Department of General Practice and Health Services Research, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, Marsilius Arkaden, Turm West, D-69120, Heidelberg, Germany.
aQua Institute for Applied Quality Improvement and Research in Health Care GmbH, Göttingen, Germany.
BMC Prim Care. 2022 Sep 2;23(1):221. doi: 10.1186/s12875-022-01834-4.
In recent years, healthcare has faced many different crises around the world such as HIV-, Ebola- or H1N1-outbrakes, opioid addiction, natural disasters and terrorism attacks). In particular, the current pandemic of Covid-19 has challenged the resilience of health systems. In many healthcare systems, primary care practices play a crucial role in the management of crises as they are often the first point of contact and main health care provider for patients. Therefore, this study explored which situations are perceived as crises by primary care practice teams and potential strategies for crisis management.
A qualitative observational study was conducted. Data were collected in interviews and focus groups with experts from primary care practices and stakeholders focusing on primary care practices in Germany such as physicians, medical assistants, practice managers, quality managers, hygiene managers and institutions on health system level (politics, research and health insurance). All interviews and focus groups were audio-recorded and transcribed verbatim. A qualitative content analysis was performed using a rapid qualitative analysis approach first, followed by a thematic analysis.
Two focus groups and 26 interviews including 40 participating experts were conducted. Many different situations were perceived as crises, varying from issues in the practice organization to problems on health system level and international disasters. Distinct aspects associated with the perception of a crisis situation by interviewees were the presence of emotional reactions, a need for organizational changes and a lack of necessary resources. A broad spectrum of possible strategies was discussed that could help to cope with or even prevent the emergence of an actual crisis. In particular, strengthening communication within practice teams and resilience among employees was perceived to be fundamental for improving responses to crises or preventing them.
The study provides perspectives of primary health care workers on crises in health, that could inform health policy regarding prevention and management of future crises in primary care facilities.
近年来，全球范围内的医疗保健行业面临着许多不同的危机，如 HIV、埃博拉或 H1N1 爆发、阿片类药物成瘾、自然灾害和恐怖袭击等。特别是当前的新冠疫情大流行，对卫生系统的弹性提出了挑战。在许多医疗保健系统中，基层医疗实践在危机管理中发挥着至关重要的作用，因为它们通常是患者的第一联系点和主要医疗服务提供者。因此，本研究探讨了基层医疗实践团队认为哪些情况是危机，并探讨了潜在的危机管理策略。
本研究采用定性观察性研究方法。数据收集来自于德国基层医疗实践专家和利益相关者的访谈和焦点小组，包括医生、医疗助理、实践经理、质量经理、卫生经理以及卫生系统层面的机构（政治、研究和健康保险）。所有访谈和焦点小组都进行了录音，并逐字记录。采用快速定性分析方法首先进行定性内容分析，然后进行主题分析。
共进行了 2 个焦点小组和 26 次访谈，共有 40 名参与专家。研究人员认为许多不同的情况都是危机，从实践组织的问题到卫生系统层面和国际灾难的问题。受访者对危机情况的感知与存在情绪反应、组织变革的需要以及缺乏必要资源等方面密切相关。讨论了一系列可能有助于应对甚至预防实际危机的策略。特别是，加强实践团队内部的沟通和员工的适应力被认为是改善对危机的应对或预防危机的根本。
本研究提供了基层医疗保健工作者对健康危机的看法，这可以为卫生政策提供信息，以预防和管理基层医疗机构未来的危机。
