Primary Care Leaders Research Articles

Face-to-Face Relationships Still Matter in a Digital Age: A Call for a 5th C in the Core Tenets of Primary Care.

We primary care clinicians, scholars, and leaders ascribe value to Barbara Starfield's core tenets of primary care-the 4 Cs: first contact, comprehensiveness, coordination, and continuity. In today's era of rapid technological advancements and dwindling resources, what are the implications for face-to-face interactions of patient-clinician relationships? We propose adding a 5th C: "Contiguity." Contiguity-or physical proximity and presence-is a key dimension that not only enables the necessary technical aspects of a physical exam but also authenticates the most human aspects of a relationship and occurs specifically when we are physically vulnerable and responsible for the other before us. This, in turn, may best enable us to bridge difference and nurture trust with our patients. We measure what we value and, thus, naming Contiguity as a core tenet assures that we will not lose sight of this keystone in a patient's relationship with their personal physician.

Evaluation of the first 5 years of the Next Generation GP leadership programme: balancing autonomy and accountability

BackgroundIn 2017, a group of trainee general practitioners (GPs) came together to design and deliver a six-session leadership development programme for their peer trainee and early career GPs: the Next...

Operationalizing a 3-year standalone, accelerated medical school curriculum to nurture physicians to become primary care and health system leaders

The United States faces a shortage of primary care physicians. To address this, there have been pioneering efforts to develop accelerated pathways with a primary care focused curriculum for undergraduate medical education. The New York University Grossman Long Island School of Medicine (NYU GLISOM) was conceptualized as the first standalone, accelerated, tuition-free program in the US in over 100 years, with mission-centered curriculum on primary care and health system leadership. The aim of this article is to map the process for the development of a three-year integrated curriculum, describe the pedagogical approach that guided the design of the longitudinal courses, share the student and faculty’s perspective about the curriculum, and describe the early outcomes of the first two graduate classes. A major key driver for curricular design is integrating longitudinal courses of Clinical Ambulatory Practice Experience (CAPE), Health Systems Science (HSS), and Learning Community - Social Sciences, Humanities, Ethics and Professionalism (LC-SHEP) over three years and active learning through Problem Based Learning (PBL). We have successfully operationalized an accelerated, standalone, integrated medical school curriculum mission-centered on primary care and health system leadership. Our outcomes reveal a higher percentage (76% N =45) of NYU GLISOM students entering primary care compared to national benchmarks. The integration of the longitudinal courses of HSS, LC-SHEP, and CAPE is a key pillar to reinforce the tenants of primary care and health system leadership. Focused interview of graduates from the pioneer cohort consistently stated that the longitudinal courses prepared them well for residency in primary care and as a health systems’ change agent. Despite the challenges of an accelerated program, NYU GLISOM successfully integrated the longitudinal courses with optimal performance and achievement of educational program objectives. Our experience can serve as a model for innovation and design of an accelerated three-year primary care curriculum.

Barriers Facing Primary Care Leaders in Implementing Goals of Care Conversations with Seriously Ill Veterans

Barriers Facing Primary Care Leaders in Implementing Goals of Care Conversations with Seriously Ill Veterans

Improving healthcare delivery at a district hospital through teaching interns - A short report.

Every district in Malawi has at least two doctors managing the social and healthcare needs of the local population. The medical doctors at the district are involved in administrative work and have minimal time for clinical practice. As such in most district hospitals, clinical officers (COs) form the backbone of patient care provision. These are cadres that have a 3-year training in clinical medicine; they work side by side with medical assistants (MAs) and nurses. Apart from the Ministry of Health (MoH) workforce, the Department of Family Medicine (FM) of Kamuzu University of Health Sciences (KUHeS) has its main district site at Mangochi. Family physicians and residents from FM department assist in provision of mentorship and teaching to other cadres. Work-based learning requires various strategies and approaches. The experience reported here involves deliberate mentorship and support to enhance the learning of other cadres. Family medicine residents learn through the active participation in these sessions to become future consultants and leaders in primary health care.

Key informants perspectives on creating a high impact research department in family and community medicine: a qualitative project.

Primary care is integral to the health system and population health. Primary care research is still in development and most academic departments lack effective research investments. High impact primary care research programs are needed to advance the field to ensure a robust primary care system for the future. The project objective was to understand key informants' views of structures, functions, and processes required to create a high impact research program in an academic primary care department. A descriptive qualitative project with key informants from research programs in primary care. Participants included international research leaders in primary care (n = 10), department of family and community researchers (n = 37) and staff (n = 9) in an academic primary care department, other university leaders (n = 3) and members of the departmental executive leadership team (1 department; 25 members). Semi-structured interviews (n = 27), and focus groups (n = 6) were audio recorded, transcribed, and analyzed using thematic analysis. We used a socioecological framework which described micro, meso, macro levels of influence. At the micro level despite barriers with respect to funding, protected time and lack of formal mentorship, personal motivation was a key factor. At the meso level, the organizational structure that promoted collaboration and a sense of connection emerged as a key factor. Specifically research leaders identified a research faculty development pipeline based on equity, diversity, inclusion, indigeneity, and accessibility principles with thematic areas of focus as key enablers. Lastly, at the macro level, an overarching culture and policies that promoted funding and primary care research was associated with high impact programs. The alignment/complementarity of micro, meso, and macro level factors influenced the creation of a high impact research department in primary care. High impact research in primary care is facilitated by the development of researchers through formalized and structured mentorship/sponsorship and a department culture that promote primary care research.

A rapid review of opportunities and challenges in the implementation of social prescription interventions for addressing the unmet needs of individuals living with long-term chronic conditions

BackgroundPeople with long-term chronic conditions often struggle to access and navigate complex health and social services. Social prescription (SP) interventions, a patient-centred approach, help individuals identify their holistic needs and increase access to non-clinical resources, thus leading to improved health and well-being. This review explores existing SP interventions for people with long-term chronic conditions and identifies the opportunities and challenges of implementing them in primary healthcare settings.MethodsThis rapid review followed the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines and searched relevant articles in three databases (PubMed/MEDLINE, EMBASE, and Web of Science) by using subject headings and keywords combined with Boolean operators. The search encompassed articles published between January 2010 and June 2023. Two authors independently conducted study screening and data abstraction using predefined criteria. A descriptive synthesis process using content analysis was performed to summarise the literature.ResultsFifteen studies were included, with all but one conducted in the United Kingdom, and revealed that social prescribers help guide patients with long-term chronic conditions to various local initiatives related to health and social needs. Effective implementation of SP interventions relies on building strong relationships between social prescribers and patients, characterised by trust, empathy, and effective communication. A holistic approach to addressing the unmet needs of people with long-term chronic conditions, digital technology utilisation, competent social prescribers, collaborative healthcare partnerships, clinical leadership, and access to local resources are all vital components of successful SP intervention. However, the implementation of SP interventions faces numerous challenges, including accessibility and utilisation barriers, communication gaps, staffing issues, an unsupportive work environment, inadequate training, lack of awareness, time management struggles, coordination and collaboration difficulties, and resource constraints.ConclusionThe present review emphasises the importance of addressing the holistic needs of people with long-term chronic conditions through collaboration and coordination, training of social prescribers, community connections, availability of local resources, and primary care leadership to ensure successful interventions, ultimately leading to improved patient health and well-being outcomes. This study calls for the need to develop or utilise appropriate tools that can capture people's holistic needs, as well as an implementation framework to guide future contextual SP interventions.

Implementing new forms of collaboration and participation in primary health care: leveraging past learnings to inform future initiatives

Introduction Within primary health care policy, there is an increasing focus on enhancing involvement with secondary health care, social care services and communities. Yet, translating these expectations into tangible changes frequently encounters significant obstacles. As part of an investigation into the progress made in achieving primary health care reform in Aotearoa New Zealand, realist research was undertaken with those charged with responsibility for national and local policies. The specific analysis in this paper probes primary health care leaders’ assessments of progress towards more collaboration with other health and non-health agencies, and communities. Aim This study aimed to investigate how ideas for more integration and joinedup care have found their way into the practice of primary health care in Aotearoa New Zealand. Methods Applying a realist logic of inquiry, data from semi-structured interviews with primary health care leaders were analysed to identify key contextual characteristics and mechanisms. Explanations were developed of what influenced leaders to invest energy in joined-up and integrated care activities. Results Our findings highlight three explanatory mechanisms and their associated contexts: a willingness to share power, build trusting relationships and manage task complexity. These underpin leaders’ accounts of the success (or otherwise) of collaborative arrangements. Discussion Such insights have import in the context of the current health reforms for stakeholders charged with developing local approaches to the planning and delivery of health services.

Embedding Pharmacist Prescribing into Undergraduate Pharmacist Education: A Qualitative Analysis of Student and Stakeholder Perspectives

Abstract Introduction From 2026 onwards, upon passing the registration exam, all pharmacy students will become independent prescribers (IP), with the aim of maximising the diagnostic and therapeutic skillset of all pharmacist graduates. As a result of this, pharmacy undergraduate education requires a shift in curriculum design to align with the change in direction the profession demands. Research is required to ascertain the needs of the local workforce to identify how the Master of Pharmacy (MPharm) course needs to change to future proof the pharmacy workforce and prepare them to independently prescribe. The GPhC new standards for pharmacist prescribing act as a scaffold for the structure of the course, but individual institutions have a level of freedom in curriculum design. Aim To identify the skills, knowledge and best pedagogical approaches required by key stakeholders in the local workforce, to develop an undergraduate prescribing programme for pharmacy students in a North-East England University Pharmacy School. Methods Two focus groups were conducted, one with key educational stakeholders in the North-East of England (Hospital, Primary Care and Academic Leaders in Pharmacy) and one with current MPharm students attending Newcastle University. Participants were selected via convenience sampling. Each group had n=5 participants. Data were recorded and transcribed, then analysed using thematic analysis in NVivo 12 to draw out key themes to consider when redesigning the MPharm curriculum. The project was granted ethical approval by Newcastle University’s Ethics Committee on 27/09/22, Reference 25121/2022. Results Five key themes were derived, with several overlapping across both groups. Themes identified: course content, teaching methods, assessment methods, current level of practice, and barriers to implementation. Within these themes, the key areas where stakeholders and students felt more training was required were identified as; diagnostic skills, mental health, dealing with patients with comprehension difficulties and dealing with complex decisions. The ways in which best to deliver this content were found to be through placement and seminars, also with students notably enjoying problem-based learning (PBL). Issues with hospitals having the capacity to provide adequate placement time for all students was a key concern amongst the stakeholders and was recognised as a key barrier to implementation of enhanced education in the future. Regarding digitalisation of teaching, students expressed a dislike for online delivery of content, but could see the benefits in teaching of emerging technology. However, it was ultimately felt that technology could not replace real-life experience. OSCEs (Objective Structured Clinical Examinations) were recognised as the best way to assess prescribing ability, however further modifications could be made to make them more specific to independent prescribing. Discussion/Conclusion Stakeholders and students felt the current programme should place greater emphasis on diagnostic skills and complex patient scenarios, with specific focus on people with additional needs such as autism. Additional awareness of the diversity of patients and how this affects prescribing decisions also was raised as a pertinent consideration. Limitations of this research include the small sample size of participants, which limits generalisability of opinions contributed. This was due to lack of recruitment time as a result of project time constraints.

Study protocol: maintaining preventive care during public health emergencies through effective coordination

BackgroundScreening lies at the heart of preventive care. However, COVID-19 dramatically disrupted routine screening efforts, resulting in excess mortality not directly attributable to COVID-19. Screening rates during COVID varied markedly by facility and clinical condition, suggesting susceptibilities in screening and referral process workflow. To better understand these susceptibilities and identify new practices to mitigate interrupted care, we propose a qualitative study comparing facilities that exhibited high, low, and highly variable performance (respectively) in screening rates before and during the pandemic. We will be guided by Weaver et al.’s multi-team systems (MTS) model of coordination, using cancer and mental health screening rates as exemplars.MethodQualitative analysis of interviews and focus groups with primary care personnel, leadership, and patients at 10 VA medical centers. We will select sites based on rurality, COVID-19 caseload at the beginning of the pandemic, and performance on five outpatient clinical performance indicators of cancer and mental health screening. Sites will be categorized into one of five screening performance groups: high performers, low performers, improvers, plummeters, and highly variable.We will create process maps for each performance measure to create a workflow baseline and then interview primary care leadership to update the map at each site. We will clinician conduct focus groups to elicit themes regarding clinician coordination patterns (e.g., handoffs), strategies, and barriers/facilitators to screening during COVID. We will also conduct patient interviews to examine their screening experience during this period, for context. All interviews and focus groups will be audio-recorded, transcribed, and enhanced by field notes. We will analyze clinician transcripts and field notes using iterative, rapid analysis. Patient interviews will be analyzed using inductive/deductive content analysis.DiscussionOur study represents a unique opportunity to inform the multi-team systems literature by identifying specific forms of information exchange, collective problem solving, and decision-making associated with higher and improved clinical performance. Specifically, our study aims to detect the specific points in the screening and referral process most susceptible to disruption and coordination processes that, if changed, will yield the highest value. Findings apply to future pandemics or any event with the potential to disrupt care.

The process of nurses' role negotiation in general practice: A grounded theory study.

To explain the process by which nurses' roles are negotiated in general practice. Primary care nurses do important work within a social model of health to meet the needs of the populations they serve. Latterly, in the face of increased demand and workforce shortages, they are also taking on more medical responsibilities through task-shifting. Despite the increased complexity of their professional role, little is known about the processes by which it is negotiated. Constructivist grounded theory. Semi-structured interviews were conducted with 22 participants from 17 New Zealand general practices between December 2020 and January 2022. Due to COVID-19, 11 interviews were via Zoom™. Concurrent data generation and analysis, using the constant comparative method and common grounded theory methods, identified the participants' main concern and led to the construction of a substantive explanatory theory around a core category. The substantive explanatory theory of creating place proposes that the negotiation of nurse roles within New Zealand general practice is a three-stage process involving occupying space, positioning to do differently and leveraging opportunity. Nurses and others act and interact in these stages, in accordance with their conceptualizations of need-responsive nursing practice, towards the outcome defining place. Defining place conceptualizes an accommodation between the values beliefs and expectations of individuals and pre-existing organizational norms, in which individual and group-normative concepts of need-responsive nursing practice are themselves developed. The theory of creating place provides new insights into the process of nurses' role negotiation in general practice. Findings support strategies to enable nurses, employers and health system managers to better negotiate professional roles to meet the needs of the populations they serve, while making optimum use of nursing skills and competencies. Findings can inform nurses to better negotiate the complexities of the primary care environment, balancing systemic exigencies with the health needs of populations. What Problem Did the Study Address? In the face of health inequity, general practice nurses in New Zealand, as elsewhere, are key to meeting complex primary health needs. There is an evidence gap regarding the processes by which nurses' roles are negotiated within provider organizations. A deeper understanding of such processes may enable better use of nursing skills to address unmet health need. What Were the Main Findings? Nurses' roles in New Zealand general practice are determined through goal-driven negotiation in accordance with individual concepts of need-responsive nursing practice. Individuals progress from occupying workspaces defined by the care-philosophies of others to defining workplaces that incorporate their own professional beliefs, values and expectations. Negotiation is conditional upon access to role models, scheduled dialogue with mentors and decision-makers, and support for safe practice. Strong clinical and organizational governance and individuals' own positive personal self-efficacy are enablers of effective negotiation. Where and on Whom Will the Research Have Impact? The theory of Creating Space can inform organizational and individual efforts to advance the roles of general practice nurses to meet the health needs of their communities. General practice organizations can provide safe, supported environments for effective negotiation; primary care leaders can promote strong governance and develop individuals' sense of self-efficacy by involving them in key decisions. Nurses themselves can use the theory as a framework to support critical reflection on how to engage in active negotiation of their professional roles. The authors adhered to relevant EQUATOR guidelines using the COREQ reporting method. Researchers and participants currently working in general practice were involved in the development of this study. By the process of theoretical sampling and constant comparison, participants' comments helped to shape the study design. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: An understanding of the processes by which health professionals negotiate their roles is important to support them to meet the challenges of increased complexity across all health sectors globally.

Embedding genomics across the NHS: a primary care perspective

Primary care remains the point of access to the NHS as well as having key roles in care coordination and prescribing. Therefore, embedding of genomic medicine in the NHS relies on successful implementation into the primary care landscape. Primary care is currently facing considerable challenges, including increasing numbers of patients and consultations per GP, multiple health conditions and polypharmacy, all contributing to increasing workload within a resource-constrained system. Although genomic medicine has enormous potential to benefit patients, its successful implementation demands alignment with existing skills and working practices, development of underpinning informatics infrastructure, integration into care pathways with consideration of commissioning and leadership. Here, we set out current initiatives and future strategies to support primary care colleagues in the delivery of genomic medicine, covering issues of workforce development and education, primary care leadership, and data and digital considerations.

"What We're Doing Now…Is More Than Water Cooler": Perspectives of Primary Care Leaders on Leading Through (and Beyond) COVID-19.

COVID-19 presented numerous challenges to primary care, but little formal research has explored the experience of practice leaders and their strategies for managing teams as the crisis unfolded. Describe the experience of leaders in US primary care delivery organizations, and their strategies for leading teams during COVID-19 and beyond. Qualitative study using semi-structured interviews performed between 9/15/2020 and 8/31/2021. Purposive sample of 17 clinical leaders in a range of US primary care organizations. An iterative grounded review of interview transcripts was performed, followed by immersion/crystallization analysis. Early in the pandemic, practice leaders reported facing rapid change and the need for constant decision-making, amidst an environment of stress, fear, and uncertainty, but this was buffered by a strong sense of purpose. Later, leaders noted the emergence of layered crises, and evolving challenges including fatigue, burnout, and strained relationships within their organizations and with the communities they serve. Leaders described four interrelated strategies for supporting their teams: (1) Being intentionally present, physically and emotionally; (2) Frequent and transparent communication; (3) Deepening and broadening relationships; (4) Increasing adaptive decision-making, alternating between formal hierarchical and flexible participatory processes. These strategies were influenced by individual leaders' perceived autonomy, which was impacted by the leader's specific role, and organizational size, complexity, and funding model. As the burnout and workforce crises have accelerated, the identified strategies can be useful to leaders to support teams and build organizational resilience in primary care moving forward.

180° view on general practitioners’ leadership skills: practice-level comparisons of leader and staff assessments using data from the cluster-randomised controlled IMPROVEjob study

ObjectivesStrong primary care leaders are needed to assure high quality services for patient populations. This study analysed general practitioners’ (GP) leadership skills comparing practice-level self and staff assessments based on...

MP37-09 DEVELOPMENT OF URINARY INCONTINENCE CLINICAL DECISION SUPPORT TOOLS FOR USE IN PRIMARY CARE

MP37-09 DEVELOPMENT OF URINARY INCONTINENCE CLINICAL DECISION SUPPORT TOOLS FOR USE IN PRIMARY CARE

MP72-06 IMPORTANCE OF PRIMARY CARE LEADERSHIP INVOLVEMENT: RECRUITMENT LESSONS FROM AN OFFICE-BASED URINARY INCONTINENCE INTERVENTION

You have accessJournal of UrologyCME1 Apr 2023MP72-06 IMPORTANCE OF PRIMARY CARE LEADERSHIP INVOLVEMENT: RECRUITMENT LESSONS FROM AN OFFICE-BASED URINARY INCONTINENCE INTERVENTION Kyle Okamuro, Catherine Bresee, Isabella Dolendo, Karyn Eilber, Ramy Eskander, Tamara Grisales, Jejo Koola, Allison Mays, Carmen Mendez, Marlene Millen, Teryl Nuckols, Joshua Pevnick, David Reuben, Jennifer Singer, Ming Tai-Seale, Florin Vaida, Katherine Ward, Neil Wenger, Tajnoos Yazdany, Xi Zhu, and Jennifer Anger Kyle OkamuroKyle Okamuro More articles by this author , Catherine BreseeCatherine Bresee More articles by this author , Isabella DolendoIsabella Dolendo More articles by this author , Karyn EilberKaryn Eilber More articles by this author , Ramy EskanderRamy Eskander More articles by this author , Tamara GrisalesTamara Grisales More articles by this author , Jejo KoolaJejo Koola More articles by this author , Allison MaysAllison Mays More articles by this author , Carmen MendezCarmen Mendez More articles by this author , Marlene MillenMarlene Millen More articles by this author , Teryl NuckolsTeryl Nuckols More articles by this author , Joshua PevnickJoshua Pevnick More articles by this author , David ReubenDavid Reuben More articles by this author , Jennifer SingerJennifer Singer More articles by this author , Ming Tai-SealeMing Tai-Seale More articles by this author , Florin VaidaFlorin Vaida More articles by this author , Katherine WardKatherine Ward More articles by this author , Neil WengerNeil Wenger More articles by this author , Tajnoos YazdanyTajnoos Yazdany More articles by this author , Xi ZhuXi Zhu More articles by this author , and Jennifer AngerJennifer Anger More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003340.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Low rates of recruitment pose significant barriers to the success of trials and can lead to incomplete trials, insufficient power, and inconclusive results. There is limited literature on strategies to recruit providers for studies evaluating practice-based interventions. We sought to identify barriers to recruitment of primary care (PC) providers and improve enrollment for an office-based urinary incontinence (UI) intervention. METHODS: The intervention consists of a combination of academic detailing, clinical decision support, co-management with a dedicated advanced practice provider, and implementation of an e-consult referral service, in which referrals lacking appropriate primary UI care are returned. The recruitment goal of the study is to enroll 225 providers, across 60 primary care offices within 4 Southern California medical groups. Recruitment barriers were identified based on clinician and PC leadership feedback. RESULTS: Between February and October 2022, meetings were held between study investigators and PC leadership at each site to identify eligible PC offices. Offices were excluded for intrinsic and extrinsic factors incompatible with the study design including lack of integration with the electronic medical record environment and transitioning clinical leadership. Eligible offices were contacted and asked to participate. Providers cited time constraints, prioritization of other medical issues during the visit, discomfort providing UI counsel or initiating UI medications, and concerns of increased clinic burden as barriers to enrollment. Strategies that improved provider buy-in included PC leadership emphasizing the implementation of Medicare 5 Star metrics for UI as the future of standard clinical care, investigators integrating provider feedback into the design of the intervention, and emphasizing study interventions that could reduce clinical burden. With these strategies, 61 offices across the 4 sites agreed to participate. CONCLUSIONS: Lower than expected recruitment rates threaten the success of a clinical trial. Early identification of potential barriers and involvement of PC leadership in intervention design and office selection can improve recruitment rates and lead to high-quality practice-based intervention trials. Source of Funding: Funded by the Agency of Healthcare Research and Quality. Project 1U18HS028740 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1026 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kyle Okamuro More articles by this author Catherine Bresee More articles by this author Isabella Dolendo More articles by this author Karyn Eilber More articles by this author Ramy Eskander More articles by this author Tamara Grisales More articles by this author Jejo Koola More articles by this author Allison Mays More articles by this author Carmen Mendez More articles by this author Marlene Millen More articles by this author Teryl Nuckols More articles by this author Joshua Pevnick More articles by this author David Reuben More articles by this author Jennifer Singer More articles by this author Ming Tai-Seale More articles by this author Florin Vaida More articles by this author Katherine Ward More articles by this author Neil Wenger More articles by this author Tajnoos Yazdany More articles by this author Xi Zhu More articles by this author Jennifer Anger More articles by this author Expand All Advertisement PDF downloadLoading ...

Self-efficacy: A key coaching consideration for primary care

Self-efficacy can provide the foundation for motivation, wellbeing and personal accomplishment. Darren Leech explains how coaching for self-efficacy could be relevant for primary care leaders working at practice, ‘place’ and system level in today's NHS

Implementing social interventions in primary care in Canada: A qualitative exploration of lessons learned from leaders in the field.

Primary health care providers and practices are increasingly instituting direct interventions into social determinants of health and health inequities, but experiences of the leaders in these initiatives remain largely unexamined. Sixteen semi-structured interviews with Canadian primary care leaders in developing and implementing social interventions were conducted to assess barriers, keys to success, and lessons learned from their work. Participants focused on practical approaches to establishing and maintaining social intervention programs and our analysis pointed to six major themes. A deep understanding of community needs, through data and client stories, forms a foundation for program development. Improving access to care is essential to ensuring programs reach those most marginalized. Client care spaces must be made safe as a first step to engagement. Intervention programs are strengthened by the involvement of patients, community members, health team staff, and partner agencies in their design. The impact and sustainability of these programs is enhanced by implementation partnerships with community members, community organizations, health team members, and government. Health providers and teams are more likely to assimilate simple, practical tools into practice. Finally, institutional change is key to establishing successful programs. Creativity, persistence, partnership, a deep understanding of community and individual social needs, and a willingness to overcome barriers underlie the implementation of successful social intervention programs in primary health care settings.

The Impact of Work Stress on Doctor’s Performance through Employee Engagement and Moderation of the COVID-19 Pandemic (Study on Primary Health Care)

BACKGROUND: Doctors at primary health care are prone to have work stress and it can affect their performance. Employee engagement may have close relationship with the doctor’s performance during the COVID-19 pandemic. AIM: This study aims to determine the relationship between work stress and the doctor’s performance at primary health care using employee engagement mediation and COVID-19 pandemic moderation. METHODS: This research is a descriptive study using a quantitative approach which was conducted on 354 doctors at Malang primary health care. The questionnaire was analyzed using partial least square. RESULTS: The work stress had a significant positive effect on the doctor’s performances (β = 0.257, t-stat = 3.324). Work stress has a significant positive effect on employee engagement (β = 0.726, t-stat = 22,967). Employee engagement does not significantly affect the doctor’s performance (β = 0.044, t-stat 0.105). Employee engagement does not mediate the work stress effect on doctor’s performance (β = 0.032, t-stat = 0.105). The COVID-19 pandemic did not moderate the work stress effect on doctors’ performance (β = −0.222, t-stat = 0.981). CONCLUSION: Primary health care leaders still need to pay attention to factors that can reduce the doctor’s performance and employee engagement, include factors that can increase the work stress during the COVID-19 Pandemic.

Developing Leadership in a Time of Transformation.

The recently released National Academies of Sciences, Engineering, and Medicine report counts development of strong and coordinated primary care leadership among the 7 critical facilitators required for the United States to succeed in Implementing High-Quality Primary Care .[1][1] The results of