Primary healthcare delivery: an exploratory case study of a "See&Treat" unit
Abstract: Primary health care centres (PHCC) and hospital emergency departments (EDs) are the first line of healthcare and the institutions responsible of taking care of the population's primary health care (PHC) needs. PHC treats both acute patients with minor complaints and patients with chronic conditions. Despite the very different needs of these patients, research on how care processes should be designed to meet the different needs in PHC is limited. In this thesis we draw upon the concepts of volume and variety from operations management literature and use an exploratory case study to understand how a concept, previously studied in EDs, referred to as "See-and-Treat", can be used to treat acute patients with minor complaints in PHC. We find that care process reconfiguration by taking laboratory tests and payment before the consultation makes all information needed for clinical decisions available before the consultation, instead of having to wait after the consultation for test results as often seen in a traditional setting. Furthermore, we find that a "See-and-treat" approach seems to provide high quality care to patients with minor complaints. We identify that a sheet of paper called "symptom form" is a central aspect of the care process. It guides all activities of the studied care process and it can contribute to care quality by decreasing input and output variety and manage the inherent variety in the care process. The symptom form could build in quality and safety in the process itself, however, as inclusion criteria for the studied intervention are not adhered to, the seen quality could be due to personnel competence rather than care process design.
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