Currently submitted to: JMIR Nursing
Date Submitted: May 15, 2020
Open Peer Review Period: May 14, 2020 - Jul 9, 2020
(currently open for review)
Expanded roles, staff skills, and blurring professional boundaries: Impact of healthcare organisation ethos and structure on frontline staff
Co-ordinated Care (CC) and TeleHealth (TH) services have the potential to deliver quality care to chronically ill patients. They can both reduce the economic burden of chronic care and maximise the delivery of clinical services. Such services require new behaviours, routines and ways of working directed at improving health outcomes, administrative efficiency, cost effectiveness and user (patient and health professional) experience. As part of a multinational project exploring the use of CC and TH, questionnaires were sent to service managers and frontline practitioners. These questionnaires gathered quantitative and qualitative data related to organisational issues in the implementation of CC and TH. Three analytical stages were followed: Preliminary analysis allowing a direct comparison of responses of service managers and frontline staff to a range of organizational issues; Secondary analysis to establish statistically significant relationships between baseline and follow-up questionnaires; Qualitative analysis of free text responses of service managers and frontline staff. Both frontline practitioners and managers highlighted that training, tailored to the needs of different professional groups and staff grades, was a crucial element in the successful implementation of new services. Frontline staff were markedly less positive than managers in their views regarding the responsiveness of their organisation and pace of change. The data presented provides evidence that the set-up of healthcare services are positively associated with outcomes in a number of areas, particularly tailored staff training, rewards for good service, staff satisfaction and patient involvement.
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