Professor, School of Nursing and School of Health Sciences, University of Northern BC (UNBC)
UNBC Knowledge Mobilization Research Chair, Northern Health
Co-lead, UNBC Health Research Institute

macleod@unbc.ca

Please describe your most important contribution(s) to primary care research
In northern BC, we have been exploring how transformation of primary health care can happen through whole system change. The contribution to primary care research is the articulation of the ‘how’ of whole primary health care change. The researchers, working in partnership with Northern Health, have provided ongoing qualitative information about the processes of change, that has enabled healthcare leaders to articulate and shape their approaches to change. A second important contribution is the articulation of rural nurses’ roles in primary health care from a national study on rural and remote nursing. Further information has been published in Healthcare Policy.

Please describe your current work or upcoming research projects related to primary care
I am leading a longitudinal study, Partnering for Change I and II, undertaken in partnership with Northern Health. The first phase of the study, funded by CIHR, has resulted in five publications including an overview publication. The second phase is ongoing.

What are the key messages from your primary care research to share with other stakeholders (e.g. clinicians, policymakers, patients)?
Ongoing, sustainable whole system change is possible, but it takes much, much longer than expected. For innovation to happen, productive partnerships need to be created and sustained among communities, physicians, and health authorities. Actively building and maintaining relationships are key. All of the changes need to keep the focus on people, their needs and possibilities, within the context of their communities. By keeping an eye out for and taking advantage of opportunities, productive change can happen. A key to change is to actively encourage and support experimentation while managing risk. It is inevitable that there will be tensions. To keep whole system change moving forward, it is critical to address tensions and work through them constructively. Ongoing, trusting relationships, together with a common vision and supportive environments make this possible.

The contributions of rural and remote nurses to primary care are rendered invisible by contemporary characterizations of primary care workplaces. Rural and remote nurses in Canada provide primary care in many settings outside of what are conventionally understood to be primary care workplaces (i.e., nursing station, community health centre, or physician’s office/family practice unit or team, nursing station/outpost/nurse clinic, NP-led clinic, multidisciplinary PHC clinic).