Interdisciplinary Team Processes Within an In-Home Service Delivery Organization

Physician leadership in e-health? A systematic literature review

Purpose This paper aims to systematically review the literature on roles of physicians in virtual teams (VTs) delivering healthcare for effective "physician e-leadership" (PeL) and implementation of e-health. Design/methodology/approach The analyzed studies were retrieved with explicit keywords and criteria, including snowball sampling. They were synthesized with existing theoretical models on VT research, healthcare team competencies and medical leadership. Findings Six domains for further PeL inquiry are delineated: resources, task processes, socio-emotional processes, leadership in VTs, virtual physician-patient relationship and change management. We show that, to date, PeL studies on socio-technical dynamics and their consequences on e-health are found underrepresented in the health literature; i.e. no single empirical, theoretic or conceptual study with a focus on PeL in virtual healthcare work was identified. Research limitations/implications E-health practices could benefit from organization-behavioral type of research for discerning effective physicians' roles and inter-professional relations and their (so far) seemingly modest but potent impact on e-health developments. Practical implications Although best practices in e-health care have already been identified, this paper shows that physicians' roles in e-health initiatives have not yet received any in-depth study. This raises questions such as are physicians not yet sufficiently involved in e-health? If so, what (dis)advantages may this have for current e-health investments and how can they best become involved in (leading) e-health applications' design and implementation in the field? Originality/value If effective medical leadership is being deployed, e-health effectiveness may be enhanced; this new proposition needs urgent empirical scrutiny.

Success Through Teamwork in the Home Health Setting: The Role of Occupational Therapy

Since 2002 and the introduction of outcome-based quality improvement reports by the Centers for Medicare and Medicaid Services, all home health professionals have recognized a heightened importance in the measurement of change in the daily functioning of patients from onset to discharge of the agency's service. As health care professionals whose expertise focuses on safe and meaningful participation in occupations of daily living, occupational therapists can play a key role on the inter-disciplinary team in a home health care agency. This article outlines the potential benefits of expanding the role of the occupational therapist as an interdisciplinary team member and explores challenges and solutions to maximize collaborative opportunities with the occupational therapy practitioner in home health.

Development and testing of the Dementia Symptom Management at Home (DSM-H) program: An interprofessional home health care intervention to improve the quality of life for persons with dementia and their caregivers

Home health care agencies are increasingly taking care of sicker, older patients with greater comorbidities. However, they are unequipped to appropriately manage these older adults, particular persons living with dementia (PLWD). We therefore developed the Dementia Symptom Management at Home (DSM-H) Program, a bundled interprofessional intervention, to improve the care confidence of providers, and quality of care delivered to PLWD and their caregivers. We implemented the DSM-H with 83 registered nurses, physical therapists, and occupational therapists. Overall, there was significant improvement in pain knowledge (5.9%) and confidence (26.5%), depression knowledge (14.8%) and confidence (36.1%), and neuropsychiatric symptom general knowledge (16.8%), intervention knowledge (20.9%), attitudes (3.4%) and confidence (27.1%) at a statistical significance of (P < .0001). We also found significant differences between disciplines. Overall, this disseminable program proved to be implementable and improve clinician's knowledge and confidence in caring for PLWD, with the potential to improve quality of care and quality of life, and decrease costs.

The Role of Leader Boundary Activities in Enhancing Interdisciplinary Team Effectiveness

This study examined how leaders’ internal and external activities mediate the relationship of functional heterogeneity and interteam goal interdependence to team effectiveness (in-role performance and innovation) in interdisciplinary teams. The results of the structural equation model from a sample of 92 interdisciplinary teams indicate that leaders’ internal activities fully mediate the relationship of team functional heterogeneity and interteam goal interdependence to team in-role performance. The leaders’ external activities were found to fully mediate the relationship of interteam goal interdependence to team innovation. We discuss the implications of these findings for both theory and practice.

Evidence of a shared purpose, critical reflection, innovation and leadership in interprofessional healthcare teams: a realist synthesis

Realist synthesis is a theory-driven approach for evaluating complex interventions using empirical evidence, which seeks an explanatory analysis of who a complex intervention works for, how, why, and in what circumstances. Interprofessional teamworking in healthcare is one such complex intervention, as teams are influenced by social and organizational factors, which makes them highly variable and context dependent. This article concludes a series of four articles that report on a realist synthesis of interprofessional teamworking. The synthesis identified 13 mechanisms that are reported in the literature to be the underlying processes through which interprofessional teamworking produces its effects. This article explores four of these mechanisms: a shared purpose; critical reflection; innovation; and leadership. These mechanisms together explain how a team sets and maintains its focus and direction. This article highlights that whilst many assumptions are made within the healthcare literature about how these mechanisms operate within teams, these assumptions are not always founded upon strong empirical evidence.

Using realist synthesis to understand the mechanisms of interprofessional teamwork in health and social care

Realist synthesis offers a novel and innovative way to interrogate the large literature on interprofessional teamwork in health and social care teams. This article introduces realist synthesis and its approach to identifying and testing the underpinning processes (or "mechanisms") that make an intervention work, the contexts that trigger those mechanisms and their subsequent outcomes. A realist synthesis of the evidence on interprofessional teamwork is described. Thirteen mechanisms were identified in the synthesis and findings for one mechanism, called "Support and value" are presented in this paper. The evidence for the other twelve mechanisms ("collaboration and coordination", "pooling of resources", "individual learning", "role blurring", "efficient, open and equitable communication", "tactical communication", "shared responsibility and influence", "team behavioural norms", "shared responsibility and influence", "critically reviewing performance and decisions", "generating and implementing new ideas" and "leadership") are reported in a further three papers in this series. The "support and value" mechanism referred to the ways in which team members supported one another, respected other's skills and abilities and valued each other's contributions. "Support and value" was present in some, but far from all, teams and a number of contexts that explained this variation were identified. The article concludes with a discussion of the challenges and benefits of undertaking this realist synthesis.

Comparing patient and provider perceptions of home- and community-based services: social network analysis as a service integration metric

Integrated home- and community-based services (HCBS) for frail seniors require a unique style of teamwork and collaboration. In four case studies, patient perceptions of teamwork and collaboration among their HCBS care providers are compared with those of the providers themselves using network analysis. The degree of coherence between these perceived networks are examined using network analytics, and network visualizations are discussed. The value of network analysis in research on HCBS is considered.

Collaborative and interdisciplinary health care teams: ready or not?

Collaborative team-based practice within an interdisciplinary health service environment is an important consideration for the nursing profession. Policy directions suggest that collaborative professional skills can address complex client needs within a framework of primary health care and social accountability for health service quality, cost, and access. The pursuit of collaborative and interdisciplinary care is generally agreed to be a worthy goal. However, implementation methodologies and outcomes related to collaborative and interdisciplinary care remain elusive within a rapidly changing health care environment. This article provides a critical analysis of the multiple historical, political, economic, and social professionalization challenges associated with the achievement of collaborative team-based practice. The author argues that it is not feasible to implement broad-based team structures at the present time. Considerable effort would be required to prepare disciplines to function as a team and to address fragmented services, equitable service funding, and procurement of resources to sustain team efforts. Strategic and influential use of power and knowledge may support the efforts of nurse leaders in practice, education, research, and administration to effect change for the development of collaborative and interdisciplinary practice.