Introducing medical assistants into Australian general practices: understanding receptivity and normalisation influences

Increasing demand for health care services combined with a health workforce that is maldistributed, often underutilised and facing shortages in critical professions has resulted in a sustainability problem for Australiaâs health system.This research describes and evaluates the introduction of a medical assistant role and nationally recognised qualification into the Australian health care workforce from its conception through to the early years of course delivery and role integration into general practices in Queensland, South Australia and New South Wales.The aim of the research was to explore three questions: (a) what are the contextual elements in the Australian general practice sector that have the greatest influence on receptivity to the introduction of medical assistants, (b) beyond receptivity to change, what other contextual factors most strongly influence the normalisation of medical assisting within the primary care system, and (c) does an appreciation of these forces add to existing theoretical models and provide a stronger basis for understanding the likelihood of success of an intervention in a complex system.Using a mixed-methods approach, 198 participants were involved in interviews and surveys, including medical assistants, GPs, practice managers, practice nurses, receptionists and patients. The experiences of the researcher in the development of the medical assisting role and training program are described as part of this study.A new Receptivity and Normalisation Influences (RNI) model was developed using a grounded theory approach to data analysis.When applied to the medical assisting intervention, the RNI model illustrates the elements contributing to the strongly receptive individual and organisational contexts within participating general practices, but also highlights the neutral and opposing forces at the sector and macro levels that, unless addressed, may prevent the normalisation, and therefore long-term sustainability, of the medical assisting role in Australia.The RNI model may be generalisable beyond the medical assisting intervention. The model has elements in common with diffusion of innovations theory and with normalisation process theory, but is unique in its explanation of the relative importance and roles of different contexts in influencing initial adoption decisions (receptivity) versus influencing the ability of an innovation to become sustainably embedded in a system (normalisation)