Evidence of collaboration, pooling of resources, learning and role blurring in interprofessional healthcare teams: a realist synthesis

Collecting pieces for the 'puzzle': Nurses' intraprofessional collaboration in the hospital-to-home transition of older patients

BACKGROUND AND AIM

Communication is a key factor in intraprofessional collaboration between hospital nurses and homecare nurses in hospital-to-home transitions of older patients with complex care needs. Gaining knowledge of the nature of cross-sectoral communication is crucial for understanding how nurses collaborate to ensure a seamless patient trajectory. This study explores how cross-sectoral electronic health records communication influences collaboration between hospital nurses and homecare nurses when discharging older patients with complex care needs.

METHOD

The study is based on qualitative group interviews with six hospital nurses and 14 homecare nurses working at different hospitals and municipalities across Denmark. Data were analysed using reflexive thematic analysis, as described by Braun and Clark.

FINDINGS

The themes Collecting pieces for the 'puzzle': Losing the holistic picture of the patient; Working blindfolded: limited provision of and access to critical information; and Bypassing the 'invisible wall': dialogue supports cohesion illustrate the impact of organisational structures within electronic health records have on hospital nurses' and homecare nurses' intraprofessional collaboration across sectors. Challenges with predefined and word-limited elements in digital communication, and inadequate and limited access to significant medical information were identified. To compensate for the inadequacy of the electronic health records, direct contact and dialogue were emphasised as ways of fostering successful collaboration and overcoming the barriers created by electronic health records.

CONCLUSION

Despite hospital nurses' and homecare nurses' desire to conduct holistic patient assessments, their ability to collaborate was hindered by failures in electronic health record communication resulting from restrictive organisational structures across sectors. Thus, it became necessary for hospital nurses and homecare nurses to bypass the electronic health record system and engage in dialogue to provide holistic care when discharging older patients with complex care needs. However, by hospital nurses and homecare nurses compensating for counter-productive organisational structures, problems brought about by the electronic health record system paradoxically remain invisible.

Developing the future research agenda for the health and social care workforce in the United Kingdom: Findings from a national forum for policymakers and researchers

There is a gap between healthcare workforce research and decision-making in policy and practice. This matters more than ever given the urgent staffing crisis. As a national research network, we held the first ever United Kingdom (UK) forum on healthcare workforce evidence in March 2023. This paper summarises outputs of the event including an emerging UK healthcare workforce agenda and actions to build research capacity and bridge the gap between academics and decisionmakers. The forum brought together over 80 clinical and system leaders, policymakers and regulators with workforce researchers. Fifteen sessions convened by leading experts combined knowledge exchange with deliberative dialogue over 2 days. Topics ranged from workforce analytics, forecasting, international migration to interprofessional working. In the small groups that were convened, important gaps were identified in both the existing research body and uptake of evidence already available. There had not been enough high quality evaluations of recent workforce initiatives implemented at pace, from virtual wards to e-rostering. The pandemic had accelerated many changes in skillmix and professional roles with little learning from other countries and systems. Existing research was often small-scale or focused on individual, rather than organisational solutions in areas such as staff wellbeing. In terms of existing research, managers were often unaware of accepted high quality evidence in areas like the relationship between registered nurse staffing levels and patient outcomes. More work is needed to engage new disciplines from labour economics and occupational health to academic human resources and to strengthen the emerging diverse community of healthcare workforce researchers.

The mobilisation of professional identity: A scoping and lexical review

Interprofessional care obliges different healthcare professions to share decision-making and sometimes, practices. Given established hierarchies, it can be difficult to promote interprofessional care, partly because of the need to reshape professional identities. Despite interest in effective interprofessional care, there is limited research on how professional identity can be mobilised to promote it. A scoping review as well as lexical review of academic publications was conducted to address this void. After searching seven academic databases and screening the identified publications, 22 publications met the inclusion criteria. They collectively reported on 22 interventions, most of which were used in healthcare. The scoping review suggested there is some evidence that professional identities can be mobilised. Yet, of the 22 interventions, only ten explicitly targeted professional identity. The most common intervention was a training or development program, followed by workplace redesign. The need for internal motivation to mobilise professional identity was reported as was the impact of external drivers, like extending the scope of practice. Extending these findings, the lexical review demonstrated that, among the 22 publications, the relationship between professional identity and mobilisation did not feature prominently within the discourse. Furthermore, it seems that geography matters-that is, while all the publications spoke of professional identity, they differed by region on how they did this. Given these findings, concentrated scholarship is needed on the relationship between professional identity and interprofessional care, lest interprofessional care programs have limited, sustained effect. Implications for scholars and practitioners are explicated.

Acceptability and barriers of a GP-physiotherapist partnership in the diagnosis and management of COPD in primary care: A qualitative study

INTRODUCTION

Chronic obstructive pulmonary disease (COPD) is commonly diagnosed and managed in primary care but there is evidence that this has been suboptimal, with low confidence expressed in providing interventions requiring behaviour change. The aim of this study was to determine the acceptability of a general practitioner (GP)-physiotherapist partnership in the diagnosis and management of COPD in primary care and to explore the experiences of participants during the implementation of the model.

METHODS

Semi-structured interviews were conducted with physiotherapists (n = 3), GPs (n = 2), practice nurses (PNs) (n = 2) and patients (n = 12) who had participated in the InNovaTivE Gp-physiotheRapist pArTnErship for copD (INTEGRATED) trial. We sought to explore participants' views about their experiences and perceived benefits, barriers and facilitators to the implementation of this model of care. Interviews were transcribed, coded and thematically analysed. Synthesis of the data was guided by the Theoretical Domains Framework for clinician interviews and the health belief model for patient interviews.

RESULTS

All clinicians felt that this integrated model helped to optimise care for patients with COPD by facilitating evidence-based practice. GPs and PNs valued the physiotherapist's knowledge and skills relating to diagnosis and management, which was reported to complement their own management and improve patient outcomes. Patients reported a sense of empowerment following their appointments and acknowledged improved self-management skills. However, physiotherapists reported many patients were already engaging in positive health behaviours. Responses were mixed on the effectiveness of the model in facilitating teamwork between clinicians with different perspectives concerning management, communication pathways and logistical issues, such as time and room availability, being cited as barriers.

CONCLUSIONS

An experienced cardiorespiratory physiotherapist embedded into a small number of primary care practices to work in partnership with GPs for COPD diagnosis and management was acceptable and viewed as beneficial for patients. Barriers relating to logistics and resources remain, which must be addressed to optimise implementation.

PATIENT OR PUBLIC CONTRIBUTION

Patient input was obtained from qualitative feedback from a prior study conducted by two authors and was used to refine the model of care to determine the added value of a physiotherapist integrated into the primary care team. This feedback was also used to refine the interview guides utilised in this study determine the acceptability of this model of care. We had health service involvement from the rehabilitation service of the local health district who were directly involved in determining study aims and establishing the project around the priorities for their chronic disease integration service. For example, this project aimed to engage with a less severe patient population in primary care who would benefit from pulmonary rehabilitation. The findings from this study will be used to further tailor the model of care to the needs of the public and patients.

TRIAL REGISTRATION

ACTRN12619001127190.

The Working Relationship Between Emergency Room Nurses and Medical Rape Victim Advocates: A Qualitative Examination of Nurses' Perceptions of the Influence of Nurse Training and Experience on Nurse-Advocate Interactions

Nurses and medical advocates respond to sexual assault survivors seeking hospital services. Ideally, both providers work collaboratively. However, this does not always happen. Extant research on the nurse-advocate relationship focuses on Sexual Assault Nurse Examiners (SANEs). This study examines how ER nurses perceive their training and experience influence the working relationships between emergency room (ER) nurses (not exclusively SANEs) and medical advocates. Key findings indicate nurses perceive increased training improves (a) role understanding, (b) trust, (c) respect, (d) rapport, and (e) appreciation. Less training was associated with poorer role understanding and trust.

Physicians and nurses professional relationship with criminal investigation in dealing with survivors of sexual abuse: a scoping review

Survivors of sexual abuse and their families seek help from criminal law enforcement agencies and health professionals to obtain justice and health care. Many communities have implemented multi-professional collaborative models so that the victim's well-being is assured and the truth is established. However, there is a general lack of evidence on how to best articulate these teams with the healthcare professionals caring for the survivors.Therefore, this Scoping Review was conducted in order to analyze and to map the barriers and facilitators of the relationship between health professionals and the criminal investigation team in the care of survivors of sexual abuse. The methodology proposed by the Joanna Briggs Institute for Scoping Reviews was used, and the Bronstein five dimension model of interprofessional collaboration served as the basis for the analysis of barriers and facilitators. Quantitative, qualitative and mixed studies, primary and secondary sources, text and opinion documents were included. Content analysis was performed on the main findings of the collected studies. Twelve articles were identified and analyzed. Collaboration, communication, hierarchy, skills, confidentiality, and leadership emerged as key themes. Multidisciplinary Sexual Assault Nurse Examiner (SANE) and Sexual Assault Response Teams (SARTs) were implemented to coordinate care, but conflicting goals and values among professionals posed challenges. Communication failures and inadequate information sharing hindered collaboration. Neutral leaders who coordinate teams, minimize groupthink, and improve decision-making were found to be valuable. Engaging across disciplinary boundaries and addressing power dynamics were challenging but could be addressed through facilitation and conflict resolution. This review highlights the importance of effective collaboration and interaction within teams and with other professionals in the care of sexual abuse survivors.

United and flexible: a collaborative approach to early vocational rehabilitation on a spinal unit. A realist study

STUDY DESIGN

Qualitative study using realist review.

OBJECTIVES

To conceptualise how Early Intervention Vocational Rehabilitation (EIVR) functions within inpatient multidisciplinary contexts during spinal cord injury (SCI) rehabilitation.

SETTING

New Zealand Spinal Unit.

METHODS

People with newly acquired SCI and members of their rehabilitation team were observed in a range of rehabilitation sessions, team meetings and therapeutic interactions. Participants were also interviewed to explore how EIVR functioned alongside the multidisciplinary team (MDT). Interviews and observations were transcribed, coded and analysed using realist methods.

RESULTS

We identified three primary contexts which influenced how EIVR was delivered within the MDT: (1) a united approach, (2) a flexible approach, and (3) a hesitant approach. These contexts generated four work-related outcomes for people with SCI; enhanced work self-efficacy, strengthened hope for work, maintained work identity, and the less desirable outcome of increased uncertainty about work.

CONCLUSIONS

To optimise work outcomes for people after SCI, it is important to consider how EIVR is delivered and integrated within the wider MDT. Such an understanding can also inform the establishment of new EIVR services in different settings. Results suggest that unity, flexibility and clarity between EIVR services and the wider MDT are essential foundations for supporting people with SCI on their journey to employment.

SPONSORSHIP

This research was funded by Health Research Council NZ grant in partnership with Canterbury District Health Board.

How do stroke early supported discharge services achieve intensive and responsive service provision? Findings from a realist evaluation study (WISE)

BACKGROUND

Stroke Early Supported Discharge (ESD) involves provision of responsive and intensive rehabilitation to stroke survivors at home and it is recommended as part of the stroke care pathway. Core components have been identified to guide the delivery of evidence-based ESD, however, service provision in England is of variable quality. The study sought to understand how and in what conditions the adoption of these components drives the delivery of responsive and intensive ESD services in real world settings.

METHODS

This qualitative study was part of a wider multimethod realist evaluation project (WISE) conducted to inform large-scale ESD implementation. Overarching programme theories and related context-mechanism-outcome configurations were used as a framework to guide data collection and analysis. Six case study sites were purposively selected; interviews and focus groups with ESD staff members were conducted and analysed iteratively.

RESULTS

We interviewed 117 ESD staff members including clinicians and service managers. Staff highlighted the role of certain core components including eligibility criteria, capacity, team composition and multidisciplinary team (MDT) coordination in achieving responsive and intensive ESD. Regardless of the geographical setting, adhering to evidence-based selection criteria, promoting an interdisciplinary skillset and supporting the role of rehabilitation assistants, allowed teams to manage capacity issues and maximise therapy time. Gaps in the stroke care pathway, however, meant that teams had to problem solve beyond their remit to cater for the complex needs of patients with severe disabilities. Adjusting MDT structures and processes was seen as key in addressing challenges posed by travel times and rural geography.

CONCLUSIONS

Despite variations in the wider service model of operation and geographical location, the adoption of core components of ESD helped teams manage the pressures and deliver services that met evidence-based standards. Findings point to a well-recognised gap in service provision in England for stroke survivors who do not meet the ESD criteria and emphasise the need for a more integrated and comprehensive stroke service provision. Transferable lessons could be drawn to inform improvement interventions aimed at promoting evidence-based service delivery in different settings.

TRIAL REGISTRATION

ISRCTN: 15,568,163, registration date: 26 October 2018.

Cues Disseminated by Professional Associations That Represent 5 Health Care Professions Across 5 Nations: Lexical Analysis of Tweets

BACKGROUND

Collaboration across health care professions is critical in efficiently and effectively managing complex and chronic health conditions, yet interprofessional care does not happen automatically. Professional associations have a key role in setting a profession's agenda, maintaining professional identity, and establishing priorities. The associations' external communication is commonly undertaken through social media platforms, such as Twitter. Despite the valuable insights potentially available into professional associations through such communication, to date, their messaging has not been examined.

OBJECTIVE

This study aimed to identify the cues disseminated by professional associations that represent 5 health care professions spanning 5 nations.

METHODS

Using a back-iterative application programming interface methodology, public tweets were sourced from professional associations that represent 5 health care professions that have key roles in community-based health care: general practice, nursing, pharmacy, physiotherapy, and social work. Furthermore, the professional associations spanned Australia, Canada, New Zealand, the United Kingdom, and the United States. A lexical analysis was conducted of the tweets using Leximancer (Leximancer Pty Ltd) to clarify relationships within the discourse.

RESULTS

After completing a lexical analysis of 50,638 tweets, 7 key findings were identified. First, the discourse was largely devoid of references to interprofessional care. Second, there was no explicit discourse pertaining to physiotherapists. Third, although all the professions represented in this study support patients, discourse pertaining to general practitioners was most likely to be connected with that pertaining to patients. Fourth, tweets pertaining to pharmacists were most likely to be connected with discourse pertaining to latest and research. Fifth, tweets about social workers were unlikely to be connected with discourse pertaining to health or care. Sixth, notwithstanding a few exceptions, the findings across the different nations were generally similar, suggesting their generality. Seventh and last, tweets pertaining to physiotherapists were most likely to refer to discourse pertaining to profession.

CONCLUSIONS

The findings indicate that health care professional associations do not use Twitter to disseminate cues that reinforce the importance of interprofessional care. Instead, they largely use this platform to emphasize what they individually deem to be important and advance the interests of their respective professions. Therefore, there is considerable opportunity for professional associations to assert how the profession they represent complements other health care professions and how the professionals they represent can enact interprofessional care for the benefit of patients and carers.

From approachables on the sidelines to dedicated sensitives: developing a leadership typology among healthcare leaders utilizing grounded theory

PURPOSE

Based on a resulting typing model, this paper focuses on four types of leaders (Approachables on the sidelines, Distanced overseers, Realistic succeeders and Dedicated sensitives), who differ in the analytical core category of "development of awareness."

DESIGN/METHODOLOGY/APPROACH

Internal team coaching is intended to strengthen leaders in the health care system. The Team Leader Coaching Programme (TLCP) was implemented as an internal coaching instrument at rehabilitation centers using a train-the-trainer format. Twenty-one team leaders were surveyed on their experience of the coaching process they implemented in their teams. The interviews were analyzed using the grounded theory method (GTM) as theoretically discussed by representatives of second-generation GTM (Charmaz, 2014).

FINDINGS

Use of the TLCP proved to be an intervention for initiating and enhancing an awareness development process regarding team leaders' reflections on their own position and leadership role, regardless of their profession. This process was found to be a prerequisite for implementing the learned content. The typing model is discussed given current contextual conditions in the rehabilitation system and their connectivity in practice for integrating coaching elements into daily management.

ORIGINALITY/VALUE

This article presents a typology of healthcare leaders. Thanks to the reconstructive approach using grounded theory methodology, this article presents an in-depth analysis of the implementation process of a coaching program. The findings are both connectable to applied leadership research and useable for further development of training and interventions to strengthen team leaders in clinical settings.

Nurses’ Contributions in Rural Family Medicine Education: A Mixed-Method Approach

Family medicine residents frequently collaborate with nurses regarding clinical decisions and treatments, which contributes to their education. In rural areas, these residents experience a wider scope of practice by collaborating with nurses. However, nurses’ contributions to rural family medicine education have not been clarified. This study measured the contributions of 88 rural community hospital nurses to family medicine education using a quantitative questionnaire and interviews. The interviews were recorded, transcribed verbatim, and analyzed using the grounded theory approach. Nurses’ average clinical experience was 20.16 years. Nurses’ contributions to the roles of teacher and provider of emotional support were statistically lower among participants working in acute care wards than those working in chronic care wards (p = 0.024 and 0.047, respectively). The qualitative analysis indicated that rural nurses’ contributions to family medicine education focused on professionalism, interprofessional collaboration, and respect for nurses’ working culture and competence. Additionally, nurses struggled to educate medical residents amid their busy routine; this education should be supported by other professionals. Rural family medicine education should incorporate clinical nurses as educators for professionalism and interprofessional collaboration and as facilitators of residents’ transition to new workplaces. Subsequently, other professionals should be more actively involved in improving education quality.

Impact of ‘Enhanced’ Intermediate Care Integrating Acute, Primary and Community Care and the Voluntary Sector in Torbay and South Devon, UK

Introduction:

Intermediate care (IC) was redesigned to manage more complex, older patients in the community, avoid admissions and facilitate earlier hospital discharge. The service was ‘enhanced’ by employing GPs, pharmacists and the voluntary sector to be part of a daily interdisciplinary team meeting, working alongside social workers and community staff (the traditional model).

Methods:

A controlled before-and-after study, using mixed methods and a nested case study. Enhanced IC in one locality (Coastal) is compared with four other localities where IC was not enhanced until the following year (controls), using system-wide performance data (N = 4,048) together with ad hoc data collected on referral-type, staff inputs and patient experience (N = 72).

Results:

Coastal showed statistically significant increase in EIC referrals to 11.6% (95%CI: 10.8%–12.4%), with a growing proportion from GPs (2.9%, 95%CI: 2.5%–3.3%); more people being cared for at home (10.5%, 95%CI: 9.8%–11.2%), shorter episode lengths (9.0 days, CI 95%: 7.6–10.4 days) and lower bed-day rates in ≥70 year-olds (0.17, 95%CI: 0.179–0.161). The nested case study showed medical, pharmacist and voluntary sector input into cases, a more holistic, coordinated service focused on patient priorities and reduced acute hospital admissions (5.5%).

Discussion and conclusion:

Enhancing IC through greater acute, primary care and voluntary sector integration can lead to more complex, older patients being managed in the community, with modest impacts on service efficiency, system activity, and notional costs off-set by perceived benefits.

A National Survey of Collaboration Between Nurse Faculty Members and Staff Nurses in the Clinical Learning Environment

AIM

The purpose of this study was to measure collaboration in the clinical learning environment.

BACKGROUND

Clinical learning, which is essential for nursing education, allows students to integrate what they have learned in the classroom in a complex social context with an interactive network of forces. Stakeholders are nursing students, nursing faculty, and staff nurses who must collaborate in providing an effective learning environment for students.

METHOD

Quantitative data were collected via the Collaboration in the Clinical Learning Environment tool, an author-developed 24-item Likert scale designed to measure the amount of collaboration between staff nurses and nursing faculty members in the clinical learning environment.

RESULTS

Three groups (n = 882) were surveyed: staff nurses, nurse faculty, and nurses who worked concurrently in academia and practice.

CONCLUSION

This study adds to the literature on collaboration between nursing faculty members and staff nurses. It also highlights areas for improvement for both parties.

Standards for Interprofessional Collaboration in the Treatment of Individuals With Autism

Interprofessional collaboration has become an essential component in the treatment of individuals with autism spectrum disorder, as practitioners from a range of disciplines are often necessary to address the core features and co-occurring conditions. Theoretically, such cross-disciplinary collaboration results in superior client care and maximal outcomes by capitalizing on the unique expertise of each collaborating team member. However, conflict in collaborative practice is not uncommon given that the treatment providers come from varying educational backgrounds and may have opposing core values, fundamental goals, and overall approaches. Although the overarching interest of each of these professionals is to improve client outcomes and quality of life, they may be unequipped to effectively navigate the barriers to collaboration. This article reviews the potential benefits and misconceptions surrounding interprofessional collaboration and highlights common sources of conflict. As a proposed solution to many of the identified issues, we offer a set of standards for effective collaborative practice in the interprofessional treatment of autism spectrum disorder. These standards prioritize client care and value each discipline's education and unique contributions. They are intended to function as core standards for all treatment team members, promote unity, prevent conflict, and ultimately help practitioners achieve the most integrated collaborative practice among professionals of varying disciplines.

Large-scale implementation of stroke early supported discharge: the WISE realist mixed-methods study

Background

In England, the provision of early supported discharge is recommended as part of an evidence-based stroke care pathway.

Objectives

To investigate the effectiveness of early supported discharge services when implemented at scale in practice and to understand how the context within which these services operate influences their implementation and effectiveness.

Design

A mixed-methods study using a realist evaluation approach and two interlinking work packages was undertaken. Three programme theories were tested to investigate the adoption of evidence-based core components, differences in urban and rural settings, and communication processes.

Setting and interventions

Early supported discharge services across a large geographical area of England, covering the West and East Midlands, the East of England and the North of England.

Participants

Work package 1: historical prospective patient data from the Sentinel Stroke National Audit Programme collected by early supported discharge and hospital teams. Work package 2: NHS staff (n = 117) and patients (n = 30) from six purposely selected early supported discharge services.

Data and main outcome

Work package 1: a 17-item early supported discharge consensus score measured the adherence to evidence-based core components defined in an international consensus document. The effectiveness of early supported discharge was measured with process and patient outcomes and costs. Work package 2: semistructured interviews and focus groups with NHS staff and patients were undertaken to investigate the contextual determinants of early supported discharge effectiveness.

Results

A variety of early supported discharge service models had been adopted, as reflected by the variability in the early supported discharge consensus score. A one-unit increase in early supported discharge consensus score was significantly associated with a more responsive early supported discharge service and increased treatment intensity. There was no association with stroke survivor outcome. Patients who received early supported discharge in their stroke care pathway spent, on average, 1 day longer in hospital than those who did not receive early supported discharge. The most rural services had the highest service costs per patient. NHS staff identified core evidence-based components (e.g. eligibility criteria, co-ordinated multidisciplinary team and regular weekly multidisciplinary team meetings) as central to the effectiveness of early supported discharge. Mechanisms thought to streamline discharge and help teams to meet their responsiveness targets included having access to a social worker and the quality of communications and transitions across services. The role of rehabilitation assistants and an interdisciplinary approach were facilitators of delivering an intensive service. The rurality of early supported discharge services, especially when coupled with capacity issues and increased travel times to visit patients, could influence the intensity of rehabilitation provision and teams’ flexibility to adjust to patients’ needs. This required organising multidisciplinary teams and meetings around the local geography. Findings also highlighted the importance of good leadership and communication. Early supported discharge staff highlighted the need for collaborative and trusting relationships with patients and carers and stroke unit staff, as well as across the wider stroke care pathway.

Limitations

Work package 1: possible influence of unobserved variables and we were unable to determine the effect of early supported discharge on patient outcomes. Work package 2: the pragmatic approach led to ‘theoretical nuggets’ rather than an overarching higher-level theory.

Conclusions

The realist evaluation methodology allowed us to address the complexity of early supported discharge delivery in real-world settings. The findings highlighted the importance of context and contextual features and mechanisms that need to be either addressed or capitalised on to improve effectiveness.

Trial registration

Current Controlled Trials ISRCTN15568163.

Funding

This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 22. See the NIHR Journals Library website for further project information.

Therapeutic radiographers supporting individuals undergoing radiotherapy to stop smoking: Testing a training resource in clinical practice

INTRODUCTION

This study developed and piloted the first online training package to support implementation and delivery of brief smoking cessation interventions for therapeutic radiographers in four radiotherapy departments in England.

METHODS

A previously reported systematic literature review and data analysis from the previously reported pre-focus group questionnaire and focus groups enabled the development of an online training package. The questionnaire was repeated by the participating therapeutic radiographers following completion of the training resource (n = 31). The results of the comparative questions from the pre and post questionnaires were analysed using the Statistical Package for Social Sciences (SPSS Version 24).

RESULTS

In total, 43 therapeutic radiographer participants completed the pre-questionnaire and 31 participants continued to complete the post questionnaire, having completed the online training package. The previously conducted focus groups identified several barriers to the delivery of smoking cessation, that were addressed through the development of an online training package. Following the completion of the training; therapeutic radiographers had increased knowledge and confidence regarding smoking cessation, the number of therapeutic radiographers who believe that smoking cessation is part of their role increased and therapeutic radiographers more routinely have conversations about smoking cessation.

CONCLUSION

The training resource improved therapeutic radiographers' knowledge and confidence and increased awareness of the role of the therapeutic radiographer in the provision of smoking cessation interventions. Challenges remain that continue to prevent some therapeutic radiographers from delivering smoking cessation interventions and strong leadership and implementation of strategy and guidance is essential to ensure wider implementation. Recording and measuring impact of interventions remains an area to be addressed, alongside cultural changes and reassurance around the therapeutic relationship.

IMPLICATIONS FOR PRACTICE

This training tool has proven to be effective in the sample within this study and should be disseminated and evaluated more widely across radiotherapy provision within the United Kingdom.

Observing Interprofessional Collaboration: Impact on Attitude and Knowledge Acquisition

Interprofessional collaboration (IPC) in the medical field is an important factor for good clinical outcomes and should be taught as early as in undergraduate medical education. Since implementing IPC training is an organizational challenge, students are often limited in their opportunities to experience real-life IPC. Therefore, an approach where students observe successful IPC activities of role models in an applied anatomical format was proposed. It was studied whether observing IPC activities in undergraduate anatomical education has an impact on both students' attitude toward IPC and on knowledge acquisition. Further, it was examined whether the attitudes and knowledge of students from different medical disciplines were influenced in different ways. Therefore, 75 medical students and thirty-eight physiotherapy students participated in a study with the task of observing a live broadcast of an interprofessional teaching session. Participants were asked about their attitudes toward interprofessional learning, their evaluation of professional responsibilities, and their profession-specific knowledge before and after observing the IPC session. The participants' attitude toward interprofessional learning improved for both groups of students. Moreover, students of physiotherapy adjusted their evaluation of their own and others' professional responsibilities after observing IPC. In both student groups, knowledge increased, in particular, with respect to the field of knowledge in other professions. So, observing IPC can modify students' attitudes and support knowledge acquisition. The implementation of IPC observations provides students from various healthcare disciplines with a clearer impression of professionals' responsibilities and gives learners the opportunity to acquire knowledge from healthcare fields unfamiliar to them.

Feedback from health professionals in postgraduate medical education: Influence of interprofessional relationship, identity and power

INTRODUCTION

Capitalising on direct workplace observations of residents by interprofessional team members might be an effective strategy to promote formative feedback in postgraduate medical education. To better understand how interprofessional feedback is conceived, delivered, received and used, we explored both feedback provider and receiver perceptions of workplace feedback.

METHODS

We conducted 17 individual interviews with residents and eight focus groups with health professionals (HPs) (two nurses, two rehabilitation therapists, two pharmacists and two social workers), for a total of 61 participants. Using a constructivist grounded theory approach, data collection and analysis proceeded as an iterative process using constant comparison to identify and explore themes.

RESULTS

Conceptualisations and content of feedback were dependent on whether the resident was perceived as a learner or a peer within the interprofessional relationship. Residents relied on interprofessional role understanding to determine how physician competencies align with HP roles. The perceived alignment was unique to each profession and influenced feedback credibility judgements. Residents prioritised feedback from physicians or within the Medical Expertise domain-a role that HPs felt was over-valued. Despite ideal opportunities for direct observation, operational enactment of feedback was influenced by power differentials between the professions.

DISCUSSION

Our results illuminate HPs' conceptualisation of feedback for residents and the social constructs influencing how their feedback is disseminated. Professional identity and social categorisation added complexity to feedback acceptance and incorporation. To ensure that interprofessional feedback can achieve desired outcomes, education programmes should implement strategies to help mitigate intergroup bias and power imbalance.

Sustainability of an IPCP program within a federally qualified health center including interprofessional student team placements

In an effort to improve teamwork and collaborative care at a Federally Qualified Health Center (FQHC), the Midwest Interprofessional Practice, Education, and Research Center (MIPERC) collaborated on the implementation of an interprofessional collaborative practice (IPCP) program that included placement of multidisciplinary student teams. The MIPERC IPCP program supported staff, preceptor and student teams through interprofessional education and structured interprofessional activities for students, including daily huddles, interprofessional student team visits, and nurse triage phone calls. Results from the project's first year were previously reported (Nagelkerk et al., 2017b). Ongoing effects of IPCP on staff morale, IPE knowledge and practice efficiency were measured. Study tools included demographic forms, pre/post module knowledge tests, focus groups and program evaluations. The mean number of clinic patient visits per hour per medical provider was calculated to evaluate practice efficiency. Students (n = 26) and staff (n = 30) demonstrated improvement (p ≤.05) in knowledge test scores for Patient Safety, Team Dynamics and Tips for Behavioral Changes. Providers increased the number of patients seen per hour. Program evaluations and focus group data from providers, staff, and students indicated IPCP programs can be sustainable with ongoing intentional team care strategies.

Formative peer assessment in higher healthcare education programmes: a scoping review

OBJECTIVES

Formative peer assessment focuses on learning and development of the student learning process. This implies that students are taking responsibility for assessing the work of their peers by giving and receiving feedback to each other. The aim was to compile research about formative peer assessment presented in higher healthcare education, focusing on the rationale, the interventions, the experiences of students and teachers and the outcomes of formative assessment interventions.

DESIGN

A scoping review.

DATA SOURCES

Searches were conducted until May 2019 in PubMed, Cumulative Index to Nursing and Allied Health Literature, Education Research Complete and Education Research Centre. Grey literature was searched in Library Search, Google Scholar and Science Direct.

ELIGIBILITY CRITERIA

Studies addressing formative peer assessment in higher education, focusing on medicine, nursing, midwifery, dentistry, physical or occupational therapy and radiology published in peer-reviewed articles or in grey literature.

DATA EXTRACTIONS AND SYNTHESIS

Out of 1452 studies, 37 met the inclusion criteria and were critically appraised using relevant Critical Appraisal Skills Programme, Joanna Briggs Institute and Mixed Methods Appraisal Tool tools. The pertinent data were analysed using thematic analysis.

RESULT

The critical appraisal resulted in 18 included studies with high and moderate quality. The rationale for using formative peer assessment relates to giving and receiving constructive feedback as a means to promote learning. The experience and outcome of formative peer assessment interventions from the perspective of students and teachers are presented within three themes: (1) organisation and structure of the formative peer assessment activities, (2) personal attributes and consequences for oneself and relationships and (3) experience and outcome of feedback and learning.

CONCLUSION

Healthcare education must consider preparing and introducing students to collaborative learning, and thus develop well-designed learning activities aligned with the learning outcomes. Since peer collaboration seems to affect students' and teachers' experiences of formative peer assessment, empirical investigations exploring collaboration between students are of utmost importance.

The patient at the centre: evidence from 17 European integrated care programmes for persons with complex needs

BACKGROUND

As the prevalence of multi-morbidity increases in ageing societies, health and social care systems face the challenge of providing adequate care to persons with complex needs. Approaches that integrate care across sectors and disciplines have been increasingly developed and implemented in European countries in order to tackle this challenge. The aim of the article is to identify success factors and crucial elements in the process of integrated care delivery for persons with complex needs as seen from the practical perspective of the involved stakeholders (patients, professionals, informal caregivers, managers, initiators, payers).

METHODS

Seventeen integrated care programmes for persons with complex needs in 8 European countries were investigated using a qualitative approach, namely thick description, based on semi-structured interviews and document analysis. In total, 233 face-to-face interviews were conducted with stakeholders of the programmes between March and September 2016. Meta-analysis of the individual thick description reports was performed with a focus on the process of care delivery.

RESULTS

Four categories that emerged from the overarching analysis are discussed in the article: (1) a holistic view of the patient, considering both mental health and the social situation in addition to physical health, (2) continuity of care in the form of single contact points, alignment of services and good relationships between patients and professionals, (3) relationships between professionals built on trust and facilitated by continuous communication, and (4) patient involvement in goal-setting and decision-making, allowing patients to adapt to reorganised service delivery.

CONCLUSIONS

We were able to identify several key aspects for a well-functioning integrated care process for complex patients and how these are put into actual practice. The article sets itself apart from the existing literature by specifically focussing on the growing share of the population with complex care needs and by providing an analysis of actual processes and interpersonal relationships that shape integrated care in practice, incorporating evidence from a variety of programmes in several countries.

Exploring interdisciplinary teamwork to support effective ward rounds

PURPOSE

This paper aims to explore if health professionals share understanding of teamwork that supports collaborative ward rounds.

DESIGN/METHODOLOGY/APPROACH

A purpose-designed survey was conducted in two acute medical and two rehabilitation wards from a metropolitan teaching hospital. Medical officers, nurses and allied health professionals participated. To understand characteristics that support collaborative ward rounds, questions developed from literature and industry experience asked: what are the enablers and challenges to teamwork; and what are clinicians' experiences of positive teamwork? Descriptive and thematic analyses were applied to the dimensions of effective teamwork as a framework for deductive coding.

FINDINGS

Seventy-seven clinicians participated (93% response rate). Findings aligned with dimensions of teamwork framework. There was no meaningful difference between clinicians or specialty. Enablers to teamwork were: effective communication, shared understanding of patient goals, and colleague's roles. Challenges were ineffective communication, individual personalities, lack of understanding about roles and responsibilities, and organisational structure. Additional challenges included: time; uncoordinated treatment planning; and leadership. Positive teamwork was influenced by leadership and team dynamics.

PRACTICAL IMPLICATIONS

Ward rounds benefit from a foundation of collaborative teamwork. Different dimensions of teamwork present during ward rounds support clinicians' shared understanding of roles, expectations and communication.

ORIGINALITY/VALUE

Rounds such as structured rounding, aim to improve teamwork. Inverting this concept to first develop effective collaboration will support team adaptability and resilience. This enables teams to transition between the multiple rounding processes undertaken in a single ward. The emphasis becomes high-quality teamwork rather than a single rounding process.

Understanding key mechanisms of successfully leading integrated team-based services in health and social care: protocol for a realist synthesis

INTRODUCTION

As systems of health and social care in England move towards more integrated and collaborative models, leaders will need different skills than their predecessors to enable system leadership, building partnerships and working across organisations and sectors. There is little understanding of what the mechanisms for effective leadership across integrated health and social care systems might be, the contexts that influence good leadership, or the nature of the resulting outcomes. This review aims to identify, refine and test programme theories of leadership of integrated team-based services in health and social care, exploring what works, for whom and in what circumstances.

METHODS AND ANALYSIS

This study uses a realist synthesis approach, following RAMESES guidelines, supported by stakeholder consultation. Stage 1 will develop initial programme theories about leadership of integrated health and social care based on a review of the scientific and grey literature and a stakeholder consultation workshop. Stage 2 will involve focused searching of empirical literature, data extraction and synthesis to refine the initial programme theories and identify relationships between identified contexts, mechanisms and outcomes. A second stakeholder event will guide the focus of the review. Stage 3 will further refine and interrogate the theories testing them against substantive theory on leadership of complex systems and through the experiences and expertise of the stakeholder group.

ETHICS AND DISSEMINATION

Our study does not require ethics committee approval. This research will contribute to building an in-depth understanding of what aspects of leadership of integrated team-based services work, for whom and in what circumstances. It will identify the professional development needs of leaders and provide recommendations about optimal organisational and interorganisational structures and processes that support effective leadership in integrated health and social care systems. Findings will be disseminated through peer-reviewed journal publications, conference presentations and formal and informal reports.

PROSPERO REGISTRATION NUMBER

CRD42018119291.

Interprofessional barriers in patient flow management: an interview study of the views of emergency department staff involved in patient admissions

Patient flow in emergency departments (EDs) is notoriously difficult to manage efficiently. While much of the attention has focused on the procedures, protocols and pathways in which patients receive their first hours of care, less attention has been paid to the relational factors that make it happen. Our study is the first, to our knowledge, to consider the role of interprofessional barriers, defined as suboptimal ways of working, as perceived by ED staff in patient flow management. Drawing on 19 interviews with hospital staff in an acute tertiary trauma center hospital in England, we established three flow-related types of interprofessional barriers: ED teamwork barriers, performance-driven coordination barriers, and referral-related collaborative barriers. Knotworking was recognized as a form of interactions and asset to teamworking, coordination, and collaboration. Identifying processes such as chasing, escalating, and advocating enabled our investigation to highlight a very complex set of interprofessional interactions, and signpost what the suboptimal practices of flow management are. Our analysis holds promise for hospitals beyond the National Health Service in England.

A "Behind-the-Scenes" Look at Interprofessional Care Coordination: How Person-Centered Care in Safety-Net Health System Complex Care Clinics Produce Better Outcomes

Introduction:

While the effectiveness of team-based care and wrap-around services for high utilizers is clear, how complex care clinics deliver effective, person-centered care to these vulnerable populations is not well understood. This paper describes how interactions among interprofessional team members enabled individualized, rapid responses to the complex needs of vulnerable patients at the Virginia Commonwealth University Health System’s Complex Care Clinic.

Methods:

Researchers attended twenty weekly care coordination meetings, audio-recorded the proceedings, and wrote brief observational field notes. Researchers also qualitatively interviewed ten clinic team members. Emergent coding based on grounded theory and a consensus process were used to identify and describe key themes.

Results:

Analysis resulted in three themes that evidence the structures, processes, and interactions which contributed to the ability to provide person-centred care: team-based communication strategies, interprofessional problem-solving, and personalized patient engagement efforts.

Conclusion:

Our study suggests that in care coordination meetings team members were able to strategize, brainstorm, and reflect on how to better care for patients. Specifically, flexible team leadership opened an inter-disciplinary communicative space to foster conversations, which revealed connections between the physical, and socio-emotional components of patients’ lives and hidden factors undermining progress, while proactive strategies prevented patient’s rapid deterioration and unnecessary use of inappropriate health services.

Examining subacute nurses' roles in a changing healthcare context

AIMS AND OBJECTIVES

To explore and describe nurses' role in the rehabilitation and care of patients in one subacute care facility in Melbourne, Australia.

BACKGROUND

The role of nurses in subacute care and within the rehabilitation team is evolving and remains unclear.

DESIGN

Mixed methods.

METHODS

Fourteen nurses from seven rehabilitation and geriatric evaluation and management wards in one subacute facility in Melbourne, Australia, were observed in practice for two hours and then interviewed. Activities were recorded electronically. Interviews were audio-recorded and transcribed. Data were analysed using content analysis. The study complied with the Consolidated Criteria for Reporting Qualitative Research (COREQ).

RESULTS

Three main themes are as follows: (a) Nurses as rehabilitators; (b) Teamwork in rehabilitation; and (c) The changing context of subacute care. Nurses prioritised patient personal and clinical care above other responsibilities. They were largely excluded from team decision-making because clinical responsibilities precluded them from attending team meetings. Unsuitable buildings, increased patient acuity and time constraints were further challenges.

CONCLUSIONS

Nurses have a multifaceted role in patient rehabilitation that is poorly understood. An evaluation of the nursing role within the interdisciplinary team, skills and processes of care may increase understanding, and improve communication and relationships between disciplines potentially benefiting patients. Role clarity and differentiation in nursing skills are required within the nursing workforce.

RELEVANCE TO CLINICAL PRACTICE

Nurses have a unique role in both clinical care and rehabilitation of patients, and as part of the interdisciplinary team. Respectful professional relationships need fostering within the interdisciplinary team to achieve optimal patient outcomes. The way that team meetings and decision-making occur in the subacute wards requires adjustment to ensure that the valuable contribution of nurses, both to the interdisciplinary team and to the rehabilitation of patients, is used and acknowledged to improve patient care.

The roles of healthcare professionals in diabetes care: a qualitative study in Norwegian general practice

Objective: To explore the experiences of general practitioners (GPs), nurses and medical secretaries in providing multi-professional diabetes care and their perceptions of professional roles.Design, setting and subjects: Semi-structured interviews were conducted with six GPs, three nurses and two medical secretaries from five purposively sampled diabetes teams. Interviews were analysed thematically.Main outcome measures: Healthcare professionals' (HCPs') experiences of multi-professional diabetes care in general practice.Results: The involvement of nurses and medical secretaries (collaborating health care professionals) was mainly motivated by GPs' time pressure and their perception of diabetes care as easy to standardize. GPs reported that diabetes care had become more structured and continuous after the involvement of collaborating health care professionals (cHCPs). cHCPs defined their role differently from GPs, emphasizing that their approach included acknowledging patients' need for diabetes education, listening to their stories and meeting their need for emotional support. GPs appeared less involved in patients' emotional concerns and more focused on the biomedical aspects of illness. There was little emphasis on teamwork among GPs and cHCPs, and none of the practices used care plans to involve patients in decisions or unify treatment among professionals. Participants stated that institutional structures including a discriminatory remuneration system, lack of role descriptions and missing procedures for collaborative approaches were an obstacle to MPC.Conclusions: cHCPs worked independently under delegated leadership of the GPs. Although cHCPs had a complementary role, HCPs in general practice may not take full advantage of the potential of sharing patient responsibility and learning with, from and about each other. Contextual barriers for team-based care approaches should be addressed in future research.KEY POINTSIt has been suggested that multi-professional approaches improve quality of care in people with long-term conditions.In this study, nurses and medical secretaries perceived to have a complementary role to general practitioners (GPs) in diabetes care, focusing on patient education, building trusting relationships and providing patients with emotional support.As multi-professional collaboration was minimal, GPs, nurses and medical secretaries in the included practices may not take full advantage of the potential of sharing care responsibility and learning with, from and about each other.

An ontology-driven framework to support the dynamic formation of an interdisciplinary healthcare team

BACKGROUND AND PURPOSE

Teamwork has become a modus operandi in healthcare and delivery of patient care by an interdisciplinary healthcare team (IHT) is now a prevailing modality of care. We argue that a formal and automated support framework is needed for an IHT to properly leverage information technology resources. Such a framework should allow for patient preferences and expand a representation of a clinical workflow with a formal model of dynamic formation of a team, especially with regards to team leader- and membership, and the assignment of tasks to team members. Our goal was to develop such a support framework, present its prototype software implementation and verify the implementation using a proof-of-concept use case. Specifically, we focused on clinical workflows for in-patient tertiary care and on patient preferences with regards to selecting team members and team leaders.

MATERIALS AND METHODS

Drawing on the research on clinical teamwork we defined the conceptual foundations for the proposed framework. Then, we designed its architecture and used ontology-driven design and first-order logic with associated reasoning methods to create and operationalize architectural elements. Finally, we incorporated existing solutions for business workflow modeling and execution as a backend for implementing the proposed framework.

RESULTS

We developed a Team and Workflow Management Framework (TWMF) with semantic components that allow for formalizing and operationalizing team formation in in-patient tertiary care setting and support provider-related patient preferences. We also created a prototype software implementation of TWMF using the IBM Business Process Manager platform. This implementation was evaluated in several simulated patient scenarios.

CONCLUSIONS

TWMF integrates existing workflow technologies and extends them with the capabilities to support dynamic formation of an IHT. Results of this research can be used to support real-time execution of clinical workflows, or to simulate their execution in order to assess the impact of various conditions (e.g., patterns of work shifts, staffing) on IHT operations.

Getting the Sergeants on your side: the importance of interpersonal relationships and cultural interoperability for generating interagency collaboration between nurses and the police in custody suites

In this article, I contribute to the literature around interagency collaboration, especially between law enforcement and health care, by reconciling the previous work of Sarah Charman (2014) with the interprofessional teamwork literature. Drawing upon a semi-structured interview-based study with 20 custody nurses working in English police custody suites (analysed using Framework Analysis), I explore the ways they are able to achieve interagency collaboration with a particular police officer, the Desk Sergeant. I argue that nurses accomplish interagency interoperability by interacting regularly with the Desk Sergeant, anticipating their needs and limiting their own goals to those that are commensurate with the Desk Sergeant's, notably providing information and avoiding deaths in custody. Such practices are similar to the strategies of 'Cultural Interoperability' noted by Charman (2014); however, this study also identifies that such strategies are only available once a successful working relationship has formed between Desk Sergeant and nurse, and as a result, similarly to the findings of interprofessional teamwork studies, the success or failure of attempts to collaborate across agencies is underpinned by interpersonal relations. The paper concludes by commenting on the importance of analysing both the interpersonal and organisation levels when studying collaboration.

Gender issues in physician-nurse collaboration in healthcare teams: Findings from a cross-sectional study

AIMS

The aims of the study were (a) to assess whether the proportion of female nurses and female physicians in a given unit influences the attitude of collaboration between nurses and physicians as reported by nurses, and (b) to examine how these two dimensions interact to influence attitudes towards cooperation.

BACKGROUND

Available studies have documented that gender influences the collaboration between physicians and nurses, but no have explored the influence of specific combinations-such as a high proportion of female nurses and a high proportion of female physicians.

METHODS

A cross-sectional study involving 700 nurses working in 36 hospital units in Italy. The validated Italian version of the Jefferson Scale of Attitudes towards Physician-Nurse Collaboration was used. A three stages hierarchical linear regression was performed by entering: (a) the control variables at the individual and at the unit levels, (b) the proportion of female nurses and physicians and (c) the two-way interaction.

RESULTS

A total of 430 nurses participated; the average Jefferson Scale of Attitudes towards Physician-Nurse Collaboration total score was 48.64 ± 5.27. At the second and third stages of the hierarchical linear regression model (explaining 12.8% and 14.1% of the Jefferson Scale of Attitudes towards Physician-Nurse Collaboration variance, respectively), having more female RNs as staff (model two: ß = 0.61, p =< .1; model three: ß = 0.69, p =< .05) was significantly associated with higher Jefferson Scale of Attitudes towards Physician-Nurse Collaboration scores; differently, higher physician-nurse ratios (model two: ß = -4.09, p =< .05; model three: ß = -4.54, p =< .01), and more female physicians (model two: ß = -1.06, p =< .05; model three: ß = -1.29, p =< .01) were associated with lower Jefferson Scale of Attitudes towards Physician-Nurse Collaboration scores.

CONCLUSION

There is a decreased collaboration as reported by nurses when predominantly male nursing teams interact with teams with more female physicians. However, in units lead by female physicians, having more female members among the nursing team, ensures increased attitudes of collaboration as reported by nurses.

IMPLICATIONS FOR NURSING MANAGEMENT

With the increasing proportion of female physicians and male nurses, unit mangers should be prepared to manage their influence on interprofessional cooperation.

Motivation as a mechanism underpinning exercise-based falls prevention programmes for older adults with cognitive impairment: a realist review

OBJECTIVES

This review aimed to identify mechanisms underlying participation in falls prevention interventions, in older adults with cognitive impairment. In particular we studied the role of motivation.

DESIGN

A realist review of the literature.

DATA SOURCES

EMBASE, MEDLINE, CINAHL, the Cochrane Library, PsycINFO and PEDRO.

ELIGIBILITY CRITERIA

Publications reporting exercise-based interventions for people with cognitive impairment, including dementia, living in the community.

DATA EXTRACTION AND SYNTHESIS

A 'rough programme theory' (a preliminary model of how an intervention works) was developed, tested against findings from the published literature and refined. Data were collected according to elements of the programme theory and not isolated to outcomes. Motivation emerged as a key element, and was prioritised for further study.

RESULTS

An individual will access mechanisms to support participation when they think that exercise will be beneficial to them. Supportive mechanisms include having a 'gate-keeper', such as a carer or therapist, who shares responsibility for the perception of exercise as beneficial. Lack of access to support decreases adherence and participation in exercise. Motivational mechanisms were particularly relevant for older adults with mild-to-moderate dementia, where the exercise intervention was multicomponent, in a preferred setting, at the correct intensity and level of progression, correctly supported and considered, and flexibly delivered.

CONCLUSION

Motivation is a key element enabling participation in exercise-based interventions for people with cognitive impairment. Many of the mechanisms identified in this review have parallels in motivational theory. Clinically relevant recommendations were derived and will be used to further develop and test a motivationally considered exercise-based falls intervention for people with mild dementia.

PROSPERO REGISTRATION NUMBER

CRD42015030169.

Effect of interprofessional (IP) faculty development on perceptions of IP collaboration and on IP behaviors

Positive interprofessional (IP) collaboration is an expectation in healthcare to ensure positive patient care outcomes, and IP faculty development is one way to promote self-efficacy gains. Our pilot study assessed interprofessional behaviors and positive interprofessional perceptions with faculty/staff using two interventions. We hypothesized that increased interprofessional faculty development in simulation would have a positive effect on faculty/staff behavior and would result in increased positivity regarding interprofessional behaviors. We collected data on positive IP perceptions. The interventions included standard and intensive faculty development in simulation as compared to a control. Our mixed-method study design consisted of qualitative and quantitative assessments, including focus group interviews and demographics and Interdisciplinary Education Perception Scale (IEPS) questionnaires. Assessments occurred at baseline, 1-3 months and 3-6 months. Data suggested better retention of positive interprofessional perceptions in the intensive training group; however, all groups had a gradual decline in positive interprofessional perceptions. Our outcomes contribute to the literature focused on improved collaborative patient care.

Nurses' perceptions of the dynamics and impacts of teamwork with physicians in labour and delivery

Interprofessional teamwork is touted as essential to positive patient, staff, and organizational outcomes. However, differing understandings of teamwork and divergent professional cultures amongst healthcare providers influence the success of teamwork. In labour and delivery, nurse-physician teamwork is vital to safe, family-centered maternity care. In this focused ethnography, the perceptions of obstetrical nurses were sought to understand nurse-physician teamwork and the features that facilitate or impede it. These nurses acknowledged working in a normative hierarchy, with physicians ultimately responsible for patient care decision-making. They described myriad ways in which they navigated traditional power dynamics and smoothed working relationships with physicians, such as circumventing disrespectful behaviors, venting with each other, highlighting their own autonomy, using tactical communication, and managing unit resources. According to these nurses, key facilitators of functional nurse-physicians relationships were time, trust, respect, credibility, and social connection. Further, the nature of their working relationships with physicians influenced their perceptions regarding intent to stay, workplace morale, and patient outcomes.

Pharmacy student and pharmacist perceptions of professional socialism and communication in a real-life clinical setting

OBJECTIVES

To determine the impact of authentic clinical tasks on student confidence in interprofessional communication and assess the perceptions of pharmacists and pharmacy undergraduate students on how their degree prepares them to communicate and integrate with other healthcare professionals.

METHODS

Pharmacists completed a questionnaire regarding how their degree prepared them to communicate with other healthcare professionals. Third- and fourth-year pharmacy undergraduate students completed a modified questionnaire with questions relating to interprofessional learning and their experiences of reflective interprofessional communication tasks whilst on hospital placement. The questionnaires produced a combination of qualitative and quantitative data.

KEY FINDINGS

Pharmacists (n = 36) and pharmacy students (n = 186) were in agreement that interprofessional training is important for undergraduate pharmacy students. Over 80% of student respondents viewed the interprofessional communication skills task as a useful method to develop communication skills with an increase in confidence following completion of the task. A variety of methods ranging from classroom- to practical-based sessions may be used to develop communication skills and professional socialism.

CONCLUSIONS

Interprofessional learning has an important role for all working within the multidisciplinary healthcare team and contributes to the development of collaborative working relationships. It should be introduced and reinforced throughout undergraduate studies and continued in the workplace.

Primary care networks and team effectiveness: the case of a large-scale quality improvement disparity reduction program

Documentation of primary care teams' involvement in disparity reduction efforts exists, yet little is known about how teams interact or perceive their effectiveness. We investigated how the social network and structural ties among primary-care-clinic team members relate to their perceived team effectiveness (TE), in a large-scale disparity reduction intervention in Israel's largest insurer and provider of services. A mixed-method design of Social Network Analysis and qualitative data collection was employed. 108 interviews with medical, nursing, and administrative teams of 26 clinics and their respective managerial units were performed and information on the organizational ties, analyzing density and centrality, collected. Pearson correlations examined association between network measures and perceived TE. Clinics with strong intra-clinic density and high clinic-subregional-management density were positively correlated with perceived TE. Clinic in-degree centrality was also positively associated with perceived TE. Qualitative analyses support these findings with teamwork emerging as a factor which can impede or facilitate teams' ability to design and implement disparity reduction interventions. The study demonstrates that in an organization-wide disparity reduction initiative, cohesive intra-network structure and close relations with mid-level management increase the likelihood that teams perceive themselves as possessing the skills and resources needed to lead and implement disparity reduction efforts. List of abbreviations Team Effectiveness (TE); Clalit Health Services (Clalit); Social Network Analysis (SNA); Quality Improvement (QI); National Health Care Collaborative (NHPC); Tampa Bay Community Cancer Network (TBCCN).

Conceptualizing collaboration in nursing

Nurses practicing at every level need a clear definition of collaboration before applying the concept in daily practice. Additionally, a conceptual definition of collaboration in nursing assists nurse researchers in finding or developing instruments for measuring collaboration and attributes of collaboration, which will enhance research findings. Collaboration extends beyond communication and includes sharing, teamwork, and respect. Multiple databases including CINAHL, PubMed, and ERIC were searched using the keywords collaboration, nursing, concept analysis, sharing, respect, and teamwork. For this analysis, using Walker and Avant's method, the conceptual definition of collaboration in nursing is an intraprofessional or interprofessional process by which nurses come together and form a team to solve a patient care or healthcare system problem with members of the team respectfully sharing knowledge and resources. Two instruments consistent with the conceptual definition of collaboration are The Mayo High Performance Teamwork Scale (MHPTS) and Team Strategies and Tools to Enhance Performance and Patient Safety (Team STEPPS) and these instruments are summarized in this study. Finally, case scenarios are given to illustrate exemplars of collaboration in clinical practice.

Communication and Relational Ties in Inter-Professional Teams in Norwegian Specialized Health Care: A Multicentre Study of Relational Coordination

Introduction:

The delivery of integrated care depends on the quality of communication and relationships among health-care professionals in inter-professional teams. The main aim of this study was to investigate individual and team communication and relational ties of teams in specific care processes within specialized health care.

Methods:

This cross-sectional multi-centre study used data from six somatic hospitals and six psychiatric units (N = 263 [response rate, 52%], 23 care processes) using a Norwegian version of the Relational Coordination Survey. We employed linear mixed-effect regression models and one-way analyses of variance.

Results:

The mean (standard deviation) relational coordination total score ranged from 4.5 (0.33) to 2.7 (0.50). The communication and relationship sub-scale scores were significantly higher within similar functional groups than between contrasting functional groups (P < .05). Written clinical procedures were significantly associated with higher communication scores (P < .05). The proportion of women in a team was associated with higher communication and relationship scores (P < .05).

Conclusion:

The Relational Coordination Survey shows a marked variation in team functions within inter-professional teams in specialized health-care settings. Further research is needed to determine the reasons for these variations.

Integrating research, clinical care, and education in academic health science centers

Purpose One of the major issues faced by academic health science centers (AHSCs) is the need for mechanisms to foster the integration of research, clinical, and educational activities to achieve the vision of evidence-informed decision making (EIDM) and optimal client care. The paper aims to discuss this issue. Design/methodology/approach This paper synthesizes literature on organizational learning and collaboration, evidence-informed organizational decision making, and learning-based organizations to derive insights concerning the nature of effective workplace learning in AHSCs. Findings An evidence-informed model of collaborative workplace learning is proposed to aid the alignment of research, clinical, and educational functions in AHSCs. The model articulates relationships among AHSC academic functions and sub-functions, cross-functional activities, and collaborative learning processes, emphasizing the importance of cross-functional activities in enhancing collaborative learning processes and optimizing EIDM and client care. Cross-functional activities involving clinicians, researchers, and educators are hypothesized to be a primary vehicle for integration, supported by a learning-oriented workplace culture. These activities are distinct from interprofessional teams, which are clinical in nature. Four collaborative learning processes are specified that are enhanced in cross-functional activities or teamwork: co-constructing meaning, co-learning, co-producing knowledge, and co-using knowledge. Practical implications The model provides an aspirational vision and insight into the importance of cross-functional activities in enhancing workplace learning. The paper discusses the conceptual and empirical basis to the model, its contributions and limitations, and implications for AHSCs. Originality/value The model's potential utility for health care is discussed, with implications for organizational culture and the promotion of cross-functional activities.

Organizing for teamwork in healthcare: an alternative to team training?

Purpose

The purpose of this paper is to explore how organizational design could support teamwork and to identify organizational design principles that promote successful teamwork.

Design/methodology/approach

Since traditional team training sessions take resources away from production, the alternative approach pursued here explores the promotion of teamwork by means of organizational design. A wide and pragmatic definition of teamwork is applied: a team is considered to be a group of people that are set to work together on a task, and teamwork is then what they do in relation to their task. The input – process – output model of teamwork provides structure to the investigation.

Findings

Six teamwork enablers from the healthcare team literature – cohesion, collaboration, communication, conflict resolution, coordination, and leadership – are discussed, and the organizational design measures required to implement them are identified. Three organizational principles are argued to facilitate the teamwork enablers: team stability, occasions for communication, and a participative and adaptive approach to leadership.

Research limitations/implications

The findings could be used as a foundation for intervention studies to improve team performance or as a framework for evaluation of existing organizations.

Practical implications

By implementing these organizational principles, it is possible to achieve many of the organizational traits associated with good teamwork. Thus, thoughtful organization for teamwork can be used as an alternative or complement to the traditional team training approach.

Originality/value

With regards to the vast literature on team training, this paper offers an alternative perspective on how to improve team performance in healthcare.