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Dadich A, Best S. The mobilisation of professional identity: A scoping and lexical review. PLoS One 2024; 19:e0298423. [PMID: 38626144 PMCID: PMC11020764 DOI: 10.1371/journal.pone.0298423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 01/24/2024] [Indexed: 04/18/2024] Open
Abstract
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.
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Affiliation(s)
- Ann Dadich
- School of Business, Western Sydney University, Parramatta, NSW, Australia
| | - Stephanie Best
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
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Krystallidou D, Kersbergen MJ, de Groot E, Fluit CRMG, Kuijer-Siebelink W, Mertens F, Oosterbaan-Lodder SCM, Scherpbier N, Versluis MAC, Pype P. Interprofessional education for healthcare professionals. A BEME realist review of what works, why, for whom and in what circumstances in undergraduate health sciences education: BEME Guide No. 83. MEDICAL TEACHER 2024:1-18. [PMID: 38513054 DOI: 10.1080/0142159x.2024.2314203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 01/31/2024] [Indexed: 03/23/2024]
Abstract
AIM To provide an evidence-informed program theory (PT) for Interprofessional Education (IPE) that adds to the knowledge base of how IPE in undergraduate health sciences education works. METHODS We undertook a realist review of the literature and synthesis of the evidence combined with stakeholder experience. Our initial program theory (IPT), built around development, delivery and evaluation of IPE interventions, was tested and refined following an in-depth search of the literature and consultation with stakeholders. The literature (2010-2022) was selected based on the realist criteria of relevance and rigor, as well as on conceptual richness of the studies. RESULTS Our PT is built upon 124 CMOs (Context of IPE interventions, Mechanisms that fired within that context, and IPE Outcomes), from 58 studies. Our PT comprises an array of elements found in the Context, including traits and behavioral displays of students and facilitators, and discusses four Mechanisms (feeling responsible, feeling enthusiastic/excited, feeling safe to take risks, and feeling ready), which are likely to lead to outcomes related to the Interprofessional Education Collaborative (sub)competencies. DISCUSSION Results were linked to learning theories to further build our understanding. The PT can serve as a guide for the development, delivery, and evaluation of IPE interventions.
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Affiliation(s)
- Demi Krystallidou
- School of Languages and Literature, Centre for Translation Studies, University of Surrey, Guildford, UK
| | - Maria J Kersbergen
- Department of Dentistry, Radboud University Medical Center, Nijmegen, The Netherlands
- School of Health Studies, Research group Organisation of Healthcare and Social Services, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Esther de Groot
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Cornelia R M G Fluit
- Health Academy, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Wietske Kuijer-Siebelink
- School of Education, Research on Responsive Vocational and Professional Education, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Radboudumc Health Academy, Research on Learning and Education, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Fien Mertens
- Department of Public Health and Primary Care, Centre for Interprofessional Collaboration in Education, Research and Practice, Ghent University, Ghent, Belgium
| | | | - Nynke Scherpbier
- Department of Primary and Long-term Care, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Marco A C Versluis
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, Groningen, The Netherlands
| | - Peter Pype
- Department of Public Health and Primary Care, Centre for Interprofessional Collaboration in Education, Research and Practice, Ghent University, Ghent, Belgium
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Dadich A, Wells R, Williams SJ, Taskin N, Coskun M, Grenier C, Ponsignon F, Scahill S, Best S. Cues Disseminated by Professional Associations That Represent 5 Health Care Professions Across 5 Nations: Lexical Analysis of Tweets. J Med Internet Res 2023; 25:e42927. [PMID: 36920443 PMCID: PMC10131722 DOI: 10.2196/42927] [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: 09/24/2022] [Revised: 01/09/2023] [Accepted: 01/27/2023] [Indexed: 01/29/2023] Open
Abstract
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.
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Affiliation(s)
- Ann Dadich
- School of Business, Western Sydney University, Parramatta, Australia
| | - Rebecca Wells
- Department of Management, Policy and Community Health, University of Texas, Texas, TX, United States
| | - Sharon J Williams
- School of Health & Social Care, Swansea University, Swansea, United Kingdom
| | - Nazim Taskin
- Department of Management Information Systems, Boğaziçi University, Istanbul, Turkey
| | - Mustafa Coskun
- Department of Management Information Systems, Boğaziçi University, Istanbul, Turkey
| | | | | | - Shane Scahill
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Douglas N, Mays N, Al-Haboubi M, Manacorda T, Thana L, Wistow G, Durand MA. Observations of community-based multidisciplinary team meetings in health and social care for older people with long term conditions in England. BMC Health Serv Res 2022; 22:758. [PMID: 35676685 PMCID: PMC9175164 DOI: 10.1186/s12913-022-07971-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 04/05/2022] [Indexed: 11/20/2022] Open
Abstract
Background Community-based multi-disciplinary teams (MDTs) are the most common means to encourage health and social care service integration in England yet are rarely studied or directly observed. This paper reports on two rounds of non-participant observations of community-based multi-disciplinary team (MDT) meetings in two localities, as part of an evaluation of the Integrated Care and Support Pioneers Programme. We sought to understand how MDT meetings coordinate care and identify their ‘added value’ over bilateral discussions. Methods Two rounds of structured non-participant observations of 11 MDTs (28 meetings) in an inner city and mixed urban–rural area in England (June 2019-February 2020), using a group analysis approach. Results Despite diverse settings, attendance and caseloads, MDTs adopted similar processes of case management: presentation; information seeking/sharing; narrative construction; solution seeking; decision-making and task allocation. Patient-centredness was evident but scope to strengthen ‘patient-voice’ exists. MDTs were hampered by information governance rules and lack of interoperability between patient databases. Meetings were characterised by mutual respect and collegiality with little challenge. Decision-making appeared non-hierarchical, often involving dyads or triads of professionals. ‘Added value’ lay in: rapid patient information sharing; better understanding of contributing agencies’ services; planning strategies for patients that providers had struggled to find the right way to engage satisfactorily; and managing risk and providing mutual support in stressful cases. Conclusions More attention needs to be given to removing barriers to information sharing, creating scope for constructive challenge between staff and deciding when to remove cases from the caseload.
Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07971-x.
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Affiliation(s)
- Nick Douglas
- Policy Innovation and Evaluation Research Unit (PIRU), Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK. .,Now School of Psychology, University of Sussex, Brighton, East Sussex, UK.
| | - Nicholas Mays
- Policy Innovation and Evaluation Research Unit (PIRU), Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Mustafa Al-Haboubi
- Policy Innovation and Evaluation Research Unit (PIRU), Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Tommaso Manacorda
- Policy Innovation and Evaluation Research Unit (PIRU), Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK.,Now Public Health, Advocacy and Welfare, Italian Multiple Sclerosis Society, Genoa, Italy
| | - Lavanya Thana
- Policy Innovation and Evaluation Research Unit (PIRU), Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Gerald Wistow
- Policy Innovation and Evaluation Research Unit (PIRU), Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK.,Care Policy & Evaluation Centre, London School of Economics & Political Science, London, UK
| | - Mary Alison Durand
- Policy Innovation and Evaluation Research Unit (PIRU), Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
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Impact of ‘Enhanced’ Intermediate Care Integrating Acute, Primary and Community Care and the Voluntary Sector in Torbay and South Devon, UK. Int J Integr Care 2022; 22:14. [PMID: 35282155 PMCID: PMC8855731 DOI: 10.5334/ijic.5665] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/28/2022] [Indexed: 11/29/2022] Open
Abstract
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.
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Hillewerth K, Schönbächler Marcar C, Rettke H, van Holten K. Erfahrungen bei der Anwendung einer interprofessionellen Anamnese im Krankenhaus. Pflege 2021; 34:103-112. [PMID: 33615856 DOI: 10.1024/1012-5302/a000793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Experiences with the application of an interprofessional anamnesis in hospitals - A qualitative accompanying study Abstract. Background: Interprofessional cooperation is a key issue today when addressing quality improvement and process optimization in the healthcare sector. Interprofessional documentation systems play an important role here. AIM This article describes the experiences of 19 nurses and physicians in an acute care hospital before and after the introduction of an interprofessional anamnesis. The aim was to show whether and how interprofessional cooperation changed during the ten months study period. METHODS The data are based on three group discussions at three different times with six to seven newly recruited participants in an interprofessional composition. The data analysis was carried out using the documentary method after Bohnsack. RESULTS The group discussions document different phases of a developing interprofessional cooperation. By recognizing different professional perspectives and process structures, areas of responsibility could be clarified and trust could be built. This enabled the participants to benefit from the new cooperation and to introduce further common improvement requests. CONCLUSIONS An interprofessionally developed working tool, such as shared instruments for taking and recording the anamnesis, can have a positive influence on interprofessional cooperation. Interprofessional exchange formats appear to have a beneficial effect on this development process.
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Czypionka T, Kraus M, Reiss M, Baltaxe E, Roca J, Ruths S, Stokes J, Struckmann V, Haček RT, Zemplényi A, Hoedemakers M, Rutten-van Mölken M. The patient at the centre: evidence from 17 European integrated care programmes for persons with complex needs. BMC Health Serv Res 2020; 20:1102. [PMID: 33256723 PMCID: PMC7706259 DOI: 10.1186/s12913-020-05917-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 11/12/2020] [Indexed: 12/21/2022] Open
Abstract
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.
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Affiliation(s)
- Thomas Czypionka
- Institute for Advanced Studies, Josefstädter Straße 39, 1080, Vienna, Austria.,London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
| | - Markus Kraus
- Institute for Advanced Studies, Josefstädter Straße 39, 1080, Vienna, Austria.
| | - Miriam Reiss
- Institute for Advanced Studies, Josefstädter Straße 39, 1080, Vienna, Austria
| | - Erik Baltaxe
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Villarroel 170, Barcelona,, 08036,, Catalonia, Spain
| | - Josep Roca
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Villarroel 170, Barcelona,, 08036,, Catalonia, Spain
| | - Sabine Ruths
- University of Bergen, Postboks 7804, 5020, Bergen, Norway
| | - Jonathan Stokes
- University of Manchester, 7th Floor, Williamson Building, Oxford Road, Manchester, M13 9P, UK
| | - Verena Struckmann
- Berlin University of Technology, Strasse des 17. Juni 135 (H80), 10623, Berlin, Germany
| | | | - Antal Zemplényi
- Syreon Research Institute, Mexikoi str. 65/A, 1142, Budapest, Hungary
| | - Maaike Hoedemakers
- Erasmus University Rotterdam, P.O.Box 1738, 3000, DR, Rotterdam, The Netherlands
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Silverio SA, Cope LC, Bracken L, Bellis J, Peak M, Kaehne A. The implementation of a Technician Enhanced Administration of Medications [TEAM] model: An evaluative study of impact on working practices in a children's hospital. Res Social Adm Pharm 2020; 16:1768-1774. [PMID: 32035869 DOI: 10.1016/j.sapharm.2020.01.016] [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] [Received: 11/13/2019] [Revised: 01/20/2020] [Accepted: 01/26/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Children are frequently prescribed unlicensed and off-label medicines meaning dosing and administration of medicines to children is often based on poor quality guidance. In UK hospitals, nursing staff are often responsible for administering medications. Medication Errors [MEs] are problematic for health services, though are poorly reported and therefore difficult to quantify with confidence. In the UK, children's medicines require administration by at least two members of ward staff, known as a 'second check' system, thought to reduce Medication Administration Errors [MAEs]. OBJECTIVES To assess the impact on working practices of the introduction of a new way of working, using Technician Enhanced Administration of Medications [TEAM] on two specialist wards within a children's' hospital. To evidence any potential impact of a TEAM ward-based pharmacy technician [PhT] on the reporting of MEs. METHODS A TEAM PhT was employed on two wards within the children's hospital and trained in medicines administration. Firstly, an observational pre-and-post cohort design was used to identify the effect of TEAM on MEs. We analysed the hospital's official reporting system for incidents and 'near misses', as well as the personal incident log of the TEAM PhT. Secondly, after implementation, we interviewed staff about their perceptions of TEAM and its impact on working practices. RESULTS We affirm MEs are considerably under-reported in hospital settings, but TEAM PhTs can readily identify them. Further, placing TEAM PhTs on wards may create opportunities for inter-professional knowledge exchange and increase nurses' awareness of potential MAEs, although this requires facilitation. CONCLUSIONS TEAM PhT roles may be beneficial for pharmacy technicians' motivation, job satisfaction, and career development. Hospitals will need to consider the balance between resources invested in TEAM PhTs and the level of impact on reporting MEs. Health economic analyses could provide evidence to fully endorse integration of TEAM PhTs for all hospital settings.
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Affiliation(s)
- Sergio A Silverio
- Department of Women & Children's Health, King's College London, London, UK; Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK; Department of Psychological Sciences, University of Liverpool, Liverpool, UK.
| | - Louise C Cope
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, UK
| | - Louise Bracken
- Paediatric Medicines Research Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Jennifer Bellis
- Pharmacy Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Matthew Peak
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, UK; Paediatric Medicines Research Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Axel Kaehne
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, UK
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Wallace I, Barratt H, Harvey S, Raine R. The impact of Clinical Nurse Specialists on the decision making process in cancer multidisciplinary team meetings: A qualitative study. Eur J Oncol Nurs 2019; 43:101674. [PMID: 31689677 DOI: 10.1016/j.ejon.2019.101674] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 09/26/2019] [Accepted: 10/08/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE There are well-documented barriers to nurse participation in cancer multidisciplinary team (MDT) meetings. This paper aims to identify the approaches used by Clinical Nurse Specialists (CNSs) in this setting to contribute during discussion, and to consider the impact of these approaches on the decision making process. In doing so it aims to highlight ways that CNSs can increase their influence, and enhance multidisciplinary engagement. METHODS This study is based on analysis of observation data from 122 MDT meetings in gynaecology, haematology and skin cancer MDTs. Field notes were reviewed, identifying 58 cases where CNSs contributed to MDT discussion. Audio recordings of the relevant sections were then transcribed and analysed thematically. RESULTS Five approaches were used by CNSs to contribute in MDT meetings: sharing information, asking questions, providing practical suggestions, framing and using humour. These approaches influenced three key intermediary processes identified during the analysis ('successful contributions'): prompting discussion, influencing a treatment plan and facilitating teamwork. CNSs contributed successfully in cases where medical factors (such as relapsed disease or complex comorbidities) or non-medical factors (such as strong patient preference), had the potential to impact on the ability of teams to deliver treatment. CONCLUSIONS CNSs have an important role in cancer MDT meetings. By focusing on a subset of cases where CNSs contributed during MDT discussion, this study has provided an insight into approaches that can be adopted by CNSs to increase their influence on the decision making process, enabling teams to capitalise on their knowledge and expertise in MDT meetings.
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Affiliation(s)
- Isla Wallace
- Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
| | - Helen Barratt
- Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
| | - Sarah Harvey
- UCL School of Management, University College London, Level 38, 1 Canada Square, London, E14 5AB, UK.
| | - Rosalind Raine
- Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
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Abstract
This article addresses the current and desired future state of interprofessional practice in pediatric hospital medicine. It focuses on identifying optimal team composition and work patterns, describing the value of parent involvement on both the patient's care team and on operational teams, describing the need for interprofessional education, and identifying outcomes associated with interprofessional teamwork. The article also identifies challenges and opportunities for growth as interprofessional teamwork increasingly becomes a standard practice within healthcare settings.
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Affiliation(s)
- Jennifer Baird
- Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS #74, Los Angeles, CA 90027, USA.
| | - Michele Ashland
- Lucile Packard Children's Hospital Stanford, 725 Welch Road, Palo Alto, CA 94304, USA
| | - Glenn Rosenbluth
- Office of Graduate Medical Education, Pediatrics Residency Training Program, Department of Pediatrics, University of California, San Francisco, 5th Floor, Mission Hall Box 3214, 550 16th Street, San Francisco, CA 94143, USA
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Register S, Peterson DT, Swatzell K, White ML. Effect of interprofessional (IP) faculty development on perceptions of IP collaboration and on IP behaviors. J Interprof Care 2019; 33:809-811. [PMID: 30895842 DOI: 10.1080/13561820.2019.1593115] [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: 10/27/2022]
Abstract
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.
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Affiliation(s)
- Shilpa Register
- Ophthalmology, UAB, Birmingham, AL, USA.,UAB Office of Interprofessional Simulation for Innovative Clinical Practice, Birmingham, AL, USA
| | - Dawn Taylor Peterson
- School of Medicine, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kelley Swatzell
- Clinical and Diagnostic Sciences, UAB School of Health Professions, Birmingham, AL, USA
| | - Marjorie Lee White
- UAB Office of Interprofessional Simulation for Innovative Clinical Practice, Birmingham, AL, USA
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Gleddie M, Stahlke S, Paul P. Nurses' perceptions of the dynamics and impacts of teamwork with physicians in labour and delivery. J Interprof Care 2018:1-11. [PMID: 30596305 DOI: 10.1080/13561820.2018.1562422] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 07/29/2018] [Accepted: 12/14/2018] [Indexed: 10/27/2022]
Abstract
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.
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Affiliation(s)
- Megan Gleddie
- a University of Alberta, Edmonton Clinic Health Academy , Edmonton , Alberta , Canada
| | - Sarah Stahlke
- b Faculty of Nursing , University of Alberta, Edmonton Clinic Health Academy , Alberta , Canada
| | - Pauline Paul
- a University of Alberta, Edmonton Clinic Health Academy , Edmonton , Alberta , Canada
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Al Harthy SN, Tuppal CP, Sta. Ana AE, Reynecke J, Al Husami I, Al Rubaiey A. Interprofessional Competency Framework for Health Service Managers in Oman: An e-Delphi Study. Oman Med J 2018; 33:486-496. [PMID: 30410691 PMCID: PMC6206412 DOI: 10.5001/omj.2018.90] [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] [Received: 05/15/2018] [Accepted: 06/26/2018] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES This study aimed to develop the required interprofessional competencies for health service managers in Oman. METHODS Experts (n = 20) were selected based on their years' experience, position, fluency in English (both verbal and written), and who had completed higher education at either masters or doctorate levels in the relevant field. The data collection consisted of three rounds. Responses were collected and extracted from a web-based designed survey and subsequently analyzed. RESULTS Experts agreed on the nine interprofessional domains and 41 competencies based on the inclusion of means (M) 3 4.4, an interquartile distribution (IQD) ≤ 1.25, and > 80.0% agreement. Findings revealed that there were levels of agreement (90.0% to 95.0%) among the experts in the nine interprofessional competency domains namely: resilience (M = 4.7, IQD = 0.40), research leverage (M = 4.7, IQD = 0.60), interprofessional ethics (M = 4.7, IQD = 0.80), quality improvement (M = 4.7, IQD = 0.80), information technology (M = 4.6, IQD = 0.80), leadership (M = 4.5, IQD = 1.00), management skills (M = 4.5, IQD = 0.80), communication (M = 4.5, IQD = 1.00), and team dynamics (M = 4.5, IQD = 1.00). CONCLUSIONS The development of interprofessional competencies for health service managers is an impetus to strengthen the human resources capabilities, sustain a high level of quality patient outcomes, and to achieve the Ministry of Health's Health Vision 2050.
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Affiliation(s)
- Said Nasser Al Harthy
- Health Service Management Program, Higher Institute for Health Specialties, Ministry of Health, Muscat, Oman
| | - Cyruz P. Tuppal
- Health Service Management Program, Higher Institute for Health Specialties, Ministry of Health, Muscat, Oman
| | - Ana E. Sta. Ana
- Health Service Management Program, Higher Institute for Health Specialties, Ministry of Health, Muscat, Oman
| | - Jenny Reynecke
- Health Service Management Program, Higher Institute for Health Specialties, Ministry of Health, Muscat, Oman
| | - Imad Al Husami
- Health Service Management Program, Higher Institute for Health Specialties, Ministry of Health, Muscat, Oman
| | - Abdallah Al Rubaiey
- Health Specialty Education, Office of the Undersecretary of Planning Affairs, Ministry of Health, Muscat, Oman
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Cunningham U, Ward ME, De Brún A, McAuliffe E. Team interventions in acute hospital contexts: a systematic search of the literature using realist synthesis. BMC Health Serv Res 2018; 18:536. [PMID: 29996820 PMCID: PMC6042358 DOI: 10.1186/s12913-018-3331-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 06/26/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Research on team effectiveness in healthcare has focussed on whether effective teams yield positive outcomes for patients and on the effectiveness of team interventions to improve performance. Limited understanding exists of what works for whom within an effective team, or how and why the context in which the team operates enables team members both as individuals and as a collective to enact behaviours that promote positive outcomes. METHODS This realist synthesis of the literature explores the relationship between team interventions, underlying teamwork mechanisms generated by those interventions, and the resultant impact on patient outcomes in an acute hospital context. A systematic search of five healthcare and healthcare management academic databases: PubMed, PsychINFO, CINAHL, ABInform, Emerald Management and three grey literature databases: ERIC, OpenDOAR and Open Grey was undertaken. Five experts in the field were also contacted to source relevant literature. Using PRISMA guidelines, relevant studies published between January 2006 and January 2017 were systematically searched by a team of three people. Drawing on realist methodology, data were synthesised using context, mechanism and outcome configurations as the unit of analysis to identify enablers and barriers to effective team interventions. RESULTS Out of 3347 papers retrieved, 18 were included in the final synthesis. From these, five contextual enablers were identified: an inter-disciplinary focus and flattened hierarchy; effective communication; leadership support and alignment of team goals with organisational goals; credibility of intervention; and appropriate team composition with physician involvement. Ten recurring mechanisms were identified, the most frequently occurring of which was shared responsibility. CONCLUSIONS The advantage of using realist synthesis to extrapolate data from the literature is that it considers the context and mechanisms that will impact effectiveness of healthcare team interventions. This methodological approach provides a different perspective to other types of syntheses and offers insight as to why certain contextual elements may yield more success than others. Findings therefore tend to have more practical implications. Specificity of detail in terms of how external drivers impact on healthcare team interventions was limited in the articles extracted for analysis. This broader perspective is therefore an important consideration for future research.
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Affiliation(s)
- U. Cunningham
- Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - M. E. Ward
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - A. De Brún
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - E. McAuliffe
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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Abstract
PurposeDifferences in professional values, organisational interests and access to resources are key issues to be addressed when integrating services. They are widely seen by service planners and commissioners to be matters of governance. However, they also inform critical debates in political science. In essence they revolve around the question of distribution, or (how to decide) who gets what. The purpose of this paper is to re-frame the subject of inter-organisational governance in integration by conceptualising it through the lens of three prominent politico-theoretical approaches: the liberal, the authoritarian and the radical-utopian.Design/methodology/approachA discussion paper that proceeds by utilising political science terms of reference and applying it to a public management problem.FindingsAll three theories provide particular insights into the way in which service planners and commissioners may think about the inescapable plurality of values and interests in integration programmes. Where the liberal perspective places particular emphasis on the purpose and utility of organisational autonomy and self-direction, the authoritarian model highlights the need to produce results within tight timescales. It also accords with the manner in which integration policy is normally implemented, top down. The radical-utopian model is built on the least realistic assumptions but offers researchers a useful framework to assess the rationale and effectiveness of value-based policy in integration programmes wherever robust inter-organisational structures fail to materialise.Originality/valueWhilst there has been significant research on how to conceptualise integration programmes, scholars have usually championed a public management approach. The potential insights of political thought have not been explored until now. The paper demonstrates that the wider conceptual framework of political theory has significant purchase in the field of integration studies and can help us understand the benefits and limitations of an interdisciplinary approach.
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Mertens F, de Groot E, Meijer L, Wens J, Gemma Cherry M, Deveugele M, Damoiseaux R, Stes A, Pype P. Workplace learning through collaboration in primary healthcare: A BEME realist review of what works, for whom and in what circumstances: BEME Guide No. 46. MEDICAL TEACHER 2018; 40:117-134. [PMID: 29094626 DOI: 10.1080/0142159x.2017.1390216] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Changes in healthcare practice toward more proactive clinical, organizational and interprofessional working require primary healthcare professionals to learn continuously from each other through collaboration. This systematic review uses realist methodology to consolidate knowledge on the characteristics of workplace learning (WPL) through collaboration by primary healthcare professionals. METHODS Following several scoping searches, five electronic bibliographic databases were searched from January 1990 to December 2015 for relevant gray and published literature written in English, French, German and Dutch. Reviewers worked in pairs to identify relevant articles. A set of statements, based on the findings of our scoping searches, was used as a coding tree to analyze the papers. Interpretation of the results was done in alternating pairs, discussed within the author group and triangulated with stakeholders' views. RESULTS Out of 6930 references, we included 42 publications that elucidated who, when, how and what primary healthcare professionals learn through collaboration. Papers were both qualitative and quantitative in design, and focused largely on WPL of collaborating general practitioners and nurses. No striking differences between different professionals within primary healthcare were noted. Professionals were often unaware of the learning that occurs through collaboration. WPL happened predominantly through informal discussions about patient cases and modeling for other professionals. Any professionals could both learn and facilitate others' learning. Outcomes were diverse, but contextualized knowledge seemed to be important. DISCUSSION/CONCLUSIONS Primary care professionals' WPL is multifaceted. Existing social constructivist and social cognitivist learning theories form a framework from which to interpret these findings. Primary care policy makers and managers should ensure that professionals have access to protected time, earmarked for learning. Time is required for reflection, to learn new ways of interaction and to develop new habits within clinical practice.
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Affiliation(s)
- Fien Mertens
- a Department of Family Medicine and Primary Health Care , Ghent University , Gent , Belgium
| | - Esther de Groot
- b The Julius Center for Health Sciences and Primary Care , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Loes Meijer
- b The Julius Center for Health Sciences and Primary Care , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Johan Wens
- c Department of Primary and Interdisciplinary Care Antwerp , University of Antwerp , Antwerp , Belgium
| | - Mary Gemma Cherry
- d Psychology of Healthcare Research Group, Department of Psychological Sciences , Institute of Psychology, Health and Society, University of Liverpool , Liverpool , UK
| | - Myriam Deveugele
- a Department of Family Medicine and Primary Health Care , Ghent University , Gent , Belgium
| | - Roger Damoiseaux
- b The Julius Center for Health Sciences and Primary Care , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Ann Stes
- e Antwerp School of Education, Centre for Excellence in Higher Education , University of Antwerp , Antwerp , Belgium
| | - Peter Pype
- a Department of Family Medicine and Primary Health Care , Ghent University , Gent , Belgium
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Karam M, Tricas-Sauras S, Darras E, Macq J. Interprofessional Collaboration between General Physicians and Emergency Department Teams in Belgium: A Qualitative Study. Int J Integr Care 2017; 17:9. [PMID: 29588632 PMCID: PMC5853879 DOI: 10.5334/ijic.2520] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 08/23/2017] [Indexed: 11/28/2022] Open
Abstract
This study aimed to assess interprofessional collaboration between general physicians and emergency departments in the French speaking regions of Belgium. Eight group interviews were conducted both in rural and urban areas, including in Brussels. Findings showed that the relational components of collaboration, which are highly valued by individuals involved, comprise mutual acquaintanceship and trust, shared power and objectives. The organizational components of collaboration included out-of-hours services, role clarification, leadership and overall environment. Communication and patient's role were also found to be key elements in enhancing or hindering collaboration across these two levels of care. Relationships between general physicians and emergency departments' teams were tightly linked to organizational factors and the general macro-environment. Health system regulation did not appear to play a significant role in promoting collaboration between actors. A better role clarification is needed in order to foster multidisciplinary team coordination for a more efficient patient management. Finally, economic power and private practice impeded interprofessional collaboration between the care teams. In conclusion, many challenges need to be addressed for achievement of a better collaboration and more efficient integration. Not only should integration policies aim at reinforcing the role of general physicians as gatekeepers, also they should target patients' awareness and empowerment.
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Young J, Egan T, Jaye C, Williamson M, Askerud A, Radue P, Penese M. Shared care requires a shared vision: communities of clinical practice in a primary care setting. J Clin Nurs 2017; 26:2689-2702. [DOI: 10.1111/jocn.13762] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Jessica Young
- Department of General Practice and Rural Health; University of Otago; Dunedin New Zealand
| | - Tony Egan
- Department of General Practice and Rural Health; University of Otago; Dunedin New Zealand
| | - Chrystal Jaye
- Department of General Practice and Rural Health; University of Otago; Dunedin New Zealand
| | - Martyn Williamson
- Department of General Practice and Rural Health; University of Otago; Dunedin New Zealand
| | | | - Peter Radue
- Department of General Practice and Rural Health; University of Otago; Dunedin New Zealand
- Mornington Health Centre; Dunedin New Zealand
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Bagayogo FF, Lepage A, Denis JL, Lamothe L, Lapointe L, Vedel I. Grassroots inter-professional networks: the case of organizing care for older cancer patients. J Health Organ Manag 2016; 30:971-84. [DOI: 10.1108/jhom-01-2016-0013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper of inter-professional networks is to analyze the evolution of relationships between professional groups enacting new forms of collaboration to address clinical imperatives.
Design/methodology/approach
This paper uses a case study based on semi-structured interviews with physicians and nurses, document analysis and informal discussions.
Findings
This study documents how two inter-professional networks were developed through professional agency. The findings show that the means by which networks are developed influence the form of collaboration therein. One of the networks developed from day-to-day, immediately relevant, exchange, for patient care. The other one developed from more formal and infrequent research and training exchanges that were seen as less decisive in facilitating patient care. The latter resulted in a loosely knit network based on a small number of ad hoc referrals while the other resulted in a tightly knit network based on frequent referrals and advice seeking.
Practical implications
Developing inter-professional networks likely require a sustained phase of interpersonal contacts characterized by persuasion, knowledge sharing, skill demonstration and trust building from less powerful professional groups to obtain buy-in from more powerful professional groups. The nature of the collaboration in any resulting network depends largely on the nature of these initial contacts.
Originality/value
The literature on inter-professional healthcare networks focusses on mandated networks such as NHS managed care networks. There is a lack of research on inter-professional networks that emerged from the bottom up at the initiative of healthcare professionals in response to clinical imperatives. This study looks at some forms of collaboration that these “grass-root” initiatives engender and how they are consolidated.
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Abstract
Purpose
– The purpose of this paper is to report the preliminary evaluation findings of an integration programme in the children’s health care sector in the North West of England. The programme was led by the local Clinical Commissioning Group (CCG) utilising a semi-autonomous working group model. It comprised horizontal and vertical integration. The evaluation reflects the emerging policy context of CCG leadership in the field of health care planning and commissioning.
Design/methodology/approach
– The evaluation used a mixed method observational study design to obtain the views and opinions of stakeholders and measured their change over time. A series of initial semi-structured interviews was conducted with purposively selected key professionals in strategic positions to assist in designing a survey instrument. An online survey was launched at programme inception and repeated at five months. Respondents were members of five implementation working groups. Survey responses were subjected to a descriptive analysis and tests of correlation.
Findings
– The data showed high levels of commitment and perceptions of shared vision and goals amongst respondents which were relatively stable over time. Responses also indicated that the programme was perceived to have a considerable impact on collaborative work but that this initial effect decreased over time. There were no significant attitudinal differences across sectors or professional groups.
Originality/value
– The study demonstrates the strengths and weaknesses of the multi-agency working group model to implement change. Whilst confirming initial positive effects of integration programmes on collaborative work, over time this appears to wear off to be replaced by increased levels of skepticism amongst participants. The author findings have implications for service commissioners and service planners engaging in vertical or horizontal integration of children’s services.
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Sottas B, Mentrup C, Meyer PC. Interprofessional education and practice in Sweden / Interprofessionelle Bildung und Praxis in Schweden. INTERNATIONAL JOURNAL OF HEALTH PROFESSIONS 2016. [DOI: 10.1515/ijhp-2016-0002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
There are some significant differences between the health systems in German speaking Europe and Sweden: In Sweden, the number of hospitals is small, caregiving services in the hospital and ambulatory sector are integrated, health professionals with university degrees are granted extended competencies and rights incl. first line consultation and limited prescription. Education is designed to prepare for these functions and responsibilities. It started more than 30 years ago when Linköping implemented the OECD-model of Health Universities. Interprofessional teaching, common learning of the various tracks and training on real patients are constitutive elements of this novel approach. Karolinska University in Stockholm adopted the model in 1998 and gave way to a nationwide reform. A recommendation of the German Science Council regarding training of health professionals, published 2012, drew the attention of educators to this approach. The paper explains the circumstances of the consolidation of this concept. It is important to realize that overarching governance principles and measures deriving from health and education policy are of crucial importance. They evolve from evaluations of needs carried out by the regional health agencies which lead to conditional mandates and financial incentives to the education sector. Moreover, decisions taken by the national board for accreditation and quality assurance take also in account the goals set and the outcomes in education and caregiving. Outside Sweden they would be considered an inappropriate limitation of academic freedom.The paper ends with a reflection of impressions collected during a study trip and shows some lessons to be learnt from the Swedish education and practice.
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Affiliation(s)
- Beat Sottas
- Sottas Formative Works , Bourguillon , Switzerland
| | - Christiane Mentrup
- Zürcher Hochschule für Angewandte Wissenschaften , Technikumstrasse 71, 8401 Winterthur , Switzerland
| | - Peter C. Meyer
- Zürcher Hochschule für Angewandte Wissenschaften , Technikumstrasse 71, 8401 Winterthur , Switzerland
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Lahey W, Fierlbeck K. Legislating collaborative self-regulation in Canada: A comparative policy analysis. J Interprof Care 2016; 30:211-6. [DOI: 10.3109/13561820.2015.1109501] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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McMurtry A, Rohse S, Kilgour KN. Socio-material perspectives on interprofessional team and collaborative learning. MEDICAL EDUCATION 2016; 50:169-80. [PMID: 26812996 DOI: 10.1111/medu.12833] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 05/26/2015] [Accepted: 07/23/2015] [Indexed: 05/14/2023]
Abstract
CONTEXT Interprofessional teamwork and collaboration have become important parts of health care practice and education. Most of the literature on interprofessional learning, however, assumes that learning is something acquired by individuals and readily transferred to other contexts. This assumption severely limits the ways in which interprofessional educators and researchers can conceptualise and support learning related to collaborative interprofessional health care. Socio-material theories provide an alternative to individualistic, acquisition-oriented notions by reconceiving learning in terms of collective dynamics, participation in social communities and active engagement with material contexts. METHODS Socio-material literature and theories were reviewed to identify concepts relevant to interprofessional learning. After briefly summarising the origins and key principles of socio-material approaches, the authors draw upon specific socio-material theories--including complexity theory, cultural-historical activity theory and actor-network theory--in order to reconceive how learning happens in interprofessional contexts. This reframing of interprofessional learning focuses less on individuals and more on collective dynamics and the actual social and material relations involved in practice. DISCUSSION The paper proposes five ways in which learning may be enacted in interprofessional teamwork and collaboration from a socio-material perspective: (i) diverse contributions; (ii) social interactions and relationships; (iii) synthesis of professional ideas; (iv) integration of material elements, and (v) connections to large-scale organisations. For each of these categories, the paper provides practical illustrations to assist educators and researchers who wish to identify and assess this learning. CONCLUSIONS Although more exploratory than comprehensive, this paper articulates many key aspects of socio-material learning theories and offers practical guidance for those who wish to employ and assess them in interprofessional contexts.
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Affiliation(s)
- Angus McMurtry
- Health Professions Education Program, Faculty of Education, University of Ottawa, Ottawa, Ontario, Canada
| | - Shanta Rohse
- Health Professions Education Program, Faculty of Education, University of Ottawa, Ottawa, Ontario, Canada
| | - Kelly N Kilgour
- Health Professions Education Program, Faculty of Education, University of Ottawa, Ottawa, Ontario, Canada
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Widmark C, Sandahl C, Piuva K, Bergman D. What do we think about them and what do they think about us? Social representations of interprofessional and interorganizational collaboration in the welfare sector. J Interprof Care 2015; 30:50-5. [PMID: 26710235 DOI: 10.3109/13561820.2015.1055716] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Professionals in healthcare, social services, and schools often collaborate when addressing children and adolescents with complex psychosocial needs. Based on theory of social representations, we investigated how professionals in the mentioned organizations perceived each other through their experiences of collaboration. Twenty-nine unit managers and 35 staff members were interviewed in 12 focus groups, and the data collected were subjected to content analysis. Most social representations indicated complex and problematic interprofessional collaboration, although some were positive in nature. We also found social representations regarding ignorance of each other's organizations, distrust, unavailability, and uncommunicativeness. Conceptions of the other party's way of thinking appeared to include adverse attitudes and low expectations from the other side. Concurrently, there was mutual understanding of the limited room to maneuver and heavy workloads. The professionals' perceptions reflected frustration and ambivalence, and also indicated that dialogue was prevented by established boundaries and low expectations. We conclude that arenas are needed for productive dialogue and exchange of relevant knowledge in such collaborative systems, and that management should enable staff to collaborate based on the existing boundaries.
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Affiliation(s)
- Catharina Widmark
- a Medical Management Centre , Karolinska Institutet , Stockholm , Sweden
| | - Christer Sandahl
- a Medical Management Centre , Karolinska Institutet , Stockholm , Sweden
| | - Katarina Piuva
- b Department of Social Work , Stockholm University , Stockholm , Sweden
| | - David Bergman
- a Medical Management Centre , Karolinska Institutet , Stockholm , Sweden
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Hewitt G, Sims S, Greenwood N, Jones F, Ross F, Harris R. Interprofessional teamwork in stroke care: Is it visible or important to patients and carers? J Interprof Care 2014; 29:331-9. [PMID: 25158116 DOI: 10.3109/13561820.2014.950727] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Interprofessional teamwork is seen in healthcare policy and practice as a key strategy for providing safe, efficient and holistic healthcare and is an accepted part of evidence-based stroke care. The impact of interprofessional teamwork on patient and carer experience(s) of care is unknown, although some research suggests a relationship might exist. This study aimed to explore patient and carer perceptions of good and poor teamwork and its impact on experiences of care. Critical incident interviews were conducted with 50 patients and 33 carers in acute, inpatient rehabilitation and community phases of care within two UK stroke care pathways. An analytical framework, derived from a realist synthesis of 13 'mechanisms' (processes) of interprofessional teamwork, was used to identify positive and negative 'indicators' of teamwork. Participants identified several mechanisms of teamwork, but it was not a subject most talked about readily. This suggests that interprofessional teamwork is not a concept that is particularly important to stroke patients and carers; they do not readily perceive any impacts of teamwork on their experiences. These findings are a salient reminder that what might be expected by healthcare professionals to be important influences on experience may not be perceived to be so by patients and carers.
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Affiliation(s)
- Gillian Hewitt
- Cardiff School of Social Sciences, Cardiff University , Cardiff , UK and
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26
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Sims S, Hewitt G, Harris R. Evidence of a shared purpose, critical reflection, innovation and leadership in interprofessional healthcare teams: a realist synthesis. J Interprof Care 2014; 29:209-15. [PMID: 25051089 DOI: 10.3109/13561820.2014.941459] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
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.
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Affiliation(s)
- Sarah Sims
- Faculty of Health, Social Care and Education, Kingston University and St George's University of London , Surrey, London , UK and
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