Introduction Enhancing quality and safety in primary health systems is of central importance to funders, practitioners, policy makers and consumers. In this paper we explore the roles of general practice nurses in relation to quality and safety. Method Cross-sectional multimethod study of 25 Australian general practices. Using rapid appraisal we collected data for each practice from interviews with practice nurses, general practitioners andpractice managers; photographs of nurse-identified ‘keyworkspaces’; structured observation of nurses for two one-hour sessions; and floor plans. Results Quality was articulated in two domains, reflecting both external and intrinsic determinants. External determinants included a large number of essentially structural, procedural or regulatory processes, the most marked of these being practice accreditation and occupational health and safety; these corresponded to the Habermasian idea of system. Intrinsic determinants related mostly to nurse perception of their own quality behaviour, and consisted of ways and means to improve or optimise patient care; these correspond to Habermas’ notion of the lifeworld. Discussion Nurses describe a productive tension between the regulatory roles that they play in general practices, and patient-focused care, contrary to Habermas’ suggestion that system subsumes lifeworld. Current funding systems often fail to recognize the importance of the particular elements of nurse contributions to quality and safety in primary care.
Christopher Pearce, Christine Phillips, Sally Hall, Bonnie Sibbald, Julie Porritt, Rachel Yates, Kathryn Dwan, Marjan Kljakovic