Primary Care Toolkit for Family Physicians
The College of Family Physicians of Canada
This review from the UK examines the origins of primary care and the pressures currently faced in terms of patient expectation, regulation, accountability, and work force shortages. It recognizes the appropriateness of shifting both more services and more medical education from secondary to primary care. Some conclusions are drawn concerning potential solutions including skill mix changes, centralisation of services, a change in attitudes to professional mistakes, increased protected development time, evidence based education, and academic, leadership, and feedback skills for general practitioners. Six recommendations are offered as a prescription for organisational and educational change (Lord 2003).
Primary care practices are complex adaptive systems facing the need to respond to internal and external uncertainty and surprise. For clinicians and practices to maximize their ability to proactively evolve as they respond to uncertainty and surprise, they need to understand that their practices are nonlinear systems and create the time and space for learning and reflection. This article provides principles for clinicians and staff for negotiating uncertainty and surprise in an ever-changing healthcare environment (Crabtree 2003).
In medical informatics applications, major challenges to system success are often more behavioral than technical. Successfully introducing such systems into complex healthcare organizations requires an effective blend of good technical and good organizational skills. People who have low psychological ownership in a system and who vigorously resist its implementation can bring a "technically best" system to its knees. However, effective leadership can sharply reduce the behavioral resistance to change to achieve a more rapid and productive introduction of informatics technology. This paper looks at four major areas-why information system failures occur, the core theories supporting change management, the practical applications of change management, and the change management efforts in informatics (Lorenzi and Riley 2000).
A model of practice change was developed from the Study To Enhance Prevention by Understanding Practice (STEP-UP), a randomized clinical trial of 79 practices. The team conducted comparative case-study analyses of high- and low-improvement practices to identify variables that are critical to the change process. The critical elements for understanding and guiding practice change are (1) motivation of key stakeholders to achieve the target for change; (2) instrumental, personal, and interactive resources for change; (3) motivators outside the practice, including the larger healthcare environment and community; and (4) opportunities for change--that is, how key stakeholders understand the change options (Cohen, McDaniel et al. 2004).
References for information under Knowledge Transfer and Change Management:
- D Cohen, RR McDaniel Jr., et al, A Practice Change Model for Quality Improvement in primary care practice, Journal of Healthcare Management 2004, 49(3): pages 155-68, discussion pages 169-70.
- BF Crabtree, Primary Care Practices Are Full of Surprises!, Healthcare Management Review, 2003, 28(3): pages 279-83, discussion pages 289-90.
- Guiding Facilitation in the Canadian Context: Chapter 3: Facilitation as a Vehicle for Change, V R Ramsden, E Vilis, H White,
Department of Health and Community Services, Government of Newfoundland and Labrador.
- ID Graham, and J Logan, Innovations in Knowledge Transfer and Continuity of Care, Can Journal of Nursing Res, 2004, 36(2): pages 89-103.
- J Lord, Future of Primary Healthcare Education: Current Problems and Potential Solutions, Postgraduate Medicine Journal, 2003, 79(936): pages 553-60.
- NM Lorenzi and RT Riley, Managing Change: an Overview, Journal of American Medical Information Association, 2000, 7(2): pages 116-24.
- V R Ramsden, E Vilis, H White, Guiding Facilitation in the Canadian Context, Chapter 3: Facilitation as a Vehicle for Change, Department of Health and Community Services, Government of Newfoundland and Laborador, 2006: pages 20-27.
- R Rushmer, D Kelly et al, Introducing the Learning Practice - I. The Characteristics of Learning Organizations in Primary Care, Journal of Evaluation in Clinical Practice, 2004, 10(3): pages 375-86.
- R Rushmer, D Kelly et al, Introducing the Learning Practice - II. Becoming a Learning Practice, Journal of Evaluation in Clinical Practice, 2004, 10(3): pages 387-98.
- R Rushmer, D Kelly et al, Introducing the Learning Practice - III. Leadership, Empowerment, Protected Time and Reflective Practice as Core Contextual Conditions, Journal of Evaluation in Clinical Practice, 2004, 10(3): pages 399-405.