The Spread and Scale of Change in Primary Healthcare: A COVID-19 Case Study

Jennings, James Robert Douglas

The Spread and Scale of Change in Primary Healthcare: A COVID-19 Case Study

dc.contributor.advisor	Woiceshyn, Jaana
dc.contributor.advisor	Huq, Jo-Louise
dc.contributor.author	Jennings, James Robert Douglas
dc.contributor.committeemember	Santana, Maria
dc.date	2025-02
dc.date.accessioned	2024-12-24T17:19:50Z
dc.date.available	2024-12-24T17:19:50Z
dc.date.issued	2024-12-19
dc.description.abstract	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.
dc.identifier.citation	Jennings, J. (2024). The spread and scale of change in primary healthcare: a COVID-19 case study (Doctoral thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.
dc.identifier.uri	https://hdl.handle.net/1880/120276
dc.language.iso	en
dc.publisher.faculty	Graduate Studies
dc.publisher.institution	University of Calgary
dc.rights	University of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission.
dc.subject	Healthcare
dc.subject	Change Management
dc.subject	Institutional Work
dc.subject	COVID-19
dc.subject	Primary Healthcare
dc.subject.classification	Education--Business
dc.subject.classification	Health Care Management
dc.title	The Spread and Scale of Change in Primary Healthcare: A COVID-19 Case Study
dc.type	doctoral thesis
thesis.degree.discipline	Business, Haskayne School of Business
thesis.degree.grantor	University of Calgary
thesis.degree.name	Doctor of Business Administration (DBA)
ucalgary.thesis.accesssetbystudent	I do not require a thesis withhold – my thesis will have open access and can be viewed and downloaded publicly as soon as possible.