1
|
Atanackovic J, Corrente M, Myles S, Eddine Ben-Ahmed H, Urdaneta K, Tello K, Baczkowska M, Bourgeault IL. Cultivating a psychological health and safety culture for interprofessional primary care teams through a co-created evidence-informed toolkit. Healthc Manage Forum 2024:8404704241263918. [PMID: 39042941 DOI: 10.1177/08404704241263918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
The psychological health and safety of healthcare workers workplaces and learning environments impacts the quality of healthcare services. To facilitate the psychological health and safety of interprofessional primary care teams, we curated a bilingual toolkit of 122 psychological health and safety resources comprising a multi-level categorization addressing individual, team, organization, and system-level interventions. The resources in the toolkit are organized by 7 themes, based on a clustering of the 15 psychosocial factors. Adopting the framework built on the 7 themes, this article describes the toolkit development process and how it addresses the key factors for psychologically healthy and safe workplaces to foster interprofessional collaboration. Implementation of the interventions in the toolkit is an important next step for which health system leadership is critical. Additionally, we identify several gaps and call on researchers, educators, and health leaders to address them in their future work.
Collapse
Affiliation(s)
| | | | - Sophia Myles
- Canadian Health Workforce Network, Ottawa, Ontario, Canada
| | | | | | - Kamlesh Tello
- Mental Health Commission of Canada, Ottawa, Ontario, Canada
| | | | | |
Collapse
|
2
|
Graue M, Igland J, Oftedal BF, Haugstvedt A, Riise HKR, Zoffmann V, Jenum AK, Richards D, Kolltveit BCH. Interprofessional follow-up for people at risk of type 2 diabetes in primary healthcare - a randomized controlled trial with embedded qualitative interviews. Scand J Prim Health Care 2024:1-13. [PMID: 38588447 DOI: 10.1080/02813432.2024.2337071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 03/26/2024] [Indexed: 04/10/2024] Open
Abstract
OBJECTIVE To examine the effects of an empowerment-based interprofessional lifestyle intervention program among people at risk of type 2 diabetes on knowledge, skills, and confidence in self-management, health, psychological well-being, and lifestyle characteristics, and to explore the participants' perceptions of participating in the intervention. DESIGN AND METHODS In line with the Medical Research Council complex interventions research methods framework, we conducted a randomized controlled trial with embedded qualitative interviews in primary healthcare clinics in Norway between 2019-2021. Of the patients at risk (The Finnish Diabetes Risk Score Calculator (FINDRISC) ≥15 or Body Mass Index (BMI) ≥30) 142 accepted the invitation, and 14 participants from the intervention group participated in individual interviews after the 12-month follow-up. Our primary outcome was the Patient Activation Measure (PAM-13). Secondary outcomes were EQ-5D-5L, EQ-VAS, WHO-Overall health, WHO-Overall QOL, weight, height, waist circumference, and regularity of physical activity. We used thematic analysis to analyse the qualitative data. RESULTS There was no clinically relevant differences of neither the primary nor the secondary endpoints between intervention and control group. As to the qualitative data, we identified two distinct features: 'Meaningful perspectives on lifestyle changes' and 'Lifestyle change is not a linear process due to challenges faced along the way' putting ownership of their choices in life into picture. CONCLUSION The negative results of the RCT stand in contrast to the findings given by the participants voices, perceiving the intervention as a key eye opener placing their health challenges in perspective. How to interpret these seemingly conflicting findings of participants being seen, heard, and understood, helping them to take more conscious ownership of their choices in life, and at the same time demonstrating no improvements in symptoms or measures, is a dilemma that needs further exploration. We should be careful to implement interventions that do not demonstrate any effects on the quantitative outcomes.
Collapse
Affiliation(s)
- Marit Graue
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Jannicke Igland
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Norway
| | | | - Anne Haugstvedt
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Hilde Kristin Refvik Riise
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Internal Medicine, Haukeland University Hospital, Bergen, Norway
| | - Vibeke Zoffmann
- Julie Marie Centre, Rigshospitalet, Research unit for Women`s and Children`s Health, Copenhagen, Denmark
- Institute of Public Health Copenhagen University, Copenhagen, Denmark
| | - Anne Karen Jenum
- General Practice Research Unit, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - David Richards
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Beate-Christin Hope Kolltveit
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Vossevangen medical center, Voss, Norway
| |
Collapse
|
3
|
Trasancos C, Horey D. Experiences with neonatal jaundice management in hospitals and the community: interviews with Australian health professionals. BMJ Open 2024; 14:e075896. [PMID: 38355169 PMCID: PMC10868246 DOI: 10.1136/bmjopen-2023-075896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 01/09/2024] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION Worldwide, neonatal jaundice accounts for considerable morbidity and mortality. Although severe adverse outcomes, such as hyperbilirubinaemia and kernicterus, are uncommon in high-income countries, these outcomes do occur, have enormous lifelong personal, health and social costs, and may be preventable. Evidence-based practice commonly relies on clinical guidelines; however, their implementation can be difficult. Implementation of neonatal jaundice care has been adversely affected by issues with professional boundaries, competing professional priorities and poor understanding of neonatal jaundice. This paper focuses on the perceptions and experiences of Australian health professionals involved in the management of neonatal jaundice. METHODS Using a qualitative descriptive approach, semistructured interviews were undertaken to gain understanding of the experiences of health professionals in Australia across the scope of care for jaundiced newborns through an interpretivist approach and to identify possible gaps in the delivery of evidence-based care. Health professionals from a range of disciplines and care settings were recruited by purposive maximum variation sampling. Interviews were conducted face-to-face or by telephone with detailed notes taken and a field journal maintained. Interview scripts were verified by participants and imported into NVivo software. Data were analysed for major themes according to type and contexts of practice. RESULTS Forty-one health professionals from six broad discipline areas were interviewed. Two major themes and explanatory subthemes were found. The first theme, falling through the gaps, highlighted gaps in evidence-based care, as described by four explanatory subthemes: professional boundaries, blindness to possibility of adverse outcomes, competing professional development priorities and unintended consequences.The second major theme, we know what should happen-but how?, described participant perceptions that it was known what was required to improve care but how to achieve such changes was unclear. The two subthemes are: improvements in education and training, and standardised policies and protocols. CONCLUSIONS Multiple barriers to the provision of evidence-based care related to neonatal jaundice management are experienced by health professionals in Australia. Clinical guidelines are not sufficient to support health professionals deliver evidence-based care in the complex contexts in which they work. Implementation strategies for evidence-based practice need to take account of the experiences of health professionals and the challenges they face. Such strategies need to focus on improving collaboration between different disciplines for the well-being of those needing care. In the case of neonatal jaundice management, consideration is also needed in how to raise awareness of the importance of avoiding severe adverse outcomes, even when they might be rare, and how this might be done. Addressing issues that lead to disjointed care or poor knowledge of neonatal jaundice among health professionals is essential.
Collapse
Affiliation(s)
| | - Dell Horey
- La Trobe University, Melbourne, Victoria, Australia
| |
Collapse
|
4
|
Peterson E, Keehn MT, Hasnain M, Gruss V, Axelsson M, Carlson E, Jakobsson J, Kottorp A. Exploring differences in and factors influencing self-efficacy for competence in interprofessional collaborative practice among health professions students. J Interprof Care 2024; 38:104-112. [PMID: 37551921 DOI: 10.1080/13561820.2023.2241504] [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: 06/27/2022] [Accepted: 05/12/2023] [Indexed: 08/09/2023]
Abstract
The value of health care delivered via effective interprofessional teams has created an imperative for interprofessional education (IPE) and interprofessional collaborative practice (ICP). To inform IPE strategies, we investigated differences in perceived self-efficacy (SE) for competence in ICP among health professions students. The study data were collected between 2015 and 2019 from students from 13 different health professions programmes (N = 3,497) before an annual institutional interprofessional programme. Students completed the IPECC-SET-27, a validated instrument evaluating perceived SE for competence in ICP, and rated their 1) amount of previous contact with, and 2) perceived understanding of, the role of different health professions. Students in different health professions education programmes were compared using parametric statistics. Regression analyses explored factors influencing SE for competence in ICP. Findings revealed significant differences in perceived SE for competence in ICP between programmes (p < .05). Specifically, health information management/health informatics, dentistry, medicine, and nursing students expressed relatively higher SE, whereas physical therapy and occupational therapy students expressed relatively lower SE. Perceived understanding of the role of health professions (p < .01) and gender (p < .01) contributed significantly to predicting perceived SE for competence in ICP, while the amount of previous contact with other health professions did not (p = .42). The findings highlight the value of designing IPE with consideration of specific learner needs.
Collapse
Affiliation(s)
- Elizabeth Peterson
- Department of Occupational Therapy, University of Illinois Chicago, Chicago, Illinois, USA
| | - Mary Therese Keehn
- Office of the Vice Chancellor for Health Affairs, University of Illinois Chicago, Chicago, Illinois, USA
| | - Memoona Hasnain
- Department of Family and Community Medicine, College of Medicine, University of Illinois Chicago, Chicago, Illinois, USA
| | - Valerie Gruss
- College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
| | - Malin Axelsson
- Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden
| | - Elisabeth Carlson
- Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden
| | - Jenny Jakobsson
- Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden
| | - Anders Kottorp
- Faculty of Health and Society, Malmö University, Malmö, Sweden
| |
Collapse
|
5
|
Pleshkan V. A systematic review: Clinical education and preceptorship during nurse practitioner role transition. J Prof Nurs 2024; 50:16-34. [PMID: 38369368 DOI: 10.1016/j.profnurs.2023.10.005] [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: 10/12/2022] [Revised: 10/15/2023] [Accepted: 10/16/2023] [Indexed: 02/20/2024]
Abstract
BACKGROUND The demand for nurse practitioners (NP) is growing; however, the NP role transition is difficult. NP role transition starts with NP student entering the program and can last for as long as two years post-graduation. NP clinical education and preceptorship model is outdated and is in need of restructuring. PURPOSE The purpose of this literature review was to describe and explain the issues and resources within the NP clinical education and preceptorship that is used to support NPs' role transition both before and after graduation. METHODS The search years included 2010-2022. The following search terms were used: graduate nurse, advanced nursing, nurse practitioner, APRN, masters prepared, advanced nurse, nursing student, practicum, residency programs, residencies, school, program, clinical, clinical education, nursing education, health education, training, clinical site, student, preceptor, preceptorship, apprenticeship, mentor, mentorship, transition, role transition, role change, nurse's role, primary care, qualitative research, collaboration, and clinical competence. RESULTS In this review pre-graduation persistent issues with availability of clinical sites and preceptors as well as lack of consistency in competency based clinical education assessment practices were identified. Difficult transition to practice post-graduation showed inconsistent and limited support available to further develop the newly graduated entry level NPs' clinical skills. CONCLUSION Restructuring the old clinical education and preceptorship model used during the pre-graduation NP role transition stage is necessary to improve NP role transition process and graduate the required number of practice ready NPs.
Collapse
Affiliation(s)
- Viktoriya Pleshkan
- Loewenberg College of Nursing, 4055 North Park Loop, Community Health Building, Memphis, TN 38152, United States of America.
| |
Collapse
|
6
|
Crowley R, Pugach D, Williams M, Goldman J, Hilden D, Schultz AF, Beachy M. Principles for the Physician-Led Patient-Centered Medical Home and Other Approaches to Team-Based Care: A Position Paper From the American College of Physicians. Ann Intern Med 2024; 177:65-67. [PMID: 38145573 DOI: 10.7326/m23-2260] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2023] Open
Abstract
Team-based care models such as the Patient-Centered Medical Home are associated with improved patient health outcomes, better team coordination and collaboration, and increased well-being among health care professionals. Despite these attributes, hindrances to wider adoption remain. In addition, some health care professionals have sought to practice independent of the physician-led health care team, potentially undermining patient access to physicians who have the skills and training to deliver whole-person, comprehensive, and longitudinal care. In this paper, the American College of Physicians reaffirms the importance of the physician-led health care team and offers policy recommendations on professionalism, payment models, training, licensure, and research to support the expansion of dynamic clinical care teams.
Collapse
Affiliation(s)
- Ryan Crowley
- American College of Physicians, Washington, DC (R.C., D.P., M.W.)
| | - David Pugach
- American College of Physicians, Washington, DC (R.C., D.P., M.W.)
| | - Margo Williams
- American College of Physicians, Washington, DC (R.C., D.P., M.W.)
| | - Jason Goldman
- Charles E. Schmidt College of Medicine, Boca Raton, Florida (J.G.)
| | - David Hilden
- Hennepin Healthcare, Minneapolis, Minnesota (D.H.)
| | | | - Micah Beachy
- University of Nebraska Medical Center, Omaha, Nebraska (M.B.)
| |
Collapse
|
7
|
Drescher MJ, Mills G, Winkelmann ZK, Games KE. Collaborative Mental Health Care in Collegiate Athletics: Behavioral Health Providers' Perceived Role of the Athletic Trainer. J Athl Train 2023; 58:855-864. [PMID: 37071505 PMCID: PMC11215710 DOI: 10.4085/1062-6050-0530.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
CONTEXT Developing effective interprofessional teams is vital to achieving quality care for those dealing with behavioral health concerns. Athletic trainers (ATs) play a vital role, as they are often the first health care providers to interact with student-athletes participating in intercollegiate athletics. However, research regarding how behavioral health providers view the AT's role on interprofessional behavioral health teams is limited. OBJECTIVE To explore behavioral health providers' perceived role of ATs in collaborative behavioral health care. DESIGN Qualitative study. SETTING Individual interviews. PATIENTS OR OTHER PARTICIPANTS Nine behavioral health care providers (women = 6, men = 3; age range = 30-59 years, years in clinical practice = 6-25) from National Collegiate Athletic Association Power 5 schools were interviewed. DATA COLLECTION AND ANALYSIS Participants were contacted via publicly available information on their university websites. Participants engaged in individual, audio-only interviews using a commercially available teleconferencing platform. All interviews were recorded, transcribed, and returned to participants for member checking. A phenomenological approach with inductive coding and multianalyst triangulation was performed to analyze the transcripts for common themes and subthemes. RESULTS CONCLUSIONS Collaborative care models can enhance providers' abilities and maximize support of student-athlete wellness. In this study, we demonstrated that behavioral health providers working within a collaborative care model with ATs had overall positive experiences with such collaboration and that clear role delineation and responsibilities helped to foster high-quality patient care.
Collapse
|
8
|
Moosa S. Exploring the Challenges for Universal Health Coverage: A Call to Africa by AfroPHC. Risk Manag Healthc Policy 2023; 16:1999-2017. [PMID: 37790983 PMCID: PMC10544043 DOI: 10.2147/rmhp.s392454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 09/22/2023] [Indexed: 10/05/2023] Open
Abstract
The primary health care (PHC) system in Africa faces many challenges AND opportunities. To date, human resources for health in PHC are grossly insufficient in number, often inefficiently and inequitably distributed, lacking adequate training for delivering fully responsive and comprehensive frontline care and are treated inequitably within the health system. There has been a lack of solidarity among key role players in healthcare to create adequate PHC funding in Africa. Resources do not appropriately or adequately reach the frontline PHC service platform due to outdated service delivery and payment models. Patients experience PHC as numbers in a queue, with poor comprehensiveness, continuity, and coordination. Health workers are also treated like numbers in a bureaucracy that fragments and undermines training and service for integrated care around patient and population needs. However, opportunities abound with global PHC milestones, increasing political will for investment in PHC, and proven mechanisms for achieving a stronger workforce such as community health workers, clinical task-sharing, and the integration of family doctors into PHC. The African Forum for PHC (AfroPHC) has a vision for PHC and UHC that is team-based with skills mix appropriate to Africa, including family doctors, family nurse practitioners, clinical officers, community health workers and others that are empowered to take care of an empaneled population in high-quality people centred PHC. AfroPHC is making a call on stakeholders to develop and implement a regional forward-looking plan to 1) build robust PHC systems, 2) train, recruit and maintain a sufficient frontline PHC workforce, and 3) support PHC with appropriate financing. This can all come together easily in a nationally defined PHC contract using risk-adjusted blended capitation payment to decentralised PHC teams empanelled to enrolled populations, coordinated by district health services and easily administered at national or sub-national level for empowered public and private providers.
Collapse
Affiliation(s)
- Shabir Moosa
- African Forum for Primary Health Care, Johannesburg, South Africa
- Department of Family Medicine and Primary Care, University of Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
9
|
Zhang C. A Literature Study of Medical Simulations for Non-Technical Skills Training in Emergency Medicine: Twenty Years of Progress, an Integrated Research Framework, and Future Research Avenues. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4487. [PMID: 36901496 PMCID: PMC10002261 DOI: 10.3390/ijerph20054487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/26/2023] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
Abstract
Medical simulations have led to extensive developments in emergency medicine. Apart from the growing number of applications and research efforts in patient safety, few studies have focused on modalities, research methods, and professions via a synthesis of simulation studies with a focus on non-technical skills training. Intersections between medical simulation, non-technical skills training, and emergency medicine merit a synthesis of progress over the first two decades of the 21st century. Drawing on research from the Web of Science Core Collection's Science Citation Index Expanded and Social Science Citation Index editions, results showed that medical simulations were found to be effective, practical, and highly motivating. More importantly, simulation-based education should be a teaching approach, and many simulations are utilised to substitute high-risk, rare, and complex circumstances in technical or situational simulations. (1) Publications were grouped by specific categories of non-technical skills, teamwork, communication, diagnosis, resuscitation, airway management, anaesthesia, simulation, and medical education. (2) Although mixed-method and quantitative approaches were prominent during the time period, further exploration of qualitative data would greatly contribute to the interpretation of experience. (3) High-fidelity dummy was the most suitable instrument, but the tendency of simulators without explicitly stating the vendor selection calls for a standardised training process. The literature study concludes with a ring model as the integrated framework of presently known best practices and a broad range of underexplored research areas to be investigated in detail.
Collapse
Affiliation(s)
- Cevin Zhang
- School of Media and Design, Beijing Technology and Business University, Sunlight South Road 1, Beijing 102488, China
| |
Collapse
|
10
|
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.
Collapse
|
11
|
Sirimsi MM, De Loof H, Van den Broeck K, De Vliegher K, Pype P, Remmen R, Van Bogaert P. Scoping review to identify strategies and interventions improving interprofessional collaboration and integration in primary care. BMJ Open 2022; 12:e062111. [PMID: 36302577 PMCID: PMC9621161 DOI: 10.1136/bmjopen-2022-062111] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To identify strategies and interventions used to improve interprofessional collaboration and integration (IPCI) in primary care. DESIGN Scoping review DATA SOURCES: Specific Medical Subject Headings terms were used, and a search strategy was developed for PubMed and afterwards adapted to Medline, Eric and Web of Science. STUDY SELECTION In the first stage of the selection, two researchers screened the article abstracts to select eligible papers. When decisions conflicted, three other researchers joined the decision-making process. The same strategy was used with full-text screening. Articles were included if they: (1) were in English, (2) described an intervention to improve IPCI in primary care involving at least two different healthcare disciplines, (3) originated from a high-income country, (4) were peer-reviewed and (5) were published between 2001 and 2020. DATA EXTRACTION AND SYNTHESIS From each paper, eligible data were extracted, and the selected papers were analysed inductively. Studying the main focus of the papers, researchers searched for common patterns in answering the research question and exposing research gaps. The identified themes were discussed and adjusted until a consensus was reached among all authors. RESULTS The literature search yielded a total of 1816 papers. After removing duplicates, screening titles and abstracts, and performing full-text readings, 34 papers were incorporated in this scoping review. The identified strategies and interventions were inductively categorised under five main themes: (1) Acceptance and team readiness towards collaboration, (2) acting as a team and not as an individual; (3) communication strategies and shared decision making, (4) coordination in primary care and (5) integration of caregivers and their skills and competences. CONCLUSIONS We identified a mix of strategies and interventions that can function as 'building blocks', for the development of a generic intervention to improve collaboration in different types of primary care settings and organisations.
Collapse
Affiliation(s)
- Muhammed Mustafa Sirimsi
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Centre of Research and Innovations in Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Hans De Loof
- Laboratory of Physiopharmacology, Faculty of pharmaceutic sciences, University of Antwerp, Antwerp, Belgium
| | - Kris Van den Broeck
- Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | | | - Peter Pype
- Center for family medicine, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Ghent, Belgium
| | - Roy Remmen
- Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Peter Van Bogaert
- Centre for research and innovation in care (CRIC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| |
Collapse
|
12
|
Skyberg HL. Diversity, friction, and harmonisation: an ethnographic study of interprofessional teamwork dynamics. BMC Health Serv Res 2022; 22:227. [PMID: 35183177 PMCID: PMC8857853 DOI: 10.1186/s12913-022-07596-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 02/02/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Although diversity, friction, and harmonisation in interprofessional teamwork are aspects frequently conceptualised, no empirical study discusses them in combination. Focusing on risk and function with respect to each aspect, this article empirically examines how dynamics between these aspects during interprofessional teamwork interactions fosters conditions for effective teamwork.
Methods
An ethnographic study of three interprofessional teams, in the context of mental health and substance use, was conducted in Norway. Data were collected through observations of 14 team meetings and 18 in-depth interviews with health and social work professionals. Thematic analysis was applied to code the data.
Results
A conceptual ideal-type model, which includes all three aspects was developed to represent the emergent findings. The results suggest that the diversity of professional perspectives inherent in interprofessional teams is the foundation of interprofessional teamwork. However, friction is needed to promote innovation, encourage new insights, and intensify discussions. In addition, harmonisation balances professional distinctions, fosters trust, and ties professionals together.
Conclusion
This article presents a comprehensive model of how professionals work together in interprofessional teams. The model makes visible the functions and risks of each aspect and the dynamics between them. Furthermore, the article argues for mobilisation and balance of all three aspects in combination to maximise the capacity of interprofessional teamwork. Such insight can be used to support the development and successful implementation of interprofessional teamwork in health care.
Collapse
|
13
|
Everett CM, Docherty SL, Matheson E, Morgan PA, Price A, Christy J, Michener L, Smith VA, Anderson JB, Viera A, Jackson GL. Teaming up in primary care: Membership boundaries, interdependence, and coordination. JAAPA 2022; 35:1-10. [PMID: 34985006 PMCID: PMC9869344 DOI: 10.1097/01.jaa.0000805840.00477.58] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Increased demand for quality primary care and value-based payment has prompted interest in implementing primary care teams. Evidence-based recommendations for implementing teams will be critical to successful PA participation. This study sought to describe how primary care providers (PCPs) define team membership boundaries and coordinate tasks. METHODS This mixed-methods study included 28 PCPs from a primary care network. We analyzed survey data using descriptive statistics and interview data using content analysis. RESULTS Ninety-six percent of PCPs reported team membership. Team models fell into one of five categories. The predominant coordination mechanism differed by whether coordination was required in a visit or between visits. CONCLUSIONS Team-based primary care is a strategy for improving access to quality primary care. Most PCPs define team membership based on within-visit task interdependencies. Our findings suggest that team-based interventions can focus on clarifying team membership, increasing interaction between clinicians, and enhancing the electronic health record to facilitate between-visit coordination.
Collapse
Affiliation(s)
- Christine M Everett
- At Duke University in Durham, N.C., Christine M. Everett is an associate professor in the Division of PA Studies in the School of Medicine's Department of Family Medicine and Community Health and the Department of Population Health Sciences, and Sharron L. Docherty is a professor in the School of Nursing. Elaine Matheson is advanced practice provider medical director at Duke Primary Care in Durham. Perri A. Morgan is a professor in the Division of PA Studies in the Department of Family Medicine and Community Health and the Department of Population Health. In the Department of Family Medicine and Community Health, Ashley Price is a research program lead, Jacob Christy is a clinical research coordinator, and Lloyd Michener is a professor emeritus. Valerie A. Smith is an associate professor in the Department of Population Health and in the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) at the Durham VA Health Care System. John B. Anderson, Jr., is an associate professor in the Department of Family Medicine and Community Health and chief medical officer at Duke Primary Care. Anthony Viera is a professor and chair in the Department of Family Medicine and Community Health. George L. Jackson is a professor in the Department of Population Health, Department of Internal Medicine, Department of Family Medicine and Community Health and at ADAPT. The authors disclose that this research was supported by a grant from the National Institutes of Aging (K01AG53378). The grant funding source had no role in the design, conduct, collection, management, analysis, or interpretation of the data; or in the preparation, review, or approval of the manuscript. The authors have disclosed no other potential conflicts of interest, financial or otherwise. The views expressed in this paper are those of the authors and do not reflect the position or policy of Duke University, Duke Health System, the Department of Veterans Affairs, or the US government
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Gillespie C, Kleinberg F, Zogas A, Morreale A, Ourth H, Tran M, Moore T, Miller D, McCullough M. Perceptions of clinical pharmacy specialists' contributions in mental health clinical teams. Ment Health Clin 2022; 12:15-22. [PMID: 35116208 PMCID: PMC8788298 DOI: 10.9740/mhc.2022.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 11/08/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Mental health (MH) clinical pharmacy specialists (CPS) are increasingly functioning as integral providers in MH care teams. MH providers may delegate many medication management tasks to the CPS. As there is a shortage of primary care and specialist MH providers, CPS are increasingly being utilized in MH care clinics. We assess provider and CPS perceptions of the contributions of CPS to MH clinical teams in the Veterans Health Administration. Methods We examined the roles and functions of CPS in MH clinics through surveys (n = 374) and semistructured interviews (n = 16) with MH CPS and other members of MH clinical teams (psychiatrists, nurse practitioners, registered nurses, social workers) to gain insight into how CPS were integrated in these settings. We assessed perceptions of CPS contributions to MH teams, interactions between CPS and other providers, and challenges of integrating CPS into MH clinical teams. Results Contributions of CPS in MH were received positively by clinical team members. Clinical pharmacy specialists providing comprehensive medication management were especially valuable in the management of clozapine. The knowledge and training of CPS reassured providers who frequently referred to them with questions about medication and medication therapy management. MH CPS were also perceived to be received well by patients. Discussion The integration of MH CPS into MH teams was well received by team members and patients alike. The MH CPS have become important members of the MH team and are widely viewed as being able to improve access, quality, and workflow.
Collapse
Affiliation(s)
| | - Felicia Kleinberg
- Health Science Specialist, Center for Healthcare Organization and Implementation (CHOIR), VA Bedford Healthcare System, Bedford, Massachusetts
| | - Anna Zogas
- Research Health Scientist, Center for Healthcare Organization and Implementation (CHOIR), VA Bedford Healthcare System, Bedford, Massachusetts
| | - Anthony Morreale
- Associate Chief Consultant for Clinical Pharmacy, Clinical Pharmacy Practice Office, Pharmacy Benefits Management Services, US Department of Veterans Affairs, Washington, DC
| | - Heather Ourth
- Assistant Chief Consultant for Clinical Pharmacy, Clinical Pharmacy Practice Office, Pharmacy Benefits Management Services, US Department of Veterans Affairs, Washington, DC
| | - Michael Tran
- National Pharmacy Benefits Management Program Manager, Clinical Pharmacy Practice Office, Pharmacy Benefits Management Services, US Department of Veterans Affairs, Washington, DC
| | - Tera Moore
- National Pharmacy Benefits Management Program Manager, Clinical Pharmacy Practice Office, Pharmacy Benefits Management Services, US Department of Veterans Affairs, Washington, DC
| | - Donald Miller
- Research Health Scientist, Center for Healthcare Organization and Implementation (CHOIR), VA Bedford Healthcare System, Bedford, Massachusetts; Research Health Scientist, University of Massachusetts, Lowell, Zuckerberg School of Health Sciences, Department of Public Health, Lowell, Massachusetts
| | - Megan McCullough
- Research Health Scientist, Center for Healthcare Organization and Implementation (CHOIR), VA Bedford Healthcare System, Bedford, Massachusetts; Research Health Scientist, University of Massachusetts, Lowell, Zuckerberg School of Health Sciences, Department of Public Health, Lowell, Massachusetts
| |
Collapse
|
15
|
Facilitating Integration Through Team-Based Primary Healthcare: A Cross-Case Policy Analysis of Four Canadian Provinces. Int J Integr Care 2021; 21:12. [PMID: 34824561 PMCID: PMC8588891 DOI: 10.5334/ijic.5680] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 09/20/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction: Team-based care can improve integrated health services by increasing comprehensiveness and continuity of care in primary healthcare (PHC) settings. Collaborative models involving providers from different professions can help to achieve coordinated, high-quality person-centred care. In Canada, there has been variation in both the timing/pace of adoption and approach to interprofessional PHC (IPHC) policy. Provinces are at different stages in the development, implementation, and evaluation of team-based PHC models. This paper describes how different policies, contexts, and innovations across four Canadian provinces (British Columbia, Alberta, Ontario, Quebec) facilitate or limit integrated health services through IPHC teams. Methods: Systematic searches identified 100 policy documents across the four provinces. Analysis was informed by Walt and Gilson’s Policy Triangle (2008) and Suter et al.’s (2009) health system integration principles. Provincial policy case studies were constructed and used to complete a cross-case comparison. Results: Each province implemented variations of an IPHC based model. Five key components were found that influenced IPHC and integrated health services: patient-centred care; team structures; information systems; financial management; and performance measurement. Conclusion: Heterogeneity of the implementation of PHC teams across Canadian provinces provides an opportunity to learn and improve interprofessional care and integrated health services across jurisdictions.
Collapse
|
16
|
Moosa S. Family Doctor Leadership in African Primary Health Care. Afr J Prim Health Care Fam Med 2021; 13:e1-e2. [PMID: 34636600 PMCID: PMC8517723 DOI: 10.4102/phcfm.v13i1.3198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 08/18/2021] [Indexed: 11/05/2022] Open
Affiliation(s)
- Shabir Moosa
- Department of Family Medicine and Primary Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; and, WONCA Africa, University of the Witwatersrand, Johannesburg.
| |
Collapse
|
17
|
Rioux-Dubois A, Perron A. [The integration of nurse practitioners into primary health care: Rethinking the negotiation of complex dynamics]. Rech Soins Infirm 2021; 145:38-52. [PMID: 34372650 DOI: 10.3917/rsi.145.0038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Background : The integration of nurse practitioners into primary healthcare settings is highly complex, yet it has not been extensively studied with regard to broader socioprofessional changes occurring in health care.Objective : This study sought to examine the integration and negotiation of the role of nurse practitioners in interprofessional primary healthcare settings.Method : A critical ethnography framed by actor-network theory and Foucault's concepts of discourse and power was conducted in three different primary healthcare models in which semi-structured interviews (n=23 nurse practitioners), direct observation, and document analysis were performed.Results : Organizational aims, practice standards, nurse practitioners' right to self-determination, collaborative dynamics with physicians, and patient management were identified as integration factors that produced greater instability, needs for negotiation, and professional, identity, and moral difficulties for nurse practitioners.Discussion : The findings from this study challenge the widespread perception that the role of nurse practitioners lacks clarity and enable a renewed understanding of their integration process in primary healthcare settings.
Collapse
|
18
|
Sanchez A, Pablo S, Garcia-Alvarez A, Dominguez S, Grandes G. Effectiveness of two procedures for deploying a facilitated collaborative modeling implementation strategy-the PVS-PREDIAPS strategy-to optimize type 2 diabetes prevention in primary care: the PREDIAPS cluster randomized hybrid type II implementation trial. Implement Sci 2021; 16:58. [PMID: 34044869 PMCID: PMC8161614 DOI: 10.1186/s13012-021-01127-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 05/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The most efficient procedures to engage and guide healthcare professionals in collaborative processes that seek to optimize practice are unknown. The PREDIAPS project aims to assess the effectiveness and feasibility of different procedures to perform a facilitated interprofessional collaborative process to optimize type 2 diabetes prevention in routine primary care. METHODS A type II hybrid cluster randomized implementation trial was conducted in nine primary care centers of the Basque Health Service. All centers received training on effective healthy lifestyle promotion. Headed by a local leader and an external facilitator, centers conducted a collaborative structured process-the PVS-PREDIAPS implementation strategy-to adapt the intervention and its implementation to their specific context. The centers were randomly allocated to one of two groups: one group applied the implementation strategy globally, promoting the cooperation of all health professionals from the beginning, and the other performed it sequentially, centered first on nurses, who later sought the pragmatic cooperation of physicians. The following patients were eligible for inclusion: all those aged ≥ 30 years old with at least one known cardiovascular risk factor and an impaired fasting glucose level (≥ 110-125 mg/dl) but without diabetes who attended centers during the study period. The main outcome measures concerned changes in type 2 diabetes prevention practice indicators after 12 months. RESULTS After 12 months, 3273 eligible patients at risk of type 2 diabetes had attended their family physician at least once, and of these, 490 (15%) have been addressed by assessing their healthy lifestyles in both comparison groups. The proportion of at-risk patients receiving a personalized prescription of lifestyle change was slightly higher (8.6%; range 13.5-5.9% vs 6.8%; range 7.2-5.8%) and 2.3 times more likely (95% CI for adjusted hazard ratio, 1.38-3.94) in the sequential than in the global centers, after 8 months of the intervention program implementation period. The probability of meeting the recommended levels of physical activity and fruit and vegetable intake were four- and threefold higher after the prescription of lifestyle change than only assessment and provision of advice. The procedure of engagement in and execution of the implementation strategy does not modify the effect of prescribing healthy habits (p interaction component of intervention by group, p > 0.05). DISCUSSION Our results show that the PVS-PREDIAPS implementation strategy manages to integrate interventions with proven efficacy in the prevention of type 2 diabetes in clinical practice in primary care. Further, they suggest that implementation outcomes were somewhat better with a sequential facilitated collaborative process focused on enhancing the autonomy and responsibility of nurses who subsequently seek a pragmatic cooperation of GPs. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT03254979 . Registered 16 August 2017-retrospectively registered.
Collapse
Affiliation(s)
- Alvaro Sanchez
- Primary Care Research Unit of Bizkaia, Deputy Directorate of Healthcare Assistance, Basque Healthcare Service - Osakidetza, Biocruces Bizkaia Health Research Institute, Plaza Cruces s/n, E-48903, Barakaldo, Spain.
| | - Susana Pablo
- Primary Care Research Unit of Bizkaia, Deputy Directorate of Healthcare Assistance, Basque Healthcare Service - Osakidetza, Biocruces Bizkaia Health Research Institute, Plaza Cruces s/n, E-48903, Barakaldo, Spain
| | - Arturo Garcia-Alvarez
- Primary Care Research Unit of Bizkaia, Deputy Directorate of Healthcare Assistance, Basque Healthcare Service - Osakidetza, Biocruces Bizkaia Health Research Institute, Plaza Cruces s/n, E-48903, Barakaldo, Spain
| | - Silvia Dominguez
- Primary Care Research Unit of Bizkaia, Deputy Directorate of Healthcare Assistance, Basque Healthcare Service - Osakidetza, Biocruces Bizkaia Health Research Institute, Plaza Cruces s/n, E-48903, Barakaldo, Spain
| | - Gonzalo Grandes
- Primary Care Research Unit of Bizkaia, Deputy Directorate of Healthcare Assistance, Basque Healthcare Service - Osakidetza, Biocruces Bizkaia Health Research Institute, Plaza Cruces s/n, E-48903, Barakaldo, Spain
| | | |
Collapse
|
19
|
Durand F, Bourgeault IL, Hebert RL, Fleury MJ. The role of gender, profession and informational role self-efficacy in physician-nurse knowledge sharing and decision-making. J Interprof Care 2021; 36:34-43. [PMID: 34008467 DOI: 10.1080/13561820.2021.1890006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
While gender and professional status influence how decisions are made, the role played by health care professionals' informational role self-efficacy appears as a central construct fostering participation in decision-making. The goal of this study is to contribute to a better understanding of how gender and profession affect the role of self-efficacy in sharing expertise and decision-making. Validated questionnaires were answered by a cross-sectional sample of 108 physicians and nurses working in mental health care teams. A moderated mediation analysis was performed. Results reveal that the impact of sharing knowledge on informational role self-efficacy is negative for nurses. Being a nurse negatively affects the relation between informational role self-efficacy and participating in decision-making. Informational role self-efficacy is also a strong positive predictor of participation in decision-making for male physicians but less so for female physicians.
Collapse
Affiliation(s)
- François Durand
- Telfer School of Management, University of Ottawa, Ottawa, ON, Canada
| | - Ivy Lynn Bourgeault
- School of Sociological and Anthropological Studies, University of Ottawa, Ottawa, ON, Canada
| | - Robin L Hebert
- Telfer School of Management, University of Ottawa, Ottawa, ON, Canada
| | - Marie-Josée Fleury
- Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| |
Collapse
|
20
|
Nygren US, Tindberg Y, Eriksson L, Larsson U, Sandberg H, Nordgren L. Healthcare professionals' perceptions about interprofessional teamwork: a national survey within Swedish child healthcare services. BMC Health Serv Res 2021; 21:265. [PMID: 33752664 PMCID: PMC7983257 DOI: 10.1186/s12913-021-06139-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 02/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, interprofessional teamwork is described as a key method to promote health and prevent illness in children, namely, to achieve the goals of Child Healthcare Services (CHS). However, how teamwork should be designed within CHS to achieve the goals is unclear. This study aimed to investigate healthcare professionals' perceptions about 1) taking part in interprofessional teamwork, 2) team characteristics, and 3) whether the perceptions were related to professional affiliation or workplace. METHODS A national cross-sectional survey was conducted using a web-based study-specific questionnaire sent to all accessible nurses, physicians, and psychologists in Swedish CHS (n = 3552). The response rate was 31.5%. To identify possible associations, logistic regressions were conducted. RESULTS Almost all respondents, 1096/1119 (97.9%), reported taking part in some type of interprofessional teamwork within the Swedish CHS. Among those, the most common was team-based visits (82.2%). It was perceived that performing team-based visits resulted in fulfilled goals, expertise exceeding individual team members' competences, provision of high-quality care, and meeting children's and families' needs, to a greater extent, than if not performing team-based visits. Correspondingly, working as a team in parental groups was perceived as resulting in fulfilled goals, meeting the needs of children and their families, and continuity within the team to a greater extent than if not working together in a team. Professional affiliation was associated with different perceptions and types of teamwork. Family Centers were positively associated with all types of teamwork as well as continuity within the team. CONCLUSIONS Healthcare professionals' perceptions about team characteristics were associated with professional affiliation, workplace, and type of teamwork (defined as team activities) within the CHS. Professionals within Swedish CHS, taking part in team-based visits and in interprofessional teamwork in parental groups, perceived that the team fulfilled its goals and met the needs of children and families to a greater extent than professionals not taking part in these types of teamwork. Professionals at Family Centers were more likely to work in teams in different ways. Knowledge about interprofessional teamwork for individuals and groups in Swedish CHS might also be valuable in other healthcare settings, dealing with complex needs.
Collapse
Affiliation(s)
- Ulrika Svea Nygren
- Department of Public Health and Caring Sciences, Uppsala University, BMC, Box 564, 751 22, Uppsala, Sweden.
- Center for Clinical Research Sörmland/Uppsala University, Box 529, 631 07, Eskilstuna, Sweden.
| | - Ylva Tindberg
- Center for Clinical Research Sörmland/Uppsala University, Box 529, 631 07, Eskilstuna, Sweden
- Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, 751 85, Uppsala, Sweden
| | - Leif Eriksson
- Department of Public Health and Caring Sciences, Uppsala University, BMC, Box 564, 751 22, Uppsala, Sweden
| | - Ulf Larsson
- Center for Clinical Research Sörmland/Uppsala University, Box 529, 631 07, Eskilstuna, Sweden
| | - Håkan Sandberg
- School of Health, Care and Social Welfare, Mälardalen University, Box 883, 721 23, Västerås, Sweden
| | - Lena Nordgren
- Department of Public Health and Caring Sciences, Uppsala University, BMC, Box 564, 751 22, Uppsala, Sweden
- Center for Clinical Research Sörmland/Uppsala University, Box 529, 631 07, Eskilstuna, Sweden
| |
Collapse
|
21
|
Byerly LK, Floren LC, Yukawa M, O'Brien BC. Getting outside the box: exploring role fluidity in interprofessional student groups through the lens of activity theory. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2021; 26:253-275. [PMID: 32705403 DOI: 10.1007/s10459-020-09983-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 07/13/2020] [Indexed: 05/15/2023]
Abstract
Health professionals' roles and scopes often overlap, creating a need for role clarity in interprofessional teamwork. Yet, such clarity does not mean roles are fixed within teams and some literature suggests role flexibility can enhance team functioning. Interprofessional practice competencies and learning activities often emphasize knowledge and definition of roles, but rarely attend to the dynamic nature of roles and influential contextual factors. This study explores role fluidity in interprofessional student groups using an activity theory framework. Using a collective instrumental case study approach, the authors examine the fluidity of one physical therapy (PT) student's role within 3 different interprofessional (medical, pharmacy, PT) student groups completing nursing home patient care plans. Field notes, group debriefing interviews, and care plans were collected and coded from all care planning sessions. Codes mapped to group-specific activity systems that compared role-influencing interactions and tensions. The PT student's role fluidity varied in each group's activity system, influenced primarily by system tensions from implicit rules (e.g., encouraging questions), division of labor (e.g., rigid profession-based task assignment), and tool use (e.g., computers). Attention to modifiable system elements, such as tool use and explicit rules of inclusivity, could foster role fluidity and improve interprofessional teamwork and learning environments.
Collapse
Affiliation(s)
- Laura K Byerly
- Division of General Internal Medicine and Geriatrics, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, L-475, Portland, OR, 97239, USA.
| | - Leslie C Floren
- School of Pharmacy, University of California San Francisco, San Francisco, CA, USA
| | - Michi Yukawa
- Division of Geriatrics, University of California San Francisco, San Francisco, CA, USA
| | - Bridget C O'Brien
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
22
|
Dynamics of interprofessional teamwork: Why three logics are better than one. Soc Sci Med 2020; 265:113472. [PMID: 33223384 DOI: 10.1016/j.socscimed.2020.113472] [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] [Revised: 10/13/2020] [Accepted: 10/19/2020] [Indexed: 11/21/2022]
Abstract
Much research has used three logics to understand the dynamics of interprofessionalism: 1) assimilation, that is, adapting the work of others; 2) segregation, where professional roles are separated and boundaries defended; and 3) integration, a perspective on the complementarity of professional roles. However, we found no studies analysing all three logics in connection with each other. Based on an ethnographic study of interprofessional teamwork in the field of mental health and substance use in Norway, this article explores the dynamics of interprofessionalism from all three perspectives. The data collection consisted of 14 observation sessions and 18 in-depth interviews of professionals in the field of health and social work. Investigating how, when and why each logic came into play, the results show the importance of including all three logics to leverage each one's purpose and function, and how they appear almost simultaneously in many situations. By investigating all three logics, the paper provides a broader, more comprehensive view of interprofessional teamwork.
Collapse
|
23
|
Waggie F, Arends NE. Exploring interprofessional teamwork at a tertiary public hospital in South Africa. J Interprof Care 2020; 35:672-681. [PMID: 32838588 DOI: 10.1080/13561820.2020.1803225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The landscape of health in South Africa has changed dramatically with the unprecedented rise in the burden of disease. Public health care facilities struggle to provide quality, patient-centered care to patients with complex health needs. Interprofessional teamwork is strongly advocated to improve the quality and patient-centeredness of care. This study explored the barriers and facilitators of interprofessional teamwork amongst health professionals working at a tertiary level public hospital in South Africa. The study employed a qualitative, descriptive, exploratory design. Data were collected during three focus group discussions with 14 purposively selected participants from several health professions. Barriers such as high patient turnover, lack of human resources, time, hierarchy, referral process, lack of knowledge of the roles and scopes of practice, negative attitudes, communication inefficiencies, language barriers, and professional jealousy were found to impede interprofessional teamwork. Facilitators of interprofessional teamwork included increased human resources, communication technology, respect, and relationship building. Although health professionals understand the barriers and facilitators of interprofessional teams in the provision of patient care, this study concludes that interprofessional capacity building is needed for successful interprofessional teamwork at a tertiary level public hospital setting.
Collapse
Affiliation(s)
- Firdouza Waggie
- Interprofessional Education Unit, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | | |
Collapse
|
24
|
Seaton J, Jones A, Johnston C, Francis K. Allied health professionals' perceptions of interprofessional collaboration in primary health care: an integrative review. J Interprof Care 2020; 35:217-228. [PMID: 32297811 DOI: 10.1080/13561820.2020.1732311] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This integrative review synthesizes research studies in order to explore the perceptions of allied health professionals regarding interprofessional collaboration in primary health care. A comprehensive literature search was conducted using three electronic databases and a manual search of the Journal of Interprofessional Care. The Crowe Critical Appraisal Tool was used to assess the quality of included papers. Study findings were extracted, critically examined and grouped into themes. Twelve studies conducted in six different countries met the inclusion criteria. Thematic analysis revealed five themes: (1) shared philosophy; (2) communication and clinical interaction; (3) physical environment; (4) power and hierarchy; and (5) financial considerations. This review has identified diverse key elements related to interprofessional collaboration in primary health care, as perceived by allied health professionals. Opportunity for frequent, informal communication appeared essential for interprofessional collaboration to occur. Allied health professionals working in close proximity to health practitioners from other professions had more regular interprofessional interactions than those who were geographically separated. Co-location of multiple primary health care services within the same physical space may offer increased opportunities for interprofessional collaboration. Future research should avoid reporting on allied health professionals in primary health care collectively, and isolate data to the individual professions. Direct observational methods are warranted to investigate whether allied health professionals' perceptions of interprofessional collaboration align with their actual clinical interactions in primary health care settings.
Collapse
Affiliation(s)
- Jack Seaton
- Discipline of Physiotherapy, College of Healthcare Sciences, James Cook University, Townsville, Australia
| | - Anne Jones
- Discipline of Physiotherapy, College of Healthcare Sciences, James Cook University, Townsville, Australia
| | - Catherine Johnston
- Discipline of Physiotherapy, School of Health Sciences, the University of Newcastle, Callaghan, Australia
| | - Karen Francis
- Discipline of Nursing, College of Health and Medicine, The University of Tasmania, Launceston, Australia
| |
Collapse
|
25
|
Dominguez-Cancino KA, Palmieri PA, Martinez-Gutierrez MS. National Health Policy Reform for Primary Care in Chile: A Qualitative Analysis of the Health Program Documents. J Prim Care Community Health 2020; 11:2150132720924884. [PMID: 32468927 PMCID: PMC7263108 DOI: 10.1177/2150132720924884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/14/2020] [Accepted: 04/14/2020] [Indexed: 10/29/2022] Open
Abstract
Introduction: Chilean policy makers reformed the national health policy for primary health care (PHC), shifting from the traditional biomedical model to the integral family and community health model with a biopsychosocial approach, to guide the delivery of PHC throughout the country. Purpose: To evaluate the implementation of the national health policy for PHC through an analysis of the program documents for PHC; and to identify to what extent the national health policy is expressed in each program document, and across all the documents. Methods: A qualitative document analysis with a purposive sample of program documents for PHC. The Chilean Ministry of Health website was systematically searched between October and December 2018 to identify relevant program documents. Thematic and content analysis were performed to identify evidence of the biopsychosocial approach to care delivery with each program document, including the types of interactions between professionals that contribute to person-centered or fragmented care. Results: The study included 13 PHC program documents. Three themes and 10 categories emerged from the data. Most program justifications focused on the biopsychosocial approach to care while including biomedical interventions and supporting independent professional work. Only 4 of the 13 programs were consistent in the justification, interventions, and types of stated professional interactions: 2 from the biopsychosocial and 2 from the biomedical perspectives. Conclusion: In terms of the national health policy for PHC in Chile, interprofessional collaboration and person-centered care processes and practices were partially aligned with the written content of the health program documents. As such, policy makers and health sector leaders are advised to analyze draft health program documents for consistency in translating national health policies into the written communications that define the actualization of the care model in PHC and direct professionals how to provide PHC to individuals and families.
Collapse
Affiliation(s)
- Karen A. Dominguez-Cancino
- Universidad Norbert Wiener, Lima, Peru
- Universidad María Auxiliadora, Lima, Peru
- Universidad de Chile, Santiago, Chile
| | - Patrick A. Palmieri
- Universidad Norbert Wiener, Lima, Peru
- A. T. Still University, Kirksville, MO, USA
- Walden University, Minneapolis, Minnesota, USA
| | | |
Collapse
|
26
|
O'Sullivan TA, Sy E, Bacci JL. Essential Attributes for the Community Pharmacist as Care Provider. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2020; 84:7125. [PMID: 32292190 PMCID: PMC7055410 DOI: 10.5688/ajpe7125] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 06/24/2019] [Indexed: 06/11/2023]
Abstract
Objective. To identify skills and attributes that pharmacy students need upon graduation if planning to pursue a career path as a community pharmacy practice care provider. Methods. In-depth interviews with community pharmacy stakeholders were conducted, audio-recorded, and transcribed. Interview transcripts were thematically analyzed to identify the skills and attributes pharmacy students need upon graduation to be prepared to practice as a community pharmacy-based care provider. Results. Forty-two participants were interviewed. Identified attributes that were deemed transformative for community pharmacy practice included three behaviors, five skills, and two knowledge areas. Behavioral attributes needed by future community pharmacists were an approach to practice that is forward thinking and patient-centric, and having a provider mentality. The most commonly mentioned skill was the ability to provide direct patient care, with other skills being organizational competence, communication, building relationships, and management and leadership. Critical knowledge areas were treatment guidelines and drug knowledge, and regulatory and payer requirements. Additional skills needed by community pharmacy-based providers included identification and treatment of acute self-limiting illnesses and monitoring activities for chronic health conditions. Conclusion. Essential attributes of community pharmacists that will allow practice transformation to take place include behaving in a forward-thinking, patient-centric manner; displaying a provider mentality through use of effective communication to build relationships with patients and other providers, and learning how to meet regulatory and payer requirements for prescribers. These attributes should be fostered during the student's experiential curriculum.
Collapse
Affiliation(s)
| | - Erin Sy
- University of Washington School of Pharmacy, Seattle, Washington
| | - Jennifer L Bacci
- University of Washington School of Pharmacy, Seattle, Washington
| |
Collapse
|
27
|
Soemantri D, Sari SP, Wahyuni T, Ayubi D, Mulyono S, Adiatman M, Findyartini A. Measuring the interprofessional collaborative competencies of health-care students using a validated Indonesian version of the CICS29. J Interprof Care 2019; 34:763-771. [PMID: 31829770 DOI: 10.1080/13561820.2019.1697215] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The objectives of this study are to validate an Indonesian version of the Chiba Interprofessional Competency Scale (CICS29) and measure the interprofessional competencies of undergraduate health-care students following their completion of an interprofessional education (IPE) course. This study used a cross-sectional design and was preceded by a cross translation of the instrument and a confirmatory factor analysis (CFA), which confirmed that the Indonesian-version CICS29 has good internal consistency comparable to the original model. The Indonesian version was then administered to 723 health-care students who had completed a community-based IPE course. Based on data gathered from 707 respondents (97.8%), it was found that their interprofessional competency was relatively good (mean score: 127.9 out of 145, 88.2%). The dental students scored consistently lower compared to students of other faculties, both in the overall CICS29 and all five of its subscales, three of which are specifically related to teamwork. The study has provided support for cross-cultural validity of undergraduate health-care students' interprofessional competency measures using CICS29. Further efforts are necessary to ensure that the students understand their roles and internalize the collaborative values and practices of all health professions.
Collapse
Affiliation(s)
- Diantha Soemantri
- Department of Medical Education, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.,Health Sciences Cluster, Universitas Indonesia, Depok, Indonesia.,Interfaculty Committee, Development of World Class University at the University of Indonesia, Depok, Indonesia
| | - Santi Purna Sari
- Health Sciences Cluster, Universitas Indonesia, Depok, Indonesia.,Interfaculty Committee, Development of World Class University at the University of Indonesia, Depok, Indonesia.,Clinical Pharmacy Laboratory, Faculty of Pharmacy, Universitas Indonesia, Depok, Indonesia
| | - Tri Wahyuni
- Health Sciences Cluster, Universitas Indonesia, Depok, Indonesia.,Pharmacology & Toxicology Laboratory, Faculty of Pharmacy, Universitas Indonesia, Depok, Indonesia
| | - Dian Ayubi
- Health Sciences Cluster, Universitas Indonesia, Depok, Indonesia.,Interfaculty Committee, Development of World Class University at the University of Indonesia, Depok, Indonesia.,Health Education & Behavioural Sciences Department, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Sigit Mulyono
- Health Sciences Cluster, Universitas Indonesia, Depok, Indonesia.,Interfaculty Committee, Development of World Class University at the University of Indonesia, Depok, Indonesia.,Department of Community Nursing, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
| | - Melissa Adiatman
- Health Sciences Cluster, Universitas Indonesia, Depok, Indonesia.,Interfaculty Committee, Development of World Class University at the University of Indonesia, Depok, Indonesia.,Department of Dental Public Health & Preventive Dentistry, Faculty of Dentistry, Universitas Indonesia, Salemba, Indonesia
| | - Ardi Findyartini
- Department of Medical Education, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.,Health Sciences Cluster, Universitas Indonesia, Depok, Indonesia
| |
Collapse
|
28
|
The clinical learning environment of a maternity ward: A qualitative study. Women Birth 2019; 32:e523-e529. [DOI: 10.1016/j.wombi.2019.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 01/04/2019] [Accepted: 01/06/2019] [Indexed: 12/30/2022]
|
29
|
Vogel MT, Abu-Rish Blakeney E, Willgerodt MA, Soule Odegard P, Johnson EL, Shrader S, Liner D, Dyer CA, Hall LW, Zierler B. Interprofessional education and practice guide: interprofessional team writing to promote dissemination of interprofessional education scholarship and products. J Interprof Care 2019; 33:406-413. [PMID: 30395742 PMCID: PMC6500769 DOI: 10.1080/13561820.2018.1538111] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 09/26/2018] [Accepted: 10/10/2018] [Indexed: 12/12/2022]
Abstract
Collaborations to develop, implement, evaluate, replicate, and write about interprofessional education (IPE) activities within and across institutions are wonderful opportunities to experience teamwork, team communication, ethics and values, and the roles and responsibilities of interprofessional team writing. Just as effective communication in interprofessional team-based care is essential for providing safe, high-quality health care, similar communication strategies are necessary to produce high-quality scholarship of IPE curricula and activities. Relationship and communication issues that affect health care teams' abilities to work together effectively (e.g., hierarchy, exclusion, assumptions, non-responsiveness, biases, stereotypes and poor hand-offs of information) can also occur in interprofessional team writing. Between 1970 and 2010, interprofessional practice research publications increased by 2293%. Although there has been tremendous growth in the IPE literature, especially of articles that require collaborative writing, there have not been any papers addressing the challenges of interprofessional team writing. As more teams collaborate to develop IPE, there is a need to establish principles and strategies for effective interprofessional team writing. In this education and practice guide, a cross-institutional team of faculty, staff, and graduate students who have collaborated on externally funded IPE grants, conferences, products, and workshops will share lessons learned for successfully collaborating in interprofessional team writing.
Collapse
Affiliation(s)
- Mia T. Vogel
- Washington University in Saint Louis, The Brown School, Public Health Sciences, Center for Public Health Systems Science, One Brookings Drive, Box 1196, Saint Louis, Missouri, USA 63130, 509-294-0401
| | - Erin Abu-Rish Blakeney
- University of Washington, School of Nursing, 1959 NE Pacific Street, Box 357266, Seattle, WA, USA 98195, 206-499-0944,
| | - Mayumi A Willgerodt
- University of Washington, School of Nursing, 1959 NE Pacific Street, Box 357262, Seattle, WA, USA 98195,
| | - Peggy Soule Odegard
- University of Washington, School of Pharmacy, 1959 NE Pacific Street, Seattle, WA, USA 98195, 206-543-0760,
| | - Eric L. Johnson
- Department of Family and Community Medicine, Department of Education Resources, Office of Interprofessional Education, Director of Interprofessional Education, University of North Dakota School of Medicine and Health Sciences, 1301 N Columbia Road, Grand Forks, ND, USA 58201, 701-739-0877,
| | - Sarah Shrader
- University of Kansas, School of Pharmacy, 3901 Rainbow BlvdKansas City, KS, USA 66160, 913-588-9829,
| | - Debra Liner
- University of Washington, School of Nursing, 1959 NE Pacific Street, Box 357266, Seattle, WA, USA 98195,
| | - Carla A. Dyer
- Departments of Medicine and Child Health, University of Missouri School of Medicine, Department of Medicine MA406J, One Hospital Drive, Columbia, MO 65212, 573-884-1569,
| | - Leslie W. Hall
- University of South Carolina, School of Medicine, 15 Medical Park, 3555 Harden Street Extension, Suite 300, Columbia, SC, USA 29208, 803-545-5048,
| | - Brenda Zierler
- University of Washington, School of Nursing, 1959 NE Pacific Street, Box 357266, Seattle, WA, USA 98195, 206-616-1910,
| |
Collapse
|
30
|
Inter-Sectoral Collaboration in Municipal Health Centres: A Multi-Site Qualitative Study of Supporting Organizational Elements and Individual Drivers. Int J Integr Care 2019; 19:9. [PMID: 31244563 PMCID: PMC6588026 DOI: 10.5334/ijic.4196] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction Community health centres accommodating different professional groups are expected to improve inter-sectoral collaboration between primary care providers. This study aimed to identify what has been done to support inter-sectoral collaboration between municipal professionals and general practitioners in health centres, and to explore the interactions that emerge between these professionals at the operational level. Methods The study was a multi-site qualitative study carried out in four municipal health centres in a Danish region. The study was based on documents and qualitative interviews with general practitioners, and municipal professionals and administrators in each of the health centres. A content analysis was conducted. Results The study found that little attention had been given to the organizational prerequisites for enhanced inter-sectoral collaboration in the health centres. Even though some health centres had employed coordinators, these did not play a significant role as facilitators of collaboration partly due to a lack of political and managerial attention. At the operational level, inter-sectoral collaboration was limited to ad hoc interactions between professionals. Although these interactions could be useful, they did not evolve into more systematic forms of collaboration. Conclusion The gap between policy visions and actual implementation efforts found in this study suggests that a more active and focused engagement from the political-administrative level is needed if the visions of increased inter-sectoral collaboration in health centres are to be realised.
Collapse
|
31
|
Peduzzi M, Aguiar C, Lima AMV, Montanari PM, Leonello VM, Oliveira MRD. Expansion of the interprofessional clinical practice of Primary Care nurses. Rev Bras Enferm 2019; 72:114-121. [PMID: 30942352 DOI: 10.1590/0034-7167-2017-0759] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 03/30/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the clinical practice of nurses in the interprofessional context of the Family Health Strategy. METHOD Case study in a basic health unit of the city of São Paulo with a professional team of the Family Health Strategy and of the Family Health Support Center. Direct observation and interviews with thematic analysis and triangulation were conducted. RESULTS Four empirical categories were identified: interprofessional actions guided by the logic of the user's health needs; interprofessional actions guided by the logic of expediting service; interprofessional actions with a biomedical approach and interprofessional actions with an integral/holistic approach. Six interprofessional actions that indicated the expansion of the clinical practice of the Family Health Strategy's nurses were also identified. CONCLUSION The results express the world trend of interprofessional practice and expansion of the scope of practice of different professions, particularly that of nurses, which requires consolidation based on the population's health needs.
Collapse
Affiliation(s)
- Marina Peduzzi
- Universidade de São Paulo, Nursing School. São Paulo, São Paulo, Brazil
| | - Carla Aguiar
- Organização Social Santa Catarina. São Paulo, São Paulo, Brazil
| | | | | | | | | |
Collapse
|
32
|
The supporting and inhibiting factors of interprofessional collaborative practice in a newly established teaching hospital. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.xjep.2019.03.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
33
|
Wranik WD, Price S, Haydt SM, Edwards J, Hatfield K, Weir J, Doria N. Implications of interprofessional primary care team characteristics for health services and patient health outcomes: A systematic review with narrative synthesis. Health Policy 2019; 123:550-563. [PMID: 30955711 DOI: 10.1016/j.healthpol.2019.03.015] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 03/11/2019] [Accepted: 03/23/2019] [Indexed: 01/19/2023]
Abstract
Interprofessional primary care (IPPC) teams are promoted as an alternative to single profession physician practices in primary care with focus on preventive care and chronic disease management. Characteristics of teams can have an impact on their performance. We synthesized quantitative, qualitative or mixed-methods evidence addressing the design of IPPC teams. We searched Ovid MEDLINE, Embase, CINAHL, and PAIS using search terms focused on IPPC teams. Studies were included if they discussed the influence of team structure, organization, financial arrangements, or policies and procedures, or either health care processes or outputs, health outcomes, or costs, and were conducted in Australia, Canada, the United Kingdom or New Zealand between 2003 and 2016. We screened 11,707 titles, 5366 abstracts, and selected 77 full text articles (38 qualitative, 31 quantitative and 8 mixed-methods). Literature focused on the implications of team characteristics on team processes, such as teamwork, collaboration, or satisfaction of patients or providers. Despite heterogeneity of contexts, some trends are observable: shared space, common vision and goals, clear definitions of roles, and leadership as important to good teamwork. The impacts of these on health care outputs or patient health are not clear. To move the state of knowledge beyond perception of what works well for IPPC teams, researchers should focus on quantitative causal inference about the linkages between team characteristics and patient health.
Collapse
Affiliation(s)
- Wiesława Dominika Wranik
- School of Public Administration, Faculty of Management, Dalhousie University, Canada; Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Canada.
| | - Sheri Price
- School of Nursing, Faculty of Health Professions, Dalhousie University, Canada
| | - Susan M Haydt
- School of Public Administration, Faculty of Management, Dalhousie University, Canada
| | | | - Krista Hatfield
- School of Journalism and Communication, Carleton University, Canada
| | - Julie Weir
- Halifax Partnership, Dalhousie University, Canada
| | - Nicole Doria
- Maritime SPOR Support Unit, Dalhousie University, Canada
| |
Collapse
|
34
|
Ablett L. How can ways of working with others be developed to improve perinatal mental health care? ACTA ACUST UNITED AC 2019. [DOI: 10.12968/bjom.2019.27.3.178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Lucy Ablett
- Masters student, The Open University; Midwife, The Royal Devon & Exeter NHS Foundation Trust
| |
Collapse
|
35
|
Manspeaker SA, Hankemeier DA. Challenges to and Resources for Participation in Interprofessional Collaborative Practice: Perceptions of Collegiate Athletic Trainers. J Athl Train 2019; 54:106-114. [PMID: 30721095 DOI: 10.4085/1062-6050-507-17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Health care systems are increasing their emphasis on interprofessional collaborative practice (IPCP) as a necessary component to patient care. However, information regarding the challenges athletic trainers (ATs) perceive with respect to participating in IPCP is lacking. OBJECTIVE To describe collegiate ATs' perceptions of challenges to and resources for participation in IPCP. DESIGN Qualitative study. SETTING College and university. PATIENTS OR OTHER PARTICIPANTS The response rate was 8% (513 ATs [234 men, 278 women, 1 preferred not to disclose sex], years in clinical practice = 10.69 ± 9.33). DATA COLLECTION AND ANALYSIS Responses to survey-based, open-ended questions were collected through Qualtrics. A general inductive qualitative approach was used to analyze data and establish relevant themes and categories for responses. Multianalyst coding and an external auditor confirmed coding saturation and assisted in triangulation. RESULTS Challenges were reported in the areas of needing a defined IPCP team structure, respect for all involved health care parties, and concerns when continuity of care was compromised. Communication was reported as both a perceived challenge and a resource. Specific resources seen as beneficial to effective participation in IPCP included communication mechanisms such as shared patient health records and educational opportunities with individuals from other health care professions. CONCLUSIONS As ATs become more integrated into IPCP, they need to accurately describe and advocate their roles, understand the roles of others, and be open to the dynamic needs of team-based care. Development of continuing interprofessional education opportunities for all relevant members of the health care team can help to delineate roles more effectively and provide more streamlined care with the goal of improving patient outcomes.
Collapse
|
36
|
Manspeaker SA, Hankemeier DA. Collegiate athletic trainers’ perceptions of the benefits and drawbacks of interprofessional collaborative practice. J Interprof Care 2019; 33:654-660. [DOI: 10.1080/13561820.2019.1569604] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
37
|
Sørensen M, Stenberg U, Garnweidner-Holme L. A Scoping Review of Facilitators of Multi-Professional Collaboration in Primary Care. Int J Integr Care 2018; 18:13. [PMID: 30220896 PMCID: PMC6137624 DOI: 10.5334/ijic.3959] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Accepted: 08/15/2018] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Multi-professional collaboration (MPC) is essential for the delivery of effective and comprehensive care services. As in other European countries, primary care in Norway is challenged by altered patient values and the increased expectations of health administrations to participate in team-based care. This scoping review reports on the organisational, processual, relational and contextual facilitators of collaboration between general practitioners (GP) and other healthcare professionals (HCPs) in primary care. METHODS A systematic search in specialist and Scandinavian databases retrieved 707 citations. Following the inclusion criteria, nineteen studies were considered eligible and examined according to Arksey and O'Malley's methodological framework for scoping reviews. The retrieved literature was analysed employing a content analysis approach. A group of stakeholders commented on study findings to enhance study validity. RESULTS Primary care research into MPC is immature and emerging in Norway. Our analysis showed that introducing common procedures for documentation and handling of patient data, knowledge sharing, and establishing local specialised multi-professional teams, facilitates MPC. The results indicate that advancements in work practices benefit from an initial system-level foundation with focus on local management and MPC leadership. Further, our results show that it is preferable to enhance collaborative skills before introducing new professional teams, roles and responsibilities. Investing in professional relations could build trust, respect and continuity. In this respect, sufficient time must be allocated during the working day for professionals to share reflections and engage in mutual learning. CONCLUSION There is a paucity of research concerning the application and management of MPC in Norwegian primary care. The work practices and relations between professionals, primary care institutions and stakeholders on a macro level is inadequate. Health care is a complex system in which HCPs need managerial support to harvest the untapped benefits of MPC in primary care. As international research demonstrates, local managers must be supported with infrastructure on a macro level to understand the embedding of practice and look at what professionals actually do and how they work.
Collapse
Affiliation(s)
- Monica Sørensen
- Department of Nursing and Health Promotion, Oslo Metropolitan University, St. Olavs Plass, 0130 Oslo, NO
- The Norwegian Directorate of Health, St. Olavs Plass, 0130 Oslo, NO
| | - Una Stenberg
- The Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Trondheimsveien 235, 0586 Oslo, NO
| | - Lisa Garnweidner-Holme
- Department of Nursing and Health Promotion, Oslo Metropolitan University, St. Olavs Plass, 0130 Oslo, NO
| |
Collapse
|
38
|
Engaging primary care professionals in collaborative processes for optimising type 2 diabetes prevention practice: the PREDIAPS cluster randomised type II hybrid implementation trial. Implement Sci 2018; 13:94. [PMID: 29996928 PMCID: PMC6042383 DOI: 10.1186/s13012-018-0783-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 06/19/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND There is a lack of evidence concerning the effectiveness of different strategies to engage healthcare professionals in collaborative processes that seek to optimise clinical practice. The PREDIAPS project aims to assess the effect of different primary health care (PHC) providers' engagement procedures in the creation and execution of a facilitated interprofessional collaborative process to optimise the integration of the recommended clinical practice for the prevention of type-2 diabetes (T2D) in routine PHC. METHODS This will be a randomised cluster type II hybrid implementation trial. Nine PHC centres from the Basque Health Service (Osakidetza) will be allocated to two different procedures to engage family doctors and nurses and create an interprofessional collaborative practice to optimise the integration of a T2D primary prevention programme. All centres and PHC professionals will receive training on current guidelines in primary prevention of T2D and effective interventions to promote healthy lifestyles. Headed by a local leader and an external facilitator, centres will conduct a collaborative structured process to model and adapt the intervention and its implementation to the specific context of professionals and centres. One of the groups will apply this strategy globally, promoting the cooperation of all health professionals from the beginning. The other will perform it sequentially, centred first on nurses, who will then seek the pragmatic cooperation of doctors. All patients without diabetes aged ≥ 30 years old who attend collaborating centres at least once during the study period and found to be at high risk of developing T2D will be eligible for programme inclusion. The main outcome measures focus on changes observed in indicators of T2D prevention clinical practice at centre level after 12 and 24 months, associated with the application of one or other engagement procedure. Secondary outcomes will compare their clinical effectiveness in changing eligible exposed patients' main lifestyle behaviours and risk factors (physical activity and diet, weight, etc.) after 12 months. DISCUSSION The PREDIAPS project will generate scientific knowledge on procedures for engaging PHC professional to facilitate feasible and effective adoption of proven interventions for the prevention of T2D in routine clinical practice through the application of implementation strategies. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT03254979 . Registered 16 August 2017.
Collapse
|
39
|
King O, Borthwick A, Nancarrow S, Grace S. Sociology of the professions: what it means for podiatry. J Foot Ankle Res 2018; 11:30. [PMID: 29942353 PMCID: PMC6000928 DOI: 10.1186/s13047-018-0275-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 06/07/2018] [Indexed: 12/02/2022] Open
Abstract
Background The health professions have progressed and evolved considerably over the last few decades in response to demographic, technological, societal and political changes. They continue to do so as the volume and complexity of population health needs steadily increase. Role boundary expansion is among the key changes to the health professions, including podiatry to meet demand. Nonetheless podiatry’s role boundary expansion has not been achieved swiftly or without resistance from neighbouring and dominant professions. This paper seeks to explain the nature of this resistance with respect to the sociology of the professions literature and to shed light on some of the factors and processes at play when role boundary changes arise in health care. Discussion Six of the most contemporaneously relevant sociology of the professions theories are summarised: Taxonomic, Marxian, Bourdieusian, Foucauldian, Boundary Work and Neo-Weberian paradigms. Conclusion This review highlights that some paradigms are more relevant than others in the current socio-political landscape. It also illustrates that there is a common theme underlying each approach to defining the professions and their boundaries: competition. This may help health professionals, including podiatrists, to understand and manage the challenges and resistance experienced when professions attempt to expand role boundaries to meet increasing and changing population health needs.
Collapse
Affiliation(s)
- Olivia King
- 1Monash Centre for Scholarship in Health Education, Monash University, Clayton, 3800 Australia
| | - Alan Borthwick
- 2University of Southampton, Highfield, Southampton, SO17 1BJ UK
| | - Susan Nancarrow
- 3Southern Cross University, Military Drive, Lismore, 2480 Australia
| | - Sandra Grace
- 3Southern Cross University, Military Drive, Lismore, 2480 Australia
| |
Collapse
|
40
|
Tran C, Kaila P, Salminen H. Conditions for interprofessional education for students in primary healthcare: a qualitative study. BMC MEDICAL EDUCATION 2018; 18:122. [PMID: 29866079 PMCID: PMC5987484 DOI: 10.1186/s12909-018-1245-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 05/30/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Primary healthcare in Sweden and worldwide has a diverse structure with many kinds of healthcare units involved. This is a challenge for collaboration between different professions in primary healthcare, as the different healthcare professions often work in silos. Interprofessional education (IPE) in the context of primary healthcare is less studied than IPE at hospitals and most of the studies in primary healthcare have focused on collaboration between general practitioners and nurses. The aim of this study was to describe how healthcare students perceived conditions for IPE in primary healthcare. METHODS Qualitative group interviews were used and a total of 26 students, recruited on a voluntary basis participated in four group interviews with students mixed from study programmes in nursing, physiotherapy, occupational therapy and medicine. Students from the study programme in medicine were in their second to eleventh semesters of 11 semesters in total, whilst students from the occupational therapist, physiotherapist and nursing programmes were in their fourth to sixth of six semesters in total. RESULTS Our findings indicated one theme: Students perceived a need for support and awareness of IPE from both study programmes and clinical placements. Five categories were found to belong to the theme. Students' tunnel-vision focus on their own profession may have affected their ability to collaborate with students from other professions. The nature of the patients' healthcare problems decided if they were perceived as suitable for IPE. Clinical supervisors' support for and attitude towards IPE were important. The hierarchy between different professions was perceived as a hindrance for seeking help from the other professions. The students asked for more collaboration between different study programmes, in order to gain knowledge about the roles and responsibilities of the other professions. CONCLUSIONS In conclusion, students in this study considered it essential for different study programmes and clinical placements to be more aware of the opportunities for and importance of IPE. The study identified conditions that were required for IPE in primary healthcare that may be helpful for healthcare teachers and clinical supervisors to better understand how students perceive IPE in primary healthcare, thus facilitating the planning of IPE.
Collapse
Affiliation(s)
- Carrie Tran
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Alfred Nobels Allé 23, 141 83 Huddinge, Sweden
| | - Päivi Kaila
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Alfred Nobels Allé 23, 141 83 Huddinge, Sweden
| | - Helena Salminen
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Alfred Nobels Allé 23, 141 83 Huddinge, Sweden
| |
Collapse
|
41
|
The need for flexibility when negotiating professional boundaries in the context of home care, dementia and end of life. AGEING & SOCIETY 2018. [DOI: 10.1017/s0144686x18000375] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACTProfessional boundaries may help care staff to clarify their role, manage risk and safeguard vulnerable clients. Yet there is a scarcity of evidence on how professional boundaries are negotiated in a non-clinical environment (e.g. the home) by the home-care workforce in the context of complex care needs (e.g. dementia, end-of-life care). Through analysis of semi-structured interviews, we investigated the experiences of home-care workers (N = 30) and their managers (N = 13) working for a range of home-care services in the South-East and London regions of England in 2016–17. Findings from this study indicate that home-care workers and their managers have clear perceptions of job role boundaries, yet these are modified in dementia care, particularly at end of life which routinely requires adaptability and flexibility. As a lone worker in a client's home, there may be challenges relating to safeguarding and risk to both clients and workers. The working environment exacerbates this, particularly during end-of-life care where emotional attachments to both clients and their family may affect the maintenance of professional boundaries. There is a need to adopt context-specific, flexible and inclusive attitudes to professional boundaries, which reconceptualise these to include relational care and atypical workplace conventions. Pre-set boundaries which safeguard clients and workers through psychological contracts may help to alleviate to some extent the pressure of the emotional labour undertaken by home-care workers.
Collapse
|
42
|
Maharaj S, Chung C, Dhugge I, Gayevski M, Muradyan A, McLeod KE, Smart A, Cott CA. Integrating Physiotherapists into Primary Health Care Organizations: The Physiotherapists' Perspective. Physiother Can 2018; 70:188-195. [PMID: 29755175 DOI: 10.3138/ptc.2016-107.pc] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: This study's purpose was to gain insight into physiotherapists' perspectives on the perceived barriers and facilitators of integrating physiotherapists into primary health care (PHC) teams. Method: A qualitative descriptive approach consisting of semi-structured face-to-face or telephone interviews was used. Interviews were audio recorded, transcribed verbatim, and checked by the interviewers to ensure trustworthiness. Data were analyzed using Braun and Clarke's six steps to thematic analysis. Results: Eight participants were interviewed, representing physiotherapists from diverse demographics and geographical regions in Ontario. Common themes discussed were the orientation process, their experiences of integrating the physiotherapist's role into the organization, programme development compared with one-to-one care, the characteristics of the physiotherapist and the interdisciplinary team, and the resources available in the organization. Our key findings of influential factors for integration were (1) the diversity and novelty of new physiotherapists' role, (2) team members' understanding of the physiotherapists' role, and (3) physiotherapists' actions and values regarding PHC. Conclusions: The integration process is affected by factors ranging from individual to system levels. The integration of physiotherapists into PHC would be enhanced by a greater understanding of the role of physiotherapy in PHC by physiotherapists, other health care professionals, and system planners.
Collapse
Affiliation(s)
- Sai Maharaj
- Department of Physical Therapy, Faculty of Medicine, University of Toronto
| | - Christine Chung
- Department of Physical Therapy, Faculty of Medicine, University of Toronto
| | - Inderdeep Dhugge
- Department of Physical Therapy, Faculty of Medicine, University of Toronto
| | - Maria Gayevski
- Department of Physical Therapy, Faculty of Medicine, University of Toronto
| | - Asya Muradyan
- Department of Physical Therapy, Faculty of Medicine, University of Toronto
| | | | - Amanda Smart
- Practice and Member Services, Ontario Physiotherapy Association, Toronto
| | - Cheryl A Cott
- Department of Physical Therapy, Faculty of Medicine, University of Toronto
| |
Collapse
|
43
|
Teamwork in primary palliative care: general practitioners' and specialised oncology nurses' complementary competencies. BMC Health Serv Res 2018. [PMID: 29514681 PMCID: PMC5842567 DOI: 10.1186/s12913-018-2955-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Generalists such as general practitioners and district nurses have been the main actors in community palliative care in Norway. Specialised oncology nurses with postgraduate palliative training are increasingly becoming involved. There is little research on their contribution. This study explores how general practitioners (GPs) and oncology nurses (ONs) experience their collaboration in primary palliative care. METHODS A qualitative focus group and interview study in rural Northern Norway, involving 52 health professionals. Five uni-professional focus group discussions were followed by five interprofessional discussions and six individual interviews. Transcripts were analysed thematically. RESULTS The ideal cooperation between GPs and ONs was as a "meeting of experts" with complementary competencies. GPs drew on their generalist backgrounds, including their often long-term relationship with and knowledge of the patient. The ONs contributed longitudinal clinical observations and used their specialised knowledge to make treatment suggestions. While ONs were often experienced and many had developed a form of pattern recognition, they needed GPs' competencies for complex clinical judgements. However, ONs sometimes lacked timely advice from GPs, and could feel left alone with sick patients. To avoid this, some ONs bypassed GPs and contacted palliative specialists directly. While traditional professional hierarchies were not a barrier, we found that organization, funding and remuneration were significant barriers to cooperation. GPs often did not have time to meet with ONs to discuss shared patients. We also found that ONs and GPs had different strategies for learning. While ONs belonged to a networking nursing collective aiming for continuous quality improvement, GPs learned mostly from their individual experience of caring for patients. CONCLUSIONS The complementary competences and autonomous roles of a specialised nurse and a general practitioner represented a good match for primary palliative care. When planning high-quality teamwork in primary care, organizational barriers to cooperation and different cultures for learning need consideration.
Collapse
|
44
|
Pedersen MS, Landheim A, Møller M, Lien L. Acting on audit & feedback: a qualitative instrumental case study in mental health services in Norway. BMC Health Serv Res 2018; 18:71. [PMID: 29386020 PMCID: PMC5793343 DOI: 10.1186/s12913-018-2862-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 01/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The National Guideline for Assessment, Treatment and Social Rehabilitation of Persons with Concurrent Substance Use and Mental Health Disorders, launched in 2012, is to be implemented in mental health services in Norway. Audit and feedback (A&F) is commonly used as the starting point of an implementation process. It aims to measure the research-practice gap, but its effect varies greatly. Less is known of how audit and feedback is used in natural settings. The aim of this study was to describe and investigate what is discussed and thematised when Quality Improvement (QI) teams in a District Psychiatric Centre (DPC) work to complete an action form as part of an A&F cycle in 2014. METHODS This was an instrumental multiple case study involving four units in a DPC in Norway. We used open non-participant observation of QI team meetings in their natural setting, a total of seven teams and eleven meetings. RESULTS The discussions provided health professionals with insight into their own and their colleagues' practices. They revealed insufficient knowledge of substance-related disorders and experienced unclear role expectations. We found differences in how professional groups sought answers to questions of clinical practice and that they were concerned about whether new tasks fitted in with their routine ways of working. CONCLUSION Acting on A&F provided an opportunity to discuss practice in general, enhancing awareness of good practice. There was a general need for arenas to relate to practice and QI team meetings after A&F may well be a suitable arena for this. Self-assessment audits seem valuable, particular in areas where no benchmarked data exists, and there is a demand for implementation of new guidelines that might change routines and develop new roles. QI teams could benefit from having a unit leader present at meetings. Nurses and social educators and others turn to psychiatrists or psychologists for answers to clinical and organisational questions beyond guidelines, and show less confidence or routine in seeking research-based information. There is a general need to emphasise training in evidence-based practice and information seeking behaviour for all professional groups.
Collapse
Affiliation(s)
- Monica Stolt Pedersen
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, P.B. 104, 2340, Brumunddal, Norway. .,Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Anne Landheim
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, P.B. 104, 2340, Brumunddal, Norway.,Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | | | - Lars Lien
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, P.B. 104, 2340, Brumunddal, Norway.,Inland Norway University of Applied Sciences, Campus Elverum, Elverum, Norway
| |
Collapse
|
45
|
Distributed leadership in health care teams: Constellation role distribution and leadership practices. Health Care Manage Rev 2018; 41:200-12. [PMID: 26131606 DOI: 10.1097/hmr.0000000000000073] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Recent literature has been critical of research that adopts a narrow focus on single leaders and on leadership attributes and has called for attention to leadership that is distributed among individuals and to practices in which leaders engage. We conducted a study of health care teams where we attended to role distribution among leadership constellation members and to loose or tight coupling practices between leaders and the remainder of the team. This focus provides insights into how leadership can be practiced and structured to enhance team functioning. METHODOLOGY A qualitative, multicase study of four teams was conducted. Data collection involved 44 interviews with almost all the members of the teams and 18 team meeting observations. Thematic analysis was conducted by the two authors. FINDINGS Leadership constellations can give rise to leadership role overlaps and gaps that may create ambiguity within teams, ambiguity is diminished if the leaders can agree on which leader assumes ultimate authority in an area, the presence of more leaders does not necessarily entail more comprehensive fulfillment of team needs, and teams' needs for tight or loose leadership practices are influenced by contextual factors that we elaborate. PRACTICE IMPLICATIONS (a) It is important to recognize areas of overlap and gaps in leadership roles and to provide clarity about role boundaries to avoid ambiguity. Role mapping exercises and open discussions should be considered. (b) Attempting to spread formal leadership responsibilities informally among individuals is not always a workable strategy for addressing team needs.
Collapse
|
46
|
Bentley M, Freeman T, Baum F, Javanparast S. Interprofessional teamwork in comprehensive primary healthcare services: Findings from a mixed methods study. J Interprof Care 2017; 32:274-283. [DOI: 10.1080/13561820.2017.1401986] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Michael Bentley
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, Australia
| | - Toby Freeman
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, Australia
| | - Fran Baum
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, Australia
| | - Sara Javanparast
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, Australia
| |
Collapse
|
47
|
Szafran O, Torti JM, Kennett SL, Bell NR. Family physicians’ perspectives on interprofessional teamwork: Findings from a qualitative study. J Interprof Care 2017; 32:169-177. [DOI: 10.1080/13561820.2017.1395828] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Olga Szafran
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Sandra L Kennett
- Clinical Nurse Specialist, Edmonton Oliver Primary Care Network, Family Medicine Clinic, Misericordia Community Hospital, Edmonton, Alberta, Canada
| | - Neil R Bell
- Department of Family Medicine, University of Alberta, Family Medicine Clinic, Misericordia Community Hospital, Edmonton, Alberta, Canada
| |
Collapse
|
48
|
Sangaleti C, Schveitzer MC, Peduzzi M, Zoboli ELCP, Soares CB. Experiences and shared meaning of teamwork and interprofessional collaboration among health care professionals in primary health care settings: a systematic review. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2017; 15:2723-2788. [PMID: 29135752 DOI: 10.11124/jbisrir-2016-003016] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND During the last decade, teamwork has been addressed under the rationale of interprofessional practice or collaboration, highlighted by the attributes of this practice such as: interdependence of professional actions, focus on user needs, negotiation between professionals, shared decision making, mutual respect and trust among professionals, and acknowledgment of the role and work of the different professional groups. Teamwork and interprofessional collaboration have been pointed out as astrategy for effective organization of health care services as the complexity of healthcare requires integration of knowledge and practices from differente professional groups. This integration has a qualitative dimension that can be identified through the experiences of health professionals and to the meaning they give to teamwork. OBJECTIVE The objective of this systematic review was to synthesize the best available evidence on the experiences of health professionals regarding teamwork and interprofessional collaboration in primary health care settings. INCLUSION CRITERIA TYPES OF PARTICIPANTS The populations included were all officially regulated health professionals that work in primary health settings: dentistry, medicine, midwifery, nursing, nutrition, occupational therapy, pharmacy, physical education, physiotherapy, psychology, social work and speech therapy. In addition to these professionals, community health workers, nursing assistants, licensed practical nurses and other allied health workers were also included. PHENOMENA OF INTEREST The phenomena of interest were experiences of health professionals regarding teamwork and interprofessional collaboration in primary health care settings. CONTEXT The context was primary health care settings that included health care centers, health maintenance organizations, integrative medicine practices, integrative health care, family practices, primary care organizations and family medical clinics. National health surgery as a setting was excluded. TYPES OF STUDIES The qualitative component of the review considered studies that focused on qualitative data including designs such as phenomenology, grounded theory, ethnography, action research and feminist research. SEARCH STRATEGY A three-step search strategy was utilized. Ten databases were searched for papers published from 1980 to June 2015. Studies published in English, Portuguese and Spanish were considered. METHODOLOGICAL QUALITY Methodological quality was assessed using the Qualitative Assessment and Review Instrument developed by the Joanna Briggs Institute. All included studies received a score of at least 70% the questions in the instrument, 11 studies did not address the influence of the researcher on the research or vice-versa, and six studies did not present a statement locating the researcher culturally or theoretically. DATA EXTRACTION Qualitative findings were extracted using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. DATA SYNTHESIS Qualitative research findings were pooled using a pragmatic meta-aggregative approach and the Joanna Briggs Institute Qualitative Assessment and Review Instrument software. RESULTS This review included 21 research studies, representing various countries and healthcare settings. There were 223 findings, which were aggregated into 15 categories, and three synthesized findings: CONCLUSIONS: This review shows that health professionals experience teamwork and interprofessional collaboration as a process in primary health care settings; its conditions, consequences (benefits and barriers), and finally shows its determinants. Health providers face enormous ideological, organizational, structural and relational challenges while promoting teamwork and interprofessional collaboration in primary health care settings. This review has identified possible actions that could improve implementation of teamwork and interprofessional collaboration in primary health care.
Collapse
Affiliation(s)
- Carine Sangaleti
- 1Nursing Department, The Midwestern State University (UNICENTRO), Paraná, Brazil 2Paulista Medical School, Universidade Federal de São Paulo, São Paulo, Brazil 3Nursing School, University of São Paulo (EEUSP) and The Brazilian Centre for Evidence-based Healthcare: a Joanna Briggs Institute Centre of Excellence, São Paulo, Brazil
| | | | | | | | | |
Collapse
|
49
|
Lim AG, North N, Shaw J. Navigating professional and prescribing boundaries: Implementing nurse prescribing in New Zealand. Nurse Educ Pract 2017; 27:1-6. [DOI: 10.1016/j.nepr.2017.08.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 02/27/2017] [Accepted: 08/06/2017] [Indexed: 11/30/2022]
|
50
|
Lam P, Lopez Filici A, Middleton C, McGillicuddy P. Exploring healthcare professionals' perceptions of the anesthesia assistant role and its impact on patients and interprofessional collaboration. J Interprof Care 2017; 32:24-32. [PMID: 29083250 DOI: 10.1080/13561820.2017.1379960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
To practice interprofessional collaboration (IPC), understanding the roles of each profession in the team is key. Anesthesia assistants (AAs) are a relatively new addition to the Canadian healthcare system. As a result, its role in the delivery of anesthesia care can be misunderstood by other healthcare professionals. Using an exploratory multiple case study design, this article explores healthcare professionals' perceptions of the AA role and its impact on patients and IPC. Sixteen semi-structured, in-depth interviews were conducted with a purposive sample of nine healthcare professions from inside and outside the peri-operative care unit in two urban, acute care, university-affiliated teaching research hospitals in Ontario. A thematic analysis of the interview transcripts identified five overarching themes: limited understanding of the AA role, improved patient-centred care, improve IPC and interprofessional education, ongoing challenges, and the future direction for professional growth. Results indicated that despite regular clinical practice collaboration, participants have a limited understanding of AAs in terms of their educational prerequisites, scope of practice, and roles. One reason for this lack of understanding is that there is a high variability of titles and clinical duties for non-physician anesthesia providers. The diverse range of anesthesia services provided by AAs can also become a barrier to the full understanding of their scope of practice and roles. The limited understanding of the AA role was reported as one of AAs' ongoing challenges. It prevents AAs from realising their full scope of practice. Participants suggested that AAs' professional growth should focus on promoting and expanding their role. Understanding other healthcare professionals' perceptions of AAs will assist them to become better ambassadors for their role, and to more effectively promote and practice IPC. Ultimately, this will result in improved interprofessional teamwork to deliver effective and efficient patient care.
Collapse
Affiliation(s)
- Phoebe Lam
- a Department of Anesthesia and Pain Management , University Health Network , Toronto , Canada
| | - Ana Lopez Filici
- b Anesthesia Clinical Services, Department of Anesthesia and Pain Management , University Health Network , Toronto , Canada
| | - Claire Middleton
- c Department of Anesthesia and Pain Management , University Health Network and The Michener Institute of Education at UHN , Toronto , Canada
| | - Patricia McGillicuddy
- d Collaborative Academic Practice , University Health Network , Toronto , Canada.,e Department of Social Work , University of Toronto , Toronto , Canada
| |
Collapse
|