What systems participants know about access and service entry and why managers should listenRohena Duncombe
A Northern NSW LHD, Bryon Central Hospital Box 1066, Byron Bay, NSW 2481, Australia.
B Charles Sturt University, Locked Bag 588, Wagga Wagga, NSW 2678, Australia. Email: firstname.lastname@example.org
Australian Health Review 41(4) 449-454 https://doi.org/10.1071/AH16036
Submitted: 6 February 2016 Accepted: 6 July 2016 Published: 29 August 2016
Objective The present study looked at the views of people directly involved in the entry process for community health counselling using the frame of the health access literature. The concurrence of system participants’ views with the access literature highlights access issues, particularly for people who are vulnerable or disadvantaged. The paper privileges the voices of the system participants, inviting local health services to consider using participatory design to improve access at the entry point.
Methods People involved in the entry process for community health counselling explored the question, ‘What, for you, are the features of a good intake system?’ They also commented on themes identified during pilot interviews. These were thematically analysed for each participant group by the researcher to develop a voice for each stakeholder group.
Results People accessing the service could be vulnerable and the entry process failed to take that into account. People directly involved in the counselling service entry system, system participants, consisted of: professionals referring in, people seeking services and reception staff taking first enquiries. They shared substantially the same concerns as each other. The responses from these system participants are consistent with the international literature on access and entry into health services.
Conclusion Participatory service design could improve primary healthcare service entry at the local level. Canvassing the experiences of system participants is important for delivering services to those who have the least access and, in that way, could contribute to health equity.
What is known about the topic? People with the highest health needs receive the fewest services. Health inequality is increasing.
What does this paper add? System participants can provide advice consistent with the academic research literature that is useful for improving service entry at the local level.
What are the implications for practitioners? Participatory design can inform policy makers and service providers. Entry systems could acknowledge the potential vulnerability or disadvantage of people approaching the service.
Additional keywords: health equity, inclusion, participatory design, social determinants of health.
References Marmot M, Wilkinson R. Social determinants of health. Oxford, Oxford University Press; 2006.
 Australian Institute of Health and Welfare (AIHW). Australian health expenditure by remoteness: a comparison of remote, regional and city health expenditure. Canberra: AIHW; 2011.
 Bender SS, Fulbright YK. Content analysis: A review of perceived barriers to sexual and reproductive health services by young people. Eur J Contracept Reprod Health Care 2013; 18 159–67.
| Content analysis: A review of perceived barriers to sexual and reproductive health services by young people.CrossRef | 23527736PubMed |
 Issakidis C, Andrews G. Who treats whom? An application of the Pathways to Care model in Australia. Aust N Z J Psychiatry 2006; 40 74–86.
| Who treats whom? An application of the Pathways to Care model in Australia.CrossRef | 16403043PubMed |
 Wen C, Hudak P, Hwang S. Homeless people’s perceptions of welcomeness and unwelcomeness in healthcare encounters. J Gen Intern Med 2007; 22 1011–7.
| Homeless people’s perceptions of welcomeness and unwelcomeness in healthcare encounters.CrossRef | 17415619PubMed |
 Christiani A, Hudson A, Nyamanthi A, Mutere M, Sweat J. Attitudes of homeless and drug using youth regarding barriers and facilitators in delivery of quality and culturally sensitive health care. J Child Adolesc Psychiatr Nurs 2008; 21 154–63.
| Attitudes of homeless and drug using youth regarding barriers and facilitators in delivery of quality and culturally sensitive health care.CrossRef | 18667048PubMed |
 Dawson A. The primary health care service experiences and needs of homeless youth: a narrative synthesis of current evidence. Contemporary Nurse 2013; 4 1313–22.
 Allan J. Improving access to hard to reach services: a soft entry to drug and alcohol services for rural Australian aboriginal communities. Soc Work Health Care 2011; 50 443–65.
| Improving access to hard to reach services: a soft entry to drug and alcohol services for rural Australian aboriginal communities.CrossRef | 21774586PubMed |
 Humphries J, Wakerman J. Primary health care in rural and remote Australia: achieving equity of access and outcomes through. Canberra: National Health and Hospitals Reform Commission; 2008.
 Wakerman J, Humphries J, Wells R, Kuipers P. Sustainable models of primary health care in rural and remote Australia – what the evidence says. In: Larson A, Lyle D, editors. A bright future for rural health: evidence-based policy and practice in rural and remote Australian health care. Canberra: Australian Rural Health Education Network; 2010. pp. 69–71.
 Srebnik D, Cauce A. Help seeking pathways for children and adolescents. J Emot Behav Disord 1996; 4 210–20.
| Help seeking pathways for children and adolescents.CrossRef |
 Jain SH. Getting consumerism right in healthcare. Pharma & Healthcare 2015. Available at: http://www.forbes.com/sites/sachinjain/2015/10/01/getting-consumerism-right-in-health-care/#61185df82bd9 [verified 25 July 2016].
 Greenhalgh T, Stones R, Swinglehurst D. Choose and book: a sociological analysis of resistance to an expert system. Soc Sci Med 2014; 104 210–9.
| Choose and book: a sociological analysis of resistance to an expert system.CrossRef | 24581080PubMed |
 Popay J, Kowarzik U, Mallinson S, Mackian S, Barker J. Social problems, primary care and pathways to help and support: addressing health inequalities at the individual level. Part II: lay perpectives. J Epidemiol Community Health 2007; 61 972–7.
| Social problems, primary care and pathways to help and support: addressing health inequalities at the individual level. Part II: lay perpectives.CrossRef | 17933955PubMed |
 Gwatkin D, Wagstaff A, Yazbeck A. Reaching the poor with health, nutrition and population services: what works, what doesn’t and why. Herndon, VA: World Bank Publications; 2005.
 Talmon M. Single session therapy. San Francisco: Jossey-Bass Publishers; 1990.
 Withers J. Street medicine: an example of reality-based health care. J Health Care Poor Underserved 2011; 22 1–4.
| 21317502PubMed |
 Walters J. Establishing a true ‘no wrong door’ approach to human services. Governing 2011. Available at: http://www.governing.com/topics/health-human-services/establishing-true-no-wrong-door-approach- human-services.html [verified 25 July 2016].
 Wilks S, Lahausse J, Edwards B. Commonwealth place based service delivery initiatives. Australian Institute of Family Studies, Research Report No. 32. 2015. Available at: https://aifs.gov.au/publications/commonwealth-place-based-service-delivery-initiatives [verified 25 July 2016].
 Silvestro R, Silvestro C. New service design in the NHS: an evaluation of the strategic alignment of NHS Direct. Int J Operations Production Manage 2003; 23 401–17.
| New service design in the NHS: an evaluation of the strategic alignment of NHS Direct.CrossRef |
 Accenture. Why first impressions matter. 2013. Available at: https://www.accenture.com/bw-en/~/media/Accenture/Conversion-Assets/DotCom/Documents/Global/PDF/Industries_11/Accenture-Why-First-Impressions-Matter-Healthcare-Providers-Scheduling.pdf [verified 25 July 2016].
 Accenture. Patient engagement: digital self scheduling set to explode in healthcare over the next five years. 2014. Available at: https://www.accenture.com/us-en/insight-patient-engagement-digital-self-scheduling-explode [verified 25 July 2016]
 Freeman T, Baum F, Lawless A, Javanparast S, Jolley G, Labonte R, Bentley M, Boffa J, Sanders D. Revisiting the ability of primary healthcare services to respond to health inequity. Aust J Prim Health 2015;
| Revisiting the ability of primary healthcare services to respond to health inequity.CrossRef |
 Levesque J-F, Harris M, Russell G. Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health 2013; 12 18–26.
| Patient-centred access to health care: conceptualising access at the interface of health systems and populations.CrossRef | 23496984PubMed |
 Penchansky R, Thomas JW. The concept of access: definition and relationships to consumer satisfaction. Med Care 1981; 19 127–40.
| The concept of access: definition and relationships to consumer satisfaction.CrossRef | 1:STN:280:DyaL3M7kslahug%3D%3D&md5=a2ab9994ed78cee60ab8e7e6896bd7a2CAS | 7206846PubMed |
 Gillingham P, Graham T. Designing electronic information systems for the future: social workers and the challenge of new public management. Crit Soc Policy 2016; 36 187–204.
| Designing electronic information systems for the future: social workers and the challenge of new public management.CrossRef |
 Bath J, Wakerman J. Impact of community participation in primary health care: what is the evidence? Aust J Prim Health 2015; 21 2–8.
| Impact of community participation in primary health care: what is the evidence?CrossRef | 24176202PubMed |
 Duncombe, R. Rural Community Health Intake Study; client intake for counselling in rural community health, HETI, Sydney. Available at: http://www.heti.nsw.gov.au/Rural-and-Remote/research-capacity-building/Completed-research-projects/2008 [verified 25 July 2016].
 Berger P, Luckmann T. The social construction of reality. New York: Penguin; 1966.
 Denzin N, Lincoln Y. The landscape of qualitative research. Thousand Oaks: Sage; 2008.
 Corey G. Student manual for theory and practice of group counselling. Belmont, CA: Thomson-Brooks/Cole; 2007.
 Grimwade JR. Practices and perceptions: referral and intake to child and adolescent mental health services. PhD Thesis, Victoria University, Melbourne; 2006.
 Gilson L. Acceptability, trust and equity. In: McIntyre D, Mooney G, editors. The economics of health equity. New York: Cambridge University Press; 2007. p. 124-147
 Grabovschi C, Loignon C, Fortin M. Mapping the concept of vulnerability related to health care disparities: a scoping review. Health Serv Res 2013; 13 94–105.
| Mapping the concept of vulnerability related to health care disparities: a scoping review.CrossRef |
 Hodas GR. Responding to childhood trauma: the promise and practice of trauma informed care. Pennsylvania: Pennsylvania Office of Mental Health and Substance Abuse Services; 2006.
 Bonevski B, Randell M, Paul C, Chapman K, Twyman L, Bryant J, Brozek I, Hughes C. Reaching the hard-to-reach: a systematic review of strategies for improving health and medical research with socially disadvantaged groups. BMC Med Res Methodol 2014; 14 42–111.
| Reaching the hard-to-reach: a systematic review of strategies for improving health and medical research with socially disadvantaged groups.CrossRef | 24669751PubMed |
 Siddiqui FR. Annotated bibliography on participatory consultations to help aid the inclusion of marginalized perspectives in setting policy agendas. Int J Equity Health 2014; 13 124–40.
| Annotated bibliography on participatory consultations to help aid the inclusion of marginalized perspectives in setting policy agendas.CrossRef | 25532831PubMed |