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01.12.2016 | Research article | Ausgabe 1/2016 Open Access

BMC Health Services Research 1/2016

‘It just has to click’: Internists’ views of: what constitutes productive interactions with chronically ill patients

Zeitschrift:
BMC Health Services Research > Ausgabe 1/2016
Autoren:
N. M. H. Kromme, C. T. B. Ahaus, R. O. B. Gans, H. B. M. van de Wiel
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12913-016-1430-6) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

The manuscript was drafted by NK. The other authors, KA, RG and HvdW, provided critical feedback on all drafts. NK carried out the interviews. NK and KA were engaged in testing, discussing and adapting the code list developed by NK. All authors, NK, KA, RG and HvdW, extensively discussed the findings with each other and read and approved the final manuscript.

Abstract

Background

According to the Chronic Care Model, productive interactions are crucial to patient outcomes. Despite productive interactions being at the heart of the Model, however, it is unclear what constitutes such an interaction. The aim of this study was to gain a better understanding of physician views of productive interactions with the chronically ill.

Method

We conducted a qualitative study and interviewed 20 internists working in an academic hospital. The data were analyzed using a constructivist approach of grounded theory. To categorize the data, a coding process within which a code list was developed and tested with two other coders was conducted.

Results

The participants engaged in goal-directed reasoning when reflecting on productive interactions. This resulted in the identification of four goal orientations: (a) health outcome; (b) satisfaction; (c) medical process; and (d) collaboration. Collaboration appeared to be conditional for reaching medical process goals and ultimately health outcome and satisfaction goals. Achieving rapport with the patient (‘clicking,’ in the term of the participants) was found to be a key condition that catalyzed collaboration goals. Clicking appeared to be seen as a somewhat unpredictable phenomenon that might or might not emerge, which one had to accept and work with. Goal orientations were found to be related to the specific medical context (i.e., a participant’s subspecialty and the nature of a patient’s complaint).

Conclusions

The participants viewed a productive interaction as essentially goal-directed, catalyzed by the two parties clicking, and dependent on the nature of a patient’s complaint. Using the findings, we developed a conceptual process model with the four goal orientations as wheels and with clicking in the center as a flywheel. Because clicking was viewed as important, but somewhat unpredictable, teaching physicians how to click, while taking account of the medical context, may warrant greater attention.
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