Physicians’ accounts of frontline tensions when implementing pilot projects to improve primary care
Journal of Health Organization and Management
ISSN: 1477-7266
Article publication date: 22 January 2018
Issue publication date: 6 March 2018
Abstract
Purpose
Canada’s primary care system has been described as “a culture of pilot projects” with little evidence of converting successful initiatives into funded, permanent programs or sharing project outcomes and insights across jurisdictions. Health services pilot projects are advocated as an effective strategy for identifying promising models of care and building integrated care partnerships in local settings. In the qualitative study reported here, the purpose of this paper is to investigate the strengths and challenges of this approach.
Design/methodology/approach
Semi-structured interviews were conducted with 34 primary care physicians who discussed their experiences as pilot project leads. Following thematic analysis methods, broad system issues were captured as well as individual project information.
Findings
While participants often portrayed themselves as advocates for vulnerable patients, mobilizing healthcare organizations and providers to support new models of care was discussed as challenging. Competition between local healthcare providers and initiatives could impact pilot project success. Participants also reported tensions between their clinical, project management and research roles with additional time demands and skill requirements interfering with the work of implementing and evaluating service innovations.
Originality/value
Study findings highlight the complexity of pilot project implementation, which encompasses physician commitment to addressing care for vulnerable populations through to the need for additional skill set requirements and the impact of local project environments. The current pilot project approach could be strengthened by including more multidisciplinary collaboration and providing infrastructure supports to enhance the design, implementation and evaluation of health services improvement initiatives.
Keywords
Acknowledgements
The authors gratefully acknowledge funding from the Ontario Ministry of Health and Long-term Care. Dr Naglie is supported by the George, Margaret and Gary Hunt Family Chair in Geriatric Medicine, University of Toronto. The funding sources played no role in the conduct of the study, data collection and analysis or the preparation of the manuscript.
Citation
Mansfield, E., Bhattacharyya, O., Christian, J., Naglie, G., Steriopoulos, V. and Webster, F. (2018), "Physicians’ accounts of frontline tensions when implementing pilot projects to improve primary care", Journal of Health Organization and Management, Vol. 32 No. 1, pp. 39-55. https://doi.org/10.1108/JHOM-01-2017-0013
Publisher
:Emerald Publishing Limited
Copyright © 2018, Emerald Publishing Limited