Sustainability Failures: The Challenge of Sustaining the NP Role and Other Innovations in Primary Health Care

Abstract

Background: Sustaining innovations in health systems is a topic of increasing importance to stakeholders interested in creating sustainable primary health care (PHC) reform. The Nurse Practitioner (NP) role, a PHC innovation, was initially introduced in Canada in the 1970s and re-implemented with PHC restructuring in the 1990s. Despite extensive evidence that NPs are a cost-effective means to providing comprehensive, high-quality care, the role is not optimized throughout much of Canada. Understanding the contextual, policy and decision-making factors that influence the sustainability of the NP role and other PHC innovations is an important addition to the current literature. Purpose: The purpose of this thesis was to examine the sustainability failure of a PHC innovation, an NP primary care clinic in Alberta, Canada. Methods: This thesis combines three linked scientific papers: 1) a scoping review of peer-reviewed and grey literature of clinic closures involving NPs, as well as the sustainability of PHC innovations and the NP role, 2) a theoretically informed critical analysis of NP funding models in Canada and 3) a single, exploratory case study of an NP primary care clinic closure in Alberta, Canada. Findings/Conclusion: Findings demonstrate that there is a paucity of peer-reviewed literature informing the sustainability of the NP role and other PHC innovations. Sustainability failures in our health system are due to deficiencies in provincial and national policies in flawed policy environments. New sustainability knowledge; an updated understanding of the sustainability of innovations in PHC and a newly visioned conceptual framework for stakeholders to use when assessing sustainability of PHC innovations have emerged from this work