Table 2 An example of categories, subcategories and strategies coded at each system-level
Category (%a) | Subcategory (%) Exemplar quotationb | Strategies |
|---|---|---|
Patient-level | ||
Empowerment and advocacy (91%) | Feels empowered as a patient (64%) “…they become partners in whatever is going on. So you see them as a partner like an equal. (GP6)” | ○ Demonstrate agency and ownership over own healthcare (e.g., following up on results, bringing advocate to consultation). |
○ Clearly indicate their healthcare needs, preferences and expectations to the provider. | ||
○ Willing to take part in practice research and open to having medical students present. | ||
Engages in shared decision-making and care planning (42%) “…willingness to undertake shared decision making and shared care… the risks and benefits of various treatments. (GP1)” | ○ Adhere to the agreed treatment plan as best as they can and try to make suggested lifestyle changes. | |
○ Are willing to build a shared understanding with the provider and engage in shared decision making. | ||
Recognises important health issues and provides accurate and useful information (36%) “…they’d be clear in their symptom description, and they’d be clear in how their symptoms are affecting them… (GP5)” | ○ Provide clear and useful feedback and history to their provider and actively engage in care planning. | |
○ Can differentiate between urgent and non-urgent issues (e.g., identifying non-serious headaches as distinct from those requiring further investigation). | ||
Actively seeks health information (27%) “…ask the doctor any concerns, any questions you have about the treatment. (P5)” | ○ Actively engage during the consultation and ask for clarification and expansion as necessary to facilitate understanding of health condition and treatment plan. | |
○ Independently research relevant health information and seek the provider’s input as necessary. | ||
Provider-level | ||
Communication and rapport building with patient (100%) | Listens to the patient (73%) “…they’re listening attentively to what you’re saying…and they are giving it the credence that it deserves. (P13)” | ○ Give the patient their full attention and make the patient feel like they are listening and not rushing through the consultation. |
○ Listen attentively to what the patient is saying and give it credence. | ||
Reassures the patient and alleviates their concerns (61%) “…ask them what they think is going wrong or going on, what are they most worried about, and then addressing those factors as well. (P9)” | ○ Try to make patients feel comfortable and use techniques to put them at ease (e.g., making small talk), especially during difficult procedures. | |
○ Identify the patients’ concerns and reassure them where they can (e.g., explain patients concerns definitively). | ||
Builds a supportive relationship and gets to know the patient (61%) “…they would know your history, they’d know your family’s history. (P5)” | ○ Get to know the patient on a personal level and find commonalities. | |
○ Build a long-term relationship with the patient and leverage it to provide necessary care. | ||
Trusts the patient and treats them with dignity and kindness (52%) “They’re nice, friendly…they make me feel comfortable to talk about everything. (P6)” | ○ Treat the patient in a respectful, friendly and caring manner. | |
○ Communicate in an open and honest way with the patient. | ||
○ Trust the patient to follow action plan as best as they can. | ||
Communicates effectively with the patient (42%) “…finding a level that’s appropriate for the patient… and knowing how to pitch it. (GP7)” | ○ Demonstrate clear and direct communication and focused body language. | |
○ Pick up on patient cues and tailors their communication style to suit the patient. | ||
Clinical Microsystem (Team)-level | ||
Team collaboration (97%) | Collaborates to provide integrated care (70%) “…our roles are different but they don’t work in isolation in parallel, they are integrated all the time. (GP11)” | ○ Coordinate effectively to provide seamless services to patients (e.g., allow admin staff to pass on messages to patients, engage in results coming back as a team). |
○ Refer patients within the team and help out colleagues to provide integrated care to patients (e.g., asking questions). | ||
Uses structured lines of communication (67%) “…direct means of communication between, the doctors, the consultation rooms, reception… important for it to be discreet as well. (P4)” | ○ Maintain open methods to communicate, debrief and share patient information regularly amongst the team (e.g., whiteboards). | |
○ Ensure communication about patients amongst the team remains respectful and discreet. | ||
○ Use technology to support communication and teamworking (e.g., daily electronic tasks, Whatsapp). | ||
Has regular practice meetings (55%) “…weekly meetings, monthly meetings, they have to be listened to, you have to feedback, and vice versa. (GP4)” | ○ Operate regular practice meetings to ensure good management of the practice, with more regular meetings as issues arise. | |
○ Ensure engagement with meetings and communication of discussions from meetings to all staff (e.g., full team or parts of the team are present, sharing meeting minutes). | ||
Mesosystem (Practice)-level | ||
Facilities and infrastructure (100%) | Provides a pleasant and safe environment for staff and patients (91%) “…it’s modern, it’s quite a nice building, very handy location… and it’s very spacious, airy, feels very clean, no carpets, everything, surfaces clean, clean, clean. (P7)” | ○ Maintain a well-organised and up-to-date bright, spacious and aesthetically pleasing environment (e.g., plants, art) that is conducive to patient flow and allows for flexibility in organisation. |
○ Try to create a comfortable environment for patients (e.g., water, comfortable seating, and TV or toys for kids) with adequate bathroom and baby changing facilities and potential for a separate waiting space (e.g., for patients with sensory issues). | ||
○ Create an environment suited to staff needs, including a comfortable work space, staff room and cafeteria, and staff bathroom facilities. | ||
Uses IT systems effectively to support the delivery of care (79%) “We do use technology a lot to inform patients and make announcements and try and manage our workload… (GP2)” | ○ Make effective use of different functionalities of the system to optimise care and provide feedback on the tool as necessary (e.g., recall, safety pop ups, audit, tracking and accounting features). | |
○ Provide a practice website which allows for online booking of appointments, ordering of prescriptions and payment. | ||
○ Use technology to communicate with patients and further care services (e.g., text service, electronic prescriptions to pharmacy, electronic referral to physiotherapists). | ||
Provides parking facilities and good accessibility (52%) “Car parking is a big thing, wheelchair access, a lift, accessibility. (GP4)” | ○ Provide good, safe accessibility in the practice, with a wheelchair ramp, lift and other methods of ensuring good accessibility for different needs. | |
○ Provide clearly marked parking facilities for patients and staff. | ||
Has necessary equipment and resources (39%) “…the right equipment and technology to be able to support a good practice. (GP3)” | ○ Ensure all necessary equipment is available and easily accessible within the consultation room or practice. | |
○ Provide comprehensive diagnostic facilities at the practice for bloods, ECHO and other services. | ||
Macrosystem-, Network- and National-level | ||
Integration in the healthcare system (Network) (91%) | Lines of communication are established and information is continuous (76%) “…good channels of communication setup between primary care doctors and our secondary care colleagues, where we can ask questions or ask for opinions. (GP4)” | ○ Develop and use direct and open lines of communication to secondary colleagues (e.g., to ask questions about referrals, get estimated timeframe). |
○ Send appropriate and accurate information back to primary care promptly, with an appropriate amount of detail and plan for care. | ||
○ Develop patient health records that can be accessed by all providers and share relevant information promptly with secondary care. | ||
Access to specialists and diagnostics is timely (39%) “…prompt access…whether it’s investigations or specialist consultations. (GP5)” | ○ Identify and maintain referral pathways with prompt access directly to secondary care specialists. | |
○ Identify and maintain direct access scopes and referral pathways with prompt access to diagnostics. | ||
Primary care is core of an integrated system (27%) “…properly interconnected with these other services…it’s just one kind of seamless route. (P10)” | ○ Integrate PC better in the infrastructure to provide seamless links between services (e.g., integrating primary care into hospital care services). | |
○ Use primary care resources as central to healthcare, in line with Government policy. | ||
Providers build relationships and have regular interfaces (21%) “…there has already established relationships between primary and secondary care, and it is nurtured. (GP4)” | ○ Take part in common meetings and Continuing Medical Education schemes where providers can work together and develop mutual understanding of different care settings. | |
○ Practice staff build rapport and have good working relationships with secondary care providers and services. | ||