How do General Practitioners Handle Complexities? A Team Ethnographic Study in Japan

Abstract BackgroundGeneral practitioners (GPs) commonly deal with complexities, such as patients with socio-economic-medical problems. However, the methods they use to approach these complexities are still not understood. We speculated that elucidating these methods in terms of complex adaptive systems (CAS) to comprehensively assess GPs’ daily activities would contribute to improving the professional development of GPs. This study aimed to clarify the approaches adopted by GPs in Japan to handle complexities in their daily activities and examine them in terms of CAS extracted from GPs and other healthcare professionals.MethodsWe adopted interdisciplinary team-ethnographic research. Five hospitals and four clinics in Japan, selected by purposive sampling based on the presence of expert GPs. 62 individuals of various backgrounds working in five hospitals and four clinics were interviewed. Using field notes and interview data, the researchers iteratively discussed the adequacy of our interpretations. The first author (JH) prepared a draft report, which was reviewed by the GPs at the participating facilities. Through critical and iterative consideration of the different insights obtained, the final findings emerged together with representative data.ResultsWe identified four approaches used by GPs to deal with complexities. First, GPs treat patients with complex problems as a whole being and address their problems multi-directionally. Second, GPs build horizontal, trusting relationships with other healthcare professionals and stakeholders, and thereby reduce the degree of complexity of problems. Third, GPs change the learning climate while committing to their own growth based on societal needs and by acting as role models for other professionals through daily interpersonal facilitation. Fourth, GPs share community values with multi-professionals and thereby act as a driving force for organizational change. These various interactions among GPs, healthcare professionals, organizations and communities resulted in systematization of the healthcare and welfare network in their community. ConclusionsExpert GPs developed interconnected multidimensional systems in their community health and welfare networks to adapt to fluctuating social realities using four approaches. GPs’ work environment may be considered as a complex adaptive system (CAS) and the approach of GPs to complexities is CAS-based. Our findings are expected to have practical applications for GPs.