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While A. Spinning plates or perfect jigsaw? Br J Community Nurs 2024; 29:312-313. [PMID: 38963270 DOI: 10.12968/bjcn.2024.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Affiliation(s)
- Alison While
- Emeritus Professor of Community Nursing, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London and Fellow of the Queen's Nursing Institute
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Fehsenfeld M, Maindal HT, Burau V. Rethinking organizational culture in intersectoral coordination: the perspective of boundary work. J Health Organ Manag 2024; ahead-of-print. [PMID: 38796749 DOI: 10.1108/jhom-03-2023-0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2024]
Abstract
PURPOSE The purpose of this paper is to rethink the concept of organizational culture as something that emerges bottom-up by using the sociological concepts of boundary object and boundary work as an analytical lens and to show how this approach can help understand and facilitate intersectoral coordination. DESIGN/METHODOLOGY/APPROACH We used observations and qualitative interviews to develop "deep" knowledge about processes of intersectoral coordination. The study draws on a conceptual framework of "boundary work" and "boundary objects" to show how a bottom-up perspective on organizational culture can produce better understanding of and pave the way for intersectoral coordination. We use a case of health professionals engaged in two Danish intersectoral programs developing and providing health promotion services for women with gestational diabetes mellitus (GDM). FINDINGS The study showed how boundary work revolves around negotiations on how to define, understand and act on the diagnosis of GDM. This diagnosis has the characteristics of a "boundary object", being more loosely structured in general terms, but strongly structured in local settings. Boundary objects help connect different professionals and facilitate coordination. The analysis showed how the introduction of time and the concept of "lifelong health promotion" helped to transgress existing organizational and professional boundaries. RESEARCH LIMITATIONS/IMPLICATIONS The findings contribute to the literature on organizational culture and intersectoral coordination. We highlight the benefits of a practice-oriented, bottom-up perspective for a better understanding of how shared meaning is produced in cross professional coordination and collaboration. While the theoretical implications will be general applicable when studying organizational culture, the implications for practice are sensitive to context and the processes we have described as the outcomes of boundary work are generated from cases that were most likely to provide deep insight into our research topic. PRACTICAL IMPLICATIONS For practice this can build bridges between organizational and professional boundaries. ORIGINALITY/VALUE The findings contribute to the literature on organizational culture and intersectoral coordination. We highlight the benefits of a practice-oriented, bottom-up perspective for a better understanding of how shared meaning is produced in cross professional coordination. This may build bridges between organizational and professional boundaries in practice settings.
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Affiliation(s)
| | - Helle Terkildsen Maindal
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Health Promotion Unit, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Viola Burau
- Department of Public Health, Aarhus University, Aarhus, Denmark
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Kneale D, Stansfield C, Goldman R, Lester S, Edwards RC, Thomas J. The implementation of embedded researchers in policy, public services, and commercial settings: a systematic evidence and gap map. Implement Sci Commun 2024; 5:41. [PMID: 38627834 PMCID: PMC11020794 DOI: 10.1186/s43058-024-00570-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 03/11/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Embedding researchers into policy and other settings may enhance research capacity within organisations to enable them to become more research active. We aimed to generate an evidence map on evaluations of embedded researcher interventions to (i) identify where systematic reviews and primary research are needed and (ii) develop conceptual understandings of 'embedded researchers'. We define 'embedded researchers' through a set of principles that incorporate elements such as the aim of activities, the types of relationships and learning involved, and the affiliations and identities adopted. METHODS We included studies published across all sectors, searching fourteen databases, other web sources and two journals for evaluations published between 1991 and spring 2021. Data were extracted using a coding tool developed for this study. We identified new typologies of embedded researcher interventions through undertaking Latent Class Analysis. RESULTS The map describes 229 evaluations spanning a variety of contexts. Our set of principles allowed us to move beyond a narrow focus on embedded researchers in name alone, towards consideration of the wide range of roles, activities, identities, and affiliations related to embedded researchers. We identified 108 different allied terms describing an embedded researcher. Embedded researcher activity spanned a continuum across lines of physical, cultural, institutional, and procedural embeddedness (from weaker to more intense forms of embeddedness) and took a range of forms that bridge or blur boundaries between academia and policy/practice. CONCLUSIONS We developed a broad map of international embedded researcher activity in a wide range of sectors. The map suggests that embedded researcher interventions occupy a broader suite of models than previously acknowledged and our findings also offer insight on the type and nature of this literature. Given the clear policy interest in this area, a better understanding of the processes involved with becoming embedded within an organisation is needed. Further work is also necessary to address the challenges of evaluating the work of embedded researchers, including consideration for which outcome measures are most appropriate, to better understand their influence.
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Affiliation(s)
- Dylan Kneale
- EPPI Centre, UCL Social Research Institute, University College London, London, UK.
| | - Claire Stansfield
- EPPI Centre, UCL Social Research Institute, University College London, London, UK
| | | | - Sarah Lester
- EPPI Centre, UCL Social Research Institute, University College London, London, UK
| | - Rachael C Edwards
- EPPI Centre, UCL Social Research Institute, University College London, London, UK
| | - James Thomas
- EPPI Centre, UCL Social Research Institute, University College London, London, UK
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Lalani M, Sugavanam P, Caiels J, Crocker H, Gunn S, Hay H, Hogan H, Page B, Peters M, Fitzpatrick R. Assessing progress in managing and improving quality in nascent integrated care systems in England. J Health Serv Res Policy 2024; 29:122-131. [PMID: 37914188 PMCID: PMC10910818 DOI: 10.1177/13558196231209940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
OBJECTIVES In 2022, England embarked on an ambitious reorganisation to produce an integrated health and care system, intended also to maximise population health. The newly created integrated care systems (ICSs) aim to improve quality of care, by achieving the best outcomes for individuals and populations through the provision of evidence-based services. An emerging approach for managing quality in organisations is the Quality Management System (QMS) framework. Using the framework, this study assessed how ICSs are managing and improving quality. METHODS Four ICSs were purposively sampled, with the data collected between November 2021 and May 2022. Semi-structured interviews with system leaders (n=60) from health and social care, public health and local representatives were held. We also observed key ICS meetings and reviewed relevant documents. A thematic framework approach based on the QMS framework was used to analyse the data. RESULTS The ICSs placed an emphasis on population health, reducing inequity and improving access. This represents a shift in focus from the traditional clinical approach to quality. There were tensions between quality assurance and improvement, with concerns that a narrow focus on assurance would impede ICSs from addressing broader quality issues, such as tackling inequalities and unwarranted variation in care and outcomes. Partnerships, a key enabler for integration, was seen as integral to achieving improvements in quality. Overall, the ICSs expressed concerns that any progress made in quality development and in improving population health would be tempered by unprecedented system pressures. CONCLUSION It is unclear whether ICSs can achieve their ambition. As they move away from an assurance-dominated model of quality to one that emphasises openness, learning and improvement, they must simultaneously build the digital infrastructure, staff expertise and culture to support such a shift.
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Affiliation(s)
- Mirza Lalani
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Priya Sugavanam
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - James Caiels
- Personal Social Service Research Unit, University of Kent, Canterbury, UK
| | - Helen Crocker
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | | | - Helen Hogan
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Bethan Page
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Michele Peters
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ray Fitzpatrick
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
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McElroy C, Skegg E, Mudgway M, Murray N, Holmes L, Weller J, Hamill J. Psychological Safety and Hierarchy in Operating Room Debriefing: Reflexive Thematic Analysis. J Surg Res 2024; 295:567-573. [PMID: 38086257 DOI: 10.1016/j.jss.2023.11.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 09/30/2023] [Accepted: 11/12/2023] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Debriefing is a team discussion in a constructive, supportive environment. Barriers exist to consistent, effective team debriefing in the clinical setting, especially in operating theaters. The purpose of this study was to gain insights from frontline workers on how to set up an effective debriefing policy for our operating room. METHODS This was a qualitative study in which we interviewed operating room workers in a tertiary children's hospital. Interviews were audio-recorded, transcribed, and coded. Data were analysed using the reflexive thematic analysis technique within a critical realism paradigm. RESULTS Interviews were analysed from 40 operating room staff: 14 nurses, seven anesthetic technicians, seven anaesthetists, and 12 surgeons; 25 (65%) were female. The three key themes were (1) "commitment to learning"-healthcare workers are committed to teamwork and quality improvement; (2) "it is a safe space"-psychological safety is a prerequisite for, and is enhanced by, debriefing; and (3) "natural leader"-the value of leadership, but also constructs around leadership that maintain hierarchies. CONCLUSIONS Psychological safety is both a prerequisite for and a product of debriefing. Leadership, if viewed as a collective responsibility, could help break down power structures. Given the results of this study and evidence in the literature, it is likely that routine debriefing, if well done, will improve psychological safety, facilitate team learning, reduce errors, and improve patient safety.
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Affiliation(s)
- Canice McElroy
- Department of Paediatric Surgery, Starship Children's Hospital, Auckland, New Zealand
| | - Emma Skegg
- Department of Paediatric Surgery, Starship Children's Hospital, Auckland, New Zealand
| | - Mercedes Mudgway
- Department of Paediatric Surgery, Starship Children's Hospital, Auckland, New Zealand
| | - Ngaire Murray
- Department of Paediatric Surgery, Starship Children's Hospital, Auckland, New Zealand
| | - Linda Holmes
- Department of Paediatric Surgery, Starship Children's Hospital, Auckland, New Zealand
| | - Jennifer Weller
- Centre for Medical and Health Sciences Education, The University of Auckland, Auckland, New Zealand
| | - James Hamill
- Department of Paediatric Surgery, Starship Children's Hospital, Auckland, New Zealand; Centre for Medical and Health Sciences Education, The University of Auckland, Auckland, New Zealand; Department of Paediatrics, Child and Youth Health, The University of Auckland, Auckland, New Zealand.
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Lalani M, Wytrykowski S, Hogan H. Approaches to improving patient safety in integrated care: a scoping review. BMJ Open 2023; 13:e067441. [PMID: 37015799 PMCID: PMC10083780 DOI: 10.1136/bmjopen-2022-067441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
OBJECTIVES This scoping review aimed to establish the approaches employed to improving patient safety in integrated care for community-dwelling adults with long-term conditions. DESIGN Scoping review. SETTING All care settings. SEARCH STRATEGY Systematic searches of seven academic and grey literature databases for studies published between 2000 and 2021. At the full-text review stage both the first and second reviewer (SW) independently assessed full texts against the eligibility criteria and any discrepancies were discussed. RESULTS Overall, 24 studies were included in the review. Two key priorities for safety across care boundaries for adults with long-term conditions were falls and medication safety. Approaches for these priorities were implemented at different levels of an integrated care system. At the micro-level, approaches involved care primarily in the home setting provided by multi-disciplinary teams. At the meso-level, the focus was on planning and designing approaches at the managerial/organisational level to deliver multi-disciplinary care. At the macro-level, system-wide approaches included integrated care records, training and education and the development of care pathways involving multiple organisations. Across the included studies, evaluation of these approaches was undertaken using a wide range of process and outcome measures to capture patient harm and contributory factors associated with falls and medication safety. CONCLUSIONS For integrated care initiatives to fulfil their promise of improving care for adults with long-term conditions, approaches to improve patient safety need to be instituted across the system, at all levels to support the structural and relational aspects of integrated care as well as specific risk-related safety improvements.
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Affiliation(s)
- Mirza Lalani
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Helen Hogan
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
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Lennox-Chhugani N. Inter-Disciplinary Work in the Context of Integrated Care - a Theoretical and Methodological Framework. Int J Integr Care 2023; 23:29. [PMID: 37360878 PMCID: PMC10289044 DOI: 10.5334/ijic.7544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 06/06/2023] [Indexed: 06/28/2023] Open
Abstract
Inter-disciplinary team working is an essential mechanism for the delivery of integrated care. This paper summarises a narrative review of the research on the 'work' that teams do to develop inter-disciplinary practices, addressing the question 'How do interdisciplinary teams 'become' in the context of models of integrated care?'. The narrative review identities a gap in our understanding of the active boundary work that different disciplines working together to deliver care integration engage in when creating new interdisciplinary knowledge, creating an inter-disciplinary team identity and negotiating new social and power relations. This gap is particularly significant in relation to the role played by patients and care-givers. This paper presents a way of examining inter-disciplinary working as a process of creating knowledge, identity and power relations both in terms of a theoretical lens, circuits of power, and a methodology, institutional ethnography. An explicit focus on understanding power relations within inclusive inter-disciplinary teams in care integration will contribute to our understanding of the gap between theory and implementation of care integration by focusing on the 'work' that teams do to create new knowledge.
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Tremblay D, Touati N, Usher S, Gentil B, Courval MJ. The challenge of optimizing supports for people living with and beyond cancer: creating proximity between cancer and non-profit community-based providers. Support Care Cancer 2023; 31:108. [PMID: 36625923 PMCID: PMC9831956 DOI: 10.1007/s00520-022-07569-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 12/30/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE Non-profit community-based organizations (CO) remain insufficiently integrated into cancer networks. Drawing on dimensions of proximity, this study explores how and why coordination between cancer teams and COs is established and solidified. METHODS A descriptive interpretive study is undertaken in Québec (Canada), where a cancer program has long promoted the integration of COs in the cancer trajectory. Semi-directed interviews with providers, managers and people living with and beyond cancer (total n = 46) explore the challenges of coordination between cancer and CO providers, along with facilitating or impeding factors. Three main themes related to coordination in cancer networks emerge, which are analyzed by operationalizing the multi-dimensional framework of proximity. RESULTS Findings reveal a lack of cognitive proximity, which calls for efforts to both identify patient needs and increase cancer team knowledge and appreciation of CO resources. Organizational proximity refers to systems and rules that facilitate interactions, and we find that referral mechanisms and communication channels are inadequate, with patients often playing a linking role despite barriers. Coordination improves when relational proximity is established between cancer and CO teams, and this can be enhanced by geographic proximity; in one region, COs have a physical presence within the cancer center. CONCLUSION Integrating COs into the cancer network can help meet the spectrum of needs faced by people living with and beyond cancer. This study offers managers and decision-makers insight into how coordination between cancer teams and COs can be supported. Proximity allows the distinct contributions of actors to be considered in context and contributes to understanding the "how" of integrated practice.
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Affiliation(s)
- Dominique Tremblay
- School of Nursing, Université de Sherbrooke, Longueuil Campus, 150 Place Charles-Le Moyne, Longueuil, Québec, J4K 0A8, Canada. .,Centre de Recherche Charles-Le Moyne, 150 Place Charles-Le Moyne, Longueuil, Québec, J4K 0A8, Canada.
| | - Nassera Touati
- École nationale d’administration Publique, 4750 Ave Henri-Julien, 5E Étage, Montréal, Québec H2T 3E5 Canada
| | - Susan Usher
- Centre de Recherche Charles-Le Moyne, 150 Place Charles-Le Moyne, Longueuil, Québec J4K 0A8 Canada ,École nationale d’administration Publique, 4750 Ave Henri-Julien, 5E Étage, Montréal, Québec H2T 3E5 Canada
| | - Barbara Gentil
- Centre de Recherche Charles-Le Moyne, 150 Place Charles-Le Moyne, Longueuil, Québec J4K 0A8 Canada
| | - Marie-Josée Courval
- Centre Intégré de Santé et de Services Sociaux (CISSS) de la Montérégie-Centre, 3120 Boul. Taschereau, Greenfield Park, Québec J4V 2H1 Canada
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Ryapolova N, Galea JT, Greene KY. Perceptions towards integrated care through the narrative of practicing social workers and psychologists in PHC: a cross-case analysis. JOURNAL OF INTEGRATED CARE 2022. [DOI: 10.1108/jica-08-2022-0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
PurposeIn a collective effort to build a patient-centered and coordinated health care system, social workers and psychologists are being progressively introduced to primary health care (PHC) settings worldwide. The present study aims to explore the current status of integration through the narrative of social workers and psychologists in PHC settings in Kazakhstan.Design/methodology/approachIn this paper purposive snowball sampling was utilized to recruit social workers and psychologists who work, or used to work, in PHC settings since the onset of integration in Nur-Sultan for participation in an in-depth interview. A semistructured interview guide was based on normalization process theory (NPT). Interviews were conducted via video conference, in Russian language, lasted no more than 50 min, and transcribed verbatim. Cross-case analysis of eight cases was performed using NPT constructs.FindingsCross-case analysis included findings from the interviews from five social workers and three psychologists. Four major constructs of implementation process from NPT were reflected in the findings: coherence (believes integration improves patient care, functions within integrated care), cognitive participation (individual changes to role performance, mechanisms of work), collective action (status of support from stakeholders, cooperation within a multidisciplinary team) and reflective monitoring (existing mechanisms for monitoring the integration).Research limitations/implicationsDespite organizational integration, there is a lack of successful clinical integration of social workers and psychologists in PHC settings of Kazakhstan, which is manifested by a lack of understanding of responsibilities and functions of these mental health care specialists. Consensus was reached by all participants that both social workers and psychologists are valuable assets in a multidisciplinary team.Originality/valueThe present study contributes to the current knowledge of integrated PHC service delivery by addressing the status of integrated care in Kazakhstan from interviews with key stakeholders in social work and mental health. Moving forward, improvements are needed to (1) establish the monitoring mechanism to evaluate the status of integration, (2) enhance effective collaboration within multidisciplinary teams in PHC settings and (3) increase awareness among medical workers and community members on mental health issues and the available support offered by social workers and psychologists to promote quality of life in a holistic, integrated manner.
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Riley B, de Sam Lazaro SL. Developmental surveillance: a prospective observational study on integrating occupational therapy. J Interprof Care 2022; 37:346-351. [PMID: 35997201 DOI: 10.1080/13561820.2022.2101990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
The purpose of this study was to understand the interprofessional contributions of occupational therapy services within the pediatric primary care team during developmental surveillance for health promotion and prevention. A prospective observational study of 27 well-child visits was conducted. Well-child visits were conducted by a physician, physician assistant, or nursing practitioner. This research compared observed developmental surveillance from an occupational therapy perspective to identify opportunities for supporting daily childhood activity participation. Areas of occupational and developmental participation were generally well covered during developmental surveillance. While there were no observed differences in the scope of the well-child visit conducted by different primary care professionals, habits, routines, roles, rituals, and the environments and contexts that may be impacting participation for children and families were found to be an area of limited discussion during developmental surveillance. There is an opportunity for occupational therapy practitioners to be involved in developmental surveillance with an emphasis on occupational therapy's expertise in habits, routines, roles, and contextual considerations to participation and development.
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Affiliation(s)
- Bonnie Riley
- Occupational Therapy Department, St. Catherine University, St. Paul, MN, USA.,Department of Occupational Therapy, Ithaca College, Ithaca, NY, USA
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Dimensions of Proximity: An Actionable Framework to Better Understand Integrated Practices in Cancer Networks. Int J Integr Care 2022; 22:9. [PMID: 36060829 PMCID: PMC9389948 DOI: 10.5334/ijic.6434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 08/03/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction: This study empirically explores how dimensions of proximity that support integrated care emerge from deliberate actions within a cancer network in Quebec (Canada). Methods: We conduct a supplementary analysis of qualitative data from a primary multi-case study focused on collaborative governance and cancer care integration. Data from semi-structured interviews, documents and observation are analysed to find out how relationships take shape through actions that create different dimensions of proximity, and how these contribute to integrated practices. Results: Deliberate actions at different levels within the network create dimensions of proximity. The creation of committees and communities of practice at national and local level establish geographic proximity. Relational proximity among actors emerges to different degrees in these venues. Cognitive proximity is generated by consistent promotion of the national cancer plan and person-centred care. The priority of cancer care at policy level and prescription of common standards enhance organizational proximity. Synergy between dimensions of proximity appears essential to the emergence of integrated practices. Insufficient efforts to create technological and institutional proximity contribute to inconsistent clinical and professional integration. Conclusion: The concept of proximity appears a promising complement to existing models of integration, especially in complex contexts such as cancer networks. Highlights The multiple dimensions of proximity appear a promising complement to existing models of integration, especially in complex contexts such as cancer networks.
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Alonso JM, Andrews R. Does vertical integration of health and social care organizations work? Evidence from Scotland. Soc Sci Med 2022; 307:115188. [DOI: 10.1016/j.socscimed.2022.115188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 06/23/2022] [Accepted: 06/28/2022] [Indexed: 11/29/2022]
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Löwe C, Mark P, Sommer S, Weltermann B. Collaboration between general practitioners and social workers: a scoping review. BMJ Open 2022; 12:e062144. [PMID: 36691249 PMCID: PMC9171253 DOI: 10.1136/bmjopen-2022-062144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/08/2022] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES Aim of the study is to present an overview of collaboration structures and processes between general practitioners and social workers, the target groups addressed as well the quality of available scientific literature. DESIGN A scoping review following the guidelines of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). INCLUDED SOURCES AND ARTICLES According to a pre-published protocol, three databases (PubMed, Web of Science, DZI SoLit) were searched using the participant-concept-context framework. The searches were performed on 21 January 2021 and on 10 August 2021. Literature written in English and German since the year 2000 was included. Two independent researchers screened all abstracts for collaboration between general practitioners and social workers. Articles selected were analysed regarding structures, processes, outcomes, effectiveness and patient target groups. RESULTS A total of 72 articles from 17 countries were identified. Collaborative structures and their routine differ markedly between healthcare systems: 36 publications present collaboration structures and 33 articles allow an insight into the processual routines. For all quantitative studies, a level of evidence was assigned. Various measurements are used to determine the effectiveness of collaborations, for example, hospital admissions and professionals' job satisfaction. Case management as person-centred care for defined patient groups is a central aspect of all identified collaborations between general practitioners and social workers. CONCLUSION This scoping review showed evidence for benefits on behalf of patients, professionals and healthcare systems by collaborations between general practitioners and social workers, yet more rigorous research is needed to better understand the impact of these collaborations. TRIAL REGISTRATION NUMBER www.osf.io/w673q.
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Affiliation(s)
- Cornelia Löwe
- University Hospital / Institute of General Practice and Family Medicine, Rheinische Friedrich-Wilhelms-Universitat Bonn, Bonn, Germany
| | - Patrick Mark
- University Hospital / Institute of General Practice and Family Medicine, Rheinische Friedrich-Wilhelms-Universitat Bonn, Bonn, Germany
| | - Samira Sommer
- University Hospital / Institute of General Practice and Family Medicine, Rheinische Friedrich-Wilhelms-Universitat Bonn, Bonn, Germany
| | - Birgitta Weltermann
- University Hospital / Institute of General Practice and Family Medicine, Rheinische Friedrich-Wilhelms-Universitat Bonn, Bonn, Germany
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Shaw J, Gutberg J, Wankah P, Kadu M, Gray CS, McKillop A, Baker GR, Breton M, Wodchis WP. Shifting paradigms: Developmental milestones for integrated care. Soc Sci Med 2022; 301:114975. [PMID: 35461081 DOI: 10.1016/j.socscimed.2022.114975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/21/2022] [Accepted: 04/08/2022] [Indexed: 10/18/2022]
Abstract
Frameworks for understanding integrated care risk underemphasizing the complexities of the development of integrated care in a local context. The objectives of this article are to (1) present a novel strategy for conceptualizing integrated care as developing through a series of milestones at the organizational level, and (2) present a typology of milestones empirically generated through the analysis of four cases of integrated community-based primary health care (ICBPHC) in Canada and New Zealand. Our paper reports on an analysis of 4 specific organizational case studies within a large dataset generated for an international multiple case study project of exemplar models of ICBPHC. Drawing on earlier analyses of 359 qualitative interviews with patients, caregivers, health care providers, managers, and policymakers, in this article we present a detailed analysis of 28 interviews with managers and leaders of local models of integrated care. We generated a detailed timeline of the development of integrated care as expressed by each participant, and synthesized themes across timelines within each case to identify specific milestone events. We then synthesized across cases to generate the broader milestone categories to which each event belongs. We generated 5 milestone categories containing 12 more specific milestone events. The milestone categories include (1) strategic relational, (2) strategic process change, (3) internal structural, (4) inter-organizational structural, and (5) external milestones. We propose a comprehensive framework of developmental milestones for integrated care. Milestones represent a compelling strategy for conceptualizing the development of integrated care. Practically, policymakers and health care leaders can support the implementation of integrated care by examining the history and context of a given model of care and identifying strategies to achieve milestones that will accelerate integrated care. Further research should document additional milestone events and advance the development of dynamic frameworks for integrated care.
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Affiliation(s)
- James Shaw
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, 160-500 University Avenue, Toronto, Ontario, M5G 1V7, Canada.
| | - Jennifer Gutberg
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Paul Wankah
- Department of Community Health, University of Sherbrooke, Canada
| | - Mudathira Kadu
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Carolyn Steele Gray
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Canada
| | - Ann McKillop
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - G Ross Baker
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Mylaine Breton
- Department of Community Health, University of Sherbrooke, Canada
| | - Walter P Wodchis
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada; Research Chair Implementation and Evaluation Science, Institute for Better Health, Trillium Health Partners, Canada
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Zaytseva A, Verger P, Ventelou B. United, can we be stronger? Did French general practitioners in multi-professional groups provide more chronic care follow-up during lockdown? BMC Health Serv Res 2022; 22:519. [PMID: 35440039 PMCID: PMC9016683 DOI: 10.1186/s12913-022-07937-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/08/2022] [Indexed: 11/10/2022] Open
Abstract
Background Given the importance of the continuous follow-up of chronic patients, we evaluated the performance of French private practice general practitioners (GPs) practicing in multi-professional group practices (MGP) regarding chronic care management during the first Covid-19 lockdown in Spring 2020 compared to GPs not in MGP. We consider two outcomes: continuity of care provision for chronic patients and proactivity in contacting these patients. Methods The cross-sectional web questionnaire of 1191 GPs took place in April 2020. We exploit self-reported data on: 1) the frequency of consultations for chronic patients during lockdown compared to their “typical” week before the pandemic, along with 2) GPs’ proactive behaviour when contacting their chronic patients. We use probit and bivariate probit models (adjusted for endogeneity of choice of engagement in MGP) to test whether GPs in MGP had significantly different responses to the Covid-19 crisis compared to those practicing outside MGP. Results Out of 1191 participants (response rate: 43.1%), around 40% of GPs were female and 34% were younger than 50 years old. Regression results indicate that GPs in MGP were less likely to experience a drop in consultations related to complications of chronic diseases (− 45.3%). They were also more proactive (+ 13.4%) in contacting their chronic patients compared to their peers practicing outside MGP. Conclusion We demonstrate that the MGP organisational formula was beneficial to the follow-up of patients with chronic conditions during the lockdown; therefore, it appears beneficial to expand integrated practices, since they perform better when facing a major shock. Further research is needed to confirm the efficiency of these integrated practices outside the particular pandemic setup. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07937-z.
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Affiliation(s)
- Anna Zaytseva
- Aix-Marseille University, CNRS, EHESS, Centrale Marseille, AMSE, 5-9 Boulevard Maurice Bourdet, CS 50498, 13205, Marseille Cedex 1, France. .,Southeastern Regional Health Observatory, ORS Paca, Provence-Alpes-Côte d'Azur, Marseille, France, 27 Boulevard Jean Moulin, 13385, Marseille Cedex 5, France.
| | - Pierre Verger
- Southeastern Regional Health Observatory, ORS Paca, Provence-Alpes-Côte d'Azur, Marseille, France, 27 Boulevard Jean Moulin, 13385, Marseille Cedex 5, France.,Aix-Marseille University, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13005, Marseille, France
| | - Bruno Ventelou
- Aix-Marseille University, CNRS, EHESS, Centrale Marseille, AMSE, 5-9 Boulevard Maurice Bourdet, CS 50498, 13205, Marseille Cedex 1, France
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16
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Lalani M, Marshall M. Co-location, an enabler for service integration? Lessons from an evaluation of integrated community care teams in East London. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e388-e396. [PMID: 33152144 PMCID: PMC9290730 DOI: 10.1111/hsc.13211] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/06/2020] [Accepted: 09/28/2020] [Indexed: 06/11/2023]
Abstract
In an attempt to support care integration that promotes joined up service provision and patient-centred care across care boundaries, local health and social care organisations have embarked on several initiatives and approaches. A key component of service integration is the co-location of different professional groups. In this study, we consider the extent to which co-location is an enabler for service integration by examining multi-professional community care teams. The study presents findings from a qualitative evaluation of integrated care initiatives in a borough of East London, England, undertaken between 2017 and 2018. The evaluation employed a participatory approach, the Researcher-in-Residence model. Participant observation (n = 80 hr) and both semi-structured individual (n = 16) and group interviews (six groups, n = 17 participants) were carried out. Thematic analysis of the data was undertaken. The findings show that co-location can be an effective enabler for service integration providing a basis for joint working, fostering improved communication and information sharing if conditions such as shared information systems and professional cultures (shared beliefs and values) are met. Organisations must consider the potential barriers to service integration such as differing professional identity, limited understanding of roles and responsibilities and a lack of continuity in personnel. Co-location remains an important facet in the development of multi-professional teams and local service integration arrangements, but as yet, has not been widely acknowledged as a priority in care practice. Organisations that are committed to greying care boundaries and providing joined up patient care must ensure that sufficient focus is provided at the service delivery level and not assume that decades of silo working in health and social care and strong professional cultures will be resolved by co-location.
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Affiliation(s)
- Mirza Lalani
- London School of Hygiene and Tropical MedicineLondonUK
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17
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Alessi EJ, Caldwell B, Zazzarino AS, Greenfield B, Findley PA. 'You just really have to assert yourself:' social work, nursing, and rehabilitation counseling student experiences of providing integrated behavioral health services before and after the immediate start of COVID-19. BMC Health Serv Res 2022; 22:88. [PMID: 35042482 PMCID: PMC8765676 DOI: 10.1186/s12913-022-07465-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 12/24/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Educators who train healthcare students to provide behavioral health services in primary care settings frequently encounter challenges as they work to ensure that students acquire the knowledge and skills to effectively function on interprofessional practice teams. This has become increasingly important during COVID-19, as interprofessional collaborative practice is needed more than ever to address the interrelated health, mental health, and social structural issues linked to the pandemic. METHODS We used qualitative focus groups to understand the experiences of 6 interprofessional teams (comprised of graduate social work, nursing, and rehabilitation counseling students; n = 19) providing behavioral health services in primary care settings before and after the immediate start of COVID-19. To triangulate data and enrich findings, one focus group with students' faculty supervisors was also conducted; n = 5). Data were analyzed using thematic analysis. RESULTS Four themes highlighted student participants' need to assert themselves at the beginning of their educational experience, to communicate and learn from one another to develop positive team dynamics, to contend with role confusion and missed opportunities for collaboration, and to manage the emotional impact of COVID-19 on learning. CONCLUSION Findings indicate that educators should work with clinical faculty and agency supervisors to orient students to ensure they have role clarity within the agency. Graduate students providing behavioral health services should also learn to work collaboratively within their scopes of practice to serve patients virtually, especially in preparation for public health emergencies.
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Affiliation(s)
- Edward J Alessi
- School of Social Work, Rutgers, The State University of New Jersey, 390 George Street, FL 6 - Room 607A, New Brunswick, NJ, 08901, USA.
| | - Barbara Caldwell
- School of Nursing, Division of Advanced Nursing Practice, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Anthony S Zazzarino
- School of Health Professions, Rutgers, The State University of New Jersey, Scotch Plains, NJ, USA
| | - Brett Greenfield
- School of Social Work, Rutgers, The State University of New Jersey, 390 George Street, FL 6 - Room 607A, New Brunswick, NJ, 08901, USA
| | - Patricia A Findley
- School of Social Work, Rutgers, The State University of New Jersey, 390 George Street, FL 6 - Room 607A, New Brunswick, NJ, 08901, USA
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18
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Suprapto VH, Pujawan IN, Dewi RS. Effects of human performance improvement and operational learning on organizational safety culture and occupational safety and health management performance. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2021; 28:2455-2467. [PMID: 34730476 DOI: 10.1080/10803548.2021.2002571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Human performance improvement (HPI) is a strategic approach for reducing and controlling human errors, while operational learning (OL) is part of the organization's knowledge management system focusing on day-to-day operations. This study explores the influence of HPI and OL on the development of organizational safety culture, occupational safety and health (OSH) management performance in one of Indonesia's largest oil producers. First, we conducted a focus group discussion with top management and then surveyed 260 workers. The data were then analysed using partial least squares structural equation modelling, finding that HPI has a positive significant influence on OL. Furthermore, HPI and OL have positive significant influences on OSH management performance, such that OL mediates the effects of HPI on organizational safety culture, OSH management performance. These findings imply the need to prioritize and implement measures to improve organizational safety culture, OSH management performance.
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Affiliation(s)
- Vendy Hendrawan Suprapto
- Interdisciplinary School of Management and Technology, Institut Teknologi Sepuluh Nopember, Indonesia
| | - I Nyoman Pujawan
- Department of Industrial and Systems Engineering, Institut Teknologi Sepuluh Nopember, Indonesia
| | - Ratna Sari Dewi
- Department of Industrial and Systems Engineering, Institut Teknologi Sepuluh Nopember, Indonesia
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19
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Abstract
Strengthening the learning culture and the safeguards in organizations can enhance safety and performance in preventing incidents. The effective implementation of human performance improvement and operational learning can support the organization in achieving these goals. However, there is no streamlined implementation framework that considers the alignment of strategic and tactical actions in the management system cycle to implement human performance improvement and operational learning. This paper presents an implementation framework that fills the above gaps. It consists of four steps: (1) establish/validate a strategic objective, (2) conduct an assessment, (3) develop a plan, and (4) execute the plan. The proposed framework also includes a site tour phase during operational learning as an alternative to storytelling, which has an inherent bias. This framework was tested in the land transportation system of one of Indonesia’s biggest oil producers.
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20
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Caldwell BA, Alessi EJ, DiGiulio M, Findley P, Oursler J, Wagner M. Integrating Behavioral Health into Primary Care: The Role of Psychiatric Nursing in the Development of the Interprofessional Team. Issues Ment Health Nurs 2021; 42:758-767. [PMID: 33539194 DOI: 10.1080/01612840.2020.1867676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Integrated behavioral health in a primary care setting is a paradigm shift that requires academic reconfiguration on how health care professionals are educated and trained in the clinical arena. METHOD An academic university was able to create interprofessional didactic and clinical learning experiences for students within the Schools of Nursing, Social Work, Health Professions-Rehabilitation Counseling Department and Pharmacy resulting in improved models for patient care delivery. RESULTS Interdisciplinary faculty developed the didactic, clinical and evaluative areas based on the HRSA grant work plan. Deliverables included 18 modules, case studies focused on population health, and team-focused standardized patient experiences to test their behavioral health and psychiatric skills in a primary care setting. CONCLUSIONS Faculty from the different disciplines were able to collaborate on the deliverables, take the opportunities to engage students and collaborate on scholarly presentations at a national, state and local professional organizations. Academic course for interprofessional practice has been developed and implemented as an outcome of this grant.
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Affiliation(s)
| | - Edward J Alessi
- School of Social Work, Graduate Department, Rutgers University, New Brunswick, New Jersey, USA
| | - Mary DiGiulio
- School of Nursing, Rutgers University, Newark, New Jersey, USA
| | - Patricia Findley
- School of Social Work, Graduate Department, Rutgers University, New Brunswick, New Jersey, USA
| | - Janice Oursler
- School of Health Professions, Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University, Piscataway, New Jersey, USA
| | - Mary Wagner
- Department of Pharmacy Practice and Administration Ernest Mario School of Pharmacy, Rutgers University, Piscataway, New Jersey, USA
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21
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Uthoff SAK, Zinkevich A, Boenisch J, Sachse SK, Bernasconi T, Ansmann L. Collaboration between stakeholders involved in augmentative and alternative communication (AAC) care of people without natural speech. J Interprof Care 2021; 35:821-831. [PMID: 33438518 DOI: 10.1080/13561820.2020.1860918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Collaboration among health care providers is intended to dissolve boundaries between the sectors of health care systems. The implementation of adequate augmentative and alternative communication (AAC) care of people without natural speech depends highly on collaboration among multiple stakeholders such as speech and language pathologists, teachers, or physicians. This paper examines existing barriers to and facilitators of collaboration from a stakeholder perspective. Five heterogeneous focus group interviews were conducted with N= 32 stakeholders including speech and language pathologists, AAC consultants, teachers, employees of sheltered workshops, parents, and relatives of AAC users, and other educational professionals (e.g., employees of homes for persons with disabilities) at three AAC counseling centers in Germany. Interview data were analyzed by structured qualitative content analysis. The results show very different experiences of collaboration in AAC care. Factors were identified that can have both positive and negative effects on the collaboration between all stakeholders (e.g., openness toward AAC, knowledge about AAC, communication between stakeholders). In addition, stakeholder-specific influencing factors, such as working conditions or commitment to AAC implementation, were identified. The results also reveal that these factors may have an impact on the quality of AAC care. Overall, the results indicate that good collaboration can contribute to better AAC care and that adequate conditions such as personnel, and time-related resources, or financial conditions need to be established to facilitate collaboration.
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Affiliation(s)
- Sarah A K Uthoff
- Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Anna Zinkevich
- Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Jens Boenisch
- Department of Special Education and Rehabilitation,Faculty of Human Sciences, University of Cologne, Cologne, Germany
| | - Stefanie K Sachse
- Department of Special Education and Rehabilitation,Faculty of Human Sciences, University of Cologne, Cologne, Germany
| | - Tobias Bernasconi
- Department of Special Education and Rehabilitation,Faculty of Human Sciences, University of Cologne, Cologne, Germany
| | - Lena Ansmann
- Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
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22
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Mériade L, Rochette C. Integrated care pathway for breast cancer: A relational and geographical approach. Soc Sci Med 2020; 270:113658. [PMID: 33421916 DOI: 10.1016/j.socscimed.2020.113658] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/07/2020] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
Abstract
This paper examines how to apply a spatial approach (relational and geographical) to care pathways for their better integration within their territories. Based on the case study of a senology department of a French Cancer Diagnosis, Treatment and Research Centre, we apply a mixed research methodology using qualitative data (synthesis documents, meeting minutes, in-depth interviews) and quantitative data relating to the mobility and geographical location of a cohort of 1798 patients treated in this centre. Our results show the inseparable nature of the relational dimension and the geographical approach to move towards greater integration of breast cancer care pathways. This inseparability is constructed from the proposal of a method for mapping the integrated care pathways in their territories. This method, applied to our case study, allows us to identify four main categories of pathways for the cohort of patients studied.
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Affiliation(s)
- Laurent Mériade
- CleRMa - Research Chair "Health and Territories" - IAE School of Management - Clermont Auvergne University, 11, boulevard Charles de Gaulle, 63000, Clermont-Ferrand, France.
| | - Corinne Rochette
- CleRMa - Research Chair "Health and Territories" - IAE School of Management - Clermont Auvergne University, 11, boulevard Charles de Gaulle, 63000, Clermont-Ferrand, France.
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