Table 3.

Differences in perceptions across the health system

		EXECUTIVE: Macro	CLINICAL MANAGERS: Meso	CLINICIANS: Micro
PURPOSE		Population health with solution focus	Specific clinical groups with process focus	Individual needs – solution focus on individual systems
INTER-RELATIONSHIPS	KEY SOURCE OF FEEDBACK	Population health data	Observations of time and resources required to manage individual patient	Limited interdisciplinary feedback
	ASSUMPTIONS	Primary care will address obesity	Dietitians will weigh people and lead on weight loss to address obesity	Need to have rapport with person before can raise weight
	HAVING THE CONVERSATION	Communication about obesity needs to be at a population level	Obesity is a taboo topic and can only be discussed if the individual patient wants to discuss	Need to have rapport and would only discuss weight with a patient as linked to presenting health issue
PERSPECTIVES	CONCERN (IN RELATION TO OBESITY)	Physical demands (extra staff/extra equipment/ increased level of service) of caring for people with obesity in hospital and implications for resources	Managing practical issues relating to caring for people with obesity e.g. equipment, double handed visits	Not being able to do enough to address breadth of reasons for why an individual may be obese plus obesity impacting on effectiveness of treatment for presenting problem
	ROLE OF HEALTH IN PREVENTION	Individual prevention is futile, need population approach	Health theoretically has a prevention role BUT too busy providing treatment	Try to do opportunistic prevention with patients – feel they have duty of care
	WEIGHING PATIENTS	Clinicians should weigh patients	Have ensured bariatric weighing equipment is available but do not consider impact of weight in planning of services	Do not routinely weigh patients and many feel shouldn’t weigh patients
BOUNDARIES	WHAT LIMITS PREVENTION	Political will to make large scale and legislative changes	Complexity of patients	Service criteria/scope of practice
	POLICY	Responsible for policy – focus on population level and health staff	Aware of policy but it does not impact on the service criteria/clinical focus	Unaware of policy to direct clinical care but are looking for guidance
	CLINICAL FOCUS	Moving healthcare from hospital to community/ reducing hospital demand	Providing services that can manage complex needs	Providing care within service criteria and scope of practice (obesity prevention not in any service criteria)