General practitioners’ perceptions of distributed leadership in providing integrated care for elderly chronic multi-morbid patients: a qualitative study

Abstract

Background Distributed Leadership (DL) has been suggested as being helpful when different health care professionals and patients need to work together across professional and organizational boundaries to provide integrated care (IC). This study explores whether General Practitioners (GPs) adopt leadership actions that transcend organizational boundaries to provide IC for patients and discusses whether the GPs’ leadership actions in collaboration with patients and health care professionals contribute to DL. Methods We interviewed GPs (n = 20) of elderly multimorbid patients in a municipality in Norway. A qualitative interpretive case design and Gioia methodology was applied to the collection and analysis of data from semi-structured interviews. Results GPs are involved in three processes when contributing to IC for elderly multimorbidity patients; the process of creating an integrated patient experience, the workflow process and the process of maneuvering organizational structures and medical culture. GPs take part in processes comparable to configurations of DL described in the literature. Patient micro-context and health care macro-context are related to observed configurations of DL. Conclusion Initiating or moving between different configurations of DL in IC requires awareness of patient context and the health care macro-context, of ways of working, capacity of digital tools and use of health care personnel.

A Qualitative Study on Distributed Leadership in Integrated Care: Exploring the Experiences of Elderly Multimorbid Patients with GP Collaboration

“…Additionally, study findings show that delivering more holistic healthcare services will require digital correspondence that does not narrow the focus to the selected topics healthcare professionals consider relevant to each other. 19 In reference to the literature on distributed leadership, this finding is consistent with research suggesting that pluralized leadership has both collective and individual elements, and that collective leadership may need the support of both infrastructure and individual agency. 21–23 …”

“…Additionally, study findings show that delivering more holistic healthcare services will require digital correspondence that does not narrow the focus to the selected topics healthcare professionals consider relevant to each other. 19 In reference to the literature on distributed leadership, this finding is consistent with research suggesting that pluralized leadership has both collective and individual elements, and that collective leadership may need the support of both infrastructure and individual agency. [21][22][23] In addition, the study shows that if GPs limit their efforts to direction setting or only function as coordinators or implementors of medical tasks and interventions in isolation from the rest of the collective, this will limit the contribution the collective process has in creating a patient experience of integrated care.…”

“…Patients’ recollections and experiences of collaborating with their GP and home care nurses in day-to-day practice and during health deterioration were key themes of interviews. 19 Additionally, interviews focused on the patient’s efforts, actions, and thoughts on how to regain health and live as well as possible. Similarly, GP interviews focused on GPs’ experience from collaborating with other healthcare providers and the GPs’ recollections of the patient’s most recent hospitalization.…”

Older Adults’ Experiences With Participation and eHealth in Care Coordination: Qualitative Interview Study in a Primary Care Setting

“…All residents in Norway have the right to a GP. GPs are employed at different GP offices within the municipality, which are open during the day from Monday to Friday [ 37 ]. In addition, municipalities are responsible for emergency services, such as local emergency rooms that are open 24 hours a day, 7 days a week.…”

“…In addition, municipalities are responsible for emergency services, such as local emergency rooms that are open 24 hours a day, 7 days a week. Citizens in a municipality who need acute treatment are either referred to the local intermunicipal acute inpatient care (AIC) unit or the nearby regional hospital [ 37 ].…”