Development of Primary Care Cluster in a Dense Urban Area, Samutprakan Province

Abstract

The objective of this research was to study and develop a family medicine clinic in dense urban areas of Samutprakarn province. It was conducted as a qualitative participatory research during the peri­od of April 2018 to March 2019, and the main approach was applied from the family medicine clinic guideline of Thailand’s Ministry of Public Health (3S) and the McKinsey’s concept (McKinsey’s 7 S framework). The population used in the study consisted of hospital directors, public health executives, family medicine clinical development team and operating team in the family medicine clinic, totaling 30 people through participatory development process in 5 steps which consisted of context study process, problem determination process, research planning process, monitoring process and research conclusion process. The tools used in this research consisted of document study, family medicine operation report of Bangkaew health promotion hospital, in-depth interview, group discussion, participatory work pro­cess, participatory workshops and participatory observation. Qualitative data were analyzed with content analysis. The outcome from the 5-step process was the primary care cluster model for in dense urban areas of Samutprakarn Province (Samutprakarn 7S Model) which consisted of 7 elements as follows: (1) Strategy: there was a strategy aimed at service excellence; (2) Structure: there were the building structure and coordinated community organizations in accordance with the characteristics of the urban areas; (3) System: there was a service system in the family medicine clinic and in the community with infrastructure support and equipped with information technology system; (4) Staff: there were personnel management process and the organization of the family medicine team; (5) Skills: there was a development of public health care knowledge in family medicine, consulting system and the learning exchange through context based learning system (CBL); (6) Style: there was a teamwork with the mechanism of improving the quality of life at the district level and community participation in health promotion and self-care; (7) Shared values: there were common values at all levels to place patients as the center of health care in accordance with family medicine principle. Based on the successful outcomes, it is recommended that the model should be adopted and applied as a guideline for the operation of family medicine clinic in dense urban areas.