Make it happen and make it matter : implementation and impact of primary healthcare-academia partnerships

Abstract: Introduction: Most patients’ health problems are initially managed within primary healthcare. Increasingly, current reforms in healthcare emphasize the important role of primary healthcare in the healthcare system. Therefore, improvement becomes particularly important in this setting. One improvement strategy that has received increased attention recently is that healthcare professionals and academics should work in closer collaboration. However, few empirical studies report findings on how to implement such collaborations or report on their achievements. Aim: The aim of this thesis is to increase knowledge about the implementation and impact of healthcare-academia partnership initiatives and why those impacts happen. Methods: A qualitative research approach was used with an exploratory case study research design. Data was acquired in semi-structured, in-depth, individual interviews with those responsible for the implementation (all managers and coordinators) at eight coordinating centres of an academic primary healthcare initiative. The initiative covers approximately 500 primary healthcare services in central Sweden. Three interview rounds from 2013 to 2017 were conducted. Data was also collected through analysis of policy document. Findings: The findings show that the implementation of the partnership initiative seemed guided by how the implementation was supported (e.g. committed time, resources, competence, and facilitation), the possibilities to engage in partnerships while delivering ordinary care services, how partnerships and its parts were understood, as well how partnerships respond to practice needs in a timely way. The impact was found as focus on students’ clinical training, limited research and network activities, changes in work conditions, students and research as more natural parts of care practice, as well as increased attention to improvement of care quality, mainly at the coordinating centres. Conclusions: Primary healthcare practice and academia can be regarded as natural partners in developing research and education to improve care practice. However, establishment of such partnerships is not an easy or linear process. In contrast, their creation is characterised by uncertainty not only about where to start, but also about the impact of different courses of action. Partnerships are complex undertakings that need to be carefully managed. If not, promising partnership initiatives may fail, and even contribute to unwanted impacts. By making partnerships happen and matter in practice, trust and interest in research and education can increase, which, in the long run, will help close the gap between practice and academia and contribute to improve care practice.