Table 1
Concept overlap across four levels: trap doors.
| Concept groups | Analytic level | Concept | Definition |
|---|---|---|---|
| System structure and design | Policy | Policy subsystem – funding and governance | Applicable legislation, regulation, guidelines. Eligibility criteria for patients to enter the program. |
| Patient-carer | Access to services (universal coverage) | Patients have access to all basic necessary health care services when needed which are free at the point of care. Related to system level concept of university coverage captured in the Ham model. | |
| System governance | Policy | Funding and governance arrangement – all levels | How services are delivered in terms of governance structures and payment mechanisms. |
| Organization | Organizational infrastructure and design: Resources and Governance | Resources: Amount and sources of funding Governance: Board composition, activities and oversight. | |
| Organization structure and leadership | Organization | Leadership, strategy and clinician engagement | Leadership style of the organization and level to which clinicians and frontline providers are engaged in decision-making (e.g. centralized or distributed/shared, responsive approaches; receptivity to new ideas). |
| Provider | Organization of delivery system – leadership | Elements of the organization of the delivery system specifically focused on leadership and support for frontline providers. | |
| IT systems design and utilization | Organization | Organizational infrastructure and design: IT systems | Information technology systems available in and across organizations (e.g. decision support tools, electronic information systems, electronic health records, interoperability). |
| Provider | Provider use of IT system | What information technology systems (in particular clinical information systems) are used by providers in clinical practice. | |
| System level values and perspectives | Policy | Why deliver this model of care – case site level | The organizational impetus for delivering this particular model of care and the nature of the care provided. |
| Organization | Social-Psychological context: Organizational culture | The overarching focus and goals of the organization, as well as the character of the organization, managerial style and employee support and overall cohesion. Includes organizational climate concepts such as openness and flexibility in the organization, change readiness, and employee burnout/stress. | |
| Care Coordination | Policy | Delivery arrangements – case site and matrix level | Who delivers care in terms of direct care delivery (in-house staff), contracting out, partnerships, and/or referrals. |
| How services are delivered – case site and matrix level | The extent to which models use integrating/coordinating mechanisms (e.g. inter-disciplinary teams, integrated care plans, information technology used to integrate). | ||
| Organization | Teamwork and collaboration | Use of multiple modes of communication within and between teams, feelings of teamwork, cooperation, information sharing and goal alignment, staff input in decision-making. | |
| Inter-organizational linkages | Formal and informal connections made between different organizations in a network. Including connections between different teams. Focus on process of working across organizational boundaries. | ||
| Provider | Delivery system design | Team level functioning and leadership and continuity of care. | |
| Community linkages | Providers ability to link patients to outside resources and partnerships with community organizations. | ||
| Patient-carer | Care coordination | Patient and carer perceptions of level to which their care from different providers is aligned. | |
| Person-centred design | Policy | Who is targeted – case site level | Which individuals and communities are being served by the project defined in terms of their acute and chronic illness profile, their geography, culture or needs. |
| Provider | Delivery system design – population management | Adopting a systematic approach to population management, and seeking ways to meet community needs. | |
| Patient-carer | Patient and carer demographics | Information regarding patient and carer personal information (i.e. gender/sex, age), health and social status, culture and ethnicity, beliefs and values. | |
| Program design and monitoring | Policy | What services are delivered – case site level | What types of services are provided by the project. |
| Governance structure – matrix and subsystem levels | How agencies fund and oversee projects (governance and accountability arrangements). | ||
| Organization | Clinical processes | Use of clinical practice guidelines (adoption, availability and organizational support for adoption. | |
| Continuous quality improvement (CQI) | Adoption of quality improvement processes (strategies, committees, patient experience and outcome collection measures). | ||
| Provider | Types of services | Services delivered to patients and quality improvement processes. | |
| Self-management support | Services specifically around supporting self-management, assessment and documentation. | ||
| Decision-support | Use and availability of decision-support tools, enabling use of evidence based practice. | ||
| Patient-carer | Types of services used | Services used by both patients and carers. | |
| Self-management and prevention. | Reported self-management support received, as well as support for patients to engage in their care and do more self-care activities, such as engaging in goal-setting. |
Figure 1
Implementation of Integrated Community-Based Primary Health Care Concept Map.