Behind the Closed Door: Using Ethnography to Understand Family Health Teams

Project Summary

This qualitative study closely examines the dynamics of organizational change within six Ontario Family Health Teams (FHTs). Combining direct and indirect observation, interviews, document reviews and team climate assessments, our research will address how individual practitioners and the practices are influenced by the substantial changes associated with a new model of care. We intend to describe how becoming a FHT affects routines in the practice, with a particular emphasis on how those routines relate to caring for people living with chronic illness. Ethnography is an ideal method for gaining an in-depth understanding of what is really happening in primary care organizations. Results will inform practitioners and those responsible for developing primary care in Ontario.

Context/Objectives

As a central strategy for primary health care renewal in Ontario, the development of FHTs will, within a few years, see thousands of primary care providers and hundreds of thousands of their patients moving to a sophisticated, complex and collaborative model of care. The evolving and complex FHT model will have major consequences for traditional primary care workplaces. Interdisciplinary teamwork means that professionals with different types of relationships with patients and varied and sometimes overlapping scopes of practice will need to align their skills and contributions. Furthermore, unanticipated consequences may await those who do manage to navigate changes in role and responsibility.

This research is specifically aimed at trying to understand how organizational change is happening in FHTs. We intend to describe how becoming a FHT affects routines in the practice, with a particular emphasis on how those routines relate to caring for people living with chronic illness.

Research Questions

Two research questions are guiding our data collection and analysis.

1) How does the transition into a FHT influence organizational and clinical routines, particularly those relating to the care of persons living with chronic illness?

2) What key organizational routines are appropriate for future interventions using educational outreach facilitation?

Methods

Data collection will involve observation by a field worker of activities within the practice, over a total of 4 weeks per site during a six-month period. This time is expected to comprise two periods of up to 2 weeks of observation, with periodic short visits to the practice as needed (e.g., to attend the orientation of a new staff member, or a practice planning meeting).

Through periodic observation, interviews, document reviews and the use of a Team Climate Assessment tool, the study team will develop a well-rounded picture, for each participating FHT, of the practice and clinical routines, and the approach to management of a chronic condition prevalent in the FHT’s patient population. We will gather data using the following methods:

Direct Observation:   

• Health care providers
• Front desk and administrative staff
• Patients

Indirect Observation:

• Audio-recordings of participating patients’ visits to health care providers

Interviews with:

• Health care providers
• Other practice staff
• Patients

Document reviews:

• FHT proposal, operating and business plan
• Meeting agendas and minutes
• Internal communications
• Other relevant documents developed since original submissions to the Ministry of Health and Long-Term Care (MOHLTC)

Team Climate Assessment:

• Survey administered at study onset

Timeline

Phase 1 (April – June 2007) Project development and consultation:
Finalization of project, submission and approval of ethics application, refinement of data collection tools, recruitment of Advisory Board

Phase 2 (July – August 2007) Pilot testing and participant recruitment:
Conduct of pilot study; testing, refinement and calibration of data collection and analysis tools; finalization of recruitment of 6 FHTs

Phase 3 (September 2007 – February 2008) Data collection and iterative analysis:
Data collection in 6 FHTs, data analysis, feedback sessions and quality assessment

Phase 4 (February – April 2008) Analysis, synthesis, consultation and dissemination:
Final analysis of data, feedback sessions, written and oral presentation of findings, and final MOHLC report

Investigators

Grant Russell, MBBS, MFM, PhD

Robert Geneau, PhD

Barbara Farrell, PharmD

Staff

Jackie Schultz, Project Manager - jschultz@uottawa.ca

Wendy Martin, Research Associate

Natalie Ward, Research Associate

Samantha Evans, Research Associate