BackgroundMost Western nations have sought primary care (PC) reform due to the rising costs of health care and the need to manage long-term health conditions. A common reform—the introduction of inter-professional teams into traditional PC settings—has been difficult to implement despite financial investment and enthusiasm.ObjectiveTo synthesize findings across five jurisdictions in three countries to identify common contextual factors influencing the successful implementation of teamwork within PC practices.MethodsAn international consortium of researchers met via teleconference and regular face-to-face meetings using a Collaborative Reflexive Deliberative Approach to re-analyse and synthesize their published and unpublished data and their own work experience. Studies were evaluated through reflection and facilitated discussion to identify factors associated with successful teamwork implementation. Matrices were used to summarize interpretations from the studies.Results
Seven common levers influence a jurisdiction’s ability to implement PC teams. Team-based PC was promoted when funding extended beyond fee-for-service, where care delivery did not require direct physician involvement and where governance was inclusive of non-physician disciplines. Other external drivers included: the health professional organizations’ attitude towards team-oriented PC, the degree of external accountability required of practices, and the extent of their links with the community and medical neighbourhood. Programs involving outreach facilitation, leadership training and financial support for team activities had some effect.ConclusionThe combination of physician dominance and physician aligned fee-for-service payment structures provide a profound barrier to implement team-oriented PC. Policy makers should carefully consider the influence of these and our other identified drivers when implementing team-oriented PC.
In the landmark 1990 publication Scholarship Reconsidered, Boyer challenged the 'teaching verses research debates' by advocating for the scholarship of discovery, teaching, integration, and application. The scholarship of discovery considers publications and research as the yardstick in the merit, promotion and tenure system the world over. But this narrow view of scholarship does not fully support the obligations of universities to serve global societies and to improve health and health equity. Mechanisms to report the scholarship of teaching have been developed and adopted by some universities. In this article, we contribute to the less developed areas of scholarship, i.e. integration and application. We firstly situate the scholarship of discovery, teaching, integration and application within the interprofessional and knowledge exchange debates. Second, we propose a means for health science scholars to report the process and outcomes of the scholarship of integration and application with other disciplines, decision-makers and communities. We conclude with recommendations for structural and process change in faculty merit, tenure, and promotion systems so that health science scholars with varied academic portfolios are valued and many forms of academic scholarship are sustained. It is vital academic institutions remain relevant in an era when the production of knowledge is increasingly recognized as a social collaborative activity.
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