Informal task shifting and patient safety

A qualitative study of experiences among general practitioners in Norway

Planned and formalized task shifting between different levels of health care is nationally and internationally a relevant and legitimate strategy for development of health care, often motivated by cost-effective utilization of professional resourcves. The Coordination Reform (2012) increased general practitioners (GPs’) responsibilities in many ways, often without knowledgebased documentation and formal decisions. There are several indications that this trend may have lead to an extensive, unformal task shifting towards GPs, probably constituting an important causal factor for the current crisis among GPs in Norway. Several GPs describe how such tasks from time to time also may impose risks on patient safety, while research knowledge about such challenges are lacking.

The points of departure for this project are different types of task shifting perceived by GPs as challenges for appropriate professional practice. We discuss potential causal mechanisms and consequences and consider preconditions for formalized and adequate task shifting corresponding with the professional competence and structural framework of the GPs necessary to accomodate patient security.

In a qualitative study we explore such experiences among GPs in Norway in a convenience sample of openended written texts from a Facebook group for GPs. Data will be analyzed with systematic text condensation, a methor for thematic, crosscase analysis. Analysis will emphasize issues that may contribute to concrete quality improvement locally and nationally.

Project team: Kirsti Malterud - project leader (NORCE), GP/senior researcher Ph.D. Anette Fosse (Norwegian Centre of Rural Medicine, Tromsø, Norway) and assistant county medical officer Ph.D. Aase Aamland (Health, Care and Social Services, County Governor of Agder, Arendal, Norway).