Less is More in Primary Health Care Doctoral Candidate, Sanne Lykke Lundstrøm Project in cooperation between -DTU Management Engineering, Technical University of Denmark -Research Unit of General practice, University of Copenhagen -Research Unit of General practice, University at Southern Denmark

2DTU Management, Danmarks Tekniske Universitet General Practice in Denmark The Danish welfare system with universal access to health care is build around the primary health care All Danish residents have free and direct access to general practitioners (GPs) This gatekeeping system essentially is designed to support the principle that treatment ought to take place at the lowest effective care level along with the idea of continuity of care provided by a family doctor General practices have been able to adapt and position them as an important part of the Danish health care system by providing cost-efficient, first-line services and careful gatekeeping

3DTU Management, Danmarks Tekniske Universitet General practice are facing big challenges Quality of treatment have showed significant variation in general practice The patient load are getting bigger due to a growing elderly population and a decreasing number of GPs The number of patients with chronic diseases are growing in general practice Patients who earlier were treated in the secondary sector are now being moved to general practice for treatment and monitoring e.g. patients with diabetic, COPD…

4DTU Management, Danmarks Tekniske Universitet Relational Coordination Shared goals Shared knowledge Mutual respect Frequent communication Timely communication Problem-solving communication

5DTU Management, Danmarks Tekniske Universitet Organisational Social Capital Justice Cooperation Trust

6DTU Management, Danmarks Tekniske Universitet Aim of this study To measure levels of relational coordination and organisational social capital in the Danish general practice To examine if high relational coordination and/or relational coordination is correlated with characteristics of general practice.

7DTU Management, Danmarks Tekniske Universitet Questionnaire Relational coordination: –7 items –7 dimensions Social capital: –11 items –4 dimension: Vertical trust, Horizontal trust Justice cooperation skills Background information: –Profession –Full time – part time –Gender –Years in general practice

8DTU Management, Danmarks Tekniske Universitet Data collection ProfessionAntal Doctor – owner 1127 Doctor - employee 801 Secretary674 Nurse253 Technician63 Others75 Didn’t check the box 36

Præsentationens navn9DTU Management, Danmarks Tekniske Universitet Results The practice form were highly significant for the rating of organisational social capital and relational coordination. Single-handed practices had the highest rating of social capital and relational coordination; –partnership had the lowest Practices with a higher patient to employee ratio had higher relational coordination. Geography location, gender and age were not significant for the rating of organisational social capital or relational coordination

10DTU Management, Danmarks Tekniske Universitet Are we building a better or worse general practice? There is a general move towards larger practices from both a political side as well as from healthcare professionals, in particular physicians In order for larger general practices to fully utilise the resources available to them, they need to make coordination and communication a priority Earlier studies shows that relational coordination is associated with high quality of treatment and organisational social capital is associated with job satisfaction and low turnover. We need to reconsider if fewer, but larger general practice are the right way to handle the increasing demand on general practice due to the growing and ageing population.

11DTU Management, Danmarks Tekniske Universitet Thank you for your attention