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Merging existing practices with new ones: the adjustment of organizational routines to using cancer patient pathways in primary healthcare
Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.ORCID-id: 0000-0003-3503-7164
Umeå universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.ORCID-id: 0000-0003-1975-9060
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.ORCID-id: 0000-0002-5203-9877
Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.ORCID-id: 0000-0003-0661-8269
2022 (Engelska)Ingår i: BMC Health Services Research, E-ISSN 1472-6963, Vol. 22, nr 1, artikel-id 3Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: The introduction of new tools can bring unintended consequences for organizational routines. Cancer Patient Pathways (CPP) were introduced into the Swedish healthcare system in 2015 to shorten time to diagnosis and treatment. Primary healthcare (PHC) plays a central role since cancer diagnosis often begins in PHC units. Our study aimed to understand how PHC units adjusted organizational routines to utilizing CPPs.

Method: Six PHC units of varied size from both urban and rural areas in northern Sweden were included. Grounded theory method was used to collect and analyse group interviews at each unit. Nine group interviews with nurses and physicians, for a total of 41 participants, were performed between March and November 2019. The interviews focused on CPPs as tools, the PHC units’ routines and providers’ experiences with using CPPs in their daily work.

Results: Our analysis captured how PHC units adjusted organizational routines to utilizing CPPs by fusing existing practices with new practices to offer better quality of care. Specifically, three overarching organizational routines within the PHC units were identified. First, Manoeuvring diverse patient needs with easier patient flow, the PHC units handled the diverse needs of the population while simultaneously drawing upon CPPs to ease the patient flow within the healthcare system. Second, (Dis) integrating internal know-how, the PHC units drew upon internal competence even when PHC know-how was not taken into account by those driving the CPP initiative. Third, Coping with unequal relationships toward secondary care, the PHC units dealt with being in an unequal position while adopting CPPs instead further decreased possibilities to influence decision-making between care-levels.

Conclusion: Adopting CPPs as a tool within PHC units brought various unintended consequences in organizational routines. Our study from northern Sweden illustrates that the PHC know-how needs to be integrated into the healthcare system to improve the use of new tools as CPP. Further, the relationships between different levels of care should be taken in account when introducing new tools for healthcare. Also, when adopting innovations, unintended consequences need to be further explored empirically in diverse healthcare contexts internationally in order to generate deeper knowledge in the research area.

Ort, förlag, år, upplaga, sidor
BioMed Central (BMC), 2022. Vol. 22, nr 1, artikel-id 3
Nyckelord [en]
Adaption, Cancer, Grounded Theory Method, Group interviews, Organizations, Primary care nurses, Primary care physicians, Routines, Standardized patient pathways, Unintended consequences
Nationell ämneskategori
Omvårdnad
Identifikatorer
URN: urn:nbn:se:umu:diva-191123DOI: 10.1186/s12913-021-07348-6ISI: 000737069900003PubMedID: 34974839Scopus ID: 2-s2.0-85122161997OAI: oai:DiVA.org:umu-191123DiVA, id: diva2:1626036
Forskningsfinansiär
Region Västerbotten, RV-731891Region Västerbotten, RV-744851Region Västerbotten, RV-855211Region Västerbotten, RV-931881Region Västerbotten, RV-939898Visare Norr, 939897Visare Norr, 929986Visare Norr, 838121Cancerforskningsfonden i Norrland, LP-18-2193KempestiftelsernaTillgänglig från: 2022-01-10 Skapad: 2022-01-10 Senast uppdaterad: 2023-05-25Bibliografiskt granskad

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Fjällström, PetterCoe, Anna-BrittLilja, MikaelHajdarevic, Senada

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