TY - JOUR
T1 - Healthcare professionals as change agents
T2 - Factors influencing bottom-up, personal initiatives on appropriate care, a qualitative study in the Netherlands
AU - Krijgsheld, Marcel
AU - Schmidt, Eduard J. E. T.
AU - Levels, Edwin
AU - Schuurmans, Marieke M. J.
N1 - Publisher Copyright:
© 2024 The Author(s)
PY - 2024/9
Y1 - 2024/9
N2 - Introduction: Healthcare organisations face multiple challenges, often conceptualised as appropriate care. It requires change on different levels: healthcare systems (macro), healthcare organisations (meso), and healthcare professionals (micro). This study focuses on bottom-up changes initiated by healthcare professionals. The aim is to investigate hindering and stimulating factors healthcare professionals experience. Materials and methods: The study used a qualitative design with purposive sampling of eight Dutch healthcare professionals who initiated changes. We conducted online interviews and used Atlas TI with a combination of open, axial, and selective coding for data analysis. Results: The results indicate that professionals are often mission-driven when they initiate change, support from clients and peers may help them overcome barriers. Conversely, peers who feel threatened in their autonomy hinder initiatives of professionals, especially when their changes have financial consequences for their organization. Conclusion: Aligning and integrating macro- and micro-level initiatives is crucial to advancing the movement towards appropriate care and stimulating bottom-up initiatives of healthcare professionals. More research remained needed, in particular studies on the hindering or stimulating role of employers and healthcare professionals' representatives, and the adoption of the concept of appropriate care by patients.
AB - Introduction: Healthcare organisations face multiple challenges, often conceptualised as appropriate care. It requires change on different levels: healthcare systems (macro), healthcare organisations (meso), and healthcare professionals (micro). This study focuses on bottom-up changes initiated by healthcare professionals. The aim is to investigate hindering and stimulating factors healthcare professionals experience. Materials and methods: The study used a qualitative design with purposive sampling of eight Dutch healthcare professionals who initiated changes. We conducted online interviews and used Atlas TI with a combination of open, axial, and selective coding for data analysis. Results: The results indicate that professionals are often mission-driven when they initiate change, support from clients and peers may help them overcome barriers. Conversely, peers who feel threatened in their autonomy hinder initiatives of professionals, especially when their changes have financial consequences for their organization. Conclusion: Aligning and integrating macro- and micro-level initiatives is crucial to advancing the movement towards appropriate care and stimulating bottom-up initiatives of healthcare professionals. More research remained needed, in particular studies on the hindering or stimulating role of employers and healthcare professionals' representatives, and the adoption of the concept of appropriate care by patients.
KW - Appropriate care
KW - Bottom-up change
KW - Change agents
KW - Healthcare
KW - Personal Innitiatives
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UR - http://www.scopus.com/inward/record.url?scp=85197510952&partnerID=8YFLogxK
U2 - 10.1016/j.healthpol.2024.105120
DO - 10.1016/j.healthpol.2024.105120
M3 - Article
C2 - 38981279
SN - 0168-8510
VL - 147
JO - Health Policy
JF - Health Policy
M1 - 105120
ER -