Remaking Practices in the Redesign of a Primary Healthcare Program

Abstract

Objective: To develop a detailed account of changed practices in everyday work in the redesign of a primary healthcare program.

Design: The research aimed to produce layered and rich descriptions of the complex and multidimensional remaking of health practices. Empirical data was gathered through ethnographic methods including; interviewing, self-reporting, observation and shadowing. The subjects of the research were involved as active participants in the research design, data gathering and analysis.

Setting: HealthOne was a New South Wales government attempt to provide a local and responsive model to improve chronic disease management in primary and community healthcare settings. We report specifically on the HealthOne program implemented in a suburb of Western Sydney.

Main outcome measures: The research did not aim to evaluate the program but to uncover instances of professional learning though identifying changes in professional practice. These were noted and observed by the researchers and research participants or through reflexive conversations with the program planners, healthcare workers and the research team.

Results: Drawing on the work of a number of learning and practice-based theory writers, particularly those using a socio-material approach, we describe how practice change has occurred and how work practices
have been remade at this site - especially in the role of the General Practice Liaison Nurse (GPLN).

Conclusions: The research demonstrated the potential for new categories and practices of health work to emerge; this was especially seen in the work of the GPLN but also extended to new ways of working through General Practitioners and community health networks.

Abbreviations: GP – General Practitioner; GPLN – General Practice Liaison Nurse.