Department of Nursing, Umeå University, SE-901 87, Umeå, Sweden.
Department of Sociology, Umeå University, SE-901 87, Umeå, Sweden.
BMC Health Serv Res. 2022 Jan 2;22(1):3. doi: 10.1186/s12913-021-07348-6.
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.
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.
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.
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.
新工具的引入可能会给组织常规带来意想不到的后果。癌症患者路径（CPP）于 2015 年引入瑞典医疗保健系统，以缩短诊断和治疗时间。初级保健（PHC）发挥着核心作用，因为癌症诊断通常始于 PHC 单位。我们的研究旨在了解 PHC 单位如何调整组织常规以利用 CPP。
从瑞典北部的城市和农村地区选取了六个规模不同的 PHC 单位。使用扎根理论方法在每个单位收集和分析小组访谈。2019 年 3 月至 11 月期间，共进行了 9 次小组访谈，共有 41 名护士和医生参加。访谈重点是 CPP 作为工具、PHC 单位的常规以及提供者在日常工作中使用 CPP 的经验。
我们的分析捕捉到 PHC 单位如何通过融合现有实践和新实践来调整组织常规以利用 CPP，从而提供更好的护理质量。具体来说，在 PHC 单位中确定了三个总体组织常规。首先，通过更容易的患者流程来调整多样化的患者需求，PHC 单位处理了人口的多样化需求，同时利用 CPP 来简化医疗保健系统内的患者流程。其次，（不）整合内部专业知识，即使 PHC 知识没有被推动 CPP 倡议的人考虑在内，PHC 单位也利用内部能力。第三，应对向二级保健的不平等关系，PHC 单位在采用 CPP 时处理不平等地位，同时进一步减少了在护理水平之间做出决策的可能性。
在 PHC 单位中采用 CPP 作为工具带来了组织常规中的各种意想不到的后果。我们来自瑞典北部的研究表明，需要将 PHC 知识整合到医疗保健系统中，以提高 CPP 等新工具的使用。此外，在引入新的医疗保健工具时，应考虑不同层次的护理关系。当采用创新时，需要在国际上不同的医疗保健背景下进一步从经验上探索意外后果，以在该研究领域产生更深入的知识。
