Community paramedicine through multiple stakeholder lenses using a modified soft systems methodology

Abstract

Introduction Community paramedicine (CP) is an emerging model of care which expands paramedic scopes of practice to collaboratively support primary healthcare delivery in underserviced and disadvantaged communities. CP is a patient-centred holistic approach focussed on improving health outcomes, with success heavily reliant on integrative partnerships. This research aimed to identify key stakeholder perspectives about the value of CP in rural Australia. Methods A workshop was conducted using a modified soft system methodology (SSM) that asked participants to consider the value of CP from the perspective of five key stakeholder groups. The 50 participants consisted of paramedics and volunteer ambulance officers, paramedic service executives, paramedic educators, Medicare Local representatives and a general practitioner. Participants were randomly allocated to five stakeholder groups: paramedic profession; Minister for Health and Ageing; consumers, chief executive and executive management team of an ambulance service; and healthcare professionals. The application of SSM placed the five groups into three broad categories of stakeholders: customers, actors, and owners. ‘Customers’ in this context are patients, families and carers. ‘Actors’ are paramedics and volunteer ambulance officers, and ambulance service executives. The ‘owners’ are the Office of the Minister and those with the power to facilitate or block initiatives. Participants were allocated 15 minutes to brainstorm the question: “What can a community paramedic do for you to improve rural health provision?” Group views were verbally shared with all workshop participants and video recorded for analysis. Results The ‘customers’ asked about CP from patient, family and carer perspectives, and were highly engaged with questions about how, when and where CP could operate. The paramedic and volunteer ambulance officer group of ‘actors’ battled to move beyond their emergency response mindset to articulate a clear CP vision. The executive management team responded from a strategic and risk management perspective focussing on patient safety and corporate image. They identified the need to form stakeholder partnerships. The ‘owners’ representing the Office of the Minister focussed on the holistic and wellness benefits of CP. The health professional group anticipated the CP role could provide collaborative care and support doctors. Conclusions The findings suggest many participants had a limited understanding of CP, which creates a barrier for implementation. Key benefits identified included a reduction in financial and physical burdens on the rural healthcare sector and improved outcomes for consumers. Active participation of stakeholders in the process of introducing CP programs, where people are comfortable questioning current practices and encouraged to explore new concepts and innovations, would enable a shared understanding of program aims and expectations. For paramedic services to expand service delivery models in rural Australia community participation and engagement with stakeholders is essential. They and paramedics must be willing to embrace meaningful and collaborative partnerships with patients, broader health networks, social services, politicians and researchers, and be prepared to step away from their traditional ‘command and control’ culture to co-design innovative paramedic models. SSM was a worthwhile approach to stakeholder engagement that has the potential to improve implementation of community paramedic programs through improved inclusion and the valuing of stakeholder perspectives.