A novel perspective of Australian primary care dietetics: Insights from an exploratory study using complex adaptive systems theory

Abstract

Aims: Effective quality improvement strategies are essential to enhancing outcomes of dietetic care. Interventions informed by complex adaptive systems theory have demonstrated effectiveness in other healthcare settings. This study aimed to explore primary care dietetics practice using complex adaptive systems theory and to identify factors that individuals across the healthcare system can examine and address to improve the quality of dietetic care.

Methods: Qualitative analysis of semi-structured interviews of healthcare consumers and professionals involved in the provision of dietetic care. Data collection and analysis was guided by a complexity-informed conceptual framework. The Framework Method was used to code transcripts and identify themes describing primary care dietetics.

Results: Twenty-three consumers and 26 primary care professionals participated. Participants described dietetic care as being delivered by individuals organised into formal and informal systems that were influenced by the wider environment, including legal, economic, and socio-cultural systems. Dietitians described interactions with consumers as a learning opportunity and sought education, mentoring, or supervision to address knowledge and skill gaps. Relationships underpinned transfer of information between individuals.

Conclusion: Complex adaptive systems theory proved to be a useful conceptual framework for primary care dietetics. Factors identified at the macro (e.g., funding), meso (e.g., professional networks), and micro (e.g., consumer education) levels should be examined and addressed to improve the quality of dietetic care.

Keywords: complex adaptive systems; primary care; private practice; qualitative research; quality of care; systems analysis.

FIGURE 1

Methods used in this study to recruit participants and collect and analyse data. All data was collected prior to analysis. Items numbered 1–7 identify the Framework Method and comprised the following steps: (1) transcription; (2) familiarisation with transcripts; (3) coding transcripts; (4) developing the analytical framework; (5) applying the analytical framework to remaining transcripts; (6) charting data into framework matrices using participants (rows) and analytical framework elements (columns); and (7) interpreting the data to identify themes. Steps 2–4 were conducted by two researchers by first coding three consumer transcripts and then three professional transcripts. These six transcripts were selected by the lead author to maximise variation in content between the transcripts. Steps 5–6 were conducted by the lead author. A matrix was created for each of the five components of the complexity‐informed conceptual framework in Step 6.

FIGURE 2

Conceptual model of primary care dietetics as a complex adaptive system derived from experiences of consumers and professionals. The inner box represents primary care dietetics while the outermost box represents other systems in the environment. The dotted line between the two illustrates that agents are simultaneously members of all systems. Within the inner box, ‘history’ represents historical factors that influence agents in the present. ‘Care teams’ and ‘healthcare organisations’ represent two types of systems to which agents belong. Healthcare organisations are the legal entities within which dietitians practice while care teams are networks of healthcare professionals who work together to provide care to consumers. These systems range in complexity and maturity. The arrows connecting ‘care teams’ and ‘healthcare organisations’ illustrate that the systems are superimposed on each other. In the middle of the box is the care process, comprising initiation, delivery, and implementation. Collaboration among agents, including healthcare professionals and the consumer, occurs throughout the care process. Relationships between agents facilitate the movement of information, and the strength of relationships dictates the level of integration and communication.