# A Collective Intelligence Strategy for Evaluating and Advancing Nurse Autonomy in Primary Care

## TL;DR

This paper introduces a new tool to evaluate nurse-led care in primary healthcare, showing how it can improve teamwork and decision-making.

## Contribution

The xGID instrument is a novel standardized tool for evaluating nurse demand management adoption in primary care teams.

## Key findings

- High NDM adoption was observed with a mean score of 7.6 out of 10.
- Nurses showed critical views on teamwork and accessibility, highlighting systemic challenges.
- Professional autonomy and multi-domain action were strong areas of NDM adoption.

## Abstract

Background: European health systems are shifting toward more proactive, person-centered models, thereby highlighting the need to strengthen nurses’ clinical leadership in primary care. Nurse demand management (NDM) has emerged as an innovative practice which allows nurses to autonomously and comprehensively respond to a population’s health needs. However, knowledge on its implementation varies widely, often being intuitive, partly due to the absence of standardized evaluation tools. The xGID instrument aims to measure the degree of NDM adoption in primary care teams (PCTs), activating collective intelligence mechanisms to foster shared diagnosis, organizational reflection, and the generation of targeted recommendations. Methods: We designed and implemented xGID in 47 PCTs in Catalonia, involving 1474 healthcare professionals. Data were collected through structured surveys assessing key dimensions of NDM adoption, including professional autonomy, teamwork, continuity, and accessibility. Results: Overall adoption of NDM was high, with a mean score of 7.6 out of 10. Notable differences emerged between professional groups and practice areas. Nurses tended to be more critical of teamwork, longitudinal care, and accessibility, reflecting the central yet high-pressure role they play in NDM. High-scoring dimensions included professional autonomy and the capacity to act across multiple domains, whereas weaker areas pointed to systemic organizational challenges. Conclusions: The preliminary findings indicate that a standardized tool for NDM evaluation is a cornerstone for identifying contextual barriers and guiding the transformation of care models. Its participatory and strategic approach offers novel pathways to embed data-driven decision-making into daily clinical practice, consolidating NDM as a key pillar of future primary care.