General practice from the perspective of a learning organisation

摘要

This thesis sought to explore primary healthcare specifically General Practice microsystems in New South Wales (NSW) from the perspective of a learning organisation. It sought to demonstrate the synergies between effective high performing clinical microsystems providing excellent patient care and the ability of a learning organisation to engage in innovation and improvement.General Practice is the gatekeeper to the health system in Australia and in a bid to curb rising health care expenditure it is increasingly seen as the locus for preventative health, health promotion and chronic disease management. The imperative in addressing this functional shift in focus is ensuring that staff are equipped with the necessary skills to perform these and their other roles effectively. Over recent years, the concept of a “learning organisation” has been introduced as one way of improving the collective capabilities of individuals and teams. This study attempted to establish whether General Practice microsystems were functioning as learning organisations, by first identifying the characteristics of such organisations and then considering how the learning needs of staff, both formal and informal, were addressed. A mixed method approach, including the use of questionnaires for staff (both clinical and administrative) and patients, and in-depth, semi-structured interviews with staff were employed to gather data. This methodology was selected as it is among the most effective in exploring the complexities that exist within health care systems. Research results have identified that while NSW General Practice microsystems are learning organisations there is a predominance of informal and discipline specific learning. Acknowledging that a preponderance of learning in the workplace is likely to be informal there remain opportunities for improvement, for example in fostering interdisciplinary practice, increased patient engagement and feedback and increasing quality improvement activities. There are no pre-requisite educational qualifications for the reception role, and in this light the responsibilities these staff assume warrants closer examination. Recommendations made addressing these issues involve changes at the micro, macro and mesosystem level.