Leading primary care under the weight of COVID-19: how leadership was enacted in six australian general practices during 2020

Kathleen Wisbey; Riki Lane; Jennifer Neil; Jenny Advocat; Karyn Alexander; Benjamin F. Crabtree; William L. Miller; Grant Russell

doi:10.1071/PY23045

RESEARCH ARTICLE (Open Access)

Previous Next Contents Vol 30(1)

Leading primary care under the weight of COVID-19: how leadership was enacted in six australian general practices during 2020

Kathleen Wisbey

^A , Riki Lane

^A , Jennifer Neil ^A , Jenny Advocat

^B , Karyn Alexander ^A , Benjamin F. Crabtree

^C , William L. Miller ^D and Grant Russell

^A ^*

+ Author Affiliations

- Author Affiliations

^A Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne Vic., Australia.

^B School of Primary and Allied Health Care, Monash University, Melbourne, Vic., Australia.

^C Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Jersey, NJ, USA.

^D Department of Family Medicine, Lehigh Valley Health Network, Allentown, PA, USA.

^* Correspondence to: grant.russell@monash.edu

Australian Journal of Primary Health 30, PY23045 https://doi.org/10.1071/PY23045

Submitted: 3 March 2023 Accepted: 21 December 2023 Published: 19 January 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of La Trobe University. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Background

The COVID-19 pandemic challenged health care delivery globally, providing unique challenges to primary care. Australia’s primary healthcare system (primarily general practices) was integral to the response. COVID-19 tested the ability of primary health care to respond to the greater urgency and magnitude than previous pandemics. Early reflections highlighted the critical role of leaders in helping organisations negotiate the pandemic’s consequences. This study explores how general practice leadership was enacted during 2020, highlighting how leadership attributes were implemented to support practice teams.

Methodology

We performed secondary analysis on data from a participatory prospective qualitative case study involving six general practices in Melbourne, Victoria, between April 2020 and February 2021. The initial coding template based on Miller et al.’s relationship-centred model informed a reflexive thematic approach to data re-analysis, focused on leadership. Our interpretation was informed by Crabtree et al.’s leadership model.

Results

All practices realigned clinical and organisational routines in the early months of the pandemic – hierarchical leadership styles often allowing rapid early responses. Yet power imbalances and exclusive communication channels at times left practice members feeling isolated. Positive team morale and interdisciplinary teamwork influenced practices’ ability to foster emergent leaders. However, emergence of leaders generally represented an inherent ‘need’ for authoritative figures in the crisis, rather than deliberate fostering of leadership.

Conclusion

This study demonstrates the importance of collaborative leadership during crises while highlighting areas for better preparedness. Promoting interdisciplinary communication and implementing formal leadership training in crisis management in the general practice setting is crucial for future pandemics.

Keywords: community health care, delivery of health care, delivery of health care: integrated, health care disparities, organisation: culture, patient care: management, patient care: team, patient-centred care, physicians’ practice patterns, primary health care.

References

Balasubramanian BA, Chase SM, Nutting PA, Cohen DJ, Strickland PAO, Crosson JC, Miller WL, Crabtree BF, the ULTRA Study Team (2010) Using learning teams for reflective adaptation (ULTRA): insights from a team-based change management strategy in primary care. Annals of Family Medicine 8, 425-432.
| Crossref | Google Scholar | PubMed |

Becker MC (2004) Organizational routines: a review of the literature. Industrial and Corporate Change 13(4), 643-678.
| Crossref | Google Scholar |

Boroujeni M, Saberian M, Li J (2021) Environmental impacts of COVID-19 on Victoria, Australia, witnessed two waves of Coronavirus. Environmental Science and Pollution Research 28, 14182-14191.
| Crossref | Google Scholar | PubMed |

Braithwaite J, Tran Y, Ellis LA, Westbrook J (2021) The 40 health systems, COVID-19 (40HS, C-19) study. International Journal for Quality in Health Care 33, mzaa113.
| Crossref | Google Scholar |

Braun V, Clarke V (2006) Using thematic analysis in psychology. Qualitative Research in Psychology 3, 77-101.
| Crossref | Google Scholar |

Crabtree BF, Howard J, Miller WL, Cromp D, Hsu C, Coleman K, Austin B, Flinter M, Tuzzio L, Wagner EH (2020) Leading innovative practice: leadership attributes in LEAP practices. Milbank Q 98, 399-445.
| Crossref | Google Scholar | PubMed |

Desborough J, Dykgraaf SH, Phillips C, Wright M, Maddox R, Davis S, Kidd M (2021) Lessons for the global primary care response to COVID-19: a rapid review of evidence from past epidemics. Family Practice 38, 811-825.
| Crossref | Google Scholar | PubMed |

Donahue KE, Halladay JR, Wise A, Reiter K, Lee SY, Ward K, Mitchell M, Qaqish B (2013) Facilitators of transforming primary care: a look under the hood at practice leadership. Annals of Family Medicine 11(Suppl 1), S27-S33.
| Crossref | Google Scholar | PubMed |

Edmondson AC (2003) Speaking up in the operating room: how team leaders promote learning in interdisciplinary action teams. Journal of Management Studies 40, 1419-1452.
| Crossref | Google Scholar |

Edwards S, Gordon L, Guzman CEV, Tuepker A, Park B (2022) Perspectives of primary care leaders on the challenges and opportunities of leading through the COVID-19 pandemic. The Annals of Family Medicine 20, 2891.
| Crossref | Google Scholar |

Fineman S (2000) ‘Emotion in organizations.’ (Sage Publications: London; Thousand Oaks, Calif)

Finlayson M, Sheridan N, Cumming J (2009) Nursing developments in PHC 2001-07, Health Services Research Centre, Victoria University of Wellington, New Zealand. Available at http://www.victoria.ac.nz/hsrc/reports/previous-reports_2009.aspx

Gale NK, Heath G, Cameron E, Rashid S, Redwood S (2013) Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Medical Research Methodology 13(1), 117.
| Crossref | Google Scholar |

Geerts JM, Kinnair D, Taheri P, Abraham A, Ahn J, Atun R, Barberia L, Best NJ, Dandona R, Dhahri AA, Emilsson L, Free JR, Gardam M, Geerts WH, Ihekweazu C, Johnson S, Kooijman A, Lafontaine AT, Leshem E, Lidstone-Jones C, Loh E, Lyons O, Neel KAF, Nyasulu PS, Razum O, Sabourin H, Schleifer Taylor J, Sharifi H, Stergiopoulos V, Sutton B, Wu Z, Bilodeau M (2021) Guidance for health care leaders during the recovery stage of the COVID-19 pandemic: a consensus statement. JAMA Network Open 4, e2120295.
| Crossref | Google Scholar | PubMed |

King N (2012) Doing template analysis. In ‘Qualitative organizational research: core methods and current challenges’. (Eds G Symon, C Cassell) pp. 426–450. (Sage)

Kippen R, O’Sullivan B, Hickson H, Leach M, Wallace G (2020) A national survey of COVID-19 challenges, responses and effects in Australian general practice. Australian Journal of General Practice 49, 745-751.
| Crossref | Google Scholar | PubMed |

Lane R, Russell G, Bardoel EA, Advocat J, Zwar N, Davies PGP, Harris MF (2017) When colocation is not enough: a case study of General Practitioner Super Clinics in Australia. Australian Journal of Primary Health 23, 107-113.
| Crossref | Google Scholar |

Levesque JF, Harris MF, Scott C, et al. (2018) Dimensions and intensity of inter-professional teamwork in primary care: evidence from five international jurisdictions. Family Practice 35(3), 285-294.
| Crossref | Google Scholar | PubMed |

McInnes S, Peters K, Bonney A, Halcomb E (2015) An integrative review of facilitators and barriers influencing collaboration and teamwork between general practitioners and nurses working in general practice. Journal of Advanced Nursing 71, 1973-1985.
| Crossref | Google Scholar | PubMed |

Miller WL, Crabtree BF, Nutting PA, Stange KC, Jaén CR (2010) Primary care practice development: a relationship-centered approach. Annals of Family Medicine 8, S68-S79.
| Crossref | Google Scholar | PubMed |

Moel-Mandel C, Sundararajan V (2021) The impact of practice size and ownership on general practice care in Australia. Medical Journal of Australia 214, 408-410.e1.
| Crossref | Google Scholar |

Patton MQ (2002) ‘Qualitative research and evaluation methods.’ (Sage Publications: Thousand Oaks, CA, USA)

Plsek PE, Wilson T (2001) Complexity, leadership, and management in healthcare organisations. BMJ 323(7315), 746-749.
| Crossref | Google Scholar | PubMed |

QSR International Pty Ltd (2018) ‘NVivo qualitative data analysis software. Version 12.’ (QSR International Pty Ltd)

Rogers L, De Brún A, Birken SA, Davies C, McAuliffe E (2020) The micropolitics of implementation; a qualitative study exploring the impact of power, authority, and influence when implementing change in healthcare teams. BMC Health Services Research 20, 1059.
| Crossref | Google Scholar | PubMed |

Russell G, Advocat J, Geneau R, Farrell B, Thille P, Ward N, Evans S (2012) Examining organizational change in primary care practices: experiences from using ethnographic methods. Family Practice 29, 455-461.
| Crossref | Google Scholar | PubMed |

Russell G, Advocat J, Lane R, et al. (2021) How do general practices respond to a pandemic? Protocol for a prospective qualitative study of six Australian practices. BMJ Open 11(9), e046086.
| Crossref | Google Scholar | PubMed |

Russell G, Lane R, Neil J, et al. (2023) At the edge of chaos: a prospective multiple case study in Australian general practices adapting to COVID-19. BMJ Open 13(1), e064266.
| Crossref | Google Scholar | PubMed |

Standiford TC, Davuluri K, Trupiano N, Portney D, Gruppen L, Vinson AH (2021) Physician leadership during the COVID-19 pandemic: an emphasis on the team, well-being and leadership reasoning. BMJ Leader 5(1), 20-25.
| Crossref | Google Scholar |

Tong A, Sainsbury P, Craig J (2007) Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care 19, 349-357.
| Crossref | Google Scholar | PubMed |

Verhoeven V, Tsakitzidis G, Philips H, Van Royen P (2020) Impact of the COVID-19 pandemic on the core functions of primary care: will the cure be worse than the disease? A qualitative interview study in Flemish GPs. BMJ Open 10, e039674.
| Crossref | Google Scholar | PubMed |