What Are the Factors Influencing Implementation of Advanced Access in Family Medicine Units? A Cross-Case Comparison of Four Early Adopters in Quebec

Table 4

A distribution of the themes across the four family medicine units.

	Influencing factors
Themes-subthemes	FMU 1	FMU 2	FMU 3	FMU 4
Structural level
Training (FMOQ, other)	+	+	+	+
(i) Better understanding of the philosophy of advanced access matching supply to demand
(ii) Dissemination of knowledge to team members
Physicians’ practice and rotations in multiple clinical settings
(i) Lack of availability of providers
(ii) Decreased capacity to meet patients’ needs
Organizational level
Collective leadership	+			+
(i) Presence of a local champion and collective approach to change
(ii) Training and coaching of all team members
(iii) Communication strategy and regular feedback
(iv) Coconstruction of tools
(v) Team development of an adjustment strategy for resolving problems encountered
(vi) Ongoing staff motivation
Resources
(i) Insufficient numbers of family physicians and nurses
(ii) Insufficient number of clerical staff members
(iii) Lack of adequately trained professionals: physicians, nurses, clerical staff
(iv) High turnover of clerical staff
(v) Technology resources: dysfunctional computer system
Formalized tool
(i) Clarifies role
(ii) Facilitates assessment of the request and referral to the appropriate professional
Management capacity
(i) Lack of decision-making power: selecting, recruiting clerical staff, technology resources, allocation of financial resources
Openness to change	+	+		+
(i) Nursing skill development
(ii) Reorganizing and improving practice and access
(iii) Exchanging expertise and interprofessional practice
Professional level
Attitudes of resistance at the initial phase (physicians)
(i) Misunderstanding/erroneous understanding of the concept advanced access
(ii) Not being convinced about its usefulness
(iii) Fear of loss of patients
(iv) Lack of regular availability at the clinic
Patient level
Culture, habits
(i) Patients’ responsibility for booking appointments and follow-ups
(ii) Annual physical exam
(iii) Patient habits (elderly patients used to book appointments in advance)
(iv) Consulting a family physician versus going to emergency room
(v) Follow-up visits with the nurse instead of the physician

FMU = family medicine unit; FMOQ = Quebec’s Federation of General Practitioners; factors that positively influence implementation (facilitator) = +; factors that negatively influence implementation (barrier) = −; factor that still is in its development stage = .