No Band-Aids for papercuts: understanding and addressing challenges of administrative workload in primary care in Canada.

backgroundThe challenges associated with administrative workload in primary care have been widely acknowledged and discussed, yet little qualitative research has been conducted to understand experiences of administrative workload among primary care clinicians and administrative staff or to inform strategies to address it.

objectiveTo understand experiences of administrative workload in primary care and how areas of concern might be addressed.

methodsWe conducted thirty-six (36) semi-structured qualitative interviews with family physicians, nurse practitioners, and administrative staff working in primary care clinics in the Canadian provinces of Nova Scotia and New Brunswick. We used Braun and Clarke's approach to reflexive thematic analysis, which resonated with our critical qualitative approach and critical relativist epistemology.

findingsWe identified three themes using inductive and descriptive analysis. The first pertains to working without the right tools or guidelines to support administrative processes. The second theme highlights tensions within teamwork surrounding administrative work, which negatively impact team collaboration. The third theme recognizes that primary care components are interconnected and interdependent, and that this needs to be considered when addressing challenges of administrative workload.

conclusionInefficient tools (e.g. some electronic medical records, lack of interconnectivity between information systems, lengthy forms), lack of documentation of processes, lack of training, loss of autonomy over decision-making, interprofessional tensions embedded in system challenges, and Band-Aid solutions to complex problems all increased administrative workload in primary care.