada |
title_full_unstemmed | Engaging primary care physicians in system change – an interpretive qualitative study in a remote and rural health region in Northern British Columbia, Canada |
title_short | Engaging primary care physicians in system change – an interpretive qualitative study in a remote and rural health region in Northern British Columbia, Canada |
title_sort | engaging primary care physicians in system change – an interpretive qualitative study in a remote and rural health region in northern british columbia, canada |
topic | General practice / Family practice |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6549631/ https://www.ncbi.nlm.nih.gov/pubmed/31142534 http://dx.doi.org/10.1136/bmjopen-2018-028395 |
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