背景:为了满足医疗保健服务的复杂需求,2006年,卫生部和长期护理部(MOHLTC)将医师助理(PA)引入安大略省医疗保健系统,目的是帮助增加获得护理的机会,减少等待时间,改善护理的连续性,并为医疗保健队伍提供灵活的补充。将医疗保健组织表征为复杂的自适应系统(CAS)可以提供对优化和限制成功的PA集成的关系和交互的洞察力。这项研究的目的是探索跨多个案例设置的PA的集成,并了解PA在复杂的自适应系统中的作用。
方法:探索性,多病例研究用于检查四种环境中的PA角色整合:家庭医学,急诊医学,普外科,住院药物。采访了安大略省13家医院和6家家庭医学诊所的46家医疗保健提供者和管理人员,加拿大。分析分三个阶段进行,包括四个案例中的每个案例的归纳主题分析,跨案例主题分析,和更广泛的,与特定复杂性理论感兴趣原理相关的跨案例模式的演绎探索。
结果:在19个不同的医疗保健网站上采访了46个医疗保健提供者。支持各种医疗保健环境中的PA捐款,角色意识的重要性,监督关系属性,和角色脆弱性是相互关联和动态的。调查结果代表了PA和其他医疗保健提供者的经验,并证明PA的工作意愿和建立关系的能力如何允许建立跨专业的,协作,和以人为本的护理。作为复杂自适应系统中的自组织代理(即,卫生组织),PA角色探索揭示了团队行为模式,非线性互连,开放的关系,动态系统,以及复杂性理论定义的角色实现的遗产。
结论:通过探索PA在多个站点中的作用,复杂性理论透镜同时培养了对新兴模式的认识,安大略省医疗保健系统定义的背景下的关系和非线性相互作用。通过建立合作,医院和社区环境中的跨专业护理模式,PA为安大略省的医疗保健环境做出了重大贡献。
BACKGROUND: To meet the complex needs of healthcare delivery, the Ministry of Health and Long Term Care (MOHLTC) introduced Physician Assistants (PAs) into the Ontario health care system in 2006 with the goal of helping to increase access to care, decrease wait times, improve continuity of care and provide a flexible addition to the healthcare workforce. The characterization of healthcare organizations as complex adaptive systems (CAS) may offer insight into the relationships and interactions that optimize and restrict successful PA integration. The aim of this study is to explore the integration of PAs across multiple
case settings and to understand the role of PAs within complex adaptive systems.
METHODS: An exploratory, multiple-
case study was used to examine PA role integration in four settings: family medicine, emergency medicine, general surgery, and inpatient medicine. Interviews were conducted with 46 healthcare providers and administrators across 13 hospitals and 6 family medicine clinics in Ontario, Canada. Analysis was conducted in three phases including an inductive thematic analysis within each of the four cases, a cross-
case thematic analysis, and a broader, deductive exploration of cross-
case patterns pertaining to specific complexity theory principles of interest.
RESULTS: Forty-six health care providers were interviewed across 19 different healthcare sites. Support for PA contributions across various health care settings, the importance of role awareness, supervisory relationship attributes, and role vulnerability are interconnected and dynamic. Findings represent the experiences of PAs and other healthcare providers, and demonstrate how the PAs willingness to work and ability to build relationships allows for the establishment of interprofessional, collaborative, and person-centered care. As a self-organizing agent in complex adaptive systems (i.e., health organizations), PA role exploration revealed patterns of team behavior, non-linear interconnections, open relationships, dynamic systems, and the legacy of role implementation as defined by complexity theory.
CONCLUSIONS: By exploring the role of PAs across multiple sites, the complexity theory lens concurrently fosters an awareness of emerging patterns, relationships and non-linear interactions within the defined context of the Ontario healthcare system. By establishing collaborative, interprofessional care models in hospital and community settings, PAs are making a significant contribution to Ontario healthcare settings.