Doing primary care integration: a qualitative study of meso-level collaborative practices
Abstract Background The integration of Primary Care (PC) into broader health systems has been a goal in jurisdictions around the world. Efforts to achieve integration at the meso-level have drawn particular attention, but there are few actionable recommendations for how to enact a ‘pro-integration c...
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| Format: | Article |
| Language: | English |
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BMC
2023-07-01
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| Series: | BMC Primary Care |
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| Online Access: | https://doi.org/10.1186/s12875-023-02104-7 |
| _version_ | 1797774051061530624 |
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| author | Myles Leslie Raad Fadaak Nicole Pinto |
| author_facet | Myles Leslie Raad Fadaak Nicole Pinto |
| author_sort | Myles Leslie |
| collection | DOAJ |
| description | Abstract Background The integration of Primary Care (PC) into broader health systems has been a goal in jurisdictions around the world. Efforts to achieve integration at the meso-level have drawn particular attention, but there are few actionable recommendations for how to enact a ‘pro-integration culture’ amongst government and PC governance bodies. This paper describes pragmatic integration activity undertaken by meso-level participants in Alberta, Canada, and suggests ways this activity may be generalizable to other health systems. Methods 11 semi-structured interviews with nine key informants from meso-level organizations were selected from a larger qualitative study examining healthcare policy development and implementation during the COVID-19 pandemic. Selected interviews focused on participants’ experiences and efforts to ‘do’ integration as they responded to Alberta’s first wave of the Omicron variant in September 2021. An interpretive descriptive approach was used to identify repeating cycles in the integration context, and pragmatic integration activities. Results As Omicron arrived in Alberta, integration and relations between meso-level PC and central health system participants were tense, but efforts to improve the situation were successfully made. In this context of cycling relationships, staffing changes made in reaction to exogenous shocks and political pressures were clear influences on integration. However, participants also engaged in specific behaviours that advanced a pro-integration culture. They did so by: signaling value through staffing and resource choices; speaking and enacting personal and group commitments to collaboration; persevering; and practicing bi-directional communication through formal and informal channels. Conclusions Achieving PC integration involves not just the reactive work of responding to exogenous factors, but also the proactive work of enacting cultural, relationship, and communication behaviors. These behaviors may support integration regardless of the shocks, staff turnover, and relational freeze-thaw cycles experienced by any health system. |
| first_indexed | 2024-03-12T22:15:18Z |
| format | Article |
| id | doaj.art-c66755a935d247f8a9be6376bb155ad6 |
| institution | Directory Open Access Journal |
| issn | 2731-4553 |
| language | English |
| last_indexed | 2024-03-12T22:15:18Z |
| publishDate | 2023-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Primary Care |
| spelling | doaj.art-c66755a935d247f8a9be6376bb155ad62023-07-23T11:21:31ZengBMCBMC Primary Care2731-45532023-07-0124111010.1186/s12875-023-02104-7Doing primary care integration: a qualitative study of meso-level collaborative practicesMyles Leslie0Raad Fadaak1Nicole Pinto2School of Public Policy, University of CalgarySchool of Public Policy, University of CalgarySchool of Public Policy, University of CalgaryAbstract Background The integration of Primary Care (PC) into broader health systems has been a goal in jurisdictions around the world. Efforts to achieve integration at the meso-level have drawn particular attention, but there are few actionable recommendations for how to enact a ‘pro-integration culture’ amongst government and PC governance bodies. This paper describes pragmatic integration activity undertaken by meso-level participants in Alberta, Canada, and suggests ways this activity may be generalizable to other health systems. Methods 11 semi-structured interviews with nine key informants from meso-level organizations were selected from a larger qualitative study examining healthcare policy development and implementation during the COVID-19 pandemic. Selected interviews focused on participants’ experiences and efforts to ‘do’ integration as they responded to Alberta’s first wave of the Omicron variant in September 2021. An interpretive descriptive approach was used to identify repeating cycles in the integration context, and pragmatic integration activities. Results As Omicron arrived in Alberta, integration and relations between meso-level PC and central health system participants were tense, but efforts to improve the situation were successfully made. In this context of cycling relationships, staffing changes made in reaction to exogenous shocks and political pressures were clear influences on integration. However, participants also engaged in specific behaviours that advanced a pro-integration culture. They did so by: signaling value through staffing and resource choices; speaking and enacting personal and group commitments to collaboration; persevering; and practicing bi-directional communication through formal and informal channels. Conclusions Achieving PC integration involves not just the reactive work of responding to exogenous factors, but also the proactive work of enacting cultural, relationship, and communication behaviors. These behaviors may support integration regardless of the shocks, staff turnover, and relational freeze-thaw cycles experienced by any health system.https://doi.org/10.1186/s12875-023-02104-7Primary carePrimary health careIntegrationMeso-levelCollaborationQualitative study |
| spellingShingle | Myles Leslie Raad Fadaak Nicole Pinto Doing primary care integration: a qualitative study of meso-level collaborative practices BMC Primary Care Primary care Primary health care Integration Meso-level Collaboration Qualitative study |
| title | Doing primary care integration: a qualitative study of meso-level collaborative practices |
| title_full | Doing primary care integration: a qualitative study of meso-level collaborative practices |
| title_fullStr | Doing primary care integration: a qualitative study of meso-level collaborative practices |
| title_full_unstemmed | Doing primary care integration: a qualitative study of meso-level collaborative practices |
| title_short | Doing primary care integration: a qualitative study of meso-level collaborative practices |
| title_sort | doing primary care integration a qualitative study of meso level collaborative practices |
| topic | Primary care Primary health care Integration Meso-level Collaboration Qualitative study |
| url | https://doi.org/10.1186/s12875-023-02104-7 |
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