Exploring a process-oriented way of working: a case study involving primary and specialised care

Background: Health care organisations have a long history of dividing work and tasks into decentralised functions and units by forming divisions and departments with delegated power. New ways of working, such as process-oriented approaches, have been called for to address challenges such as staffing shortages and resource constraints. There is limited understanding of the interplays that will occur in health care organisations during a shift from a traditional decentralised structure to a process-oriented approach. This study aims to explore the perceptions of health care staff and leaders when introducing a process-oriented routine. Method: We conducted interviews and focus groups with 29 participants in specialised and primary care in order to explore their experiences of a newly introduced routine regarding on-demand consultation, aimed at enhancing communication and patient coordination in a Swedish health care region. The participants included operating managers, schedulers and physicians. Data were analysed using reflexive thematic analysis in accordance with Braun & Clark’s guidance. Results: The findings encompass three main themes when introducing a process-oriented routine: Creates a readiness to act, The critical role of trust for adopting on-demand consultation in everyday practice and Challenges associated with transformation. The results show that health care staff and leaders are positive about the new way of working, but the readiness to act is challenged by issues of trust, as well as cultural components and structural factors such as experienced resource constraints. Conclusion: Our results underscore the need to consider not only organisational aspects but also social and individual relational factors when introducing a process-oriented way of work into a decentralised and complex health care system.