Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Box 414, 405 30 Göteborg, Sweden.
BMC Health Serv Res. 2013 Oct 3;13:382. doi: 10.1186/1472-6963-13-382.
Primary healthcare in Sweden has undergone widespread reforms in recent years, including freedom of choice regarding provider, freedom of establishment and increased privatisation. The key aims of the reforms were to strengthen the role of the patient and improve performance in terms of access and responsiveness. The aim of this study was to explore how managers at publicly owned primary healthcare centres perceived the transition of the primary healthcare system and the impact it has had on their work.
In this qualitative study, 24 managers of publicly owned primary healthcare centres in the metropolitan region of Gothenburg were recruited. Semi-structured interviews were conducted and data were analysed using content analysis inspired by Silverman.
The analysis revealed two core themes: The transition is perceived as a rapid change, enforced mainly through financial incentives and Prioritisation conflicts arise between patient groups with different needs, demands and levels of empowerment. The transition has produced powerful and rapid effects that were considered to be both positive and negative. While the new financial incentives were seen as a driving force and a tool for change, they also became a stress factor due to uncertainty, competition with other primary healthcare centres and negative feelings associated with staff cutbacks. The shift in power towards the patient improved access and service but also led to more patients with unreasonable demands. Managers found it difficult to prioritise correctly between patient groups with different needs, demands and levels of empowerment and they were concerned about potentially negative effects on less empowered patients, e.g. multi-morbid patients. Managers also experienced shortcomings in their change management skills.
This qualitative study shows the complexity of the system change and describes the different effects and perceptions of the transition from a manager's perspective. This suggests a need for improved follow-up and control in order to monitor and govern system changes and ensure development towards a more effective and sustainable primary healthcare system.
近年来，瑞典的基层医疗保健经历了广泛的改革，包括在供应商选择、设立自由和增加私有化方面的自由。改革的主要目标是加强患者的作用，并提高获取和响应能力方面的绩效。本研究旨在探讨公共拥有的基层医疗保健中心的管理者如何看待基层医疗保健系统的转型以及它对他们工作的影响。
在这项定性研究中，招募了哥德堡大都市区 24 个公共拥有的基层医疗保健中心的经理。进行了半结构化访谈，数据使用受 Silverman 启发的内容分析进行分析。
分析揭示了两个核心主题：转型被视为快速变化，主要通过财务激励来强制实施；优先考虑不同需求、要求和授权程度的患者群体之间出现冲突。转型产生了强大而快速的影响，被认为既有积极的也有消极的。虽然新的财务激励被视为驱动力和变革的工具，但由于不确定性、与其他基层医疗保健中心的竞争以及与裁员相关的负面情绪，它们也成为了一个压力因素。权力向患者转移改善了获取和服务，但也导致了更多需求不合理的患者。管理者发现很难在需求、要求和授权程度不同的患者群体之间正确优先排序，他们担心对授权程度较低的患者可能产生负面影响，例如多病患者。管理者还经历了变革管理技能方面的不足。
这项定性研究展示了系统变革的复杂性，并从管理者的角度描述了转型的不同影响和看法。这表明需要改进后续行动和控制，以监测和管理系统变革，确保向更有效和可持续的基层医疗保健系统发展。
