Engaging primary care physicians in system change – an interpretive qualitative study in a remote and rural health region in Northern British Columbia, Canada
Bibliographic record
Abstract
OBJECTIVES: To describe how physicians were engaged in primary healthcare system change in a remote and rural Canadian health authority. DESIGN: A qualitative interpretive study based on a hermeneutic approach. METHODS: 34 transcribed in-depth interviews with physicians and administrators relevant to physician engagement were purposively sampled from a larger data set of 239 interviews gathered over a 3-year period from seven communities engaged in primary healthcare transformation. Interviews were coded and analysed interpretively to develop common themes. SETTING: This research is part of a larger study, Partnering for Change I, which investigated the efforts of Northern Health, a rural regional health authority in British Columbia, to transform its healthcare system to one grounded in primary care with a focus on interdisciplinary teams. It reports how physician engagement was accomplished during the first 3 years of the study. PARTICIPANTS: Interviews with 34 individuals with direct involvement and experience in the processes of physician engagement. These included 10 physicians, three Regional Executives, 18 Primary Healthcare coordinators and three Division of Family Practice leads. RESULTS: Three major interconnected themes that depicted the process of engagement were identified: working through tensions constructively, drawing on structures for engagement and facilitating relationships. CONCLUSIONS: Physician engagement was recognised as a priority by Northern Health in its efforts to create system change. This was facilitated by the creation of Divisions of Family Practice that provided a structure for dialogue and facilitated a common voice for physicians. Divisions helped to build trust between various groups through allowing constructive conversations to surface and deal with tensions. Local context mattered. Flexibility in working from local priorities was a critical part of developing relationships that facilitated the design and implementation of system reform.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.013 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.030 | 0.015 |
| Scholarly communication | 0.006 | 0.002 |
| Open science | 0.003 | 0.004 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".