Exploring family physicians' experiences of engagement in primary-health-care reform: Implications for health leaders

Primary-care renewal in Canada has been the focus of health reform for both federal and the provincial governments since the mid-1990s. Progress toward a health system with a strong primary-health-care foundation has been slow despite the support of governments and medical associations. The mixed method study sought to answer fundamental questions about family physicians understanding of their roles in the current and future health system, and their experiences of engagement in primary-care reform. Specifically, the study sought to answer the question as to whether Kahn's (1990) mediating factors of meaningfulness; safety; and availability were reflected in participant descriptions of engagement. Conversations with family physicians in Phase I of the study yielded significant insights into the participants' lived experiences of health system change, and the attractors to Family Practice. Relationships between the participants' lived experiences of engagement and the mediating psychological factors of meaningfulness, safety and availability, as depicted by Kahn's concept of engagement were clearly demonstrated. Phase II survey results provided support for the constructs of "meaningfulness" and "safety;" limited support for the construct of "availability;" and limited support for the correlation between the three constructs and "engagement at work." Further research is indicated in this area. Of note was difficulty in engaging physicians in the study, the participant's lack of understanding as to the true purpose of primary-care reform, the physician role within PCNs, the benefits of PCNs to patients, and the impact of PCNs on patient outcomes