Department of Physical Therapy, College of Rehabilitation Sciences, University of Manitoba, R106-771 McDermot Ave, Winnipeg, MB, R3E 0T6, Canada.
DeGroote School of Business, McMaster University, 1280 Main Street West, L8S 4L8, Hamilton, ON, Canada.
BMC Prim Care. 2024 Aug 5;25(1):285. doi: 10.1186/s12875-024-02520-3.
Primary care is often described as slow to change. But conceptualized through complexity theory, primary care is continually changing in unpredictable, non-linear ways through self-organization processes. Self-organization has proven hard to study directly. We aimed to develop a methodology to study self-organization and describe how a primary care clinic self-organizes over time.
We completed a virtual case study of an urban primary care clinic from May-Nov 2021, applying methodological insights from actor-network theory to examine the complexity theory concept of self-organization. We chose to focus our attention on self-organization activities that alter organizational routines. Data included fieldnotes of observed team meetings, document collection, interviews with clinic members, and notes from brief weekly discussions to detect actions to change clinical and administrative routines. Adapting schema analysis, we described changes to different organizational routines chronologically, then explored intersecting changes. We sought feedback on results from the participating clinic.
Re-establishing equilibrium remained challenging well into the COVID-19 pandemic. The primary care clinic continued to self-organize in response to changing health policies, unintended consequences of earlier adaptations, staff changes, and clinical care initiatives. Physical space, technologies, external and internal policies, guidelines, and clinic members all influenced self-organization. Changing one created ripple effects, sometimes generating new, unanticipated problems. Member checking confirmed we captured most of the changes to organizational routines during the case study period.
Through insights from actor-network theory, applied to studying actions taken that alter organizational routines, it is possible to operationalize the theoretical construct of self-organization. Our methodology illuminates the primary care clinic as a continually changing entity with co-existing and intersecting processes of self-organization in response to varied change pressures.
基层医疗常被描述为变化缓慢。但通过复杂性理论来理解，基层医疗通过自组织过程，以不可预测的、非线性的方式不断变化。自组织很难直接研究。我们旨在开发一种研究自组织的方法，并描述一个基层医疗诊所如何随时间自我组织。
我们在 2021 年 5 月至 11 月期间对一家城市基层医疗诊所进行了虚拟案例研究，应用行动者网络理论的方法学见解来检验复杂性理论中的自组织概念。我们选择关注改变组织常规的自组织活动。数据包括观察团队会议的现场记录、文件收集、对诊所成员的访谈，以及每周简短讨论的记录，以检测改变临床和行政常规的行动。我们采用了方案分析进行调整，按时间顺序描述了不同组织常规的变化，然后探索了交叉变化。我们向参与诊所寻求了对结果的反馈。
即使在 COVID-19 大流行期间，重新建立平衡仍然具有挑战性。基层医疗诊所继续自组织，以应对不断变化的卫生政策、早期适应的意外后果、员工变动以及临床护理倡议。物理空间、技术、外部和内部政策、指南以及诊所成员都影响了自组织。改变其中一个会产生连锁反应，有时会产生新的、意料之外的问题。成员检查确认我们在案例研究期间捕捉到了组织常规变化的大部分内容。
通过应用于研究改变组织常规的行动的行动者网络理论见解，有可能对自组织的理论结构进行操作化。我们的方法阐明了基层医疗诊所在应对各种变化压力时作为一个不断变化的实体，存在共存和交叉的自组织过程。
