Care complexity, perceptions of complexity and preferences for interprofessional collaboration: an analysis of relationships and social networks in paediatrics

BACKGROUND

In the context of increasingly intricate healthcare systems, professionals are compelled to collaborate within dynamically changing interprofessional teams. Moreover, they must adapt these collaborative processes to effectively and efficiently manage the evolving complexity of care needs. It remains unclear how professionals determine care complexity and relate this complexity to their preferences for interprofessional collaboration (IPC). This study investigated the relationships between care complexity, professionals' perceived complexity and IPC preferences, and examined the variation in individual and team characteristics of IPC-practices across different levels of complexity in paediatric care.

METHODS

In an online questionnaire, 123 healthcare professionals working at an academic tertiary children's hospital scored their perceptions of complexity and preferences for IPC. They also selected family and various professions as members of the interprofessional (IP-) team based on thirteen patient cases. We employed conjoint analysis to systematically model the complexity of case descriptions across the five domains of the International Classification of Functioning, Disability and Health (ICF). Additionally, we applied social network analysis to identify important professions, crucial connectors and influential professions in the IP-team, and to describe the cohesiveness of IP-teams.

RESULTS

Modelled case complexity, professionals' perceived complexity and IPC preferences were positively associated. We found large inter-individual variations in the degree of these associations. Social network analysis revealed that the importance and influence of professions was more equally distributed when case complexity increased. Depending on the context and complexity of the case, different professions (e.g. medical doctors, social professionals, extramural professionals) were considered to be more crucial connectors within the IP-team. Furthermore, team cohesion was positively associated with modelled and perceived care complexity.

CONCLUSIONS

In conclusion, our study contributes to the existing knowledge by integrating task-specific insights and broadening the use of conjoint and social network analysis in the context of IPC. The findings substantiate the contingency theory that relates characteristics of IPC to care complexity, offering quantified insights into how IP-teams adapt to situational needs. This understanding of relationships and variations within IPC holds crucial implications for designing targeted interventions in both clinical and health profession education contexts. Consequently, it contributes to advancements in healthcare systems.

The impact of loose-parts-play on schoolyard social participation of children with and without disabilities: A case study

BACKGROUND

Outdoor social participation in the school playground is crucial for children's socio-emotional and cognitive development. Yet, many children with disabilities in mainstream educational settings are not socially included within their peer group. We examined whether loose-parts-play (LPP), a common and cost-effective intervention that changes the playground play environment to enhance child-led free play, can promote social participation for children with and without disabilities.

METHOD

Forty-two primary school children, out of whom three had hearing loss or autism, were assessed for two baseline and four intervention sessions. We applied a mixed-method design, combining advanced sensors methodology, observations, peer nominations, self-reports, qualitative field notes and an interview with the playground teachers.

RESULTS

Findings indicated for all children a decrease during the intervention in social interactions and social play and no change in network centrality. Children without disabilities displayed also an increase in solitude play and in the diversity of interacting partners. Enjoyment of LPP was high for all children, yet children with disabilities did not benefit socially from the intervention and became even more isolated compared with baseline level.

CONCLUSIONS

Social participation in the schoolyard of children with and without disabilities did not improve during LPP in a mainstream setting. Findings emphasize the need to consider the social needs of children with disabilities when designing playground interventions and to re-think about LPP philosophy and practices to adapt them to inclusive settings and goals.

Opening the black box of team-based learning (TBL): A study of verbal interactions in online application sessions

CONTEXT

In team-based learning (TBL), an instructional strategy that encourages in-depth team discussion and deep learning, interactions in terms of sharing, co-construction, constructive conflict and procedural interactions are important. Since TBL has also been applied online in recent years, the question is whether these interactions are sufficiently present in an online setting.

AIM

Gain insight into the nature and extent of these types of interactions in online TBL application sessions and to what extent these vary between teams and sessions.

METHODS

We made audiovisual recordings of 12 TBL teams in two online application sessions during assignments. Transcripts were coded and analyzed using a framework derived.

RESULTS

Teams spent more than 85% of their time on all four types of interactions in both sessions. The largest proportion of time was spent on sharing and co-construction. Constructive conflict occurred to a limited extent. We observed variation in proportion of time spent on and the distribution of the four types of interactions between teams and sessions.

DISCUSSION

All interactions important for achieving deep learning occurred in online TBL application sessions. However, the effective use of these types of interaction should not be left to chance.

Social connectedness at the playground before and after COVID-19 school closure

Social connectedness at school is crucial to children's development, yet very little is known about the way it has been affected by school closures during COVID-19 pandemic. We compared pre-post lockdown levels of social connectedness at a school playground in forty-three primary school-aged children, using wearable sensors, observations, peer nominations and self-reports. Upon school reopening, findings from sensors and peer nominations indicated increases in children's interaction time, network diversity and network centrality. Group observations indicated a decrease in no-play social interactions and an increase in children's involvement in social play. Explorative analyses did not reveal relations between changes in peer connectedness and pre-lockdown levels of peer connectedness or social contact during the lockdown period. Findings pointed at the role of recess in contributing to children's social well-being and the importance of attending to their social needs upon reopening.