“If I told you that 50% of the requests you get for same day appointments could be resolved on the phone, would you believe me?”
Aotearoa New Zealand, like many countries, is experiencing high demand for primary care services, made worse by practitioner workforce shortages within a sector dominated by for-profit general practice models. Health inequities persist with a model of care that is no longer fit for purpose. The challenges of accessing care, even more so for those patients who have complex health needs and are socio-economically disadvantaged, presents as work for patients. Under the guise of person-centred care, a new work process, clinician triage, purports to address access issues, resolving appointment demands over the phone and rationing face-to-face services so “the right people get seen.”
Institutional ethnographers are taught to follow the work processes, to uncover how things happen as they do. Within the new triage system, patients were found to do more work as they navigated access to health care. However, they received less care and less care that was relevant to their needs. Instead of triage placing patients at the centre of care (as claimed), patients were hooked into institutional interests of clinician capacity, restricted appointment allocation and availability of resources. The ideals of new public management, in particular efficiency and value for money, reduced clinicians to a resource and patients to a commodity. Clinician triage intends to improve the flow of patients through a general practice, which appeals to the business interests of the practice. Instituting standardised processes within the ideology of NPM devalues the knowledge of patients and clinicians.
This session considers the complex environment of primary care, the work of patients within the new technologies of NPM, and the power of institutional interests to capture quality improvement attempts.
“If I told you that 50% of the requests you get for same day appointments could be resolved on the phone, would you believe me?”
Aotearoa New Zealand, like many countries, is experiencing high demand for primary care services, made worse by practitioner workforce shortages within a sector dominated by for-profit general practice models. Health inequities persist with a model of care that is no longer fit for purpose. The challenges of accessing care, even more so for those patients who have complex health needs and are socio-economically disadvantaged, presents as work for patients. Under the guise of person-centred care, a new work process, clinician triage, purports to address access issues, resolving appointment demands over the phone and rationing face-to-face services so “the right people get seen.”
Institutional ethnographers are taught to follow the work processes, to uncover how things happen as they do. Within the new triage system, patients were found to do more work as they navigated access to health care. However, they received less care and less care that was relevant to their needs. Instead of triage placing patients at the centre of care (as claimed), patients were hooked into institutional interests of clinician capacity, restricted appointment allocation and availability of resources. The ideals of new public management, in particular efficiency and value for money, reduced clinicians to a resource and patients to a commodity. Clinician triage intends to improve the flow of patients through a general practice, which appeals to the business interests of the practice. Instituting standardised processes within the ideology of NPM devalues the knowledge of patients and clinicians.
This session considers the complex environment of primary care, the work of patients within the new technologies of NPM, and the power of institutional interests to capture quality improvement attempts.
“If I told you that 50% of the requests you get for same day appointments could be resolved on the phone, would you believe me?”
Aotearoa New Zealand, like many countries, is experiencing high demand for primary care services, made worse by practitioner workforce shortages within a sector dominated by for-profit general practice models. Health inequities persist with a model of care that is no longer fit for purpose. The challenges of accessing care, even more so for those patients who have complex health needs and are socio-economically disadvantaged, presents as work for patients. Under the guise of person-centred care, a new work process, clinician triage, purports to address access issues, resolving appointment demands over the phone and rationing face-to-face services so “the right people get seen.”
Institutional ethnographers are taught to follow the work processes, to uncover how things happen as they do. Within the new triage system, patients were found to do more work as they navigated access to health care. However, they received less care and less care that was relevant to their needs. Instead of triage placing patients at the centre of care (as claimed), patients were hooked into institutional interests of clinician capacity, restricted appointment allocation and availability of resources. The ideals of new public management, in particular efficiency and value for money, reduced clinicians to a resource and patients to a commodity. Clinician triage intends to improve the flow of patients through a general practice, which appeals to the business interests of the practice. Instituting standardised processes within the ideology of NPM devalues the knowledge of patients and clinicians.
This session considers the complex environment of primary care, the work of patients within the new technologies of NPM, and the power of institutional interests to capture quality improvement attempts.
Keywords
clinician triage
primary care
quality improvement
