Never has it been so pivotal to strengthen primary care delivery, in order to prevent overload in hospitals.
One of Cambridge Judge Business School’s PhD students, Harshita Kajaria-Montag, works together with faculty member Professor Stefan Scholtes and primary care provider Granta Medical Practices to understand managerial and organisational issues hampering primary care and develops recommendations to overcome them. We talked to Harshita to ask her how her collaborative project came to be and what happened because of it.
Why did you decide to engage with Granta Medical Practice?
As I began my PhD, my supervisor, Stefan Scholtes, was starting talks with Granta Medical Practice to do a collaborative project to improve their organisational practices. He told me about it, and I decided to tag along to some meetings he was having with them, to see if an interesting research project might come out of it. As soon as I did that, I knew I wanted to work with them. I was fascinated by their drive, their desire to change and to improve. I have kept working with Granta Medical Practice, now for around three years, and they are a very valuable collaborator.
What was the project with Granta Medical Practice about?
We did not know what our research question would be when we started. Both Stefan and I attended meetings, read briefings, and I shadowed some of their employees in different functions. Additionally, I performed data analysis to understand their operations. Through these interactions we realised that long-term relationships with patients are the key asset of primary care. Like all GP practices, Granta is struggling to maintain the individual connection between one doctor and one patient, known as continuity. But why? And which types of patients are most at risk of adverse consequences? Without understanding the root-causes of the drop in care continuity and the most affected patient segments it is difficult to devise effective treatments to improve it. We decided that the best way to help the practice and the wider GP community was to understand these factors through a longitudinal study, involving many practices. It took us a year to obtain a database fit for purpose but when we finally got it, with data on 400 UK primary care providers, it was great to know we had enough data to work with and to help primary care providers to understand better what they could do to solve this issue.
What was the advantage of doing a collaborative project?
For me, it was amazing to get access to such a wealth of research questions and to know that the findings of my work could lead to recommendations that would be implemented. We often ask the doctors at Granta for medical input on projects. Having this direct line with doctors increases my credibility when I present at conferences and makes my work and hypotheses stronger, because they are supported by those living the problem. For Granta Medical Practice, I think the main benefit is having someone with the chance to look at the problems they are facing from an external and broader perspective. They are all doctors, and they don’t have enough resources or time to understand organisational problems or to do the required data analysis to produce evidence. Our work is enabling them to understand better what is going on with care continuity and to come up with evidence-based initiatives to improve the situation.
What were the findings?
We found that hiring policies and turnover were key causes of worsening care continuity. Increasingly, primary care practices hire temporary doctors, working as freelancers and called on an ad-hoc basis. Even doctors that are permanent employees are shifting increasingly to part time work. This is because doctors are not happy with the work, they feel stressed, burned-out, fatigued, so they prefer to work less hours. What is exciting is that Granta Medical Practice is now trialing new structures to incentivise more of their doctors to work full time. It will be interesting to see if this will make a difference.
Any advice for PhD students?
It is worth collaborating with organisations on the ground, especially as PhD students at a business school. If you are analysing organisational practices, you have to speak to practitioners in order to develop credible and meaningful research. Knowing that other people are excited about what you are doing can also keep you motivated in the face of challenges. I also think it is important to highlight, when you are approaching potential collaborators, that you are not asking for compensation and that you are there to help them. If you make a quick useful contribution, then this will open doors. Once you engage with them, you will always have the chance to select research questions that are helpful both to them and to you. Any collaboration always needs to be two-sided.
Harshita hopes to continue to maintain her relationship with the practice and keep researching other organisational issues faced by primary care providers. Thanks to this project, she now has access to a unique database that can be used to improve healthcare delivery through changing organisational practices and there is plenty that she wants to look at. Her hope, one day, is that her findings will not only inform practices at the organisational level, but also support policy makers in finding the best ways to strengthen healthcare delivery at a regional and national level.