Analysis of Variation in Organizational Definitions of Primary Care Panels

Mayo‐Smith, Michael F.; Robbins, Rebecca A.; Murray, Mark; Weber, Rachel; Bagley, Pamela J.; Vitale, Elaina; Paige, Neil M.

doi:10.1001/jamanetworkopen.2022.7497

Cited by 4 publications

(2 citation statements)

References 63 publications

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“…In our analyses, psychological safety emerged as a previously unrecognized mechanism that partly accounts for the impact of a positive work environment on EE and DE. 49 The inverse relationship between factors in the work environment and burnout scores is partly attributable to psychological safety enabled by a positive work environment. This suggests that the benefits of improving the work environment for NPs may go beyond burnout mitigation and additionally include enhanced psychological safety and its associated benefits.…”

Section: Discussionmentioning

confidence: 99%

“…Such leader skills include confidence in communication and team dynamics, 56 managing abuse of power and social influence, 57 and promoting decision-making at the lowest levels of the organization. 49 Instituting organizational policies that value and promote speaking-up behaviors for all individuals promotes safety culture and reduces the impact of traditional social hierarchies. 57 …”

Section: Discussionmentioning

confidence: 99%

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Psychological safety is associated with better work environment and lower levels of clinician burnout

de Lisser,

Dietrich,

Spetz

et al. 2024

Health Affairs Scholar

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Burnout is attributed to negative work environments and threatens patient and clinician safety. Psychological safety is the perception that the work environment is safe for interpersonal risk taking and may offer insight into the relationship between the work environment and burnout. In this cross-sectional analysis of survey data from 621 nurse practitioners in California, we found that one-third (34%) experienced high burnout. Four factors in the work environment were negatively associated with burnout and positively associated with psychological safety. Significant mediation effects of psychological safety were observed on the relationships between each work environment factor and both emotional exhaustion and depersonalization. The largest mediation effects were observed on the total effects of Nurse Practitioner- Physician Relations and Practice Visibility on Emotional Exhaustion (37% and 32% respectively) and Independent Practice and Support and NP-Administration Relations on Depersonalization (32% and 29% respectively). We found overall that psychological safety decreased the strength of the negative relationship between work environment and burnout. We argue that research, practice, and policy efforts to mitigate burnout and improve the work environment should consider psychological safety as a metric for system level wellbeing.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Psychological safety is associated with better work environment and lower levels of clinician burnout

de Lisser,

Dietrich,

Spetz

et al. 2024

Health Affairs Scholar

View full text Add to dashboard Cite

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Perception of the compatibility of Quebec residency program characteristics with the advanced access model: a cross-sectional study

Boulais,

Deville-Stoetzel,

Racine-Hemmings

et al. 2024

BMC Prim. Care

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Background The advanced access (AA) model is among the most recommended innovations for improving timely access in primary care (PC). AA is based on core pillars such as comprehensive planning for care needs and supply, regularly adjusting supply to demand, optimizing appointment systems, and interprofessional collaborative practices. Exposure of family medicine residents to AA within university-affiliated family medicine groups (U-FMGs) is a promising strategy to widen its dissemination and improve access. Using four AA pillars as a conceptual model, this study aimed to determine the theoretical compatibility of Quebec’s university-affiliated clinics’ residency programs with the key principles of AA. Methods A cross-sectional online survey was sent to the chief resident and academic director at each participating clinic. An overall response rate of 96% (44/46 U-FMGs) was obtained. Results No local residency program was deemed compatible with all four considered pillars. On planning for needs and supply, only one quarter of the programs were compatible with the principles of AA, owing to residents in out-of-clinic rotations often being unavailable for extended periods. On regularly adjusting supply to demand, 54% of the programs were compatible. Most (82%) programs’ appointment systems were not very compatible with the AA principles, mostly because the proportion of the schedule reserved for urgent appointments was insufficient. Interprofessional collaboration opportunities in the first year of residency allowed 60% of the programs to be compatible with this pillar. Conclusions Our study highlights the heterogeneity among local residency programs with respect to their theoretical compatibility with the key principles of AA. Future research to empirically test the hypotheses raised by this study is warranted.

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Factors influencing nurse practitioner panel size in team-based primary care: a qualitative case study

Martin-Misener,

Donald,

Rayner

et al. 2024

BMC Prim. Care

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Background Lack of access to health care is a worldwide public health crisis. In primary care it has led to increases in the implementation of nurse practitioners and heightened interest in their patient panel capacity. The aim of this study was to examine factors influencing nurse practitioner patient panel size in team-based primary care in Ontario, Canada. Methods We used a multiple case study design. Eight team-based primary care practices including rural and urban settings were purposively selected as cases. Each case had two or more nurse practitioners with a minimum of two years experience in the primary care setting. Interviews were conducted in-person, audio recorded, transcribed and analysed using content analysis. Results Forty participants, including 19 nurse practitioners, 16 administrators (inclusive of executives, managers, and receptionists), and 5 physicians were interviewed. Patient, provider, organizational, and system factors influenced nurse practitioner patient panel size. There were eight sub-factors: complexity of patients’ health and social needs; holistic nursing model of care; nurse practitioner experience and confidence; composition and functioning of the multidisciplinary team; clerical and administrative supports, and nurse practitioner activities and expectations. All participants found it difficult to identify the panel size of nurse practitioners, calling it— “a grey area.” Establishing and maintaining a longitudinal relationship that responded holistically to patients’ needs was fundamental to how nurse practitioners provided care. Social factors such as gender, poverty, mental health concerns, historical trauma, marginalisation and literacy contributed to the complexity of patients’ needs. Participants indicated NPs tried to address all of a patient’s concerns at each visit. Conclusions Nurse practitioners have a holistic approach that incorporates attention to the social determinants of health as well as acute and chronic comorbidities. This approach compels them to try to address all of the needs a patient is experiencing at each visit and reduces their panel size. Multidisciplinary teams have an opportunity to be deliberate when structuring their services across providers to meet more of the health and social needs of empanelled patients. This could enable increases in nurse practitioner panel size.

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Analysis of Variation in Organizational Definitions of Primary Care Panels

Cited by 4 publications

References 63 publications

Psychological safety is associated with better work environment and lower levels of clinician burnout

Psychological safety is associated with better work environment and lower levels of clinician burnout

Perception of the compatibility of Quebec residency program characteristics with the advanced access model: a cross-sectional study

Factors influencing nurse practitioner panel size in team-based primary care: a qualitative case study

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