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Teekens T, Giardini F, Kirgil ZM, Wittek R. Shared understanding and task-interdependence in nursing interns' collaborative relations: A social network study of vocational health care internships in the Netherlands. J Interprof Care 2023; 37:999-1009. [PMID: 37184374 DOI: 10.1080/13561820.2023.2209123] [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: 06/20/2022] [Revised: 04/21/2023] [Accepted: 04/21/2023] [Indexed: 05/16/2023]
Abstract
Shared understanding among collaborators is a key element of delivering successful interprofessional care and a main challenge for professional education concerns nurturing such understanding among students. We assessed how nursing students perceived different levels of shared understanding in their collaborations with others in clinical internships. We analyse the collaborative networks of interns to examine whether individual factors (attitudes, perceptions of collaborative cultures, and motivation) or relational factors among collaborators (task-interdependence, cooperation frequency, and interprofessional and hierarchical roles) affect shared understanding among 150 Dutch nursing interns and their collaborators (n = 865). Theoretically, we stress the importance of focusing on collaborative relations in interprofessional care settings. Multilevel models distinguish two levels in explaining the variation in shared understanding, nesting collaborative relationships within individuals. Results indicate merely 37.4% of found variation of shared understanding could be attributed to individual-level factors (variation between interns), while 62.6% of variation is found within interns, showing that shared understanding differs substantially between the collaborations one intern engages in. Multilevel models reveal that task-interdependence strongly predicts shared understanding in inter- and intraprofessional collaborations. We conclude that focusing on collaborative relations is essential to foster shared understanding in vocational internship programmes, and that health care organisations should pay explicit attention to task-interdependence in interns' collaborations.
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Affiliation(s)
- Thomas Teekens
- Department of Sociology / ICS, Faculty of Behavioural and Social Sciences, University of Groningen
| | - Francesca Giardini
- Department of Sociology / ICS, Faculty of Behavioural and Social Sciences, University of Groningen
| | | | - Rafael Wittek
- Department of Sociology / ICS, Faculty of Behavioural and Social Sciences, University of Groningen
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Song Y, Jung MY, Park S, Hasnain M, Gruss V. Challenges of interprofessional geriatric practice in home care settings: an integrative review. Home Health Care Serv Q 2023; 42:98-123. [PMID: 36596311 DOI: 10.1080/01621424.2022.2164541] [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: 01/05/2023]
Abstract
This integrative review identified challenges for interprofessional home care and provided recommendations for improving geriatric home care. A search of six databases identified 982 articles; 11 of them met the review's eligibility criteria and were included in the review. Quality appraisal of the included studies was performed using two tools (Critical Appraisal Skills Program for Qualitative Research and Mixed Methods Appraisal Tool), and their overall methodological quality was found to be satisfactory. After applying D'Amour et al.'s framework, four "challenge" themes emerged: (1) lack of sharing, (2) lack of partnership, (3) limited resources and interdependency, and (4) power issues. Recommendations included providing practical multidisciplinary training guided by a standardized model, establishing streamlined communication protocols and a communication platform reflecting the actual needs of users by involving them in its design, and asking interprofessional team members to commit to home care planning and to cultivate a collaborative culture and organizational support.
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Affiliation(s)
- Youngkwan Song
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Illinois Chicago, Chicago, Illinois, USA
| | - Min Young Jung
- Scripps Research Translational Institute, La Jolla, CA, USA
| | - Sungwon Park
- Department of Health Behavior and Biological Sciences, School of Nursing, Michigan Society of Fellows 2022-2025, University of Michigan, Ann Arbor, MI, USA
| | - Memoona Hasnain
- Department of Family and Community Medicine, College of Medicine, University of Illinois Chicago, Chicago, Illinois, USA
| | - Valerie Gruss
- Department of Biobehavioral Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
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Park SE, Pinto RM. Factors that Influence Co-production among Student Interns, Consumers, and Providers of Social and Public Health Services: Implications for Interprofessional Collaboration and Training. SOCIAL WORK IN PUBLIC HEALTH 2022; 37:71-83. [PMID: 34488568 PMCID: PMC8665028 DOI: 10.1080/19371918.2021.1974638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Providers of public health and social services ("providers") develop and deliver services by engaging in interprofessional collaboration (IPC), from seeking external advice to making referrals and linkages to various social and public health services. Providers collaborate with consumers of social and public health services ("consumers") and student interns (e.g., social work, public health) to explore, determine, and deliver relevant services through a process referred to as co-production. Both IPC and co-production are widespread strategies with the potential to improve service accessibility and quality. However, the intersection of co-production and IPC remains understudied. This study examines factors that influence co-production in IPC among service providers, consumers, and student interns. We used cross-sectional survey data from an NIMH-funded study, including 379 providers in 36 HIV-service organizations in New York City. We examined the relationships between providers' perspectives on co-production in IPC and multiple provider- and organization-level variables using random-effects logistic regression. Most respondents said that consumers and students in their agency participate in IPC on the issues that concern them. Providers who perceive greater flexibility in the IPC process were more likely to agree that their organizations' providers co-produced IPC. Organizational service offerings (i.e., multilingual services, a comprehensive range of services), job positions, and full-time employment status were strong predictors of co-production. Our findings indicate that intentional and inclusive models of flexible IPC are needed. Fostering co-production in the HIV service field requires more institutional support and incentives for organizations, providers, and student interns. Implications for research and practice are discussed.
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Leadership in Integrated Care Networks: A Literature Review and Opportunities for Future Research. Int J Integr Care 2020; 20:6. [PMID: 32863804 PMCID: PMC7427680 DOI: 10.5334/ijic.5420] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction In many countries, elderly patients with chronic conditions require a web of services delivered by several providers collaborating in inter-organisational networks. In view of their global importance, it is surprising how little we know how these networks are led. Like traditional organisations, networks require leadership to function effectively. This paper reviews central characteristics of leadership in integrated care networks and proposes opportunities for future research. Theory and methods Analysing 73 studies published in leading academic journals, this paper consolidates research on leadership media, practices, activities and outcomes, covering the network, policy and organisation levels of analysis. Results Findings indicate that the field has focused on leadership media and outcomes at the network level. They also suggest that leadership in integrated care networks faces multiple tensions. Future research could usefully provide a fuller picture by examining leadership practices, activities and outcomes at the policy and organisation level, integrating advances in the wider leadership literature. Discussion and conclusion These findings contribute to the debate on leadership in integrated care networks. They also inform practice, drawing attention to persistent tensions as a core leadership challenge and offering latest scholarly evidence practitioners can use to reflect on and advance their own leadership practice.
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Abstract
Introduction: Integrated care has been posited as an important strategy for overcoming service fragmentation problems and achieving the Quadruple Aim of health care. This paper describes the Central Coast Integrative Care Program (CCICP) a complex, multi-component intervention addressing 3 target populations and more than 40 sub-projects of different scale, priority and maturity. Details are provided of the implementation including activities undertaken for each target population, in the context of the Central Coast Local Health District (CCLHD) strategies and priorities. Key lessons are drawn from the formative evaluation. Methods: A mixed methods approach to the formative evaluation was taken. Key stakeholders, professional staff with an in-depth knowledge of the program, were invited to complete surveys (n = 27) and semi-structured interviews (n = 23). The evaluation employed co-design principles with dialogue between CCICP partners and researchers throughout the process and sought to achieve a shared understanding of the dynamic context of the program, and the barriers and enablers for the various interventions. Key lessons and conclusion: Seven interdependent key lessons have been identified. These distil down to the setting of clear objectives aligning with all the goals of partners, developing strong relationships, leadership at multiple levels and communication and the building of a common language.
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Gallagher AL, Murphy C, Conway P, Perry A. Consequential differences in perspectives and practices concerning children with developmental language disorders: an integrative review. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2019; 54:529-552. [PMID: 30945410 PMCID: PMC6767586 DOI: 10.1111/1460-6984.12469] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 01/03/2019] [Accepted: 03/05/2019] [Indexed: 05/21/2023]
Abstract
BACKGROUND Inter-professional collaboration (IPC) has been recommended for many years as a means by which the needs of children with developmental language disorders (DLD) can be met at school. However, effective IPC remains difficult to achieve and our knowledge of how to support it is limited. A shared understanding between those involved has been identified as critical to IPC. AIMS To examine the literature, as one source of data, for evidence of a shared understanding between the fields of speech and language therapy (SLT) and education about children with DLD and how such needs can best be met at school. METHODS & PROCEDURES An integrative review of the literature was undertaken. A systematic search of the published, peer-reviewed literature (between 2006 and 2016) was conducted for empirical and theoretical papers and a manual search was undertaken to obtain a representative sample of policy/professional guidelines. A total of 81 papers across SLT and education were included in the review. The papers were scrutinized using a qualitative content analysis. MAIN CONTRIBUTION Although some commonality between perspectives in the literature was identified, differences between the fields dominated. These differences related to how DLD is conceptualized; how children's needs are assessed; which outcomes are prioritized and how best these outcomes can be achieved. We also found differences about what constitutes useful knowledge to guide practice. We suggest that the nature of the differences we identified in the literature may have negative implications for practitioners wishing to collaborate to meet the needs of children with DLD in school. The perspectives of practising SLTs and teachers need to be sought to determine whether the findings from the literature reflect dilemmas in practice. CONCLUSIONS Effective IPC is essential to meet the needs of children with DLD in school; yet, it remains difficult to achieve. Our review of the literature across SLT and education indicates evidence of a lack of shared understanding about DLD. If these differences are also evident in practice, then a conceptual model to support IPC may be warranted.
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Affiliation(s)
- Aoife L. Gallagher
- School of Allied Health, Faculty of Education & Health SciencesUniversity of LimerickLimerickIreland
| | - Carol‐Anne Murphy
- School of Allied Health, Faculty of Education & Health SciencesUniversity of LimerickLimerickIreland
| | - Paul Conway
- School of Education, Faculty of Education & Health SciencesUniversity of LimerickLimerickIreland
| | - Alison Perry
- School of Allied Health, Faculty of Education & Health SciencesUniversity of LimerickLimerickIreland
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A Universal Early Parenting Education Intervention in Community-Based Primary Care Settings: Development and Installation Challenges. EDUCATION SCIENCES 2018. [DOI: 10.3390/educsci8040178] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Prevention and early intervention programmes, which aim to educate and support parents and young children in the earliest stages of the family lifecycle, have become an increasingly popular policy strategy for tackling intergenerational disadvantage and developmental inequality. Evidence-based, joined-up services are recommended as best practice for achieving optimal outcomes for parents and their children; however, there are persistent challenges to the development, adoption and installation of these kinds of initiatives in community-based primary health care settings. In this paper, we present a description of the design and installation of a multi-stakeholder early parenting education and intervention service model called the Parent and Infant (PIN) programme. This new programme is delivered collaboratively on a universal, area-wide basis through routine primary care services and combines standardised parent-training with other group-based supports designed to educate parents, strengthen parenting skills and wellbeing and enhance developmental outcomes in children aged 0–2 years. The programme design was informed by local needs analysis and piloting to establish an in-depth understanding of the local context. The findings demonstrate that a hospitable environment is central to establishing interagency parenting education and supports. Partnership, relationship-building and strategic leadership are vital to building commitment and buy-in for this kind of innovation and programme implementation. A graduated approach to implementation which provides training/education and coaching as well as organisational and administrative supports for practice change, are also important in creating an environment conducive to collaboration. Further research into the impact, implementation and cost-effectiveness of the PIN programme will help to build an understanding of what works for parents and infants, as well as identifying lessons for the development and implementation of other similar complex prevention and intervention programmes elsewhere. This kind of research coupled with the establishment of effective partnerships involving service providers, parents, researchers and policy makers, is necessary to meeting the challenge of improving family education and enhancing the capacity of family services to help promote positive outcomes for children.
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Parker A, Scantlebury A, Booth A, MacBryde JC, Scott WJ, Wright K, McDaid C. Interagency collaboration models for people with mental ill health in contact with the police: a systematic scoping review. BMJ Open 2018; 8:e019312. [PMID: 29588323 PMCID: PMC5875664 DOI: 10.1136/bmjopen-2017-019312] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To identify existing evidence on interagency collaboration between law enforcement, emergency services, statutory services and third sector agencies regarding people with mental ill health. DESIGN Systematic scoping review. Scoping reviews map particular research areas to identify research gaps. DATA SOURCES AND ELIGIBILITY ASSIA, CENTRAL, the Cochrane Library databases, Criminal Justice Abstracts, ERIC, Embase, MEDLINE, PsycINFO, PROSPERO and Social Care Online and Social Sciences Citation Index were searched up to 2017, as were grey literature and hand searches. Eligible articles were empirical evaluations or descriptions of models of interagency collaboration between the police and other agencies. STUDY APPRAISAL AND SYNTHESIS Screening and data extraction were undertaken independently by two researchers. Arksey's framework was used to collate and map included studies. RESULTS One hundred and twenty-five studies were included. The majority of articles were of descriptions of models (28%), mixed methods evaluations of models (18%) and single service evaluations (14%). The most frequently reported outcomes (52%) were 'organisational or service level outcomes' (eg, arrest rates). Most articles (53%) focused on adults with mental ill health, whereas others focused on adult offenders with mental ill health (17.4%). Thirteen models of interagency collaboration were described, each involving between 2 and 13 agencies. Frequently reported models were 'prearrest diversion' of people with mental ill health (34%), 'coresponse' involving joint response by police officers paired with mental health professionals (28.6%) and 'jail diversion' following arrest (23.8%). CONCLUSIONS We identified 13 different interagency collaboration models catering for a range of mental health-related interactions. All but one of these models involved the police and mental health services or professionals. Several models have sufficient literature to warrant full systematic reviews of their effectiveness, whereas others need robust evaluation, by randomised controlled trial where appropriate. Future evaluations should focus on health-related outcomes and the impact on key stakeholders.
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Affiliation(s)
- Adwoa Parker
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Arabella Scantlebury
- Institute of Health and Society, University of Newcastle, Newcastle upon Tyne, UK
| | - Alison Booth
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | | | | | - Kath Wright
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Catriona McDaid
- York Trials Unit, Department of Health Sciences, University of York, York, UK
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Lyon AR, Whitaker K, Locke J, Cook CR, King KM, Duong M, Davis C, Weist MD, Ehrhart MG, Aarons GA. The impact of inter-organizational alignment (IOA) on implementation outcomes: evaluating unique and shared organizational influences in education sector mental health. Implement Sci 2018; 13:24. [PMID: 29415749 PMCID: PMC5804008 DOI: 10.1186/s13012-018-0721-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 01/30/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Integrated healthcare delivered by work groups in nontraditional service settings is increasingly common, yet contemporary implementation frameworks typically assume a single organization-or organizational unit-within which system-level processes influence service quality and implementation success. Recent implementation frameworks predict that inter-organizational alignment (i.e., similarity in values, characteristics, activities related to implementation across organizations) may facilitate the implementation of evidence-based practices (EBP), but few studies have evaluated this premise. This study's aims examine the impact of overlapping organizational contexts by evaluating the implementation contexts of externally employed mental health clinicians working in schools-the most common integrated service delivery setting for children and adolescents. Aim 1 is to estimate the effects of unique intra-organizational implementation contexts and combined inter-organizational alignment on implementation outcomes. Aim 2 is to examine the underlying mechanisms through which inter-organizational alignment facilitates or hinders EBP implementation. METHODS/DESIGN This study will conduct sequential, exploratory mixed-methods research to evaluate the intra- and inter-organizational implementation contexts of schools and the external community-based organizations that most often employ school-based mental health clinicians, as they relate to mental health EBP implementation. Aim 1 will involve quantitative surveys with school-based, externally-employed mental health clinicians, their supervisors, and proximal school-employed staff (total n = 120 participants) to estimate the effects of each organization's general and implementation-specific organizational factors (e.g., climate, leadership) on implementation outcomes (fidelity, acceptability, appropriateness) and assess the moderating role of the degree of clinician embeddedness in the school setting. Aim 2 will explore the mechanisms through which inter-organizational alignment influences implementation outcomes by presenting the results of Aim 1 surveys to school-based clinicians (n = 30) and conducting semi-structured qualitative interviews. Qualitative data will be evaluated using an integrative inductive and deductive approach. DISCUSSION The study aims are expected to identify intra- and inter-organizational constructs that are most instrumental to EBP implementation success in school-based integrated care settings and illuminate mechanisms that may account for the influence of inter-organizational alignment. In addition to improving school-based mental health, these findings will spur future implementation science that considers the relationships across organizations and optimize the capacity of implementation science to guide practice in increasingly complex systems of care.
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Affiliation(s)
- Aaron R Lyon
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA.
| | - Kelly Whitaker
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | - Jill Locke
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | - Clayton R Cook
- University of Minnesota, 250 Education Sciences Bldg, 56 East River Road, Minneapolis, MN, 55455, USA
| | - Kevin M King
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | - Mylien Duong
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | - Chayna Davis
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | - Mark D Weist
- University of South Carolina, 1512 Pendleton Street, Columbia, SC, 29208, USA
| | - Mark G Ehrhart
- University of Central Florida, 4111 Pictor Lane, Orlando, FL, 32816-1390, USA
| | - Gregory A Aarons
- University of California San Diego, 9500 Gilman Drive (0812), La Jolla, San Diego, CA, 92093, USA.,Child and Adolescent Services Research Center, San Diego, 92123, CA, USA
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Auschra C. Barriers to the Integration of Care in Inter-Organisational Settings: A Literature Review. Int J Integr Care 2018; 18:5. [PMID: 29632455 PMCID: PMC5887071 DOI: 10.5334/ijic.3068] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 10/31/2017] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION In recent years, inter-organisational collaboration between healthcare organisations has become of increasingly vital importance in order to improve the integration of health service delivery. However, different barriers reported in academic literature seem to hinder the formation and development of such collaboration. THEORY AND METHODS This systematic literature review of forty studies summarises and categorises the barriers to integrated care in inter-organisational settings as reported in previous studies. It analyses how these barriers operate. RESULTS Within these studies, twenty types of barriers have been identified and then categorised in six groups (barriers related to administration and regulation, barriers related to funding, barriers related to the inter-organisational domain, barriers related to the organisational domain, barriers related to service delivery, and barriers related to clinical practices). Not all of these barriers emerge passively, some are set up intentionally. They are not only context-specific, but are also often related and influence each other. DISCUSSION AND CONCLUSION The compilation of these results allows for a better understanding of the characteristics and reasons for the occurrence of barriers that impede collaboration aiming for the integration of care, not only for researchers but also for practitioners. It can help to explain and counteract the slow progress and limited efficiency and effectiveness of some of the inter-organisational collaboration in healthcare settings.
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Affiliation(s)
- Carolin Auschra
- Freie Universität Berlin, Department of Management, Boltzmannstr. 20, 14195 Berlin, DE
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McKinlay EM, Morgan SJ, Gray BV, Macdonald LM, Pullon SR. Exploring interprofessional, interagency multimorbidity care: case study based observational research. JOURNAL OF COMORBIDITY 2017; 7:64-78. [PMID: 29090190 PMCID: PMC5556439 DOI: 10.15256/joc.2017.7.103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 05/03/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND The increase in multimorbidity or co-occurring chronic illnesses is a leading healthcare concern. Patients with multimorbidity require ongoing care from many different professionals and agencies, and often report a lack of integrated care. OBJECTIVE To explore the daily help-seeking behaviours of patients with multimorbidity, including which health professionals they seek help from, how professionals work together, and perceptions and characteristics of effective interprofessional, interagency multimorbidity care. DESIGN Using a case study observational research design, multiple data sources were assembled for four patients with multimorbidity, identified by two general practitioners in New Zealand. In this paper, two case studies are presented, including the recorded instances of contact and communication between patients and professionals, and between professionals. Professional interactions were categorized as consultation, coordination, or collaboration. RESULTS The two case studies illustrated two female patients with likely similar educational levels, but with different profiles of multimorbidity, social circumstances, and personal capabilities, involving various professionals and agencies. Engagement between professionals showed varying levels of interaction and a lack of clarity about leadership or care coordination. The majority of interactions were one-to-one consultations and rarely involved coordination and collaboration. Patients were rarely included in communications between professionals. CONCLUSION Cases constructed from multiple data sources illustrate the complexity of day-to-day, interprofessional, interagency multimorbidity care. While consultation is the most frequent mode of professional interaction, targeted coordinated and collaborative interactions (including the patient) are highly effective activities. Greater attention should be given to developing and facilitating these interactions and determining who should lead them.
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Affiliation(s)
- Eileen M. McKinlay
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Sonya J. Morgan
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Ben V. Gray
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Lindsay M. Macdonald
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Susan R.H. Pullon
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
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Trifkovič KČ, Lorber M, Denny M, Denieffe S, Gönc V. Attitudes of Nursing Students Towards Learning Communication Skills. TEACHING AND LEARNING IN NURSING 2017. [DOI: 10.5772/67622] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Pullon S, Morgan S, Macdonald L, McKinlay E, Gray B. Observation of interprofessional collaboration in primary care practice: A multiple case study. J Interprof Care 2016; 30:787-794. [DOI: 10.1080/13561820.2016.1220929] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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van Rensburg AJ, Fourie P. Health policy and integrated mental health care in the SADC region: strategic clarification using the Rainbow Model. Int J Ment Health Syst 2016; 10:49. [PMID: 27453722 PMCID: PMC4957874 DOI: 10.1186/s13033-016-0081-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 07/14/2016] [Indexed: 11/17/2022] Open
Abstract
Background Mental illness is a well-known challenge to global development, particularly in low-to-middle income countries. A key health systems response to mental illness is different models of integrated health care, especially popular in the South African Development Community (SADC) region. This complex construct is often not well-defined in health policy, hampering implementation efforts. A key development in this vein has been the Rainbow Model of integrated care, a comprehensive framework and taxonomy of integrated care based on the integrative functions of primary care. The purpose of this study was to explore the nature and strategic forms of integrated mental health care in selected SADC countries, specifically how integrated care is outlined in state-driven policies. Methods Health policies from five SADC countries were analysed using the Rainbow Model as framework. Electronic copies of policy documents were transferred into NVivo 10, which aided in the framework analysis on the different types of integrated mental health care promoted in the countries assessed. Results Several Rainbow Model components were emphasised. Clinical integration strategies (coordination of person-focused care) such as centrality of client needs, case management and continuity were central considerations, while others such as patient education and client satisfaction were largely lacking. Professional integration (inter-professional partnerships) was mentioned in terms of agreements on interdisciplinary collaboration and performance management, while organisational integration (inter-organisational relationships) emerged under the guise of inter-organisational governance, population needs and interest management. Among others, available resources, population management and stakeholder management fed into system integration strategies (horizontally and vertically integrated systems), while functional integration strategies (financial, management and information system functions) included human resource, information and resource management. Normative integration (a common frame of reference) included collective attitude, sense of urgency, and linking cultures, though aspects such as conflict management, quality features of the informal collaboration, and trust were largely lacking. Conclusions Most countries stressed the importance of integrating mental health on primary healthcare level, though an absence of supporting strategies could prove to bar implementation. Inter-service collaboration emerged as a significant goal, though a lack of (especially) normative integration dimensions could prove to be a key omission. Despite the usefulness of the Rainbow Model, it failed to adequately frame regional governance aspects of integration, as the SADC Secretariat could play an important role in coordinating and supporting the development and strengthening of better mental health systems. Electronic supplementary material The online version of this article (doi:10.1186/s13033-016-0081-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- André Janse van Rensburg
- Health and Demographic Research Unit, Department of Sociology, Ghent University, Korte Meer 5, 9000 Ghent, Belgium ; Department of Political Science, Stellenbosch University, Corner Merriman and Ryneveld Street, Stellenbosch, 7602 South Africa ; Centre for Health Systems Research & Development, University of the Free State, Nelson Mandela Road, Bloemfontein, 9300 South Africa
| | - Pieter Fourie
- Department of Political Science, Stellenbosch University, Corner Merriman and Ryneveld Street, Stellenbosch, 7602 South Africa
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Challenges in Achieving Collaboration in Clinical Practice: The Case of Norwegian Health Care. Int J Integr Care 2016; 16:3. [PMID: 28435416 PMCID: PMC5351059 DOI: 10.5334/ijic.2217] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: This article summarizes and synthesizes the findings of four separate but inter-linked empirical projects which explored challenges of collaboration in the Norwegian health system from the perspectives of providers and patients. The results of the four projects are summarised in eight articles. Methods: The eight articles constituted our empirical material. Meta-ethnography was used as a method to integrate, translate, and synthesize the themes and concepts contained in the articles in order to understand how challenges related to collaboration impact on clinical work. Results: Providers’ collaboration across all contexts was hampered by organizational and individual factors, including, differences in professional power, knowledge bases, and professional culture. The lack of appropriate collaboration between providers impeded clinical work. Mental health service users experienced fragmented services leading to insecurity and frustration. The lack of collaboration resulted in inadequate rehabilitation services and lengthened the institutional stay for older patients. Conclusion: Focusing on the different perspectives and the inequality in power between patients and healthcare providers and between different providers might contribute to a better environment for achieving appropriate collaboration. Organizational systems need to be redesigned to better nurture collaborative relationships and information sharing and support integrated working between providers, health care professionals and patients.
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Quail M, Brundage SB, Spitalnick J, Allen PJ, Beilby J. Student self-reported communication skills, knowledge and confidence across standardised patient, virtual and traditional clinical learning environments. BMC MEDICAL EDUCATION 2016; 16:73. [PMID: 26919838 PMCID: PMC4769506 DOI: 10.1186/s12909-016-0577-5] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 02/02/2016] [Indexed: 05/09/2023]
Abstract
BACKGROUND Advanced communication skills are vital for allied health professionals, yet students often have limited opportunities in which to develop them. The option of increasing clinical placement hours is unsustainable in a climate of constrained budgets, limited placement availability and increasing student numbers. Consequently, many educators are considering the potentials of alternative training methods, such as simulation. Simulations provide safe, repeatable and standardised learning environments in which students can practice a variety of clinical skills. This study investigated students' self-rated communication skill, knowledge, confidence and empathy across simulated and traditional learning environments. METHOD Undergraduate speech pathology students were randomly allocated to one of three communication partners with whom they engaged conversationally for up to 30 min: a patient in a nursing home (n = 21); an elderly trained patient actor (n = 22); or a virtual patient (n = 19). One week prior to, and again following the conversational interaction, participants completed measures of self-reported communication skill, knowledge and confidence (developed by the authors based on the Four Habit Coding Scheme), as well as the Jefferson Scale of Empathy - Health Professionals (student version). RESULTS All three groups reported significantly higher communication knowledge, skills and confidence post-placement (Median d = .58), while the degree of change did not vary as a function of group membership (Median η (2) < .01). In addition, only students interacting with a nursing home resident reported higher empathy after the placement. Students reported that conversing with the virtual patient was more challenging than conversing with a nursing home patient or actor, and students appeared to derive the same benefit from the experience. CONCLUSIONS Participants self-reported higher communication skill, knowledge and confidence, though not empathy, following a brief placement in a virtual, standardised or traditional learning environment. The self-reported increases were consistent across the three placement types. It is proposed that the findings from this study provide support for the integration of more sustainable, standardised, virtual patient-based placement models into allied health training programs for the training of communication skills.
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Affiliation(s)
- Michelle Quail
- Curtin University, School of Psychology and Speech Pathology, GPO Box U1987, Perth, WA, 6845, Australia.
| | | | | | - Peter J Allen
- Curtin University, School of Psychology and Speech Pathology, GPO Box U1987, Perth, WA, 6845, Australia.
| | - Janet Beilby
- Curtin University, School of Psychology and Speech Pathology, GPO Box U1987, Perth, WA, 6845, Australia.
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Palinkas LA, Fuentes D, Finno M, Garcia AR, Holloway IW, Chamberlain P. Inter-organizational collaboration in the implementation of evidence-based practices among public agencies serving abused and neglected youth. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2015; 41:74-85. [PMID: 22886317 DOI: 10.1007/s10488-012-0437-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study examined the role of inter-organizational collaboration in implementing new evidence-based practices for addressing problem behaviors in at-risk youth. Semi-structured interviews were conducted with 38 systems leaders of probation, mental health, and child welfare departments of 12 California counties participating in a large randomized controlled trial to scale-up the use of Multidimensional Treatment Foster Care. Three sets of collaboration characteristics were identified: (1) characteristics of collaboration process, (2) characteristics of the external environment, and (3) characteristics of participating organizations and individuals. Inter-organizational collaboration enables an exchange of information and advice and a pooling of resources individual agencies may require for successful implementation.
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Affiliation(s)
- Lawrence A Palinkas
- School of Social Work, University of Southern California, 669 W. 34th Street, Los Angeles, CA, 90089-0411, USA,
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Hamilton S, Manthorpe J, Szymczynska P, Clewett N, Larsen J, Pinfold V, Tew J. Implementing personalisation in integrated mental health teams in England. J Interprof Care 2015; 29:488-93. [DOI: 10.3109/13561820.2015.1035777] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ojo O. The challenges of home enteral tube feeding: a global perspective. Nutrients 2015; 7:2524-38. [PMID: 25856223 PMCID: PMC4425159 DOI: 10.3390/nu7042524] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 02/17/2015] [Accepted: 04/01/2015] [Indexed: 12/14/2022] Open
Abstract
The aim of this review is to provide a global perspective of Home Enteral Tube Feeding (HETF) and to outline some of the challenges of home enteral nutrition (HEN) provisions. It is well established that the number of patients on HETF is on the increase worldwide due to advances in technology, development of percutaneous endoscopic gastrostomy techniques, and the shift in care provisions from acute to community settings. While the significance of home enteral nutrition in meeting the nutritional requirements of patients with poor swallowing reflexes and those with poor nutritional status is not in doubt, differences exist in terms of funding, standards, management approaches and the level of infrastructural development across the world. Strategies for alleviating some of the challenges militating against the effective delivery of HETF including the development of national and international standards, guidelines and policies for HETF, increased awareness and funding by government at all levels were discussed. Others, including development of HEN services, which should create the enabling environment for multidisciplinary team work, clinical audit and research, recruitment and retention of specialist staff, and improvement in patient outcomes have been outlined. However, more research is required to fully establish the cost effectiveness of the HEN service especially in developing countries and to compare the organization of HEN service between developing and developed countries.
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Affiliation(s)
- Omorogieva Ojo
- Faculty of Education and Health,University of Greenwich, Avery Hill Campus, Avery Hill Road, London SE9 2UG, UK.
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Berglund H, Blomberg S, Dunér A, Kjellgren K. Organizing integrated care for older persons: strategies in Sweden during the past decade. J Health Organ Manag 2015; 29:128-51. [PMID: 25735557 DOI: 10.1108/jhom-04-2013-0082] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to describe and analyse ways of organizing integrated care for older persons in Sweden during the past decade. DESIGN/METHODOLOGY/APPROACH The data consist of 62 cases of development work, described in official reports. A meta-analysis of cases was performed, including content analysis of each case. A theoretical framework comprising different forms of integration (co-ordination, contracting, co-operation and collaboration) was applied. FINDINGS Co-operation was common and collaboration, including multiprofessional teamwork, was rare in the cases. Contracting can be questioned as being a form of integration, and the introduction of consumer choice models appeared problematic in inter-organization integration. Goals stated in the cases concerned steering and designing care, rather than outcome specifications for older persons. Explicit goals to improve integration in itself could imply that the organizations adapt to strong normative expectations in society. Trends over the decade comprised development of local health care systems, introduction of consumer choice models and contracting out. RESEARCH LIMITATIONS/IMPLICATIONS Most cases were projects, but others comprised evaluations of regular organization of integrated care. These evaluations were often written normatively, but constituted the conditions for practice and were important study contributions. PRACTICAL IMPLICATIONS Guiding clinical practice to be aware of importance of setting follow-up goals. SOCIAL IMPLICATIONS Awareness of the risk that special funds may impede sustainable strategies development. ORIGINALITY/VALUE A theoretical framework of forms of integration was applied to several different strategies, which had been carried out mostly in practice. The study contributes to understanding of how different strategies have been developed and applied to organize integrated care, and highlights some relationships between integration theory and practice.
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Affiliation(s)
- Helene Berglund
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden, AND, Vårdalinstitutet, The Swedish Institute for Health Sciences, Lund, Sweden
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Pullon S, McKinlay B, Yager J, Duncan B, McHugh P, Dowell A. Developing indicators of service integration for child health: perceptions of service providers and families of young children in a region of high need in New Zealand. J Child Health Care 2015; 19:18-29. [PMID: 23939725 DOI: 10.1177/1367493513496673] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Children in many areas of New Zealand have poor health indices; statistics indicate health inequalities. Existing international indicators of child health currently take little account of local context. There are few composite indicators of how child health services are integrated at a community level. This study aimed to explore what local people consider would be useful indicators of better child health. Data for this qualitative study were collected via 24 individual interviews and two focus groups in a rural area of New Zealand. A total of 13 in-depth interviews were conducted with parents/families of small children. Participants were asked about wide-ranging aspects of child health. Also, 11 interviews and two focus groups were conducted with front line health professionals/stakeholders. Key themes from the content thematic analysis: include child health should be measured in multidimensional ways; essential interdependence of family-child health; universal access to culturally appropriate care, free primary care services and parenting education and support is needed; and there is a lack of integration and communication between health, education and social services. There is an important need to measure and monitor communication/integration across existing health, education and social services, provide better parenting support and health education and improve access to culturally appropriate primary care.
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Ojo O. Pumps, feed and sets: is procurement limiting outcomes? BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2015; 24:146-9. [PMID: 25679243 DOI: 10.12968/bjon.2015.24.3.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article aims to review the unique ways in which enteral feed, ancillary items and pumps are procured in the UK and to evaluate whether these are inhibiting innovation and reducing the choices of patients. There are a number of models that have been developed across the UK for the procurement of enteral feed, feeding accessories and pump. The two most common are the hospital-based nutrition support team, which may have an overarching role in the community, and the home enteral nutrition (HEN) team, a multidisciplinary community-based team with skilled health professionals dedicated to the delivery of the enteral nutrition service. While the HEN service has its advantages over other models in the community, it is primarily driven by its clinical role. The lack of significant opportunity for clinical audits and research within the service limits the prospects for service improvement, innovation and patients' choices.
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Affiliation(s)
- Omorogieva Ojo
- Senior Lecturer in Primary Care, University of Greenwich, London
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Ahgren B. The path to integrated healthcare: Various Scandinavian strategies. INTERNATIONAL JOURNAL OF CARE COORDINATION 2014. [DOI: 10.1177/2053435414540606] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Oliver G. Managing IV pathways through acute and community service collaboration. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2014; 23:S37. [PMID: 25158365 DOI: 10.12968/bjon.2014.23.sup14.s37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Aspinal F, Bernard S, Spiers G, Parker G. Outcomes assessment for people with long-term neurological conditions: a qualitative approach to developing and testing a checklist in integrated care. HEALTH SERVICES AND DELIVERY RESEARCH 2014. [DOI: 10.3310/hsdr02090] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundFailure to demonstrate the effect of integration on service users using conventional outcome measures suggests that research to date has failed to measure the outcomes that actually matter to people with complex long-term conditions and that might result from integrated health and social care. Developing outcome measures that capture the important issues for service users may also help to better reflect the particular ways integrated teams work and what such teams strive to achieve in addressing service user outcomes.ObjectivesThe objectives of this research were to (1) identify factors that affect integration between health and social care; (2) identify outcomes important to people with long-term neurological conditions (LTNCs) who are clients of an ‘integrated’ service; (3) develop these outcomes into a checklist and explore whether or not these outcomes can be assessed in practice; and (4) understand how different models of integration affect outcomes.Design, methods and participantsA case study approach, using in-depth, semistructured interviews, was adopted. The cases were four English primary care trusts (PCTs) and their associated local authorities. Case sites had a neurological-rehabilitation team (NRT), each with a different approach to health and social care integration. The research took place in three stages. In stage 1, interviews with 43 commissioners, managers, NRT staff and social care practitioners, and documentary analysis, helped to understand service contexts and approaches to assessment. Interviews, guided by earlier outcomes work, were held with 35 people with LTNCs to identify important outcomes. Interviews with 13 carers illustrated relationships between NRTs and carers. In stage 2, these outcomes were developed into a checklist in partnership with NRTs. NRTs used the outcomes checklist (OC) as part of their routine assessment, and we monitored its use. In stage 3, we conducted interviews and focus groups with 21 NRT staff and 12 clients to evaluate the use of the OC in practice.AnalysisQualitative data were managed and analysed thematically using the framework approach.ResultsPerson, service and structural-level factors influenced integration between health and social care. Relationships between practitioners and services often drove integration in practice. However, wider structural arrangements were important and could facilitate these relationships. We identified 20 outcomes important to people with LTNCs. These were grouped into three outcome domains: personal comfort, economic and social participation, and autonomy. Use of the OC in practice was viewed differently by the NRTs. One NRT felt that it duplicated existing assessments, one felt that it covered issues outside their remit and two felt that the OC worked for them. Some of the outcomes could be difficult for staff and clients to raise but clients felt that they should all be included in assessments. Use of the OC was sometimes challenging due to staffing and caseload pressures, changes to service structures and remit, and competing demands of other compulsory paperwork. All NRTs thought that the OC had potential value as a benchmarking or training tool. Larger, more interdisciplinary models of integrated NRTs appeared to give more scope for interpreting, assessing and potentially achieving outcomes.ConclusionsMany of the outcomes that are important to service users with LTNCs are not addressed in validated ‘outcome measures’. This has implications for commissioners and practitioners to ensure that service users’ needs are met in practice. Turning the OC into a measurement tool could go some way to addressing this. Many of the outcomes are interdependent; an impact on one particular outcome will have a ‘knock-on’ effect on other outcomes. These inter-relationships demonstrate the complexity of what is important in the lives of people with LTNCs. Service changes can affect integrated arrangements negatively. More research is needed to explore the longer-term effects of organisational change on integrated service provision.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Fiona Aspinal
- Social Policy Research Unit, University of York, York, UK
| | - Sylvia Bernard
- Social Policy Research Unit, University of York, York, UK
| | - Gemma Spiers
- Social Policy Research Unit, University of York, York, UK
| | - Gillian Parker
- Social Policy Research Unit, University of York, York, UK
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Nuño-Solinís R, Zabalegui IB, Rodríguez LSM, Arce RS, Gagnon MP. Does interprofessional collaboration between care levels improve following the creation of an integrated delivery organisation? The Bidasoa case in the Basque Country. Int J Integr Care 2013; 13:e030. [PMID: 24179454 PMCID: PMC3812313 DOI: 10.5334/ijic.1118] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 05/31/2013] [Accepted: 06/27/2013] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION This article explores the impact of the creation of a new integrated delivery organisation on the evolution of interprofessional collaboration between primary and secondary care levels. In particular, the case of the Bidasoa Integrated Healthcare Organisation is analysed. THEORY AND METHODS The evolution of interprofessional collaboration is measured through a validated Spanish questionnaire, with 10 items and a 5-point Likert scale, based on the D'Amour's model of collaboration [20]. The final sample included 146 observations (doctors and nurses). RESULTS The questionnaire identified a significant improvement on the mean scores for interprofessional collaboration of 0.57 points before and after the intervention. A significant improvement was also found in the two dimensions of the measure of interprofessional collaboration used, with the size of the change being higher for the dimension related to the organisational setting (0.63) than for interpersonal relationships (0.47). CONCLUSIONS Before and after the creation of the Bidasoa Integrated Healthcare Organisation, an improvement in the perceived degree of interprofessional collaboration between primary and secondary care levels was observed. This finding supports the benefit of a multilevel and multidimensional approach to integration, as in the described Bidasoa case. DISCUSSION Results on the two dimensions of the measure of interprofessional collaboration used seem to point to the longer time required for interpersonal relationships to change compared to the organisational setting.
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Robben SHM, Heinen MM, Makai P, Olde Rikkert MGM, Perry M, Schers HJ, Melis RJF. [Reducing fragmentation in the care of frail older people: the successful development and implementation of the Health and Welfare Information Portal]. Tijdschr Gerontol Geriatr 2013; 44:59-71. [PMID: 23494689 DOI: 10.1007/s12439-013-0014-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Our fragmented health care systems are insufficiently equipped to provide frail older people with high quality of care. Therefore, we developed the Health and Welfare Information Portal (ZWIP), an e-health intervention which aims (1) to facilitate self-management by frail older people and informal caregivers and (2) to improve collaboration among professionals. The ZWIP is a personal conference table, accessible through a secure internet connection, for multidisciplinary communication and information exchange for frail older people, their informal caregivers and professionals. After development, the ZWIP was implemented in seven general practices, and this process was evaluated by means of a mixed-methods study. Eventually, 290 frail older people and 169 professionals participated in the ZWIP. Most professionals were positive about its implementation. Facilitators for the implementation were the experienced need for improvement of interprofessional collaboration and the user-friendliness of the ZWIP. Barriers were the low computer-literacy of frail older people, start-up problems, preferring personal contact, and limited use of the ZWIP by other professionals. In sum, this article describes the successful development and implementation of the ZWIP, an e-health intervention which can reduce fragmentation in the care of frail older people.
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Affiliation(s)
- S H M Robben
- Arts in opleiding tot klinisch geriater, Afdeling Klinische Geriatrie, UMC St Radboud, Nijmegen, The Netherlands.
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Abstract
This paper examines the impact of the changes to health and social care on enteral feeding in the community, outlines implications for practice and offers recommendations to ameliorate the challenges. It is now clear that there have been significant changes especially in the last 10 years in health and social care provisions in the UK with an overarching effect on enteral nutrition in the community. Advances in technology, increasing demand and treatment costs, the need for improvement in quality, economic challenges, market forces, political influences and more choices for patients are some of the factors driving the change. Government’s vision of a modern system of health and social care is based on initiatives such as clinically led commissioning, establishment of Monitor, shifting care from acute hospitals to community settings, integrating health and social care provisions, Quality, Innovation, Productivity and Prevention (QIPP) program and the concept of “Big Society”. These strategies which are encapsulated in various guidelines, policies and legislation, including the health and social care Act, 2012 are clarified. The future challenges and opportunities brought on by these changes for healthcare professionals and patients who access enteral nutrition in the community are discussed and recommendations to improve practice are outlined.
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Andersson J, Löfström M, Bihari Axelsson S, Axelsson R. Actor or arena: contrasting translations of a law on interorganizational integration. J Health Organ Manag 2012; 26:778-93. [DOI: 10.1108/14777261211277014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Robben SH, Huisjes M, van Achterberg T, Zuidema SU, Olde Rikkert MG, Schers HJ, Heinen MM, Melis RJ. Filling the Gaps in a Fragmented Health Care System: Development of the Health and Welfare Information Portal (ZWIP). JMIR Res Protoc 2012; 1:e10. [PMID: 23611877 PMCID: PMC3626145 DOI: 10.2196/resprot.1945] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 02/28/2012] [Accepted: 06/26/2012] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Current health care systems are not optimally designed to meet the needs of our aging populations. First, the fragmentation of care often results in discontinuity of care that can undermine the quality of care provided. Second, patient involvement in care decisions is not sufficiently facilitated. OBJECTIVE To describe the development and the content of a program aimed at: (1) facilitating self-management and shared decision making by frail older people and informal caregivers, and (2) reducing fragmentation of care by improving collaboration among professionals involved in the care of frail older people through a combined multidisciplinary electronic health record (EHR) and personal health record (PHR). METHODS We used intervention mapping to systematically develop our program in six consecutive steps. Throughout this development, the target populations (ie, professionals, frail older people, and informal caregivers) were involved extensively through their participation in semi-structured interviews and working groups. RESULTS We developed the Health and Welfare Information Portal (ZWIP), a personal, Internet-based conference table for multidisciplinary communication and information exchange for frail older people, their informal caregivers, and professionals. Further, we selected and developed methods for implementation of the program, which included an interdisciplinary educational course for professionals involved in the care of frail older people, and planned the evaluation of the program. CONCLUSIONS This paper describes the successful development and the content of the ZWIP as well as the strategies developed for its implementation. Throughout the development, representatives of future users were involved extensively. Future studies will establish the effects of the ZWIP on self-management and shared decision making by frail older people as well as on collaboration among the professionals involved.
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Affiliation(s)
- Sarah Hm Robben
- Department of Geriatric Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands.
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Robben SHM, Perry M, Huisjes M, van Nieuwenhuijzen L, Schers HJ, van Weel C, Rikkert MGMO, van Achterberg T, Heinen MM, Melis RJF. Implementation of an innovative web-based conference table for community-dwelling frail older people, their informal caregivers and professionals: a process evaluation. BMC Health Serv Res 2012; 12:251. [PMID: 22894654 PMCID: PMC3470954 DOI: 10.1186/1472-6963-12-251] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 08/10/2012] [Indexed: 01/23/2023] Open
Abstract
Background Due to fragmentation of care, continuity of care is often limited in the care provided to frail older people. Further, frail older people are not always enabled to become involved in their own care. Therefore, we developed the Health and Welfare Information Portal (ZWIP), a shared Electronic Health Record combined with a communication tool for community-dwelling frail older people and primary care professionals. This article describes the process evaluation of its implementation, and aims to establish (1) the outcomes of the implementation process, (2) which implementation strategies and barriers and facilitators contributed to these outcomes, and (3) how its future implementation could be improved. Methods Mixed methods study, consisting of (1) a survey among professionals (n = 118) and monitoring the use of the ZWIP by frail older people and professionals, followed by (2) semi-structured interviews with purposively selected professionals (n = 12). Results 290 frail older people and 169 professionals participated in the ZWIP. At the end of the implementation period, 55% of frail older people and informal caregivers, and 84% of professionals had logged on to their ZWIP at least once. For professionals, the exposure to the implementation strategies was generally as planned, they considered the interprofessional educational program and the helpdesk very important strategies. However, frail older people’s exposure to the implementation strategies was less than intended. Facilitators for the ZWIP were the perceived need to enhance interprofessional collaboration and the ZWIP application being user-friendly. Barriers included the low computer-literacy of frail older people, a preference for personal communication and limited use of the ZWIP by other professionals and frail older people. Interviewees recommended using the ZWIP for other target populations as well and adding further strategies that may help frail older people to feel more comfortable with computers and the ZWIP. Conclusions This study describes the implementation process of an innovative e-health intervention for community-dwelling frail older people, informal caregivers and primary care professionals. As e-health is an important medium for overcoming fragmentation of healthcare and facilitating patient involvement, but its adoption in everyday practice remains a challenge, the positive results of this implementation are promising.
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Affiliation(s)
- Sarah H M Robben
- Department of Geriatric Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Care planning at home: a way to increase the influence of older people? Int J Integr Care 2012; 12:e134. [PMID: 23593048 PMCID: PMC3601533 DOI: 10.5334/ijic.817] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 05/25/2012] [Accepted: 06/20/2012] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Care-planning meetings represent a common method of needs assessment and decision-making practices in elderly care. Older people's influence is an important and required aspect of these practices. This study's objective was to describe and analyse older people's influence on care-planning meetings at home and in hospital. METHODS Ten care-planning meetings were audio-recorded in the older people's homes and nine were recorded in hospital. The study is part of a project including a comprehensive continuum-of-care model. A qualitative content analysis was performed. RESULTS Care-planning meetings at home appeared to enable older people's involvement in the discussions. Fewer people participated in the meetings at home and there was less parallel talking. Unrelated to the place of the care-planning meeting, the older people were able to influence concerns relating to the amount of care/service and the choice of provider. However, they were not able to influence the way the help should be provided or organised. CONCLUSION Planning care at home indicated an increase in involvement on the part of the older people, but this does not appear to be enough to obtain any real influence. Our findings call for attention to be paid to older people's opportunities to receive care and services according to their individual needs and their potential for influencing their day-to-day provision of care and service.
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Davies K, Davies P. Tensions in Commissioning: Services for Children's Speech, Language and Communication Needs in One English Region. J Health Serv Res Policy 2012; 17 Suppl 2:37-44. [DOI: 10.1258/jhsrp.2012.011121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives To investigate the tensions faced in commissioning services for children's speech, language and communication needs and to identify variation in commissioning practice in response to these tensions. Methods Quantitative and qualitative evidence from a review of speech, language and communication services in one English region, focused on three case studies. Results The case studies reveal variation in practice in relation to commissioning tensions generated by: low incidence/high needs cases, blurred boundaries between health and education, multi-agency working, parental voice and service development. The introduction of commissioning and models of practice such as ‘the commissioning cycle’ has left huge variation between localities in levels and type of provision for these services. Conclusion Large variation in commissioning practice is associated with commissioners' adoption of one of three models: a market model, an integrated model and a top-up model.
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Affiliation(s)
- Karen Davies
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester
| | - Peter Davies
- School of Education, University of Birmingham, Birmingham, UK
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Clarkson P, Hughes J, Abendstern M, Sutcliffe C, Tucker S, Philp I, Challis D. Involving specialist clinicians in policies for integrated care. JOURNAL OF INTEGRATED CARE 2011. [DOI: 10.1108/14769011111191421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Gallagher M, Skubby D, Bonfine N, Munetz MR, Teller JLS. Recognition and understanding of goals and roles: The key internal features of mental health court teams. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2011; 34:406-413. [PMID: 22071280 DOI: 10.1016/j.ijlp.2011.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The increasing involvement of people with mental illness in the criminal justice system has led to the formation of specialty programs such as mental health courts (hereafter MHCs). We discuss MHCs and the teams serving these courts. Specifically, we examine team members' perceptions of MHC goals and their own and others' roles on the MHC team. Using a semi-structured interview instrument, we conducted 59 face-to-face interviews with criminal justice and mental health treatment personnel representing 11 Ohio MHCs. Findings from our qualitative data analyses reveal that MHC personnel understand individuals' roles within the teams, recognize and appreciate the importance of different roles, and share common goals. MHCs could foster this level of understanding and agreement by working to recruit and retain individuals with experience in or willingness to learn about both the criminal justice and mental health systems. Future research should explore the impact of MHC team functioning on client outcomes.
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Hutton E, Coxon K. ‘Posture for Learning’: meeting the postural care needs of children with physical disabilities in mainstream primary schools in England – a research into practice exploratory study. Disabil Rehabil 2011; 33:1912-24. [DOI: 10.3109/09638288.2010.544837] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Upton Surgery (Worcestershire) has developed a flexible and responsive service model that facilitates multi-agency support for adult patients with complex care needs experiencing an acute health crisis. The purpose of this service is to provide appropriate interventions that avoid unnecessary hospital admissions or, alternatively, provide support to facilitate early discharge from secondary care. Key aspects of this service are the collaborative and proactive identification of patients at risk, rapid creation and deployment of a reactive multi-agency team and follow-up of patients with an appropriate long-term care plan. A small team of dedicated staff (the Complex Care Team) are pivotal to coordinating and delivering this service. Key skills are sophisticated leadership and project management skills, and these have been used sensitively to challenge some traditional roles and boundaries in the interests of providing effective, holistic care for the patient.This is a practical example of early implementation of the principles underlying the Department of Health's (DH) recent Best Practice Guidance, 'Delivering Care Closer to Home' (DH, July 2008) and may provide useful learning points for other general practice surgeries considering implementing similar models. This integrated case management approach has had enthusiastic endorsement from patients and carers. In addition to the enhanced quality of care and experience for the patient, this approach has delivered value for money. Secondary care costs have been reduced by preventing admissions and also by reducing excess bed-days. The savings achieved have justified the ongoing commitment to the service and the staff employed in the Complex Care Team. The success of this service model has been endorsed recently by the 'Customer Care' award by 'Management in Practice'. The Surgery was also awarded the 'Practice of the Year' award for this and a number of other customer-focussed projects.
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Fuller JD, Perkins D, Parker S, Holdsworth L, Kelly B, Roberts R, Martinez L, Fragar L. Building effective service linkages in primary mental health care: a narrative review part 2. BMC Health Serv Res 2011; 11:66. [PMID: 21435273 PMCID: PMC3070626 DOI: 10.1186/1472-6963-11-66] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Accepted: 03/25/2011] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Primary care services have not generally been effective in meeting mental health care needs. There is evidence that collaboration between primary care and specialist mental health services can improve clinical and organisational outcomes. It is not clear however what factors enable or hinder effective collaboration. The objective of this study was to examine the factors that enable effective collaboration between specialist mental health services and primary mental health care. METHODS A narrative and thematic review of English language papers published between 1998 and 2009. An expert reference group helped formulate strategies for policy makers. Studies of descriptive and qualitative design from Australia, New Zealand, UK, Europe, USA and Canada were included. Data were extracted on factors reported as enablers or barriers to development of service linkages. These were tabulated by theme at clinical and organisational levels and the inter-relationship between themes was explored. RESULTS A thematic analysis of 30 papers found the most frequently cited group of factors was "partnership formation", specifically role clarity between health care workers. Other factor groups supporting clinical partnership formation were staff support, clinician attributes, clinic physical features and evaluation and feedback. At the organisational level a supportive institutional environment of leadership and change management was important. The expert reference group then proposed strategies for collaboration that would be seen as important, acceptable and feasible. Because of the variability of study types we did not exclude on quality and findings are weighted by the number of studies. Variability in local service contexts limits the generalisation of findings. CONCLUSION The findings provide a framework for health planners to develop effective service linkages in primary mental health care. Our expert reference group proposed five areas of strategy for policy makers that address organisational level support, joint clinical problem solving, local joint care guidelines, staff training and supervision and feedback.
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Affiliation(s)
- Jeffrey D Fuller
- School of Nursing and Midwifery, Flinders University, Adelaide, Australia
- Northern Rivers University Department of Rural Health, School of Public Health, University of Sydney, Lismore, Australia
| | - David Perkins
- Broken Hill University Department of Rural Health, School of Public Health, University of Sydney, Broken Hill, Australia
| | | | - Louise Holdsworth
- Northern Rivers University Department of Rural Health, School of Public Health, University of Sydney, Lismore, Australia
- School of Tourism & Hospitality Management, Centre for Gambling Education & Research, Southern Cross University, Lismore, Australia
| | - Brian Kelly
- Faculty of Medicine, University of Newcastle, Newcastle, Australia
| | - Russell Roberts
- Greater Western Area Health Service, Orange, New South Wales, Australia
| | - Lee Martinez
- South Australian Department of Health, Adelaide, Australia
| | - Lyn Fragar
- Australian Centre for Agricultural Health and Safety, School of Public Health, Sydney University, Moree, Australia
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Wilberforce M, Harrington V, Brand C, Tucker S, Abendstern M, Challis D. Towards integrated community mental health teams for older people in England: progress and new insights. Int J Geriatr Psychiatry 2011; 26:221-8. [PMID: 20677214 DOI: 10.1002/gps.2517] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate progress in joint working within community mental health teams for older people (CMHTsOP) against a range of national standards, and to consider team characteristics that may hinder or facilitate integrated practice. METHODS A postal questionnaire was sent to the managers of all CMHTsOP in England. A total of 376 teams responded representing a response rate of 87.7%. Hypothesis testing and regression analysis, using a composite score based on nine indicators of integration, were conducted to address the study's aims. RESULTS Whilst the study suggests that progress was being made against a number of key standards of joint working, the study finds that most teams could not access local authority service user records, nor were health staff within most teams able to commission social care services. After controlling for other characteristics, teams with the lowest levels of integration tended to work across multiple local authorities; were managed by a nurse; had high referral rates and were located in formally integrated Care Trusts. CONCLUSIONS Improved integration could develop by NHS Trusts and local authorities encouraging more information sharing, and further delegating powers to arrange social care services to CMHTOP members. The paper highlights team and locality features that appear to cause obstacles to joint working, but there is a clear gap in the evidence relating team structures and characteristics to the quality of patient care.
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Affiliation(s)
- Mark Wilberforce
- Personal Social Services Research Unit, University of Manchester, UK.
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Elissen AMJ, van Raak AJA, Paulus ATG. Can we make sense of multidisciplinary co-operation in primary care by considering routines and rules? HEALTH & SOCIAL CARE IN THE COMMUNITY 2011; 19:33-42. [PMID: 21143542 DOI: 10.1111/j.1365-2524.2010.00946.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Although it is widely acknowledged that the complex health problems of chronically ill and elderly persons require care provision across organisational and professional boundaries, achieving widespread multidisciplinary co-operation in primary care has proven problematic. We developed an explanation for this on the basis of the concepts of routines (patterns of behaviour) and rules, which form a relatively new yet promising perspective for studying co-operation in health-care. We used data about primary care providers situated in the Dutch region of Limburg, a region that, despite high numbers of chronically and elderly persons, has traditionally few healthcare centres and where multidisciplinary co-operation is limited. A qualitative study design was used, in which interviews and documents were the main data sources. Semi-structured interviews were conducted with providers from six primary care professions in the Dutch region of Limburg; relevant documents included co-operation agreements, annual reports and internal memos. To analyse the evidence, several data matrices were developed and all data were structured according to the main concepts under study, i.e. routines and rules. Although more research is needed, our study suggests that the emergence of more extensive multidisciplinary co-operation in primary care is hampered by the organisational rules and regulations prevailing in the sector. By emphasising individual care delivery rather than co-operation, these rules stimulate the perseverance of diversity between the routines by which providers perform their solo care delivery activities, rather than the creation of the amount of compatibility between those routines that is necessary for the current, rather limited shape of multidisciplinary co-operation to expand. Further research should attempt to validate this explanation by utilising a larger research population and systematically operationalising the rules existing in the legal and--more importantly--organisational environment of primary care.
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Affiliation(s)
- Arianne M J Elissen
- Department of Health Organization, Policy and Economics (HOPE), School of Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
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Tucker S, Baldwin R, Hughes J, Benbow SM, Barker A, Burns A, Challis D. Integrating mental health services for older people in England - from rhetoric to reality. J Interprof Care 2010; 23:341-54. [PMID: 19370444 DOI: 10.1080/13561820902739833] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The provision of integrated, person-centred care is particularly important for older people with mental health problems. Nevertheless, a series of reports at the end of the last century highlighted unacceptable differences in collaborative working practices in England, variations that a national service framework specifically aimed to address. This study utilized a cross-sectional survey of old age psychiatrists to explore the extent to which, some three years after the publication of this guidance, structures to deliver integrated care across the interfaces between specialist old age mental health and primary, acute and social care services were in place. Three hundred and eighteen (72%) consultants responded. Measures to facilitate integrated practice were generally poorly developed: many areas missed targets to agree protocols for the management of older people with mental health problems with primary care; more than 45% of respondents reported the presence of fewer than two of four indicators of integration with the acute sector; and approaching 30% of respondents reported the presence of fewer than four of 13 markers of integration with social care. The implications of these findings and the challenges inherent in providing integrated care for this client group are discussed.
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Affiliation(s)
- Sue Tucker
- PSSRU, University of Manchester, Manchester, UK.
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Axelsson SB, Axelsson R. From territoriality to altruism in interprofessional collaboration and leadership. J Interprof Care 2010; 23:320-30. [PMID: 19517284 DOI: 10.1080/13561820902921811] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Interprofessional collaboration has become more and more necessary in health and social care, mainly because of the increasing specialization of services and the increasing professionalization of different occupational groups. Most interprofessional collaboration is at the same time also interorganizational and it is taking place within a complicated structure, where collaborative teamwork is combined with hierarchical co-ordination and control in a sort of matrix organization. Based on the literature on organization, leadership and collaboration, this paper discusses territorial behaviour among professional groups and agencies as a difficult barrier to interprofessional collaboration. In order to overcome that barrier, the concept of altruism is explored as an alternative to territoriality. Professional altruism as well as altruistic leadership is discussed as a condition and a possibility for interprofessional collaboration. The discussion is illustrated with empirical data from a case study of collaboration in vocational rehabilitation.
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McDonald C, McCallin A. Interprofessional collaboration in palliative nursing: what is the patient-family role? Int J Palliat Nurs 2010; 16:286-9. [DOI: 10.12968/ijpn.2010.16.6.48832] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Antoinette McCallin
- National Centre for Interprofessional Education and Collaborative Practice, Faculty of Health and Environmental Sciences AUT University, Auckland, New Zealand
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Anderson ES, Smith R, Thorpe LN. Learning from lives together: medical and social work students' experiences of learning from people with disabilities in the community. HEALTH & SOCIAL CARE IN THE COMMUNITY 2010; 18:229-240. [PMID: 20534068 DOI: 10.1111/j.1365-2524.2010.00921.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The study aims to evaluate an interprofessional community-based learning event, focussing on disability. The learning opportunity was based on the Leicester Model of Interprofessional Education, organised around the experiences and perceptions of service users and their carers. Programme participants were drawn from medicine and social work education in Leicester, UK, bringing together diverse traditions in the care of people with disabilities. Small student groups (3-4 students) worked from one of the eight community rehabilitation hospitals through a programme of contact with people with disabilities in hospital, at home or in other community settings. The evaluation, in March 2005, used a mixed methods approach, incorporating questionnaire surveys, focus group interviews with students and feedback from service users. Responses were collated and analysed using quantitative and qualitative measures. Fifty social work and 100 medical students completed the first combined delivery of the module. The findings indicated that the merging of social work and medical perspectives appear to create some tensions, although overall the student experience was found to be beneficial. Service users (16 responses) valued the process. They were not concerned at the prospect of meeting a number of students at home or elsewhere and were pleased to think of themselves as educators. Problems and obstacles still anticipated include changing the mindset of clinicians and practising social workers to enable them to support students from each other's disciplines in practice learning. The generally positive outcomes highlight that disability focussed joint learning offers a meaningful platform for interprofessional education in a practice environment.
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Affiliation(s)
- E S Anderson
- Shared Learning, Department of Medical and Social Care Education, Maurice Shock Building, Leicester LE1 9HN, UK.
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Janssens A, Peremans L, Deboutte D. Conceptualizing collaboration between children's services and child and adolescent psychiatry: A bottom--up process based on a qualitative needs assessment among the professionals. Clin Child Psychol Psychiatry 2010; 15:251-66. [PMID: 20179020 DOI: 10.1177/1359104509340651] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Little is known about the need of professionals of children's services and child and adolescent psychiatry to collaborate. This study aimed to explore the perception of practitioners of both services with regard to a future collaborative partnership improving the wellbeing of children in children's services. Eight focus groups were performed and analysed, following the principles of the Grounded Theory. The focus groups revealed that the professionals agree considerably concerning the outlines of the collaboration. They agree upon the primary goal of the partnership, their expected role and tasks. In addition, the partnership should develop in an atmosphere of mutual respect and with the intention to provide the best care for the child. The results of the focus groups are discussed in consideration of a future implementation of interventions on developing best practices at the intersection of children's services and child and adolescent psychiatry.
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Affiliation(s)
- Astrid Janssens
- University of Antwerp, Collaborative Antwerp Psychiatric Research Institute, ZNA University Centre Child and Adolescent Psychiatry Antwerp, Belgium.
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Mitchell R, Parker V, Giles M, White N. Review: Toward Realizing the Potential of Diversity in Composition of Interprofessional Health Care Teams. Med Care Res Rev 2009; 67:3-26. [DOI: 10.1177/1077558709338478] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Interprofessional approaches to health and social care have been linked to improved planning and policy development, more clinically effective services, and enhanced problem solving; however, there is evidence that professionals tend to operate in uniprofessional silos and that attempts to share knowledge across professional borders are often unsuccessful.
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Malin N, Morrow G. Models of interprofessional working within a Sure Start “Trailblazer” Programme. J Interprof Care 2009; 21:445-57. [PMID: 17654161 DOI: 10.1080/13561820701346657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This paper evaluates interprofessional working within a Sure Start "trailblazer" programme based upon definitions of multi-, inter- and trans-disciplinary practice. Examples of practice from within the programme include professionals working towards family support and child protection objectives, providing a forum for child and family referral and a programme to promote mother-child bonding. Findings are discussed in the context of linking interprofessionality with government target-setting, professional identity and values and integrated working practice for Sure Start/Children's Centres.
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Affiliation(s)
- Nigel Malin
- School of Health, Natural and Social Sciences, University of Sunderland, UK.
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Abstract
This critical evaluation considers research literature on Assertive Outreach Teams (AOTs). The extensive examination of this multi-professional service configuration is contrasted with the under-defined and untested nature of the service interventions that are provided by these teams. An audit of crisis management work in an AOT is reported and twelve areas of "life difficulties" are identified. An attempt to measure these life difficulties is then described. The use of this measurement for prioritizing referrals, managing workloads, agreeing care plans and measuring outcomes is discussed. Finally, the inadequacy of existing research approaches and associated problems in the separation of management and clinical practices are considered.
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Affiliation(s)
- Simon Wharne
- Hanover House, St Leonards-on-Sea, East Sussex, UK.
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Allan H, Bryan K, Clawson L, Smith P. Developing an interprofessional learning culture in primary care. J Interprof Care 2009; 19:452-64. [PMID: 16308169 DOI: 10.1080/13561820500215145] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This paper discusses the concept of interprofessional learning based on empirical data from an evaluation of an interprofessional learning project that was set in a British primary health care centre. A process evaluation methodology was chosen to collect the data using semi-structured interviews and focus groups with stakeholders and staff to gather their experiences and views of the project and documentary data from records written over the lifetime of the project. The paper argues that an interprofessional learning culture requires time to become embedded in everyday practice and to achieve such a culture, shared values, aims and clear communication are essential. The data suggest that there is a need to recognize responsibility for one's own learning as individuals as well as learning as teams of work colleagues if interprofessional learning is to be successful. However, even when these pre-requisites of interprofessional learning are agreed and acknowledged openly in the workplace, participants in the development of a learning culture need to recognize that there are structural controls which influence and constrain such developments which are external to participants and beyond their immediate control.
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Affiliation(s)
- Helen Allan
- Centre for Research in Nursing & Midwifery Education, European Institute of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK.
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