Table 2 Themes and categories emerging from a thematic analysis of a primary health care (PHC) teamwork
From: Teamwork in primary care: perspectives of general practitioners and community nurses in Lithuania
Themes | Categories | Verbatim |
|---|---|---|
Structure of the PHC team | Main members of a PHC team | “The team probably consists of a nurse and family physician, which is the most common primary care team model.” (FG1CN) |
Optional members of a PHC team | “Then I would count the receptionists…” (FG1GP) | |
Hierarchy in PHC teams | “Our duties are different, but we should all be on a line, more horizontal.” (FG3GP) | |
Leadership in a team | “Somebody should manage this team.” (FG3CN) | |
Synergy of PHC team members | “Intangible” team unity | “…nurse and physician […] – everything is operating automatically between them.” (FG1CN) |
Common goals of team members | “The goal is common – that patient should be stroked around from all sides; he should be happy…” (FG2GP) | |
Individual motivation to work in a team | “This depends on the person. One would do everything, another would say: ‘I was told to do that and I will not do anything more.’ There are such people in a team too…” (FG3CN) | |
Trust between teammates | “A physician should trust the nurse. If there is no trust, there is not any team.” (FG1CN) | |
Respect between teammates | “Good relationships are most important, when you are working together and do not humiliate each other.” (FG1CN) | |
Executing commands of physician | “And afterwards, in the office, she [the nurse] is doing what I am telling her to do.” (FG1GP) | |
Roles and responsibilities of team members | Well-described, known roles of team members | “Everybody should know what he must to do…” (FG2GP) |
Confusion of roles | “I do not know what her [CN] functions are. In fact we do not know what her duties are.” (FG1GP) | |
Overlap of responsibilities | “If you take physician and nurse job descriptions, you see that many roles between them are overlapping.” (FG2GP) | |
Explicit boundaries of the roles and responsibilities of team members | “The most important is not to intervene in treatment, since treatment belongs to the physician […]; the most important is to work within our own framework.” (FG2CN) | |
Delegation of tasks | “Physician should say […] what he wants from the nurse.” (FG1CN) | |
Assumed individual responsibility | “The nurse should know the boundaries of her work and take responsibility for their own actions.” (FG3GP) | |
Overlapping activities | “It might they [nurses] are performing some tasks that belongs to us, but they are not fulfilling their own tasks.” (FG2GP) | |
Autonomous performance of one’s own duties | “You should not say to a nurse, ‘You should do this or this.’ She should do this herself on the spot.” (FG1GP) | |
Sanctions for CN’s for overstepping boundaries | “And during the meeting it was said that [name] is commenting on exam results. […] They made mud out of me so badly! […]” (FG1CN) | |
Positive expectations towards CN’s “doctoring” | “She (CN) has my small stamp. I gave it to her that she could prescribe tests when I am absent” (FG2GP) | |
Differentiation of activities | “For example, all certifications in our institution are written by the informational office.” (FG2GP) | |
Competency of primary care team members | Appropriate knowledge and skills | “Sometimes I hear […] our nurses who are consulting patients by phone […]. Once in a while […] such a consultation makes me cover my ears and not listen anymore. Really, the knowledge is outdated or inaccurate…” (FG3CN) |
Supervision of competence | “She [the CN] simply sometimes does not know […]. The administration should somehow control these things.” (FG2GP) | |
Necessity of training | “I only would like to say that training is very much needed for nurses…” (FG2CN) | |
Training quality | “We are going to the training as we would like to improve our competence, but we should officially question what we are receiving during this training.” (FG3CN) | |
Communications between PHC team members | Communication as a tool to transmit work-related information | “Since we [GPs and CNs] are working in separate offices, communication is very important […]. We are referring all the information to the physician […]. It‘s time saving for the physician and his consultation.” (FG2CN) |
Communication as friendliness in the working environment | “I worked in a private [health centre], but I didn’t like working there […]. There wasn’t enough communication…” (FG2CN) | |
Means to optimise communications in a team | “We even have such a local telephone connection [between GP and CN offices]. If there is some question, we press a button and get in contact.” (FG2CN) | |
Inner language of team members | “We understand one another in a glance.” (FG1GP) | |
Difficulties in mutual communication | “They [CNs] react very sensitively […], even when you are talking very amiably […]. You see that she feels offended… somehow offended.” (FG2GP) | |
Communication strategies | “I have heard about, when a physician who was close to the patient snapped out to the nurse everything he is thinking and… and had done this so awfully.” (FG1CN) | |
Organisational background for teamwork | Synchronisation of compensation policies for team members | “Our nurses have a fixed salary, so, the less patients I have, the happier she is, since she can sit and look through a window.” (FG2GP) |
Workplace of team members | “We do not have where to let them [CNs] sit down normally so we cannot ask them to perform tasks independently. It’s really so – there is no place to sit down.” (FG1GP) | |
Appropriate time for handling procedures | “There should be some regulation on how many patients a physician can consult each day. Not how much he is consulting, but how much he should consult not losing quality.” (FG2GP) | |
Regulation of patient flows | “When, instead of 12 patients with an appointment, 30 or even more come, this simply puts out of kilter all work in a team.” (FG2GP) | |
Work in stable districts | “You feel pleased when you are going to your own district; you know all the tasks […]. It’s very important this many years to work in one place.” (FG3CN) | |
Introduction of innovations | “Everything is on an electronic record system – if you had it, you wouldn’t need to rewrite information in referrals, recipes, etc…” (FG3GP) | |
Response to the needs of personnel | - “We do not have an official time for lunch…” - “We have 15 minutes but, during this time, we take patients without appointments.” (FG2GP) | |
Training of personnel | “We have training in our institution, lectures on how to communicate with patients […]. This is needed very much.” (FG2GP) | |
Team building initiatives | “In the beginning [of institution’s activity] we had a lot of training on team work… at that time this seemed stupid and incomprehensive, but now it seems that it was worthy, this turned our heads in other direction. I mean, some understanding emerge…” (FG2GP) | |
Involvement of all personnel in non-clinical activity | “All of us – doctors and nurses – were involved in preparation of office rules […] We had to go through the legal acts and prepare internal policies. We were not happy about that, but after that we knew each other better.” (FG3CN) | |
Best practice exchanges with other institutions | “The heads of health care institutions should sit together and decide […] how to improve things […]. Now they are only competing with each other.” (FG2CN) |