Browsing by Author "Jennings, James Robert Douglas"

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    The Spread and Scale of Change in Primary Healthcare: A COVID-19 Case Study
    (2024-12-19) Jennings, James Robert Douglas; Woiceshyn, Jaana; Huq, Jo-Louise; Santana, Maria
    Implementing practice changes in Canadian healthcare has been challenging, hindering the country’s ability to adapt to meet the population's needs. Some factors contributing to this difficulty are the highly institutionalized and professionalized healthcare context, the need for greater integration within the healthcare organizational field, and a lack of understanding of the role of the meso-level in the change process. This single case study examined Calgary Zone’s (the Zone) primary care response during the first wave of the COVID-19 pandemic between January and December 2020. During this time, the Zone implemented novel practice changes, specifically a patient care pathway and a centralized Data Hub, that helped primary care physicians care for their patients in the community. This contributed to the Zone having the lowest hospitalization rate and the highest percentage of COVID-19-positive patients treated in the community in the province. This study found there were three phases to the Zone response. The first phase involved reorganizing the primary care organizational field and developing a strategy for collective action; the second phase involved work to design and adopt the practice changes; and the third phase involved formalizing and scaling the practice changes. The study found that actors engaged in a relational process that incorporated boundary work and practice work to navigate the forces within the institutional field. This study makes several contributions to theory and practice. It proposes an institutional work model for change that describes how the institutional work done by the actors involved supported the change process. It articulates the meso-level's role in helping change in the highly institutionalized and professionalized healthcare organizational field. It highlights the importance of actors' roles in the field, particularly physician leaders. It also illustrates the importance of the concept of place in the process of change.