Table 2

Themes and categories emerging from a thematic analysis of a primary health care (PHC) teamwork
Themes Categories Verbatim
Structure of the PHC team Main members of a PHC team “The team probably consists of a nurse and family physician, which is the most common primary care team model.” (FG1CN)
Optional members of a PHC team “Then I would count the receptionists…” (FG1GP)
Hierarchy in PHC teams “Our duties are different, but we should all be on a line, more horizontal.” (FG3GP)
Leadership in a team “Somebody should manage this team.” (FG3CN)
Synergy of PHC team members “Intangible” team unity “…nurse and physician […] – everything is operating automatically between them.” (FG1CN)
Common goals of team members “The goal is common – that patient should be stroked around from all sides; he should be happy…” (FG2GP)
Individual motivation to work in a team “This depends on the person. One would do everything, another would say: ‘I was told to do that and I will not do anything more.’ There are such people in a team too…” (FG3CN)
Trust between teammates “A physician should trust the nurse. If there is no trust, there is not any team.” (FG1CN)
Respect between teammates “Good relationships are most important, when you are working together and do not humiliate each other.” (FG1CN)
Executing commands of physician “And afterwards, in the office, she [the nurse] is doing what I am telling her to do.” (FG1GP)
Roles and responsibilities of team members Well-described, known roles of team members “Everybody should know what he must to do…” (FG2GP)
Confusion of roles “I do not know what her [CN] functions are. In fact we do not know what her duties are.” (FG1GP)
Overlap of responsibilities “If you take physician and nurse job descriptions, you see that many roles between them are overlapping.” (FG2GP)
Explicit boundaries of the roles and responsibilities of team members “The most important is not to intervene in treatment, since treatment belongs to the physician […]; the most important is to work within our own framework.” (FG2CN)
Delegation of tasks “Physician should say […] what he wants from the nurse.” (FG1CN)
Assumed individual responsibility “The nurse should know the boundaries of her work and take responsibility for their own actions.” (FG3GP)
Overlapping activities “It might they [nurses] are performing some tasks that belongs to us, but they are not fulfilling their own tasks.” (FG2GP)
Autonomous performance of one’s own duties “You should not say to a nurse, ‘You should do this or this.’ She should do this herself on the spot.” (FG1GP)
Sanctions for CN’s for overstepping boundaries “And during the meeting it was said that [name] is commenting on exam results. […] They made mud out of me so badly! […]” (FG1CN)
Positive expectations towards CN’s “doctoring” “She (CN) has my small stamp. I gave it to her that she could prescribe tests when I am absent” (FG2GP)
Differentiation of activities “For example, all certifications in our institution are written by the informational office.” (FG2GP)
Competency of primary care team members Appropriate knowledge and skills “Sometimes I hear […] our nurses who are consulting patients by phone […]. Once in a while […] such a consultation makes me cover my ears and not listen anymore. Really, the knowledge is outdated or inaccurate…” (FG3CN)
Supervision of competence “She [the CN] simply sometimes does not know […]. The administration should somehow control these things.” (FG2GP)
Necessity of training “I only would like to say that training is very much needed for nurses…” (FG2CN)
Training quality “We are going to the training as we would like to improve our competence, but we should officially question what we are receiving during this training.” (FG3CN)
Communications between PHC team members Communication as a tool to transmit work-related information “Since we [GPs and CNs] are working in separate offices, communication is very important […]. We are referring all the information to the physician […]. It‘s time saving for the physician and his consultation.” (FG2CN)
Communication as friendliness in the working environment “I worked in a private [health centre], but I didn’t like working there […]. There wasn’t enough communication…” (FG2CN)
Means to optimise communications in a team “We even have such a local telephone connection [between GP and CN offices]. If there is some question, we press a button and get in contact.” (FG2CN)
Inner language of team members “We understand one another in a glance.” (FG1GP)
Difficulties in mutual communication “They [CNs] react very sensitively […], even when you are talking very amiably […]. You see that she feels offended… somehow offended.” (FG2GP)
Communication strategies “I have heard about, when a physician who was close to the patient snapped out to the nurse everything he is thinking and… and had done this so awfully.” (FG1CN)
Organisational background for teamwork Synchronisation of compensation policies for team members “Our nurses have a fixed salary, so, the less patients I have, the happier she is, since she can sit and look through a window.” (FG2GP)
Workplace of team members “We do not have where to let them [CNs] sit down normally so we cannot ask them to perform tasks independently. It’s really so – there is no place to sit down.” (FG1GP)
Appropriate time for handling procedures “There should be some regulation on how many patients a physician can consult each day. Not how much he is consulting, but how much he should consult not losing quality.” (FG2GP)
Regulation of patient flows “When, instead of 12 patients with an appointment, 30 or even more come, this simply puts out of kilter all work in a team.” (FG2GP)
Work in stable districts “You feel pleased when you are going to your own district; you know all the tasks […]. It’s very important this many years to work in one place.” (FG3CN)
Introduction of innovations “Everything is on an electronic record system – if you had it, you wouldn’t need to rewrite information in referrals, recipes, etc…” (FG3GP)
Response to the needs of personnel - “We do not have an official time for lunch…” - “We have 15 minutes but, during this time, we take patients without appointments.” (FG2GP)
Training of personnel “We have training in our institution, lectures on how to communicate with patients […]. This is needed very much.” (FG2GP)
Team building initiatives “In the beginning [of institution’s activity] we had a lot of training on team work… at that time this seemed stupid and incomprehensive, but now it seems that it was worthy, this turned our heads in other direction. I mean, some understanding emerge…” (FG2GP)
Involvement of all personnel in non-clinical activity “All of us – doctors and nurses – were involved in preparation of office rules […] We had to go through the legal acts and prepare internal policies. We were not happy about that, but after that we knew each other better.” (FG3CN)
Best practice exchanges with other institutions “The heads of health care institutions should sit together and decide […] how to improve things […]. Now they are only competing with each other.” (FG2CN)

Jaruseviciene et al.

Jaruseviciene et al. BMC Family Practice 2013 14:118   doi:10.1186/1471-2296-14-118

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