Abstract
Background
Health statistics of rural and regional Australia reflect a population of generally poor health status (National Rural Health Alliance, 2021), thus highlighting a serious healthcare problem that must be addressed. Medical workforce shortage is a known issue, and the recent speculation on the rapidly shrinking numbers of primary care providers (Stone & May, 2023) suggests this shortage may impact heavily on patients trying to access preventive care and disease management services.
Increasingly, research is showing that a collaborative management of healthcare between professionals and patients can improve health outcomes (Browne et al., 2010; Gill & White, 2009; Morley & Cashell, 2017; Morris et al., 2022; Naidu, 2009). Patients are now considered, by some, to be healthcare consumers, and these patients are more educated, better informed, and more involved with the decision-making of their healthcare (Browne et al., 2010; Gill & White, 2009; Hawthorne et al., 2014; Naidu, 2009). Enhanced involvement with their own healthcare means patients share the onus of care, which may potentially impact the workload of the providers. However, for a collaboration to be successful, all parties need to cooperate to achieve a common goal, and hence providers need to understand the definition and expectation of care and outcomes from a patient’s perspective.
Healthcare quality has been, for a long time, determined by health outcomes (Keown & Darzi, 2015; Komashie et al., 2007; Marjoua & Bozic, 2012). For example, mortality rates were used to measure the level of competence of healthcare providers. Standards of professional certification and legislation was also used for quality assessments (Keown & Darzi, 2015; Komashie et al., 2007). These important historic ways of defining, measuring and assessing quality have not changed, and continue to set the benchmark for performance in the profession. Nonetheless, this focus at the professional provider level on better health and preservation of lives, seen as the very basic expectation of quality one can expect from healthcare, is not enough to effect change to improve quality. Another way to consider quality in healthcare is through measuring patient satisfaction. However, not many of these approaches define quality healthcare from a patient perspective, even though numerous healthcare experts believe patient perceptions of care are known to be an important conceptual framework in defining healthcare quality (Brown, 2007, p. 125; Duggirala et al., 2008, p. 697; Luciana, 2018, p. 86; Mohammed et al., 2016, p. 12; Ovretveit, 1992; Schafer et al., 2015, p. 161). This current study aims to understand the personal experiences patients have with their GP practices, and their expectations of quality care, to explore how primary healthcare could be improved and make health consumers part of their own healthcare journey.
Methods
Eighteen participants aged between 21 and 90 years from regional New South Wales were interviewed either face-to-face or by telephone (to comply with Covid restrictions). The interviews and reflective notes made during the interviews were thematically analysed. The semi-structured questions for the interview protocol were focused on exploring the five broad domains that are considered critical to patient experience of quality care by the Royal Australia College of General Practitioners. These domains are 1) access and availability of care, 2) information provision to patients, 3) privacy and confidentiality of care, 4) continuity of care, and 5) staff communication skills.
Results
According to the participants, access and availability of providers, as well as the communication skills of staff were identified as the main grievances. Participants reported the need for more doctors and less medical staff turnover. Access was generally difficult. Participants reported that it was hard to get an appointment, they often experienced long wait times before being seen, and finally, participants felt rushed in the consulting room. Participants recognised gatekeeping (by administrative staff) as necessary in busy practices, but staff were often perceived to be power wielding and lacking in empathy when interacting with patients, which included exhibiting unpleasant behaviours. This poor interaction led to poor experiences and participants indicated that one bad experience can impact negatively on other issues. For example, lack of continuity meant longer consultations, which meant longer waiting times for those in the waiting room or some patients missing out on getting appointments.
Most participants believed technology improves access, and initiatives such as the centralised electronic health record can enhance continuity, but they were frustrated with disinterested providers. The use of Telehealth also relieved some participants from having to travel long distances when accessing care, with the main concern expressed by some being privacy issues. Other than the two older participants who only consulted doctors if they had to, the rest of the participants indicated that they wished that their doctors showed more interest in establishing a professional relationship with them.
In general, responses from participants suggests that current healthcare services need to be more patient-focused.
Recommendations
The study uncovered that patient perceptions of quality care were broad and unique to their experiences, and that their expectations also varied. This suggests that all patients must be treated as an individual. Despite the demands, providers must work together with patients in the management of their healthcare. Patients should be encouraged, when appropriate, to be active participants in their healthcare journey.
Edward Deming, once hailed as the hero of quality (Millar, 2017) wrote that quality improvement is everyone’s job. The current regional healthcare crisis cannot be resolved but it can be improved, and it needs effort from the government and healthcare providers.
Implications for policy changes and government supports include the establishment of a state or federal government centralised taskforce that aims to recruit and deploy locum medical workers to areas of need. The government should be mindful that funds injected in rural and regional health are used appropriately, and not wasted in workforce recruiting. This would include provision of accommodation and other amenities for the workforce and not introducing new complicated bureaucratic procedures that require more funding in employing unnecessary staff. The current business models of private locum agencies should be considered when evaluating the efficiencies of setting up the taskforce.
The challenge of increased demands in healthcare services means providers must accept the need to be patient-focused and, when appropriate, engage patients in their care. The responsibility of healthcare practices is to develop care provision strategies that are relevant and appropriate to individual patients with consideration of patient preferences and expectations. Providers are also encouraged to increase the use of technology such as online booking and Telehealth consultations, as these options can make the provision of care more efficient, and potentially allow for better availability. Administrative processes should be streamlined and provide holistic care options where possible. To nurture a healthy professional relationship, good communication is essential, and the administrative staff, being part of the team to assist in care, must not be perceived as hindering a patient’s attempts to access care. Primary care practice management must endeavour to empower staff to interact with patients in a positive manner.
The viability of primary care in regional Australia rests on providers being willing to accept the challenge, learn about their responsibilities, and being able to make changes to improve.
Keywords: quality care, primary care, quality management, access, information provision, privacy and confidentiality, continuity of care, communication skills of staff
Health statistics of rural and regional Australia reflect a population of generally poor health status (National Rural Health Alliance, 2021), thus highlighting a serious healthcare problem that must be addressed. Medical workforce shortage is a known issue, and the recent speculation on the rapidly shrinking numbers of primary care providers (Stone & May, 2023) suggests this shortage may impact heavily on patients trying to access preventive care and disease management services.
Increasingly, research is showing that a collaborative management of healthcare between professionals and patients can improve health outcomes (Browne et al., 2010; Gill & White, 2009; Morley & Cashell, 2017; Morris et al., 2022; Naidu, 2009). Patients are now considered, by some, to be healthcare consumers, and these patients are more educated, better informed, and more involved with the decision-making of their healthcare (Browne et al., 2010; Gill & White, 2009; Hawthorne et al., 2014; Naidu, 2009). Enhanced involvement with their own healthcare means patients share the onus of care, which may potentially impact the workload of the providers. However, for a collaboration to be successful, all parties need to cooperate to achieve a common goal, and hence providers need to understand the definition and expectation of care and outcomes from a patient’s perspective.
Healthcare quality has been, for a long time, determined by health outcomes (Keown & Darzi, 2015; Komashie et al., 2007; Marjoua & Bozic, 2012). For example, mortality rates were used to measure the level of competence of healthcare providers. Standards of professional certification and legislation was also used for quality assessments (Keown & Darzi, 2015; Komashie et al., 2007). These important historic ways of defining, measuring and assessing quality have not changed, and continue to set the benchmark for performance in the profession. Nonetheless, this focus at the professional provider level on better health and preservation of lives, seen as the very basic expectation of quality one can expect from healthcare, is not enough to effect change to improve quality. Another way to consider quality in healthcare is through measuring patient satisfaction. However, not many of these approaches define quality healthcare from a patient perspective, even though numerous healthcare experts believe patient perceptions of care are known to be an important conceptual framework in defining healthcare quality (Brown, 2007, p. 125; Duggirala et al., 2008, p. 697; Luciana, 2018, p. 86; Mohammed et al., 2016, p. 12; Ovretveit, 1992; Schafer et al., 2015, p. 161). This current study aims to understand the personal experiences patients have with their GP practices, and their expectations of quality care, to explore how primary healthcare could be improved and make health consumers part of their own healthcare journey.
Methods
Eighteen participants aged between 21 and 90 years from regional New South Wales were interviewed either face-to-face or by telephone (to comply with Covid restrictions). The interviews and reflective notes made during the interviews were thematically analysed. The semi-structured questions for the interview protocol were focused on exploring the five broad domains that are considered critical to patient experience of quality care by the Royal Australia College of General Practitioners. These domains are 1) access and availability of care, 2) information provision to patients, 3) privacy and confidentiality of care, 4) continuity of care, and 5) staff communication skills.
Results
According to the participants, access and availability of providers, as well as the communication skills of staff were identified as the main grievances. Participants reported the need for more doctors and less medical staff turnover. Access was generally difficult. Participants reported that it was hard to get an appointment, they often experienced long wait times before being seen, and finally, participants felt rushed in the consulting room. Participants recognised gatekeeping (by administrative staff) as necessary in busy practices, but staff were often perceived to be power wielding and lacking in empathy when interacting with patients, which included exhibiting unpleasant behaviours. This poor interaction led to poor experiences and participants indicated that one bad experience can impact negatively on other issues. For example, lack of continuity meant longer consultations, which meant longer waiting times for those in the waiting room or some patients missing out on getting appointments.
Most participants believed technology improves access, and initiatives such as the centralised electronic health record can enhance continuity, but they were frustrated with disinterested providers. The use of Telehealth also relieved some participants from having to travel long distances when accessing care, with the main concern expressed by some being privacy issues. Other than the two older participants who only consulted doctors if they had to, the rest of the participants indicated that they wished that their doctors showed more interest in establishing a professional relationship with them.
In general, responses from participants suggests that current healthcare services need to be more patient-focused.
Recommendations
The study uncovered that patient perceptions of quality care were broad and unique to their experiences, and that their expectations also varied. This suggests that all patients must be treated as an individual. Despite the demands, providers must work together with patients in the management of their healthcare. Patients should be encouraged, when appropriate, to be active participants in their healthcare journey.
Edward Deming, once hailed as the hero of quality (Millar, 2017) wrote that quality improvement is everyone’s job. The current regional healthcare crisis cannot be resolved but it can be improved, and it needs effort from the government and healthcare providers.
Implications for policy changes and government supports include the establishment of a state or federal government centralised taskforce that aims to recruit and deploy locum medical workers to areas of need. The government should be mindful that funds injected in rural and regional health are used appropriately, and not wasted in workforce recruiting. This would include provision of accommodation and other amenities for the workforce and not introducing new complicated bureaucratic procedures that require more funding in employing unnecessary staff. The current business models of private locum agencies should be considered when evaluating the efficiencies of setting up the taskforce.
The challenge of increased demands in healthcare services means providers must accept the need to be patient-focused and, when appropriate, engage patients in their care. The responsibility of healthcare practices is to develop care provision strategies that are relevant and appropriate to individual patients with consideration of patient preferences and expectations. Providers are also encouraged to increase the use of technology such as online booking and Telehealth consultations, as these options can make the provision of care more efficient, and potentially allow for better availability. Administrative processes should be streamlined and provide holistic care options where possible. To nurture a healthy professional relationship, good communication is essential, and the administrative staff, being part of the team to assist in care, must not be perceived as hindering a patient’s attempts to access care. Primary care practice management must endeavour to empower staff to interact with patients in a positive manner.
The viability of primary care in regional Australia rests on providers being willing to accept the challenge, learn about their responsibilities, and being able to make changes to improve.
Keywords: quality care, primary care, quality management, access, information provision, privacy and confidentiality, continuity of care, communication skills of staff
Original language | English |
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Qualification | Doctor of Business Administration |
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Place of Publication | Australia |
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Publication status | Published - 2023 |