Exploring the Quality Paradigms in Integrated Care: The Need for Emergence and Reflection

Integration of Mental Health Support Teams in COVID-19 Units within French General Hospitals: A Qualitative Study

Introduction

This study aimed to explore the lived experience of mental health professionals (mhPs) who had been redeployed on support teams (MHSTs) implemented in general hospital for patients with coronavirus disease 2019 (COVID-19) and their families, in order to scale up mental and physical health care integration in times of epidemic crisis.

Methods

This multicentered qualitative study followed an IPSE (Inductive Process to analyze the Structure of lived Experience) research design. MhPs' recruitment took place in three general hospitals of Seine-Seine-Denis department, in Paris suburbs (France).

Results

Twenty-two participants were included. Data analysis produced three central axes: 1) the mhP in the epidemic crisis, underlying how participants confronted the unknown and adapted; 2) retrieving fundamentals of support therapy, that were: being present and listening, bonding with patients' families, and ensuring care continuity; and 3) moving forward with other health professionals, highlighting the collaborative work they developed and experienced.

Discussion

The epidemic prompted mhPs to rethink the values likely to guide the integration of their intervention with other individual and organizational care stakeholders, at different levels of health system. Normative integration based on shared appraisal of patients' and families' needs is highly required to overcome the multiple and sometimes contradictory health issues inherent in the crisis.

Conclusion

Person- and family-centered approach of integrated care (IC) is essential to address fragmentation between mental and physical health care in times of epidemic crisis. Hospital and political leaders should support and draw from bottom-up mental health IC initiatives such as MHSTs, that embody this vision, in order to improve health systems preparedness for future crises.

Patterns emerging from the TQM paradigm in relation to the 21st century complex context within TQM journal

Purpose

The purpose of this research is to explore the deployment of the total quality management (TQM) paradigm in the TQM Journal in relation to the context of the 21st century. The study builds on the theoretical framework of the four quality paradigms that together compose TQM. The four paradigms differ in their effectiveness based on the context in which they are used. In a complex context, one would expect the reflective and the emergence paradigm to flourish. The TQM Journal is one of the leading scientific journals on TQM. If the assumption that the reflective and emergent paradigm would flourish in a complex environment is correct, one will see that represented in the past five years of scientific research in that magazine.

Design/methodology/approach

The TQM Journal articles of the past five years from January 2016 till January 2021 have been chosen as the scope of an exploratory review. The author assessed the title and abstract of all articles based on the characteristics of the four quality paradigms, as described in the theoretical framework. If the title and abstract did not provide enough data to take the decision for the assessment, the whole article has been taken into account. The results have been collated, summarized and reported. Based on the results, the author explores the possible patterns.

Findings

In total, 283 articles from 2016 to 2021 (from Volume 28, Issue 1 to Volume 33, Issue 1) were included in this study. In total, 45 were read fully to be able to characterize the article. Most of the studies relate the tertiary (33.3%) and secondary (27.9%) sectors. Healthcare was the sector in 32 of the cases (11.3%). Most studies have been conducted in Europe (n = 82, 28.9%) and Asia (n = 58, 20.5%). Within Europe, Italy was the most prolific country with, respectively, 25 (30.8%) of the articles. The USA and Canada only had five articles in these five years (1.8%). Many articles did not specify the region. More than half of the articles (52.4%) worked with surveys, questionnaires or other methods to involve the customer in the research; 16 articles (5.6%) used experts in the field through expert panels and such to collect data from. In total, 107 articles (37.8%) did involve no other stakeholders than the researchers themselves. Eight studies (2.8%) used action research or co-design methodology to create optimal stakeholder participation. Based on the data, four patterns can be discovered: the context sensitivity of the articles, reflexivity, coping with uncertainty and co-creation.

Research limitations/implications

It is acknowledged that the articles in the study were published in just one scientific journal. One can expect that this will be represented in other journals on TQM. Still, it would be interesting to conduct a follow-up study in other journals on TQM and compare the results. The research is done by one subjective researcher.

Practical implications

Research on TQM should take the complexity of the context into account. For that purpose, researchers should focus more on the emergence paradigm within TQM.

Originality/value

This study is the first to investigate TQM as a holistic paradigm, including the empirical, reflective, reference and emergence paradigm in TQM research.