Canadian family physician Medecin de famille canadien · 2014
Providing high-quality care in primary care settings: how to make trade-offs.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
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Beaulieu Marie-Dominique, Geneau Robert, Del Grande Claudio, Denis Jean-Louis, Hudon Eveline, Haggerty Jeannie L, Bonin Lucie, Duplain Réjean, Goudreau Johanne, Hogg William
Аннотация
OBJECTIVE: To gain a deeper understanding of how primary care (PC) practices belonging to different models manage resources to provide high-quality care.
DESIGN: Multiple-case study embedded in a cross-sectional study of a random sample of 37 practices.
SETTING: Three regions of Quebec.
PARTICIPANTS: Health care professionals and staff of 5 PC practices.
METHODS: Five cases showing above-average results on quality-of-care indicators were purposefully selected to contrast on region, practice size, and PC model. Data were collected using an organizational questionnaire; the Team Climate Inventory, which was completed by health care professionals and staff; and 33 individual interviews. Detailed case histories were written and thematic analysis was performed.
MAIN FINDINGS: The core common feature of these practices was their ongoing effort to make trade-offs to deliver services that met their vision of high-quality care. These compromises involved the same 3 areas, but to varying degrees depending on clinic characteristics: developing a shared vision of high-quality care; aligning resource use with that vision; and balancing professional aspirations and population needs. The leadership of the physician lead was crucial. The external environment was perceived as a source of pressure and dilemmas rather than as a source of support in these matters.
CONCLUSION: Irrespective of their models, PC practices' pursuit of high-quality care is based on a vision in which accessibility is a key component, balanced by appropriate management of available resources and of external environment expectations. Current PC reforms often create tensions rather than support PC practices in their pursuit of high-quality care.
DESIGN: Multiple-case study embedded in a cross-sectional study of a random sample of 37 practices.
SETTING: Three regions of Quebec.
PARTICIPANTS: Health care professionals and staff of 5 PC practices.
METHODS: Five cases showing above-average results on quality-of-care indicators were purposefully selected to contrast on region, practice size, and PC model. Data were collected using an organizational questionnaire; the Team Climate Inventory, which was completed by health care professionals and staff; and 33 individual interviews. Detailed case histories were written and thematic analysis was performed.
MAIN FINDINGS: The core common feature of these practices was their ongoing effort to make trade-offs to deliver services that met their vision of high-quality care. These compromises involved the same 3 areas, but to varying degrees depending on clinic characteristics: developing a shared vision of high-quality care; aligning resource use with that vision; and balancing professional aspirations and population needs. The leadership of the physician lead was crucial. The external environment was perceived as a source of pressure and dilemmas rather than as a source of support in these matters.
CONCLUSION: Irrespective of their models, PC practices' pursuit of high-quality care is based on a vision in which accessibility is a key component, balanced by appropriate management of available resources and of external environment expectations. Current PC reforms often create tensions rather than support PC practices in their pursuit of high-quality care.