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Perone AK. Navigating Religious Refusal to Nursing Home Care for LGBTQ+ Residents: Comparisons Between Floor Staff and Managers. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbae122. [PMID: 39023035 DOI: 10.1093/geronb/gbae122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Indexed: 07/20/2024] Open
Abstract
OBJECTIVES Religious exemptions (exceptions to nondiscrimination laws for individual religious/moral beliefs) in health care have surged, negatively affecting LGBTQ+ older adults in nursing homes with some of the highest caregiving needs. Given job differences between floor staff and managers, this study asks: How does meaning-making differ between nursing home floor staff and managers when staff refuse to care for LGBTQ+ residents? To answer this question, this study uses social coherence as a conceptual framework to understand the process of reflection that staff employ when a colleague invokes a religious exemption to care. METHODS This qualitative comparative study uses in-depth semistructured interviews to compare responses from nursing home floor staff and managers (n = 80). Qualitative content analysis incorporated inductive and deductive coding approaches. RESULTS Staff invoked 5 frames to reach social coherence: fairness, resident safety and comfort, individual religious beliefs, job obligations, and laws/policies. Floor staff and managers invoked the same 2 reasons (fairness, resident safety and comfort) to reach social coherence. However, floor staff differed from managers by also invoking individual religious beliefs and job obligations; whereas managers turned to laws and policies to reconcile tensions between religious rights and LGBTQ+ resident rights to care. DISCUSSION In an increasingly polarized world, findings from this study illuminate nuances (and potential new areas of allyship) in how floor staff and managers understand and use various frames when deciding whether or not to accommodate a colleague who refuses care to an LGBTQ+ resident because of religious or moral reasons.
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Affiliation(s)
- Angela K Perone
- School of Social Welfare, University of California, Berkeley, California, USA
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Marc-Aurele K, Branche T, Adams A, Feister J, Boyle K, Scala M. Recommendations for creating a collaborative NICU environment to support teamwork and trainee education. J Perinatol 2023; 43:1520-1525. [PMID: 37620402 DOI: 10.1038/s41372-023-01756-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/26/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023]
Abstract
In a 2022 survey, a majority of neonatology program directors reported regular conflict between neonatal-perinatal fellows and frontline providers (FLPs) (i.e., neonatal nurse practitioners (NNPs), neonatal physician assistants (PAs), and neonatal hospitalists). This paper reviews recommendations of a multidisciplinary workgroup for creating a more collaborative unit environment that supports teamwork and education. The self-study framework is a helpful tool to identify specific pressure points at individual institutions. Implementing clear guidelines for procedural distribution and role clarification are often critical interventions. FLPs and Pediatric Physician Trainees may benefit from conflict management coaching and communication training. At the same time, we recommend that respective leaders support a psychologically safe environment for team members to feel safe to solve problems on their own. Going forward, more work is important to optimize teamwork in the setting of anticipated staffing shortages, limitations to resident neonatology exposure, changes in training requirements, and ongoing development of the FLP role.
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Affiliation(s)
| | - Tonia Branche
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Aaron Adams
- Duke University School of Medicine, Durham, NC, USA
| | - John Feister
- Stanford University School of Medicine, Stanford, CA, USA
| | - Kristine Boyle
- Lucile Packard Children's Hospital Stanford, Stanford, CA, USA
| | - Melissa Scala
- Stanford University School of Medicine, Stanford, CA, USA.
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GPs' experiences of a collaborative care model for patients with common mental disorders who need sick leave certification: a qualitative study. BJGP Open 2022; 6:BJGPO.2022.0042. [PMID: 35977733 PMCID: PMC9904781 DOI: 10.3399/bjgpo.2022.0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/02/2022] [Accepted: 07/13/2022] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND GPs are an important part of collaboration around patients with common mental disorders (CMD) in primary care. The Co-Work-Care model was implemented to further improve collaboration, and emphasised working more closely with patients through active dialogues among care managers, rehabilitation coordinators, and GPs. This enhanced collaborative model also included a person-centred dialogue meeting with patients' employers. AIM The aim of this study was to explore GPs' experiences of the Co-Work-Care model, an organisation of collaborative care at the primary care centre (PCC) that includes a person-centred dialogue meeting in the care of patients with CMD who need sick leave certification. DESIGN & SETTING Qualitative individual and group interviews were conducted with Swedish GPs with experience of the Co-Work-Care trial where the PCC was an intervention PCC with the enhanced collaboration model. METHOD GPs were sampled purposefully from different Co-Work-Care intervention PCCs in Sweden. Focus group and individual, in-depth semi-structured interviews were conducted. All interviews were analysed by systematic text condensation (STC), according to Malterud. RESULTS The following three codes describing the GPs' experiences of working in the Co-Work-Care model were identified: (1) a structured work approach; (2) competency of the care manager and the rehabilitation coordinator; and (3) gaining control through close collaboration. CONCLUSION Overall, GPs' experience was that the enhanced collaboration reduced their workload and enabled them to focus on medical care. Patient care was perceived as safer and more effective. These advantages may result in higher quality in medical and rehabilitation decisions, as well as a more sustainable and less stressful work situation for GPs.
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Larsson R, Erlingsdóttir G, Persson J, Rydenfält C. Teamwork in home care nursing: A scoping literature review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e3309-e3327. [PMID: 35862714 PMCID: PMC10084131 DOI: 10.1111/hsc.13910] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 04/22/2022] [Accepted: 07/04/2022] [Indexed: 06/15/2023]
Abstract
Due to an increased number of complex multi- and long-term ill patients, healthcare and nursing provided in patients' homes are expected to grow. Teamwork is important in order to provide effective and safe care. As care becomes more complex, the need for teamwork in home care nursing increases. However, the literature on teamwork in the patients' home environment is limited. The aim of this study is to describe the scope of the current literature on teamwork in home care nursing and outline needs for future research. Seven electronic databases were systematically searched and 798 articles were identified and screened. Seventy articles remained and were assessed for eligibility by two of the authors. Eight themes were identified among the 32 articles that met the inclusion criteria. Studies concerned with teamwork regarding isolated tasks/problems and specific teamwork characteristics were most common. Methods were predominantly qualitative. Multiple method approaches and ethnographic field studies were rare. Descriptions of the context were often lacking. The terms 'team' and 'teamwork' were inconsistently used and not always defined. However, it is apparent that teamwork is important and home care nurses play a crucial role in the team, acting as the link between professionals, the patient and their families. Future studies need to pay more attention to the context and be more explicit about how the terms team and teamwork are defined and used. More research is also needed regarding necessary team skills, effects of teamwork on the work environment and technology-mediated teamwork.
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Affiliation(s)
- Roger Larsson
- Department of Design SciencesLund UniversityLundSweden
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Cohen TN, Anger JT, Kanji FF, Zamudio J, DeForest E, Lusk C, Avenido R, Yoshizawa C, Bartkowicz S, Nemeth LS, Catchpole K. A Novel Approach for Engagement in Team Training in High-Technology Surgery: The Robotic-Assisted Surgery Olympics. J Patient Saf 2022; 18:570-577. [PMID: 35797490 PMCID: PMC9391262 DOI: 10.1097/pts.0000000000001056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION There is ongoing interest in the development of technical and nontechnical skills in healthcare to improve safety and efficiency; however, barriers to developing and delivering related training programs make them difficult to implement. Unique approaches to training such as "serious games" may offer ways to motivate teams, reinforce skill acquisition, and promote teamwork. Given increased challenges to teamwork in robotic-assisted surgery (RAS), researchers aimed to develop the "RAS Olympics," a game-based educational competition to improve skills needed to successfully perform RAS. METHODS This pilot study was conducted at an academic medical center in Southern California. Robotic-assisted surgery staff were invited to participate in the "RAS Olympics" to develop their skills and identify opportunities to improve processes. Impact of the activity was assessed using surveys and debriefs. RESULTS Sixteen operating room team members participated and reacted favorably toward the RAS-Olympics (average score, 4.5/5). They enjoyed the activity, would recommend all staff participate, felt that it was relevant to their work, and believed that they practiced and learned new techniques that would improve their practice. Confidence in skills remained unchanged. Participants preferred the RAS Olympics to traditional training because it provided an interactive learning environment. CONCLUSIONS The successful implementation of the RAS Olympics provided insight into new opportunities to engage surgical staff members while also training technical and nontechnical skills. Furthermore, this shared experience allowed surgical staff members to gain a greater appreciation for their teammates and an understanding of the current challenges and methods to improve teamwork and communication while promoting safety and efficiency in RAS.
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Affiliation(s)
- Tara N. Cohen
- Research Scientist and Associate Professor, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90069
| | - Jennifer T. Anger
- Vice Chair of Research, Gender Affirming Surgery, Urologic Reconstruction, and Female Pelvic Medicine, University of California San Diego, Department of Urology, 9400 Campus Point Drive #7897, La Jolla, CA 92037
| | - Falisha F. Kanji
- Clinical Research Assistant, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90069
| | - Jennifer Zamudio
- Clinical Research Assistant, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90069
| | - Elise DeForest
- Program Assistant, Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC 29425
| | - Connor Lusk
- Postdoctoral Scholar, Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC 29425
| | - Ray Avenido
- Robotic Surgery Specialist, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, 90048
| | - Christine Yoshizawa
- Assistant Nurse Manager, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, 90048
| | - Stephanie Bartkowicz
- Clinical Nurse IV, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, 90048
| | - Lynne S. Nemeth
- Professor, College of Nursing, Medical University of South Carolina, Charleston, SC
| | - Ken Catchpole
- Endowed Chair in Clinical Practice and Human Factors, Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC
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McKay MH, Pickens ND, Medley A, Evetts CL. Outcomes of Team-Centered, Occupational Adaptation-Based Versus Traditional Dementia Workforce Training : Résultats comparés d'une formation axée sur l'équipe et l'adaptation occupationnelle et de l'approche de formation traditionnelle pour le personnel travaillant auprès des personnes atteintes de démence. The Canadian Journal of Occupational Therapy 2021; 88:384-394. [PMID: 34668409 DOI: 10.1177/00084174211048017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Dementia workforce training aligned with Occupational Adaptation (OA) theory may facilitate teams resolving challenges in the care environment more than traditional skills-based (SB) training, although comparisons are needed. Purpose. This pilot study compared effectiveness of an OA and SB program on relative mastery and team development for dementia care teams at a continuing care retirement community. Method. In a quasi-experimental study, employees underwent nine sessions in an OA or SB program. Relative Mastery Measurement Scale and Team Development Measure results were collected pre-, mid-, post-intervention. A 3 × 2 ANOVA determined differences in group score changes across time. Findings. Data from 28 employees (14/group) showed group-by-time interaction reached statistical significance for both relative mastery (F = 3.17, df = 2, p = .05) and team development (F = 8.38, df = 2, p = .001). Implications. OA-based training may improve dementia care teams' collaborative mastery over real-world challenges. While preliminary findings inform program developers, further research must explore clinical effectiveness.
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Doyle L, Kelliher F, Harrington D. Multi-level learning in public healthcare medical teams: the role of the social environment. J Health Organ Manag 2021; ahead-of-print. [PMID: 33215478 DOI: 10.1108/jhom-05-2019-0135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This study explores how individual, dyad and team levels of learning interact in public healthcare medical teams. DESIGN/METHODOLOGY/APPROACH A single interpretive case study is carried out in the public Health Service Executive (HSE) in Ireland, involving three rounds of semi-structured interviews with non-consultant hospital doctors (NCHDs), supported by relevant professional documentation and researcher log entries. FINDINGS An experience hierarchy, interpersonal relationships and social dynamics form the backdrop to learning interactions within public healthcare medical teams. Individual and team learning primarily occur in informal settings where interpreting and developing understanding takes place either in dyads, small groups or with the whole team. NCHD learning may vary depending on how effectively they build interpersonal relationships, take advantage of informal learning opportunities and manage the social dynamics within their team. Willingness and confidence to share insights and asking questions are triggers for individual and team learning. RESEARCH LIMITATIONS/IMPLICATIONS As a single case study focused on the HSE NCHD individual and team learning experience, this research study represents a relatively small exploration of individual and team learning interplay in the public healthcare medical team environment. The development of learning theory in this domain presents an intriguing avenue of further research, including observation of interactions within a team. PRACTICAL IMPLICATIONS The findings have practical relevance to those who are interested in the effectiveness of post-graduate/ NCHD learning in the public healthcare system. Interpersonal relationships and social norms play strong roles in how interaction and learning occurs in a team. These findings highlight the challenge of ensuring consistent quality across individual NCHDs or across hospital sites when training is heavily influenced by the approach of senior colleagues/ consultants to their more junior colleagues and the degree to which they take an active interest in NCHD learning. ORIGINALITY/VALUE The proposed learning framework is a key theoretical contribution, which draws upon the multi-levels of learning and provides greater insight into how individual, dyad and team learning interact in public healthcare medical teams when managing patient care. The findings have practical relevance in how to facilitate effective teamwork and learning interactions and for those who are interested in the consistency and quality of the training experience for NCHDs.
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Affiliation(s)
- Louise Doyle
- Leadership, Education and Talent Development, Health Service Executive, Dublin, Ireland
| | - Felicity Kelliher
- Management and Organisation, Waterford Institute of Technology, Waterford, Ireland
| | - Denis Harrington
- Graduate Business, School of Business, Waterford Institute of Technology, Waterford, Ireland
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Urpo M, Eskola S, Suominen T, Roos M. Teamwork: a perspective of perioperative nurses. CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2021. [DOI: 10.15452/cejnm.2021.12.0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Wise S, Duffield C, Fry M, Roche M. Nurses' role in accomplishing interprofessional coordination: Lessons in 'almost managing' an emergency department team. J Nurs Manag 2021; 30:198-204. [PMID: 34436800 DOI: 10.1111/jonm.13464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/17/2021] [Accepted: 08/23/2021] [Indexed: 12/01/2022]
Abstract
AIM To describe how nurse coordinators accomplished day-to-day interprofessional coordination in an Australian emergency department team, drawing some lessons for the design of nurse coordinator roles in other settings. BACKGROUND Previous studies have examined leadership within nursing teams, and there are a growing number of registered nurses employed as care coordinators. There is limited literature on how the day-to-day coordination of interprofessional teams is accomplished, and by whom. METHOD Nineteen semi-structured interviews with emergency department registered nurses, doctors and nurse practitioners analysed thematically. RESULTS Three themes describe how coordinators accomplished interprofessional coordination: task coordination and oversight, taking action to maintain patient flow and negotiating an ambiguous role. CONCLUSION Better-defined nurse coordinator roles with clearer authority and associated training are essential for consistent practice. However, accomplishing interprofessional coordination will always require the situated knowledge of the complex nursing-medical division of labour in the workplace and the interpersonal relationships that are only gained through experience. IMPLICATIONS FOR NURSING MANAGEMENT The design of nurse coordinator roles must include the thorny question of 'who leads' interprofessional teams in the day-to-day coordination of tasks. New and inexperienced nurses may not have the necessary situated knowledge or interpersonal relationships to succeed. However, such roles offer an important development opportunity for future nurse managers.
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Affiliation(s)
- Sarah Wise
- Centre for Health Economics Research and Evaluation, Faculty of Business, University of Technology Sydney, Sydney, NSW, Australia
| | - Christine Duffield
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.,Nursing and Health Services Management, School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia
| | - Margaret Fry
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.,Northern Sydney Local Health District, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Michael Roche
- School of Nursing, Midwifery, and Public Health, University of Canberra, Canberra, ACT, Australia
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Kang HJ, Flores-Sandoval C, Law B, Sibbald S. Interdisciplinary Health Care Evaluation Instruments: A Review of Psychometric Evidence. Eval Health Prof 2021; 45:223-234. [PMID: 34409879 PMCID: PMC9446429 DOI: 10.1177/01632787211040859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Teamwork among health care professionals has been found to improve patient outcomes and reduce burnout. Surveys from individual team members are often used to measure the effectiveness of teamwork performance, as they provide an efficient way to capture various constructs of teamwork. This allows evaluators to better understand team functioning, areas of strength, and to identify potential areas for improvement. However, the majority of published surveys are yet to be validated. We conducted a review of psychometric evidence to identify instruments frequently used in practice and identified in the literature. The databases searched included MEDLINE, EMBASE, CINAHL, and PsycINFO. After excluding duplicates and irrelevant articles, 15 articles met the inclusion criteria for full assessment. Seven surveys were validated and most frequently identified in the literature. This review aims to facilitate the selection of instruments that are most appropriate for research and clinical practice. More research is required to develop surveys that better reflect the current reality of teamwork in our evolving health system, including a greater consideration for patient as team members. Additionally, more research is needed to encompass an increasing development of team assessment tools.
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Affiliation(s)
- Hosung Joel Kang
- Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Cecilia Flores-Sandoval
- Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.,Health and Rehabilitation Sciences, University of Western Ontario, London, Ontario, Canada
| | - Benson Law
- Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Shannon Sibbald
- Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.,Department of Family Medicine, Schulich School of Dentistry and Medicine, University of Western Ontario, London, Ontario, Canada
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Wise S, Duffield C, Fry M, Roche M. A team mental model approach to understanding team effectiveness in an emergency department: A qualitative study. J Health Serv Res Policy 2021; 27:14-21. [PMID: 34251863 DOI: 10.1177/13558196211031285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To demonstrate how the team mental model concept can broaden our understanding of team effectiveness in health care by exploring the knowledge that underpins it, and the workplace conditions that sustain it in a metropolitan emergency department (ED) in Sydney, Australia. METHODS This study draws on accounts of 19 ED clinicians (registered nurses, doctors and nurse practitioners) of their teamwork practice and perceptions of their team's effectiveness through semi-structured interviews. Analysis was conducted in two stages. A thematic analysis was followed by a template analysis using the a priori themes of task, team, team process and goal knowledge to specify the content of the team's mental model. RESULTS The content of the ED team's mental model revealed that the knowledge the team employed to coordinate their work was deeply embedded in the team's tasks and the workplace context. Team effectiveness not only relied on how well team members coordinate, but also their ability to perform their own role effectively and efficiently. Three workplace conditions were identified as enablers to individuals acquiring the knowledge needed to work effectively in the team: stability in team membership; workplace experience; and the spatial-temporal conditions of emergency work where permanent emergency doctors and nurses executed their tasks concurrently, regularly interacted and shared a common goal. CONCLUSIONS Getting health care teams 'on the same page' is a long-standing challenge. This study suggests that solutions may lay in the organisation of health care work, creating team stability and opportunities for team members to interact that allows a team mental model to emerge.
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Affiliation(s)
- Sarah Wise
- Senior Research Fellow, Centre for Health Economics Research and Evaluation, University of Technology Sydney, Australia
| | - Christine Duffield
- Emeritus Professor, Faculty of Health, University of Technology Sydney, Australia.,Professor of Nursing and Health Services Management, School of Nursing and Midwifery, Edith Cowan University, Australia
| | - Margaret Fry
- Professor of Nursing, Faculty of Health, University of Technology Sydney, Australia.,Director, Research and Practice Development Nursing and Midwifery Directorate, Northern Sydney Local Health District, Australia
| | - Michael Roche
- Professor of Mental Health Nursing, School of Nursing, Midwifery, and Public Health, University of Canberra, Australia
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12
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Flores-Sandoval C, Sibbald S, Ryan BL, Orange JB. Interprofessional team-based geriatric education and training: A review of interventions in Canada. GERONTOLOGY & GERIATRICS EDUCATION 2021; 42:178-195. [PMID: 32787710 DOI: 10.1080/02701960.2020.1805320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Given world-wide rises in the number of older adults, interprofessional education and training in geriatrics must be promoted across the learning spectrum, both for students and for health care professionals. This review examined interprofessional team-based education and training interventions in Canada focusing on the team component. A total of 10 studies (1997-2017) were eligible for analyzes. Studies offered health care providers opportunities to enhance their knowledge of geriatric competencies, as well as their ability to work in interprofessional geriatric teams. Although several interventions did not include team-based learning content explicitly, team-building opportunities, as well as assignments related to working on teams yielded positive impacts on learners. Results showed improved geriatric competencies as well as team functioning. Geriatric health care teams add significant value to the Canadian health care system. Consequently, opportunities to improve health care providers' geriatric knowledge and their ability to work in teams should be encouraged.
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Affiliation(s)
- Cecilia Flores-Sandoval
- Health and Rehabilitation Sciences Program, Faculty of Health Sciences, Western University, London, Canada
| | - Shannon Sibbald
- Department of Family Medicine, Faculty of Health Sciences, School of Health Studies, Schulich School of Medicine and Dentistry, Western University, London, Canada
- The Schulich Interfaculty Program in Public Health, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Bridget L Ryan
- Centre for Studies in Family Medicine, Department of Family Medicine; Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Joseph B Orange
- Health and Rehabilitation Sciences Program, Faculty of Health Sciences, Western University, London, Canada
- School of Communication Sciences and Disorders, Western University, London, Canada
- Canadian Centre for Activity and Aging, Western University, London, Canada
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Rydenfält C, Persson R, Arvidsson I, Holgersson C, Johansson G, Östlund B, Persson J. Exploring Local Initiatives to Improve the Work Environment: A Qualitative Survey in Swedish Home Care Practice. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2021. [DOI: 10.1177/1084822320986933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Home care for the elderly constitutes a large and growing part of the social welfare system. Though, home care work is associated with a number of work environment-related challenges, including an increased risk for injuries, musculoskeletal disorders, high levels of sick leave and staff turnover, as well as stress and high workload, research is sparse. The present study explores local initiatives to improve the work environment initiated by the home care organizations themselves, and asks whether or not these initiatives affected gender equality. A qualitative web survey was sent to Swedish home care organizations, with open questions about change initiatives intended to have a positive effect on the work environment. There is an impressive amount of local work environment-related change initiatives going on. 80 categories of change initiatives were identified in answers from 178 units. However, these change initiatives were seldom evaluated or made accessible to stakeholders outside the organization. Main themes were concerned with work organization, digitalization, and planning, which largely follows trends in society (ie, digitalization, teamwork), rather than the actual needs identified by research (eg, musculoskeletal disorders). Despite apparent gender-related challenges, little of the work was associated with gender equality. The results indicates that there is a huge learning potential as the identified initiatives can serve as inspiration for others. However, to fully take advantage of these type of initiatives, more systematic evaluations are required.
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Affiliation(s)
| | | | | | | | | | - Britt Östlund
- KTH Royal Institute of Technology, Stockholm, Sweden
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Petit Dit Dariel O, Cristofalo P. Improving patient safety in two French hospitals: why teamwork training is not enough. J Health Organ Manag 2020; ahead-of-print. [PMID: 32737962 DOI: 10.1108/jhom-02-2020-0045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The persistent challenges that healthcare organizations face as they strive to keep patients safe attests to a need for continued attention. To contribute to better understanding the issues currently defying patient safety initiatives, this paper reports on a study examining the aftermath of implementing a national team training program in two hospital units in France. DESIGN/METHODOLOGY/APPROACH Data were drawn from a longitudinal qualitative study analyzing the implementation of a French patient safety program aimed at improving teamwork in hospitals. Data collection took place over a four-year period (2015-2019) in two urban hospitals in France and included multiple interviews with 31 participants and 150 h of observations. FINDINGS Despite explicit efforts to improve inter-professional teamwork, three main obstacles interfered with healthcare professionals' attempts at safeguarding patients: perspectival variations in what constituted "patient safety", a paradoxical injunction to do more with less and conflicting organizational priorities. ORIGINALITY/VALUE This paper exposes patient safety as misleadingly consensual and identifies a lack of alignment between stakeholders in the complex system that is a hospital. This ultimately interferes with patient safety objectives and highlights that even well-equipped, frontline actors cannot achieve long-term results without more systemic organizational changes.
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Fatahi N, Kustrimovic M, Elden H. Non-Medical Radiography Staff Experiences in Inter-Professional Communication: A Swedish Qualitative Focus Group Interview Study. J Multidiscip Healthc 2020; 13:393-401. [PMID: 32431507 PMCID: PMC7201006 DOI: 10.2147/jmdh.s231442] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 02/21/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To describe the experiences of non-medical discipline staff of difficulties and possibilities in inter-professional communication within the radiology department and remitting departments. Materials and Methods Three focus group interviews were conducted with 16 non-medical discipline staff in a radiology department at a university hospital in Sweden. Data were analysed using qualitative content analysis. Results The experiences of inter-professional communication by non-medical discipline staff within the radiology department and with remitting departments can be described in three categories, and six sub categories. The informants experienced difficulties in both oral and written inter-professional communication. Inadequate structures, incorrect information and unclear language in the referral forms, lack of feedback from clinicians and radiologists, and reduced face-to-face communication were described as factors that negatively influenced communication. Other difficulties were time shortage, inadequate routines and economy issues. The possibilities described were use of face-to-face communication, interpreters, and clear and well-structured referral forms. Conclusion Non-medical staff experience that quality in inter-professional communication has a significant impact on health outcomes and patient safety. They expressed a number of difficulties in both written and oral inter-professional communication. For example inadequate written and oral communication, as well as practical issues such as routine could negatively influence the quality of the outcome of inter-professional communication. Lack of feedback from clinicians and radiologists and reduced face-to-face communication were also mentioned as factors that influence oral communication. Possibilities described to improve inter-professional communication quality and thus patient safety were professional contact on both professional and personal levels, use of interpreters, and clear and well-structured referral forms. The results of this study add to our knowledge of the difficulties and possibilities in non-medical inter-professional communication, which may enhance both safety and health outcomes for patients if implemented. Future studies in interprofessional communication is needed. ![]()
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Affiliation(s)
- Nabi Fatahi
- Department of Learning and Leadership for Health Care Professionals, Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mirjana Kustrimovic
- Department of Radiography, Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Helen Elden
- Department of Reproductive and Perinatal Health, Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Wise S, Duffield C, Fry M, Roche M. Clarifying workforce flexibility from a division of labor perspective: a mixed methods study of an emergency department team. HUMAN RESOURCES FOR HEALTH 2020; 18:17. [PMID: 32143632 PMCID: PMC7060538 DOI: 10.1186/s12960-020-0460-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 02/24/2020] [Indexed: 05/25/2023]
Abstract
BACKGROUND The need for greater flexibility is often used to justify reforms that redistribute tasks through the workforce. However, "flexibility" is never defined or empirically examined. This study explores the nature of flexibility in a team of emergency doctors, nurse practitioners (NPs), and registered nurses (RNs), with the aim of clarifying the concept of workforce flexibility. Taking a holistic perspective on the team's division of labor, it measures task distribution to establish the extent of multiskilling and role overlap, and explores the behaviors and organizational conditions that drive flexibly. METHODS The explanatory sequential mixed methods study was set in the Fast Track area of a metropolitan emergency department (ED) in Sydney, Australia. In phase 1, an observational time study measured the tasks undertaken by each role (151 h), compared as a proportion of time (Kruskal Wallis, Mann-Whitney U), and frequency (Pearson chi-square). The time study was augmented with qualitative field notes. In phase 2, 19 semi-structured interviews sought to explain the phase 1 observations and were analyzed thematically. RESULTS The roles were occupationally specialized: "Assessment and Diagnosis" tasks consumed the largest proportion of doctors' (51.1%) and NPs' (38.1%) time, and "Organization of Care" tasks for RNs (27.6%). However, all three roles were also multiskilled, which created an overlap in the tasks they performed. The team used this role overlap to work flexibly in response to patients' needs and adapt to changing demands. Flexibility was driven by the urgent and unpredictable workload in the ED and enabled by the stability provided by a core group of experienced doctors and nurses. CONCLUSION Not every healthcare team requires the type of flexibility found in this study since that was shaped by patient needs and the specific organizational conditions of the ED. The roles, tasks, and teamwork that a team requires to "be flexible" (i.e., responsive and adaptable) are highly context dependent. Workforce flexibility therefore cannot be defined as a particular type of reform or role; rather, it should be understood as the capacity of a team to respond and adapt to patients' needs within its organizational context. The study's findings suggest that solutions for a more flexible workforce may lay in the organization of healthcare work.
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Affiliation(s)
- Sarah Wise
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, PO Box 123, Broadway, NSW, 2007, Australia.
| | - Christine Duffield
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway, NSW, 2007, Australia
- School of Nursing and Midwifery, Edith Cowan University, Australia, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
| | - Margaret Fry
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway, NSW, 2007, Australia
- Director Research and Practice Development Nursing and Midwifery Directorate, Northern Sydney Local Health District, Royal North Shore Hospital, Kolling Building, St Leonards, NSW, 2065, Australia
| | - Michael Roche
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway, NSW, 2007, Australia
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Rydenfält C, Borell J, Erlingsdottir G. What do doctors mean when they talk about teamwork? Possible implications for interprofessional care. J Interprof Care 2018; 33:714-723. [PMID: 30362854 DOI: 10.1080/13561820.2018.1538943] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The concept of teamwork has been associated with improved patient safety, more effective care and a better work environment. However, the academic literature on teamwork is pluralistic, and there are reports on discrepancies between theory and practice. Furthermore, healthcare professionals' direct conceptualizations of teamwork are sometimes missing in the research. In this study, we examine doctors' conceptualizations of teamwork. We also investigate what doctors think is important in order to achieve good teamwork, and how the empirical findings relate to theory. Finally, we discuss the methodological implications for future studies. The research design was explorative. The main data consisted of semi-structured interviews with twenty clinically active doctors, analyzed with conventional content analysis. Additional data sources included field observations and interviews with management staff. There was large variation in the doctors' conceptualizations of teamwork. The only characteristic they shared in common was that team members should have specific roles. This could have consequences for practice, because the rationale behind different behaviors depends on how teamwork is conceptualized. Several of the teamwork-enabling factors identified concerned non-technical skills. Future studies should put more emphasis on the practitioners' perspective in the research design, to create a more grounded foundation for both research and practice.
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Affiliation(s)
- Christofer Rydenfält
- Department of Design Sciences, Faculty of Engineering, Lund University, Lund, Sweden
| | - Jonas Borell
- Department of Design Sciences, Faculty of Engineering, Lund University, Lund, Sweden
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