1
|
Rasouli D, Norouzi A, Ramezani G, Hashemi A. A psychometric evaluation of inter-professional education competency tool in nursing and medicine students. BMC MEDICAL EDUCATION 2024; 24:110. [PMID: 38302962 PMCID: PMC10835904 DOI: 10.1186/s12909-023-04991-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 12/19/2023] [Indexed: 02/03/2024]
Abstract
INTRODUCTION Collaboration between nurses and doctors is necessary for offering care to patients. Using team performance assessment tools and surveying them can be effective in promoting inter-professional collaboration, and the lack of a credible tool to assess inter-professional collaboration competency between the two groups is a major challenge in the healthcare sector. The present study aimed to translate and conduct a psychometric investigation on the inter-professional education collaboration (IPEC) tool for the students of medicine and nursing. METHODS The present study was a cross-sectional one conducted as a psychometric investigation of the IPEC tool at the Iran University of Medical Sciences in 2022. The initial tool contained 42 items developed according to a 5-point Likert scale, which was translated into Persian with the consent of the original researcher. The validity index and the content validity ratio were investigated by a panel of 11 specialists in medical and clinical education, and its construct validity was evaluated using confirmatory factor analysis. Also, the second population of the study included medical and nursing students of Iran University of Medical Sciences and simple random sampling method. Moreover, the reliability of the instrument was investigated using internal consistency, Cronbach's Alpha, and test-retest methods. RESULTS Based on the indicators calculated to perform a psychometric investigation over the above tool, it had acceptable reliability and validity according to the specialists. The tool evaluates inter-professional collaboration competency between the students of medicine and nursing across four areas (values and ethics, roles and responsibilities, inter-professional communication, and team-based care and teamwork). Moreover, Cronbach's Alpha coefficient for the tool was determined at 0.84. CONCLUSION The results of the study showed that the above tool could evaluate inter-professional competency as a valid and reliable questionnaire, and its results could be utilized in planning and education.
Collapse
Affiliation(s)
- Davood Rasouli
- Center for Educational Research in Medical Sciences (CERMS), Department of Medical Education, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Azam Norouzi
- Department of Medical Education, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ghobad Ramezani
- Education Development Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Akram Hashemi
- Center for Educational Research in Medical Sciences (CERMS), Department of Medical Education, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
- Medical Ethics Department, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| |
Collapse
|
2
|
Johnson K, Elvander C, Johansson K, Saltvedt S, Edqvist M. The effect of organizational belonging and profession on clinicians' attitudes toward supporting vaginal birth and interprofessional teamwork-a cross-sectional study. Acta Obstet Gynecol Scand 2023; 102:355-369. [PMID: 36629126 PMCID: PMC9951341 DOI: 10.1111/aogs.14502] [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: 08/21/2022] [Revised: 11/05/2022] [Accepted: 12/13/2022] [Indexed: 01/12/2023]
Abstract
INTRODUCTION The aim of this study was to investigate the effect of organizational belonging and profession on clinicians' attitudes toward supporting vaginal birth and interprofessional teamwork in Swedish maternity care. MATERIAL AND METHODS The study used a cross-sectional design, with a web-based survey sent to midwives, physicians and nurse assistants at five labor wards in Sweden. The survey consisted of two validated scales: the Swedish version of the Labor Culture Survey (S-LCS), measuring attitudes toward supporting vaginal birth, and the Assessment of Collaborative Environments (ACE-15), measuring attitudes toward interprofessional teamwork. Two-way ANOVA was conducted to assess the main effect of and interaction effect between organizational belonging and profession for the different subscales of the S-LCS and the ACE-15, together with Tukey's honest significant difference post-hoc analysis and partial eta squared to determine effect size. The relation between the subscales was assessed using the Pearson's correlation analysis. RESULTS A total of 539 midwives, physicians and nurse assistants completed the survey. Organizational belonging significantly influenced attitudes toward supporting vaginal birth and interprofessional teamwork, with the largest effect for Positive team culture (F = 38.88, effect size = 0.25, p < 0.001). The effect of profession was strongest for the subscale Best practices (F = 59.43, effect size = 0.20, p < 0.001), with midwives being more supportive of strategies proposed to support vaginal birth than physicians and nurse assistants. A significant interaction effect was found for four of the subscales of the S-LCS, with the strongest effect for items reflecting the Unpredictability of vaginal birth (F = 4.49, effect size = 0.07, p < 0.001). Labor ward culture (unit microculture) specifically related to supporting vaginal birth was strongly correlated to interprofessional teamwork (r = 0.598, p < 0.001). CONCLUSIONS In the current study, both organizational belonging and profession influenced attitudes toward supporting vaginal birth and interprofessional teamwork. Positive team culture was positively correlated to an organizational culture supportive of vaginal birth. Interventions to support vaginal births should include efforts to strengthen teamwork between professions, as well as considering women's values, preferences and informed choices.
Collapse
Affiliation(s)
- Karin Johnson
- Clinical Epidemiology Division, Department of Medicine SolnaKarolinska InstitutetSolnaSweden,Department of Women's Health and Health professionsKarolinska University HospitalStockholmSweden
| | - Charlotte Elvander
- Clinical Epidemiology Division, Department of Medicine SolnaKarolinska InstitutetSolnaSweden
| | - Kari Johansson
- Clinical Epidemiology Division, Department of Medicine SolnaKarolinska InstitutetSolnaSweden,Department of Women's Health and Health professionsKarolinska University HospitalStockholmSweden
| | - Sissel Saltvedt
- Department of Women's Health and Health professionsKarolinska University HospitalStockholmSweden,Department of Women's and Children's Health, Department of Medicine SolnaKarolinska InstitutetSolnaSweden
| | - Malin Edqvist
- Clinical Epidemiology Division, Department of Medicine SolnaKarolinska InstitutetSolnaSweden,Department of Women's Health and Health professionsKarolinska University HospitalStockholmSweden
| |
Collapse
|
3
|
Chen HW, O’Donnell JM, Chiu YJ, Chen YC, Kang YN, Tuan YT, Kuo SY, Wu JC. Comparison of learning outcomes of interprofessional education simulation with traditional single-profession education simulation: a mixed-methods study. BMC MEDICAL EDUCATION 2022; 22:651. [PMID: 36042449 PMCID: PMC9429663 DOI: 10.1186/s12909-022-03640-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 07/18/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Interprofessional collaborative practice is essential for meeting patients' needs and improving their health outcomes; thus, the effectiveness of interprofessional education (IPE) should be clearly identified. There is insufficient evidence in the literature to determine the outcomes of IPE compared to traditional single-profession education (SPE). This study aimed to compare the outcomes of IPE and SPE during a simulation training course. METHODS The study design was a mixed-methods, incorporated cross-over design and a qualitative survey. A total of 54 students including 18 medical students and 36 nursing students were recruited from March to April 2019. The 4-week simulation course was designed based on Kolb's experimental learning theory and Bandura's social learning theory. Participants were evenly divided into group 1 (received IPE-learning followed by SPE-learning), and group 2 (received SPE-learning followed by IPE-learning). Students' medical task performance, team behavior performance, teamwork attitude, and patient safety attitude were collected at pretest, mid-test, and posttest. Descriptive statistics and repeated measures analysis of variance were used. End-of-study qualitative feedback was collected, and content analysis was performed. RESULTS Both groups demonstrated moderate-to-large within-group improvements for multiple learning outcomes at mid-test. Group 1 students' medical task performance (F = 97.25; P < 0.001) and team behavior performance (F = 31.17; P < 0.001) improved significantly. Group 2 students' medical task performance (F = 77.77; P < 0.001), team behavior performance (F = 40.14; P < 0.001), and patient safety attitude (F = 6.82; P < 0.01) improved significantly. Outcome differences between groups were nonsignificant. Qualitative themes identified included: personal factor, professional factor, interprofessional relationship, and learning. The IPE program provided students with exposure to other professions and revealed differences in expertise and responsibilities. CONCLUSION IPE-simulation and SPE-simulation were effective interventions that enabled medical and nursing students to develop critical medical management and team behavior performance. IPE-simulation provided more opportunities for improving competencies in interprofessional collaborative practice. In circumstances with limited teaching resources, SPE-simulation can be an acceptable alternative to IPE-simulation.
Collapse
Affiliation(s)
- Hui-Wen Chen
- Department of Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - John M. O’Donnell
- Department of Nurse Anesthesia, University of Pittsburgh Nurse Anesthesia Program, Pittsburgh, Pennsylvania USA
- Winter Institute for Simulation, Education and Research (WISER) VB 360A, 230 McKee Place, Suite 300., PA 15213 Pittsburgh, USA
| | - Yu-Jui Chiu
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yi-Chun Chen
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yi-No Kang
- Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, 110 Taiwan
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Health Care Management, College of Health Technology, National Taipei University of Nursing Health Sciences, Taipei, Taiwan
| | - Yueh-Ting Tuan
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Shu-Yu Kuo
- School of Nursing, College of Nursing, Taipei Medical University, 250 Wuxing Street, Taipei, 11031 Taiwan
- Department of Nursing, Taipei Medical University Hospital Taipei Medical University, 252 Wuxing St., Taipei, 11031 Taiwan
| | - Jen-Chieh Wu
- Department of Emergency, Taipei Medical University Hospital, 252 Wuxing Street, Taipei, 110301 Taiwan
- Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, 250 Wuxing Street, Taipei, 11031 Taiwan
| |
Collapse
|
4
|
Bergerød IJ, Clay-Williams R, Wiig S. Developing Methods to Support Collaborative Learning and Co-creation of Resilient Healthcare-Tips for Success and Lessons Learned From a Norwegian Hospital Cancer Care Study. J Patient Saf 2022; 18:396-403. [PMID: 35067616 PMCID: PMC9329041 DOI: 10.1097/pts.0000000000000958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is a growing attention on the role of patients and stakeholders in resilience, but there is lack of knowledge and methods on how to support collaborative learning between stakeholders and co-creation of resilient healthcare. The aim of this article was to demonstrate how the methodological process of a consensus process for exploring aspects of next of kin involvement in hospital cancer care can be replicated as an effort to promote resilient healthcare through co-creation with multiple stakeholders in hospitals. METHODS The study applied a modified nominal group technique process developed by synthesizing research findings across 4 phases of a research project with a mixed-methods approach. The process culminated in a 1-day meeting with 20 stakeholder participants (5 next of kin representatives, 10 oncology nurses, and 5 physicians) from 2 Norwegian university hospitals. RESULTS The consensus method established reflexive spaces with collective sharing of experiences between the 2 hospitals and between the next of kin and healthcare professionals. The method promoted collaborative learning processes including identification and reflection upon new ideas for involvement, and reduction of the gap between healthcare professionals' and next of kin experiences and expectations for involvement. Next of kin were considered as important resources for resilient performance, if involved with a proactive approach. The consensus process identified both successful and unsuccessful collaborative practices and resulted in a co-designed guide for healthcare professionals to support next of kin involvement in hospital cancer care. CONCLUSIONS This study expands the body of knowledge on methods development that is relevant for collaborative learning and co-creation of resilient healthcare. This study demonstrated that the consensus methods process can be used for creating reflexive spaces to support collaborative learning and co-creation of resilience in cancer care. Future research within the field of collaborative learning should explore interventions that include a larger number of stakeholders.
Collapse
Affiliation(s)
- Inger Johanne Bergerød
- From the Stavanger University Hospital
- SHARE–Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Siri Wiig
- SHARE–Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| |
Collapse
|
5
|
Wood A, Copley J, Hill A, Cottrell N. Interprofessional identity in clinicians: A scoping review. J Interprof Care 2022:1-12. [PMID: 35880786 DOI: 10.1080/13561820.2022.2086222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 04/19/2022] [Accepted: 05/26/2022] [Indexed: 10/16/2022]
Abstract
Interprofessional collaborative practice (IPCP) has been recognized as invaluable in delivering safe, high-quality patient care with finite resources. However, despite a decade of advances in interprofessional (IP) research, policy, and competency frameworks, IPCP does not always occur in practice. One reason may be the influence of a clinician's identity in an IP context. The purpose of this scoping review was to understand the nature of IP identity in healthcare clinicians. The PRISMA framework was used to support a comprehensive search strategy and screening of 1746 articles. Inclusion criteria included original research, theses, and reviews, a primary focus on IP identity or professional identity (PI) in an IP team, and a focus on health professionals, including students transitioning to practice. Ninety-five papers met the eligibility criteria, though once charted, just four of the 95 papers focused on IP identity in clinicians. Three further papers examined shared team identity, 25 papers referred to, but did not focus on IP identity, and the remaining 63 papers explored PI in an IP team. While limited studies on clinician IP identity restrict conclusive findings, patterns were identified to direct further research on the nature of IP identity in clinicians. These include values and beliefs, individual and personal factors, profession and professional experience, education, socialization, context, leadership, and the process of IP identity development. While identity is undeniably central to being a clinician, the values, beliefs, attributes, and experiences that contribute to clinician IP identity, how clinician IP identity develops, and factors that influence IP identity remain unclear. The results of this review highlight the value of further investigation of the nature of IP identity, the interplay between PI and IP identity, and identity in an IP context.
Collapse
Affiliation(s)
- Angela Wood
- The University of Queensland, Brisbane, Australia
- Princess Alexandra Hospital, Metro South Hospital & Health Service, Brisbane, Australia
| | - Jodie Copley
- The University of Queensland, Brisbane, Australia
| | - Anne Hill
- The University of Queensland, Brisbane, Australia
| | - Neil Cottrell
- The University of Queensland, Brisbane, Australia
- Princess Alexandra Hospital, Metro South Hospital & Health Service, Brisbane, Australia
| |
Collapse
|
6
|
Altered neural cell junctions and ion-channels leading to disrupted neuron communication in Parkinson's disease. NPJ Parkinsons Dis 2022; 8:66. [PMID: 35650269 PMCID: PMC9160246 DOI: 10.1038/s41531-022-00324-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 05/05/2022] [Indexed: 12/16/2022] Open
Abstract
Parkinson’s disease (PD) is a neurological disorder that affects the movement of the human body. It is primarily characterized by reduced dopamine levels in the brain. The causative agent of PD is still unclear but it is generally accepted that α-synuclein has a central role to play. It is also known that gap-junctions and associated connexins are complicated structures that play critical roles in nervous system signaling and associated misfunctioning. Thus, our current article emphasizes how, alongside α-synuclein, ion-channels, gap-junctions, and related connexins, all play vital roles in influencing multiple metabolic activities of the brain during PD. It also highlights that ion-channel and gap-junction disruptions, which are primarily mediated by their structural-functional changes and alterations, have a role in PD. Furthermore, we discussed available drugs and advanced therapeutic interventions that target Parkinson’s pathogenesis. In conclusion, it warrants creating better treatments for PD patients. Although, dopaminergic replenishment therapy is useful in treating neurological problems, such therapies are, however, unable to control the degeneration that underpins the disease, thereby declining their overall efficacy. This creates an additional challenge and an untapped scope for neurologists to adopt treatments for PD by targeting the ion-channels and gap-junctions, which is well-reviewed in the present article.
Collapse
|
7
|
Nugus P, Travaglia J, MacGinley M, Colliver D, Mazaniello-Chezol M, Claudio F, Lewis LD. Conceptual foundations of organizational structure: re-structuring of women's health services. J Health Organ Manag 2021; ahead-of-print. [PMID: 34894117 DOI: 10.1108/jhom-09-2021-0364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Researchers often debate health service structure. Understanding of the practical implications of this debate is often limited by researchers' neglect to integrate participants' views on structural options with discourses those views represent. As a case study, this paper aims to discern the extent to which and how conceptual underpinnings of stakeholder views on women's health contextualize different positions in the debate over the ideal structure of health services. DESIGN/METHODOLOGY/APPROACH The researchers chose a self-standing, comprehensive women's health service facing the prospect of being dispersed into "mainstream" health services. The researchers gathered perspectives of 53 professional and consumer stakeholders in ten focus groups and seven semi-structured interviews, analyzed through inductive thematic analysis. FINDINGS "Women's marginalization" was the core theme of the debate over structure. The authors found clear patterns between views on the function of women's health services, women's health needs, ideal client group, ideal health service structure and particular feminist discourses. The desire to re-organize services into separate mainstream units reflected a liberal feminist discourse, conceiving marginalization as explicit demonstration of its effects, such as domestic abuse. The desire to maintain a comprehensive women's health service variously reflected post-structural feminism's emphasis on plurality of identities, and a radical feminist discourse, holding that womanhood itself constituted a category of marginalization - that is, merely being at risk of unmet health needs. ORIGINALITY/VALUE As a contribution to health organizational theory, the paper shows that the discernment of discursive underpinnings of particular stakeholder views can clarify options for the structure of health services.
Collapse
Affiliation(s)
| | - Joanne Travaglia
- Faculty of Health, University of Technology Sydney, Haymarket, Australia
| | | | | | | | | | | |
Collapse
|
8
|
Best S, Brown H, Stark Z, Long JC, Ng L, Braithwaite J, Taylor N. Teamwork in clinical genomics: A dynamic sociotechnical healthcare setting. J Eval Clin Pract 2021; 27:1369-1380. [PMID: 33949753 DOI: 10.1111/jep.13573] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 04/05/2021] [Accepted: 04/12/2021] [Indexed: 12/20/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Teamworking across sociotechnical boundaries in healthcare is growing as technological advances in medicine abound. With this progress, teams need to find new ways of working together in non-traditional settings. The novel field of clinical genomics provides the opportunity to rethink the existing approach to teamworking and how it needs to evolve. Our aim was to identify the key factors influencing teamworking in the emerging field of clinical genomics and how can they be applied in practice. METHOD We drew on three qualitative datasets from interviews undertaken in Australia, 2018/2019, that explored determinants of implementation of clinical genomics with laboratory scientists (n = 7), service and programme leads (n = 21), project officers (n = 2), clinical genetics staff (n = 26) and other medical specialists (n = 21). Data were analysed using a theory-informed matrix approach to identify themes related to teamworking. RESULTS We identify that teams in clinical genomics work in an elongated adaptive context where there is rapid evolution of the knowledge base, shifting expectations of staff roles, and fast changes of technology. Delivering care in this setting brings additional challenges to teamworking as members strive to stay abreast of current knowledge and technology. We identify four themes: (a) the role of the team in keeping knowledge up-to-date; (b) professional identity; (c) team adaptability, and (d) practical/organisational considerations. CONCLUSION Challenges to teamworking that arise in the elongated adaptive context do not always fit traditional ways of working, and innovative strategies will need to be adopted to ensure the diagnostic advances of clinical genomics are realised. Provision of time and permission for team members to share knowledge and evolve, promoting capacity building, nurturing trustful relationships and establishing boundaries are amongst the practice recommendations for organisational and team leaders, even though these activities may disrupt existing ways of working or hierarchical structures.
Collapse
Affiliation(s)
- Stephanie Best
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.,Australian Genomics Health Alliance, Royal Childrens Hospital, Melbourne, Australia
| | - Helen Brown
- Faculty of Health, Deakin University, Melbourne, Australia
| | - Zornitza Stark
- Australian Genomics Health Alliance, Royal Childrens Hospital, Melbourne, Australia.,Victorian Clinical Genetics Services, Royal Childrens Hospital, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Janet C Long
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Larissa Ng
- Victorian Clinical Genetics Services, Royal Childrens Hospital, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Natalie Taylor
- Cancer Research Division, Cancer Council NSW, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| |
Collapse
|
9
|
Guraya SY, David LR, Hashir S, Mousa NA, Al Bayatti SW, Hasswan A, Kaouas M. The impact of an online intervention on the medical, dental and health sciences students about interprofessional education; a quasi-experimental study. BMC MEDICAL EDUCATION 2021; 21:457. [PMID: 34455976 PMCID: PMC8403513 DOI: 10.1186/s12909-021-02900-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 08/14/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Interprofessional education (IPE) encompasses integration, communication, mutual trust and shared decision-making with a common goal of improved patient care and safety. Despite its crucial role, IPE has not gained its anticipated popularity. This study aims to determine the impact of an online educational intervention about IPE on medical, dental and health sciences students in the University of Sharjah (UoS). METHODS This quasi-experimental research was conducted in three phases; a pre-intervention phase where the Readiness for Interprofessional Learning Scale (RIPLS) inventory was administered online to the medical, dental and health sciences students of UoS; an intervention phase where an online workshop was organized via Microsoft Teams®; and a post-intervention phase where RIPLS was used to gather the students' attitudes towards IPE. The independent t test was used to compare the responses between genders and junior and senior students. A paired sample t test was used to determine the impact of the intervention on the students' understandings and attitudes about IPE. RESULTS Out of 800 invited students, 530 students responded to the pre-intervention RIPLS survey. A comparison of the pre-post intervention for the RIPLS subscales of teamwork and collaboration, professional identification, and professional roles showed a significant improvement of students' attitudes with p-values 0.03, 0.00 and 0.00, respectively. All workshop moderators scored a median of 4 or 5 to the essential elements of IPE during intervention except for a median of 3 for group dynamics. CONCLUSION The present data, derived from the application of a brief online educational intervention, underpins the readiness and positive attitudes of undergraduate medical students towards IPE. The positive impact of online intervention necessitates the development of a structured and unified IPE curriculum to enhance the receptiveness and application of IPE in the medical field.
Collapse
Affiliation(s)
- Salman Y. Guraya
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Leena R. David
- College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Shermin Hashir
- College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Noha A. Mousa
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | | | - Ahmed Hasswan
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Mujtaba Kaouas
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| |
Collapse
|
10
|
Nalajala N, Craig R. Leader’s behaviours for promoting innovation in a multidisciplinary musculoskeletal service. Leadersh Health Serv (Bradf Engl) 2021. [DOI: 10.1108/lhs-08-2020-0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Financial constraints, an increase in the demand for health-care from an ageing population, multiple comorbidities in both mental and physical health and delivering care closer to the community, are amongst the factors creating a need for innovation in the NHS. The purpose of this paper is to explore leader behaviours that promote innovation in a multidisciplinary musculoskeletal (MSK) service.
Design/methodology/approach
Qualitative semi-structured interviews were conducted to explore the experience and views of the multidisciplinary team (MDT) members on leadership and innovation. A total of 13 MDT members participated in the study.
Findings
Inter-professional collaboration and the absence of hierarchical behaviours are associated with a positive experience. Traditionally established hierarchy and inter-professional barriers for interaction were associated with challenging experience in MDT. There was an expression of fear of and vulnerability to being “taken over” or “eaten up” by other professions. Supportiveness, consulting behaviour, provision of time, vision and inspiring and risk-taking behaviours are associated with innovation. Target drove and monitoring behaviours or hierarchical expression of authority, directive or supervisory behaviours are negatively associated with innovation.
Practical implications
Day to day leader’s behaviours and interactions influences the work environment for innovation. Knowledge gained through Informal interaction, understanding each other’s professional strengths and weaknesses are implicit strengths of an MDT but when a member perceives their skills as less valuable to that of another member, they hold less power and influence. Therefore, a flat hierarchy provides a more effective structure for knowledge translation and maximising MDT productivity.
Originality/value
MSK services are complex adaptive systems with several pathways and interactions flowing between various specialities. For improving innovation and effective functioning of the MSK MDT, it is important to provide informal training for team leads on self-awareness of the behaviours associated with innovation.
Collapse
|
11
|
Braithwaite J, Ludlow K, Testa L, Herkes J, Augustsson H, Lamprell G, McPherson E, Zurynski Y. Built to last? The sustainability of healthcare system improvements, programmes and interventions: a systematic integrative review. BMJ Open 2020; 10:e036453. [PMID: 32487579 PMCID: PMC7265014 DOI: 10.1136/bmjopen-2019-036453] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION The sustainability of healthcare delivery systems is challenged by ageing populations, complex systems, increasing rates of chronic disease, increasing costs associated with new medical technologies and growing expectations by healthcare consumers. Healthcare programmes, innovations and interventions are increasingly implemented at the front lines of care to increase effectiveness and efficiency; however, little is known about how sustainability is conceptualised and measured in programme evaluations. OBJECTIVES We aimed to describe theoretical frameworks, definitions and measures of sustainability, as applied in published evaluations of healthcare improvement programmes and interventions. DESIGN Systematic integrative review. METHODS We searched six academic databases, CINAHL, Embase, Ovid MEDLINE, Emerald Management, Scopus and Web of Science, for peer-reviewed English journal articles (July 2011-March 2018). Articles were included if they assessed programme sustainability or sustained outcomes of a programme at the healthcare system level. Six reviewers conducted the abstract and full-text review. Data were extracted on study characteristics, definitions, terminology, theoretical frameworks, methods and tools. Hawker's Quality Assessment Tool was applied to included studies. RESULTS Of the 92 included studies, 75.0% were classified as high quality. Twenty-seven (29.3%) studies provided 32 different definitions of sustainability. Terms used interchangeably for sustainability included continuation, maintenance, follow-up or long term. Eighty studies (87.0%) clearly reported the timepoints at which sustainability was evaluated: 43.0% at 1-2 years and 11.3% at <12 months. Eighteen studies (19.6%) used a theoretical framework to conceptualise or assess programme sustainability, including frameworks that were not specifically designed to assess sustainability. CONCLUSIONS The body of literature is limited by the use of inconsistent definitions and measures of programme sustainability. Evaluations of service improvement programmes and interventions seldom used theoretical frameworks. Embedding implementation science and healthcare service researchers into the healthcare system is a promising strategy to improve the rigour of programme sustainability evaluations.
Collapse
Affiliation(s)
- Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- NHMRC Partnership Centre in Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Kristiana Ludlow
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- NHMRC Partnership Centre in Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Luke Testa
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jessica Herkes
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Hanna Augustsson
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Gina Lamprell
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Elise McPherson
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Yvonne Zurynski
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- NHMRC Partnership Centre in Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| |
Collapse
|
12
|
Yelland J, Riggs E, Dawson W, Vanpraag D, Szwarc J, Brown S. 'It requires something drastic': Interviews with health care leaders about organisational responses to social disadvantage. Women Birth 2020; 34:296-302. [PMID: 32205076 DOI: 10.1016/j.wombi.2020.03.002] [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: 09/08/2019] [Revised: 03/03/2020] [Accepted: 03/03/2020] [Indexed: 10/24/2022]
Abstract
PROBLEM Persisting disparities in maternal and child health outcomes in high income countries require new insights for health service response. BACKGROUND Significant social hardship, including factors related to migration, are associated with perinatal morbidity and mortality. The universality of maternity and child health care offers opportunities to reduce health disparities. Process evaluation of health service initiatives to address refugee health inequalities in Melbourne, Australia, is the setting for the study. AIM To explore the views of health service leaders about health system and service capacity to tailor care to address social adversity and reduce disparities in maternal and child health outcomes. METHODS In-depth interviews with leaders of maternity and maternal and child health services with questions guided by a diagram to promote discussion. Thematic analysis of transcribed interviews. FINDINGS Health care leaders recognised the level of social complexity and diversity of their clientele. The analysis revealed three key themes: grappling with the complexity of social disadvantage; 'clinical risk' versus 'social risk'; and taking steps for system change. DISCUSSION Priority given to clinical requirements and routine practices together with the rising demand for services is limiting service response to families experiencing social hardship and hampering individualised care. System change was considered possible only if health service decision makers engaged with consumer and community perspectives and that of front-line staff. CONCLUSION Achieving equity in maternal and child health outcomes requires engagement of all key stakeholders (communities, clinicians, managers) to facilitate effective system re-design.
Collapse
Affiliation(s)
- Jane Yelland
- Intergenerational Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, Australia; General Practice and Primary Health Care Academic Centre, University of Melbourne, 200 Berkeley Street, Carlton, Victoria, Australia.
| | - Elisha Riggs
- Intergenerational Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, Australia; General Practice and Primary Health Care Academic Centre, University of Melbourne, 200 Berkeley Street, Carlton, Victoria, Australia.
| | - Wendy Dawson
- Intergenerational Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, Australia.
| | - Dannielle Vanpraag
- Intergenerational Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, Australia.
| | - Josef Szwarc
- Victorian Foundation for Survivors of Torture, 4 Gardiner Street, Brunswick, Victoria, Australia.
| | - Stephanie Brown
- Intergenerational Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, Australia; General Practice and Primary Health Care Academic Centre, University of Melbourne, 200 Berkeley Street, Carlton, Victoria, Australia.
| |
Collapse
|
13
|
Pomare C, Long JC, Churruca K, Ellis LA, Braithwaite J. Interprofessional collaboration in hospitals: a critical, broad-based review of the literature. J Interprof Care 2020; 34:509-519. [PMID: 31928245 DOI: 10.1080/13561820.2019.1702515] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Interprofessional collaboration (IPC) is a common term applied in the healthcare literature, with suggestions it contributes to improved quality and safety of patient care across the globe. Despite worldwide implementation of models of IPC, past systematic or meta-reviews on this topic have concluded that the evidence is mixed. However, these reviews are yet to adequately consider the qualitative and mixed-methods literature on this topic. In this critical review, we synthesize the outcomes and key findings of IPC in hospitals, taking a broader approach by including diverse study designs. A total of 4,776 abstracts were screened from three major databases (Medline, CINAHL, Embase). Thirty-four studies fulfilled inclusion criteria. Although outcomes and key findings (e.g., staff turnover, error rates) were mostly positive, there were inconsistencies in the results. The included studies reflected a variety of study designs and different methodological approaches. Overall, our review revealed moderate evidence that IPC can positively influence patient, staff and organizational factors in hospitals, and that inconsistent findings may be due to variation in context (e.g., the cohort of patients). Recommendations from the review are to incorporate qualitative- and mixed-methods approaches to studying IPC in healthcare and tailor evaluations of IPC outcomes specific to the context.
Collapse
Affiliation(s)
- Chiara Pomare
- Australian Institute of Health Innovation, Macquarie University , Sydney, Australia
| | - Janet C Long
- Australian Institute of Health Innovation, Macquarie University , Sydney, Australia
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University , Sydney, Australia
| | - Louise A Ellis
- Australian Institute of Health Innovation, Macquarie University , Sydney, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University , Sydney, Australia
| |
Collapse
|
14
|
Buljac-Samardzic M, Doekhie KD, van Wijngaarden JDH. Interventions to improve team effectiveness within health care: a systematic review of the past decade. HUMAN RESOURCES FOR HEALTH 2020; 18:2. [PMID: 31915007 PMCID: PMC6950792 DOI: 10.1186/s12960-019-0411-3] [Citation(s) in RCA: 138] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 09/05/2019] [Indexed: 05/19/2023]
Abstract
BACKGROUND A high variety of team interventions aims to improve team performance outcomes. In 2008, we conducted a systematic review to provide an overview of the scientific studies focused on these interventions. However, over the past decade, the literature on team interventions has rapidly evolved. An updated overview is therefore required, and it will focus on all possible team interventions without restrictions to a type of intervention, setting, or research design. OBJECTIVES To review the literature from the past decade on interventions with the goal of improving team effectiveness within healthcare organizations and identify the "evidence base" levels of the research. METHODS Seven major databases were systematically searched for relevant articles published between 2008 and July 2018. Of the original search yield of 6025 studies, 297 studies met the inclusion criteria according to three independent authors and were subsequently included for analysis. The Grading of Recommendations, Assessment, Development, and Evaluation Scale was used to assess the level of empirical evidence. RESULTS Three types of interventions were distinguished: (1) Training, which is sub-divided into training that is based on predefined principles (i.e. CRM: crew resource management and TeamSTEPPS: Team Strategies and Tools to Enhance Performance and Patient Safety), on a specific method (i.e. simulation), or on general team training. (2) Tools covers tools that structure (i.e. SBAR: Situation, Background, Assessment, and Recommendation, (de)briefing checklists, and rounds), facilitate (through communication technology), or trigger (through monitoring and feedback) teamwork. (3) Organizational (re)design is about (re)designing structures to stimulate team processes and team functioning. (4) A programme is a combination of the previous types. The majority of studies evaluated a training focused on the (acute) hospital care setting. Most of the evaluated interventions focused on improving non-technical skills and provided evidence of improvements. CONCLUSION Over the last decade, the number of studies on team interventions has increased exponentially. At the same time, research tends to focus on certain interventions, settings, and/or outcomes. Principle-based training (i.e. CRM and TeamSTEPPS) and simulation-based training seem to provide the greatest opportunities for reaching the improvement goals in team functioning.
Collapse
Affiliation(s)
- Martina Buljac-Samardzic
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Bayle building, p.o. box 1738, 3000 DR Rotterdam, The Netherlands
| | - Kirti D. Doekhie
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Bayle building, p.o. box 1738, 3000 DR Rotterdam, The Netherlands
| | - Jeroen D. H. van Wijngaarden
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Bayle building, p.o. box 1738, 3000 DR Rotterdam, The Netherlands
| |
Collapse
|
15
|
Boshoff K, Murray C, Worley A, Berndt A. Interprofessional education placements in allied health: A scoping review. Scand J Occup Ther 2019; 27:80-97. [DOI: 10.1080/11038128.2019.1642955] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Kobie Boshoff
- School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Carolyn Murray
- School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Anthea Worley
- School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Angela Berndt
- School of Health Sciences, University of South Australia, Adelaide, Australia
| |
Collapse
|
16
|
Andres EB, Song W, Schooling CM, Johnston JM. The influence of hospital accreditation: a longitudinal assessment of organisational culture. BMC Health Serv Res 2019; 19:467. [PMID: 31288810 PMCID: PMC6617556 DOI: 10.1186/s12913-019-4279-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 06/19/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A growing body of evidence supports the link between hospital organisational culture and health outcomes. Organisational culture is thus an essential consideration for hospital accreditation, a practice of systematically assessing the quality of hospital care against accepted standards. This study assesses the interplay between accreditation and hospital professional staff perception of organisational culture. METHODS A prospective cohort study design was used to explore the influence of accreditation on organisational culture within a large, publicly-funded, university teaching hospital in Hong Kong. All full-time hospital and academic physicians, nurses and allied health professionals were invited to participate. Organisational culture was evaluated using the Competing Values Framework through the Quality Improvement Implementation Survey. Organisational culture was assessed longitudinally at 9 months prior to accreditation, 3 months following and 15 months after accreditation. To capture potential shifts in staff perception of organisational culture through the accreditation process, we conducted a between time-point comparison using a linear trend model. RESULTS 545 clinical staff completed the organisational culture survey pre-accreditation, 378 three- months post-accreditation and 141 15-months post-accreditation. Hierarchical culture was the dominant organisational culture domain pre-accreditation, followed by rational, developmental and group culture, respectively. Following accreditation, hierarchical culture declined but remained dominant, while group and developmental culture increased. However, the decline in hierarchical culture was U-shaped with scores increasing at 15-months post-accreditation, though not to pre-accreditation levels. When stratified by professional group, hierarchical culture declined following accreditation with corresponding increases in group culture and developmental culture among physicians and nurses, respectively. While allied health professionals did not perceive any significant cultural differences directly following accreditation, a significant increase in hierarchical culture and corresponding decrease in group culture was found 15-months post-accreditation. CONCLUSIONS This study suggests the hospital accreditation process may contribute to shifts in staff perception of organisational culture. Our findings also indicate differential views of organisational culture across professional groups. Finally, we note the striking dominance of hierarchical culture in this Hong Kong hospital across all time points, far surpassing other studies, even those in which hierarchical culture prevailed.
Collapse
Affiliation(s)
- Ellie Bostwick Andres
- University of Hong Kong, School of Public Health, Patrick Manson Building, (North Wing), 7 Sassoon Road, Hong Kong, People's Republic of China.
| | - Wei Song
- University of Hong Kong, School of Public Health, Patrick Manson Building, (North Wing), 7 Sassoon Road, Hong Kong, People's Republic of China
| | - Catherine Mary Schooling
- University of Hong Kong, School of Public Health, Patrick Manson Building, (North Wing), 7 Sassoon Road, Hong Kong, People's Republic of China
| | - Janice Mary Johnston
- University of Hong Kong, School of Public Health, Patrick Manson Building, (North Wing), 7 Sassoon Road, Hong Kong, People's Republic of China
| |
Collapse
|
17
|
O'Carroll V, McSwiggan L, Campbell M. Practice educators' attitudes and perspectives of interprofessional collaboration and interprofessional practice learning for students: A mixed-methods case study. J Interprof Care 2018; 33:414-423. [PMID: 30486692 DOI: 10.1080/13561820.2018.1551865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Interprofessional collaboration (IPC) is important for the delivery of effective integrated health and social care systems. Interprofessional practice learning (IPPL) enables students to learn to work together within a relevant context and prepare for future IPC. While there is some evidence that negative attitudes impact on IPC and interprofessional education, there is a dearth of research on health and social work professionals' attitudes and perspectives of IPC and IPPL opportunities for students. A mixed-methods case study was used to investigate practice educators' attitudes and perspectives of IPC and IPPL for their students. Results showed that attitudes were positive and that mainly meso- and macro-level factors, as opposed to the micro level, impacted on the implementation of IPC and IPPL for students' learning in practice settings. IPC was perceived to be best enabled by effective communication, established teams, IPPL for staff, and shared processes and policies. Close working proximity to other professionals encouraged informal communication and positive interprofessional relationships. Motivation and resources were perceived as enablers of IPPL, but there were often missed opportunities for IPPL. These findings suggest that further work is required to identify systems for improving IPC and to enhance IPPL opportunities for students learning within practice settings.
Collapse
Affiliation(s)
| | - Linda McSwiggan
- School of Nursing and Health Sciences, University of Dundee, Dundee, Scotland
| | - Martin Campbell
- School of Psychology and Neuroscience, University of St Andrews, Fife, Scotland
| |
Collapse
|
18
|
Braithwaite J, Vincent C, Nicklin W, Amalberti R. Coping with more people with more illness. Part 2: new generation of standards for enabling healthcare system transformation and sustainability. Int J Qual Health Care 2018; 31:159-163. [DOI: 10.1093/intqhc/mzy236] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/11/2018] [Accepted: 11/15/2018] [Indexed: 12/14/2022] Open
Affiliation(s)
- Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, NSW, Australia
- International Society for Quality in Health Care, 4th Floor, Huguenot House, 35-38 St Stephens Green, Dublin 2, Ireland
| | - Charles Vincent
- Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford, UK
| | - Wendy Nicklin
- International Society for Quality in Health Care, 4th Floor, Huguenot House, 35-38 St Stephens Green, Dublin 2, Ireland
- Queen’s University, 99 University Ave, Kingston, ON, Canada
- University of Ottawa, 75 Laurier Ave E, Ottawa, ON, Canada
| | - René Amalberti
- Haute Autorité de Santé, 5 Avenue du Stade de France, Saint-Denis, France
| |
Collapse
|
19
|
Pedersen AHM, Rasmussen K, Grytnes R, Nielsen KJ. Collaboration and patient safety at an emergency department - a qualitative case study. J Health Organ Manag 2018; 32:25-38. [PMID: 29508665 DOI: 10.1108/jhom-09-2016-0174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this paper is to examine how conflicts about collaboration between staff at different departments arose during the establishment of a new emergency department and how these conflicts affected the daily work and ultimately patient safety at the emergency department. Design/methodology/approach This qualitative single case study draws on qualitative semi-structured interviews and participant observation. The theoretical concepts "availability" and "receptiveness" as antecedents for collaboration will be applied in the analysis. Findings Close collaboration between departments was an essential precondition for the functioning of the new emergency department. The study shows how a lack of antecedents for collaboration affected the working relation and communication between employees and departments, which spurred negative feelings and reproduced conflicts. This situation was seen as a potential threat for the safety of the emergency patients. Research limitations/implications This study presents a single case study, at a specific point in time, and should be used as an illustrative example of how contextual and situational factors affect the working environment and through that patient safety. Originality/value Few studies provide an in-depth investigation of what actually takes place when collaboration between professional groups goes wrong and escalates, and how problems in collaboration may affect patient safety.
Collapse
Affiliation(s)
| | - Kurt Rasmussen
- Department of Occupational Medicine, Regional Hospital West Jutland University Research Clinic , Herning, Denmark
| | - Regine Grytnes
- Department of Occupational Medicine, Regional Hospital West Jutland University Research Clinic , Herning, Denmark
| | - Kent Jacob Nielsen
- Department of Occupational Medicine, Regional Hospital West Jutland University Research Clinic , Herning, Denmark
| |
Collapse
|
20
|
Valentine C, McKell J, Ford A. Service failures and challenges in responding to people bereaved through drugs and alcohol: An interprofessional analysis. J Interprof Care 2017; 32:295-303. [PMID: 29257913 DOI: 10.1080/13561820.2017.1415312] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This article reports findings from the first two stages of a three-stage qualitative study which considered the role of services, including public, private and charitable organisations, in responding to the needs of adults bereaved following the drug and/or alcohol-related death of someone close. The study, the first of its kind to explore the landscape and role of services in substance use deaths, was conducted over two sites: south west England and Scotland. In stage 1 of the research, adopting both convenience and purposive sampling, data were collected via semi-structured interviews on experiences and support needs of bereaved individuals (n = 106). In stage 2, six focus groups were conducted with a purposive sample of practitioners (n = 40), including those working for the police, coroner's service, procurator fiscal depute (Scotland), health service, funeral service, press, clergy, Public Health England, Drugs Policy Unit, bereavement counselling/support and alcohol and drug treatment services, to investigate how services may better respond to this bereavement. Thematic analysis from both data-sets identified two overarching themes. The first, focusing on practitioner responses, captures how these bereaved people may meet with inadequate, unkind, and discriminatory responses from services. Having to navigate unfamiliar, fragmented, and time-consuming procedures compounds the bereaved's distress at an already difficult time, illustrated by a 'mapping' of relevant services. The second relates to challenges and opportunities for those responding. Service failures reflect practitioners' poor understanding of both substance use bereavement and the range of other practitioners and services involved. Those bereaved are a poorly understood, neglected and stigmatised group of service users. There is a need for services to respond without judgement or insensitive language, and provide information about, communicate and work closely with, other services despite differences in working practices and cultures. These recommendations could positively affect bereaved peoples' experiences, alleviating stress and overwhelm at a particularly vulnerable time.
Collapse
Affiliation(s)
| | - Jennifer McKell
- b Institute for Social Marketing, University of Stirling , UK
| | - Allison Ford
- c Institute for Social Marketing , University of Stirling , UK
| |
Collapse
|
21
|
Mowat S, Hein C, Walsh T, MacDonald L, Grymonpre R, Sisler J. Changing Health Professionals’ Attitudes and Practice Behaviors Through Interprofessional Continuing Education in Oral-Systemic Health. J Dent Educ 2017; 81:1421-1429. [DOI: 10.21815/jde.017.102] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 04/08/2017] [Indexed: 12/23/2022]
Affiliation(s)
- Stephanie Mowat
- Clinical Psychology Unit, Department of Psychology; University of Western Ontario
- Rady Faculty of Health Sciences; University of Manitoba
| | - Casey Hein
- Rady Faculty of Health Sciences; University of Manitoba
| | - Tanya Walsh
- International Centre for Oral-Systemic Health, Rady Faculty of Health Sciences; University of Manitoba
| | - Laura MacDonald
- School of Dental Hygiene, College of Dentistry; Rady Faculty of Health Sciences; University of Manitoba
| | - Ruby Grymonpre
- College of Pharmacy; Rady Faculty of Health Sciences; University of Manitoba
| | | |
Collapse
|
22
|
Misfeldt R, Suter E, Oelke N, Hepp S, Lait J. Creating high performing primary health care teams in Alberta, Canada: Mapping out the key issues using a socioecological model. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.xjep.2016.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
23
|
Thompson BM, Bratzler DW, Fisher MJ, Torres A, Faculty EPIC, Sparks RA. Working together: Using a unique approach to evaluate an interactive and clinic-based longitudinal interprofessional education experience with 13 professions. J Interprof Care 2016; 30:754-761. [DOI: 10.1080/13561820.2016.1227962] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
|
24
|
Braithwaite J, Clay-Williams R, Vecellio E, Marks D, Hooper T, Westbrook M, Westbrook J, Blakely B, Ludlow K. The basis of clinical tribalism, hierarchy and stereotyping: a laboratory-controlled teamwork experiment. BMJ Open 2016; 6:e012467. [PMID: 27473955 PMCID: PMC4985874 DOI: 10.1136/bmjopen-2016-012467] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To examine the basis of multidisciplinary teamwork. In real-world healthcare settings, clinicians often cluster in profession-based tribal silos, form hierarchies and exhibit stereotypical behaviours. It is not clear whether these social structures are more a product of inherent characteristics of the individuals or groups comprising the professions, or attributable to a greater extent to workplace factors. SETTING Controlled laboratory environment with well-appointed, quiet rooms and video and audio equipment. PARTICIPANTS Clinical professionals (n=133) divided into 35 groups of doctors, nurses and allied health professions, or mixed professions. INTERVENTIONS Participants engaged in one of three team tasks, and their performance was video-recorded and assessed. PRIMARY AND SECONDARY MEASURES Primary: teamwork performance. Secondary, pre-experimental: a bank of personality questionnaires designed to assess participants' individual differences. Postexperimental: the 16-item Mayo High Performance Teamwork Scale (MHPTS) to measure teamwork skills; this was self-assessed by participants and also by external raters. In addition, external, arm's length blinded observations of the videotapes were conducted. RESULTS At baseline, there were few significant differences between the professions in collective orientation, most of the personality factors, Machiavellianism and conservatism. Teams generally functioned well, with effective relationships, and exhibited little by way of discernible tribal or hierarchical behaviours, and no obvious differences between groups (F (3, 31)=0.94, p=0.43). CONCLUSIONS Once clinicians are taken out of the workplace and put in controlled settings, tribalism, hierarchical and stereotype behaviours largely dissolve. It is unwise therefore to attribute these factors to fundamental sociological or psychological differences between individuals in the professions, or aggregated group differences. Workplace cultures are more likely to be influential in shaping such behaviours. The results underscore the importance of culture and context in improvement activities. Future initiatives should factor in culture and context as well as individuals' or professions' characteristics as the basis for inducing more lateral teamwork or better interprofessional collaboration.
Collapse
Affiliation(s)
- Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Robyn Clay-Williams
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Elia Vecellio
- South Eastern Area Laboratory Services, NSW Health Pathology, Sydney, New South Wales, Australia
| | - Danielle Marks
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Tamara Hooper
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Mary Westbrook
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Brette Blakely
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Kristiana Ludlow
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| |
Collapse
|
25
|
Havyer RD, Nelson DR, Wingo MT, Comfere NI, Halvorsen AJ, McDonald FS, Reed DA. Addressing the Interprofessional Collaboration Competencies of the Association of American Medical Colleges: A Systematic Review of Assessment Instruments in Undergraduate Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2016; 91:865-88. [PMID: 26703415 DOI: 10.1097/acm.0000000000001053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
PURPOSE To summarize characteristics and validity evidence of tools that assess teamwork in undergraduate medical education (UME), and provide recommendations for addressing the interprofessional collaboration competencies of the Association of American Medical Colleges (AAMC). METHOD The authors conducted a systematic review, searching MEDLINE, MEDLINE In-process, CINAHL, and PsycINFO from January 1, 1979, through April 1, 2014; they searched reference lists and national meeting abstracts. They included original research reports that described a quantitative tool used to assess teamwork in UME. They abstracted characteristics and validity evidence for the tools, plus study quality, according to established frameworks. Two authors independently abstracted 25% of articles and calculated agreement. Authors then applied predefined criteria to identify tools best suited to address the AAMC's teamwork competencies. RESULTS Of 13,549 citations, 70 articles describing 64 teamwork assessment tools were included. Of these 64 tools, 27 (42%) assessed teamwork in classroom, 31 (48%) in simulation, and only 7 (11%) in actual clinical settings. The majority (47; 73%) of tools assessed medical students' teamwork in interprofessional teams. On the basis of content concordance, strength of validity evidence, generalizability of scores, and level of outcomes, four published tools were recommended to assess the AAMC's teamwork competencies: the Collaborative Healthcare Interdisciplinary Relationship Planning Scale, Readiness for Interprofessional Learning Scale, Communication and Teamwork Skills assessment, and Teamwork Mini-Clinical Evaluation Exercise. CONCLUSIONS Substantial validity evidence supports the use of several UME teamwork assessments. Four tools have been appropriately designed and sufficiently studied to constitute appropriate assessments of the AAMC's teamwork competencies.
Collapse
Affiliation(s)
- Rachel D Havyer
- R.D. Havyer is assistant professor of medicine, Mayo Clinic College of Medicine, Rochester, Minnesota. D.R. Nelson is assistant professor of medicine, Mayo Clinic College of Medicine, Rochester, Minnesota. M.T. Wingo is assistant professor of medicine, Mayo Clinic College of Medicine, Rochester, Minnesota. N.I. Comfere is associate professor of dermatology and of laboratory medicine and pathology, Mayo Clinic College of Medicine, Rochester, Minnesota. A.J. Halvorsen is assistant professor of medicine, Mayo Clinic College of Medicine, Rochester, Minnesota. F.S. McDonald is professor of medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, and vice president, Graduate Medical Education, American Board of Internal Medicine, Philadelphia, Pennsylvania. D.A. Reed is associate professor of medicine and of medical education, Mayo Clinic College of Medicine, Rochester, Minnesota
| | | | | | | | | | | | | |
Collapse
|
26
|
O’Carroll V, McSwiggan L, Campbell M. Health and social care professionals’ attitudes to interprofessional working and interprofessional education: A literature review. J Interprof Care 2015; 30:42-9. [DOI: 10.3109/13561820.2015.1051614] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Veronica O’Carroll
- School of Psychology and Neuroscience, University of St. Andrews, St. Andrews, Fife, Scotland, UK
- School of Nursing and Health Sciences, University of Dundee, Dundee, Scotland, UK
| | - Linda McSwiggan
- School of Nursing and Health Sciences, University of Dundee, Dundee, Scotland, UK
| | - Martin Campbell
- School of Psychology and Neuroscience, University of St. Andrews, St. Andrews, Fife, Scotland, UK
| |
Collapse
|
27
|
Herepath A, Kitchener M, Waring J. A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03400] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BackgroundHospital patient safety is a major social problem. In the UK, policy responses focus on the introduction of improvement programmes that seek to implement evidence-based clinical practices using the Model for Improvement, Plan-Do-Study-Act cycle. Empirical evidence that the outcomes of such programmes vary across hospitals demonstrates that the context of their implementation matters. However, the relationships between features of context and the implementation of safety programmes are both undertheorised and poorly understood in empirical terms.ObjectivesThis study is designed to address gaps in conceptual, methodological and empirical knowledge about the influence of context on the local implementation of patient safety programmes.DesignWe used concepts from critical realism and institutional analysis to conduct a qualitative comparative-intensive case study involving 21 hospitals across all seven Welsh health boards. We focused on the local implementation of three focal interventions from the 1000 Lives+patient safety programme: Improving Leadership for Quality Improvement, Reducing Surgical Complications and Reducing Health-care Associated Infection. Our main sources of data were 160 semistructured interviews, observation and 1700 health policy and organisational documents. These data were analysed using the realist approaches of abstraction, abduction and retroduction.SettingWelsh Government and NHS Wales.ParticipantsInterviews were conducted with 160 participants including government policy leads, health managers and professionals, partner agencies with strategic oversight of patient safety, advocacy groups and academics with expertise in patient safety.Main outcome measuresIdentification of the contextual factors pertinent to the local implementation of the 1000 Lives+patient safety programme in Welsh NHS hospitals.ResultsAn innovative conceptual framework harnessing realist social theory and institutional theory was produced to address challenges identified within previous applications of realist inquiry in patient safety research. This involved the development and use of an explanatory intervention–context–mechanism–agency–outcome (I-CMAO) configuration to illustrate the processes behind implementation of a change programme. Our findings, illustrated by multiple nested I-CMAO configurations, show how local implementation of patient safety interventions are impacted and modified by particular aspects of context: specifically, isomorphism, by which an intervention becomes adapted to the environment in which it is implemented; institutional logics, the beliefs and values underpinning the intervention and its source, and their perceived legitimacy among different groups of health-care professionals; and the relational structure and power dynamics of the functional group, that is, those tasked with implementing the initiative. This dynamic interplay shapes and guides actions leading to the normalisation or the rejection of the patient safety programme.ConclusionsHeightened awareness of the influence of context on the local implementation of patient safety programmes is required to inform the design of such interventions and to ensure their effective implementation and operationalisation in the day-to-day practice of health-care teams. Future work is required to elaborate our conceptual model and findings in similar settings where different interventions are introduced, and in different settings where similar innovations are implemented.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
Collapse
Affiliation(s)
- Andrea Herepath
- Sir Roland Smith Centre for Strategic Management, Department of Entrepreneurship, Strategy and Innovation, Lancaster University Management School, Lancaster University, Lancaster, UK
- Cardiff Business School, Cardiff University, Cardiff, UK
| | | | - Justin Waring
- Nottingham University Business School, University of Nottingham, Nottingham, UK
| |
Collapse
|
28
|
Lam J, Ng B, Shen S, Wong C. How is Interprofessional Collaboration Applied by Radiation Therapists in the Radiation Therapy Department in British Columbia? J Med Imaging Radiat Sci 2015; 46:S43-S51.e2. [PMID: 31052107 DOI: 10.1016/j.jmir.2015.04.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 04/01/2015] [Accepted: 04/20/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Interprofessional collaboration (IPC) is the process when multiple health workers from different professional backgrounds work together with patients to deliver the highest quality of care. IPC can improve communication and knowledge sharing between collaborating professionals and can lead to an increase in efficient patient care. In the radiation therapy department, radiation oncologists, nurses, medical physicists, and radiation therapists are the key professionals involved in the multidisciplinary care team. METHODS Although there is ample literature about interprofessional collaboration, very little of it is focused in radiation oncology. Using SurveyMonkey, an online survey was made available to radiation therapists in British Columbia, Canada, for a period of 3 months. In the six British Columbia Cancer Agency centres, champion disseminators assisted in distributing the survey link through e-mail. The questions pertained to the type of IPC, frequency, and modes of collaboration along with radiation therapists' level of satisfaction with collaboration. The number of respondents was 124. RESULTS The results indicate that the top three professionals who radiation therapists collaborate with are radiation oncologists, nurses, and medical physicists, respectively. The frequency of IPC is mostly one to five times in 5 working days. The preferred method of communication with oncologists and physicists is face-to-face interactions or phone calls. The favoured method of communication with nurses is through tasking. E-mail is the least preferred method. CONCLUSIONS British Columbia radiation therapists are generally satisfied with IPC. Some suggestions for improvements regarding communication efficiency and respect for others' roles, responsibilities, and professions are made. Overall, results of this study show that IPC generates positive attitudes, teamwork, and a patient-centred model.
Collapse
Affiliation(s)
- Jennifer Lam
- British Columbia Institute of Technology, Burnaby, British Columbia, Canada.
| | - Bill Ng
- British Columbia Institute of Technology, Burnaby, British Columbia, Canada
| | - Sophie Shen
- British Columbia Institute of Technology, Burnaby, British Columbia, Canada
| | - Carolyn Wong
- British Columbia Institute of Technology, Burnaby, British Columbia, Canada
| |
Collapse
|
29
|
Nancarrow SA, Smith T, Ariss S, Enderby PM. Qualitative evaluation of the implementation of the Interdisciplinary Management Tool: a reflective tool to enhance interdisciplinary teamwork using Structured, Facilitated Action Research for Implementation. HEALTH & SOCIAL CARE IN THE COMMUNITY 2015; 23:437-448. [PMID: 25522769 DOI: 10.1111/hsc.12173] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/20/2014] [Indexed: 06/04/2023]
Abstract
Reflective practice is used increasingly to enhance team functioning and service effectiveness; however, there is little evidence of its use in interdisciplinary teams. This paper presents the qualitative evaluation of the Interdisciplinary Management Tool (IMT), an evidence-based change tool designed to enhance interdisciplinary teamwork through structured team reflection. The IMT incorporates three components: an evidence-based resource guide; a reflective implementation framework based on Structured, Facilitated Action Research for Implementation methodology; and formative and summative evaluation components. The IMT was implemented with intermediate care teams supported by independent facilitators in England. Each intervention lasted 6 months and was evaluated over a 12-month period. Data sources include interviews, a focus group with facilitators, questionnaires completed by team members and documentary feedback from structured team reports. Data were analysed qualitatively using the Framework approach. The IMT was implemented with 10 teams, including 253 staff from more than 10 different disciplines. Team challenges included lack of clear vision; communication issues; limited career progression opportunities; inefficient resource use; need for role clarity and service development. The IMT successfully engaged staff in the change process, and resulted in teams developing creative strategies to address the issues identified. Participants valued dedicated time to focus on the processes of team functioning; however, some were uncomfortable with a focus on teamwork at the expense of delivering direct patient care. The IMT is a relatively low-cost, structured, reflective way to enhance team function. It empowers individuals to understand and value their own, and others' roles and responsibilities within the team; identify barriers to effective teamwork, and develop and implement appropriate solutions to these. To be successful, teams need protected time to take for reflection, and executive support to be able to broker changes that are beyond the scope of the team.
Collapse
Affiliation(s)
- Susan A Nancarrow
- Health and Human Sciences, Southern Cross University, East Lismore, New South Wales, Australia
| | - Tony Smith
- Centre for Leadership in Health and Social Care, Sheffield Hallam University, Sheffield, UK
| | - Steven Ariss
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Pamela M Enderby
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| |
Collapse
|
30
|
Körner M, Wirtz MA, Bengel J, Göritz AS. Relationship of organizational culture, teamwork and job satisfaction in interprofessional teams. BMC Health Serv Res 2015; 15:243. [PMID: 26099228 PMCID: PMC4477418 DOI: 10.1186/s12913-015-0888-y] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 05/22/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Team effectiveness is often explained on the basis of input-process-output (IPO) models. According to these models a relationship between organizational culture (input = I), interprofessional teamwork (process = P) and job satisfaction (output = O) is postulated. The aim of this study was to examine the relationship between these three aspects using structural analysis. METHODS A multi-center cross-sectional study with a survey of 272 employees was conducted in fifteen rehabilitation clinics with different indication fields in Germany. Structural equation modeling (SEM) was carried out using AMOS software version 20.0 (maximum-likelihood method). RESULTS Of 661 questionnaires sent out to members of the health care teams in the medical rehabilitation clinics, 275 were returned (41.6%). Three questionnaires were excluded (missing data greater than 30%), yielding a total of 272 employees that could be analyzed. The confirmatory models were supported by the data. The results showed that 35% of job satisfaction is predicted by a structural equation model that includes both organizational culture and teamwork. The comparison of this predictive IPO model (organizational culture (I), interprofessional teamwork (P), job satisfaction (O)) and the predictive IO model (organizational culture (I), job satisfaction (O)) showed that the effect of organizational culture is completely mediated by interprofessional teamwork. The global fit indices are a little better for the IO model (TLI: .967, CFI: .972, RMSEA .052) than for the IPO model (TLI: .934, CFI: .943, RMSEA: .61), but the prediction of job satisfaction is better in the IPO model (R(2) = 35%) than in the IO model (R(2) = 24%). CONCLUSIONS Our study results underpin the importance of interprofessional teamwork in health care organizations. To enhance interprofessional teamwork, team interventions can be recommended and should be supported. Further studies investigating the organizational culture and its impact on interprofessional teamwork and team effectiveness in health care are important.
Collapse
Affiliation(s)
- Mirjam Körner
- Medical Psychology and Medical Sociology, University of Freiburg, Hebelstr. 29, 79104, Freiburg, Germany.
| | - Markus A Wirtz
- Department of Research Methods, Institute of Psychology, University of Education Freiburg, Kunzenweg 21, 79117, Freiburg, Germany.
| | - Jürgen Bengel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr. 41, 79085, Freiburg, Germany.
| | - Anja S Göritz
- Department of Occupational and Consumer Psychology, Institute of Psychology, University of Freiburg, Engelbergerstr. 41, 79085, Freiburg, Germany.
| |
Collapse
|
31
|
Wallin CJ, Kalman S, Sandelin A, Färnert ML, Dahlstrand U, Jylli L. Creating an environment for patient safety and teamwork training in the operating theatre: A quasi-experimental study. MEDICAL TEACHER 2015; 37:267-276. [PMID: 25180879 DOI: 10.3109/0142159x.2014.947927] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Positive safety and a teamwork climate in the training environment may be a precursor for successful teamwork training. This pilot project aimed to implement and test whether a new interdisciplinary and team-based approach would result in a positive training climate in the operating theatre. METHOD A 3-day educational module for training the complete surgical team of specialist nursing students and residents in safe teamwork skills in an authentic operative theatre, named Co-Op, was implemented in a university hospital. Participants' (n=22) perceptions of the 'safety climate' and the 'teamwork climate', together with their 'readiness for inter-professional learning', were measured to examine if the Co-Op module produced a positive training environment compared with the perceptions of a control group (n=11) attending the conventional curriculum. RESULTS The participants' perceptions of 'safety climate' and 'teamwork climate' and their 'readiness for inter-professional learning' scores were significantly higher following the Co-Op module compared with their perceptions following the conventional curriculum, and compared with the control group's perceptions following the conventional curriculum. CONCLUSION The Co-Op module improved 'safety climate' and 'teamwork climate' in the operating theatre, which suggests that a deliberate and designed educational intervention can shape a learning environment as a model for the establishment of a safety culture.
Collapse
|
32
|
Clay-Williams R, Nosrati H, Cunningham FC, Hillman K, Braithwaite J. Do large-scale hospital- and system-wide interventions improve patient outcomes: a systematic review. BMC Health Serv Res 2014; 14:369. [PMID: 25187292 PMCID: PMC4282191 DOI: 10.1186/1472-6963-14-369] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Accepted: 08/21/2014] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND While health care services are beginning to implement system-wide patient safety interventions, evidence on the efficacy of these interventions is sparse. We know that uptake can be variable, but we do not know the factors that affect uptake or how the interventions establish change and, in particular, whether they influence patient outcomes. We conducted a systematic review to identify how organisational and cultural factors mediate or are mediated by hospital-wide interventions, and to assess the effects of those factors on patient outcomes. METHODS A systematic review was conducted and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Database searches were conducted using MEDLINE from 1946, CINAHL from 1991, EMBASE from 1947, Web of Science from 1934, PsycINFO from 1967, and Global Health from 1910 to September 2012. The Lancet, JAMA, BMJ, BMJ Quality and Safety, The New England Journal of Medicine and Implementation Science were also hand searched for relevant studies published over the last 5 years. Eligible studies were required to focus on organisational determinants of hospital- and system-wide interventions, and to provide patient outcome data before and after implementation of the intervention. Empirical, peer-reviewed studies reporting randomised and non-randomised controlled trials, observational, and controlled before and after studies were included in the review. RESULTS Six studies met the inclusion criteria. Improved outcomes were observed for studies where outcomes were measured at least two years after the intervention. Associations between organisational factors, intervention success and patient outcomes were undetermined: organisational culture and patient outcomes were rarely measured together, and measures for culture and outcome were not standardised. CONCLUSIONS Common findings show the difficulty of introducing large-scale interventions, and that effective leadership and clinical champions, adequate financial and educational resources, and dedicated promotional activities appear to be common factors in successful system-wide change.The protocol has been registered in the international prospective register of systematic reviews, PROSPERO (Registration No. CRD42103003050).
Collapse
Affiliation(s)
| | | | | | | | - Jeffrey Braithwaite
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales, Level 1, AGSM Building, Sydney, NSW 2052, Australia.
| |
Collapse
|
33
|
Cloutier J, Lafrance J, Michallet B, Marcoux L, Cloutier F. French translation and validation of the Readiness for Interprofessional Learning Scale (RIPLS) in a Canadian undergraduate healthcare student context. J Interprof Care 2014; 29:150-5. [PMID: 25076020 DOI: 10.3109/13561820.2014.942837] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The Canadian Interprofessional Health Collaborative recommends that future professionals be prepared for collaborative practice. To do so, it is necessary for them to learn about the principles of interprofessional collaboration. Therefore, to ascertain if students are predisposed, their attitude toward interprofessional learning must be assessed. In the French Canadian context such a measuring tool has not been published yet. The purpose of this study is to translate in French an adapted version of the RIPLS questionnaire and to validate it for use with undergraduate students from seven various health and social care programmes in a Canadian university. According to Vallerand's methodology, a method for translating measuring instruments: (i) the forward-backward translation indicated that six items of the experimental French version of the RIPLS needed to be more specific; (ii) the experimental French version of the RIPLS seemed clear according to the pre-test assessing items clarity; (iii) evaluation of the content validity indicated that the experimental French version of the RIPLS presents good content validity and (iv) a very good internal consistency was obtained (α = 0.90; n = 141). Results indicate that the psychometric properties of the RIPLS in French are comparable to the English version, although a different factorial structure was found. The relevance of three of the 19 items on the RIPLS scale is questionable, resulting in a revised 16-item scale. Future research aimed at validating the translated French version of the RIPLS could also be conducted in another francophone cultural context.
Collapse
|
34
|
Havyer RDA, Wingo MT, Comfere NI, Nelson DR, Halvorsen AJ, McDonald FS, Reed DA. Teamwork assessment in internal medicine: a systematic review of validity evidence and outcomes. J Gen Intern Med 2014; 29:894-910. [PMID: 24327309 PMCID: PMC4026505 DOI: 10.1007/s11606-013-2686-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 09/17/2013] [Accepted: 10/02/2013] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Valid teamwork assessment is imperative to determine physician competency and optimize patient outcomes. We systematically reviewed published instruments assessing teamwork in undergraduate, graduate, and continuing medical education in general internal medicine and all medical subspecialties. DATA SOURCES We searched MEDLINE, MEDLINE In-process, CINAHL and PsycINFO from January 1979 through October 2012, references of included articles, and abstracts from four professional meetings. Two content experts were queried for additional studies. STUDY ELIGIBILITY Included studies described quantitative tools measuring teamwork among medical students, residents, fellows, and practicing physicians on single or multi-professional (interprofessional) teams. STUDY APPRAISAL AND SYNTHESIS METHODS Instrument validity and study quality were extracted using established frameworks with existing validity evidence. Two authors independently abstracted 30 % of articles and agreement was calculated. RESULTS Of 12,922 citations, 178 articles describing 73 unique teamwork assessment tools met inclusion criteria. Interrater agreement was intraclass correlation coefficient 0.73 (95 % CI 0.63-0.81). Studies involved practicing physicians (142, 80 %), residents/fellows (70, 39 %), and medical students (11, 6 %). The majority (152, 85 %) assessed interprofessional teams. Studies were conducted in inpatient (77, 43 %), outpatient (42, 24 %), simulation (37, 21 %), and classroom (13, 7 %) settings. Validity evidence for the 73 tools included content (54, 74 %), internal structure (51, 70 %), relationships to other variables (25, 34 %), and response process (12, 16 %). Attitudes and opinions were the most frequently assessed outcomes. Relationships between teamwork scores and patient outcomes were directly examined for 13 (18 %) of tools. Scores from the Safety Attitudes Questionnaire and Team Climate Inventory have substantial validity evidence and have been associated with improved patient outcomes. LIMITATIONS Review is limited to quantitative assessments of teamwork in internal medicine. CONCLUSIONS There is strong validity evidence for several published tools assessing teamwork in internal medicine. However, few teamwork assessments have been directly linked to patient outcomes.
Collapse
|
35
|
Hughes C, Pain C, Braithwaite J, Hillman K. ‘Between the flags’: implementing a rapid response system at scale. BMJ Qual Saf 2014; 23:714-7. [DOI: 10.1136/bmjqs-2014-002845] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
36
|
Clay-Williams R, Greenfield D, Stone J, Braithwaite J. On a wing and a prayer: an assessment of modularized crew resource management training for health care professionals. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2014; 34:56-67. [PMID: 24648364 DOI: 10.1002/chp.21218] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Evidence suggests that Crew Resource Management (CRM), a form of team training, is beneficial. In CRM training, participants learn individual portable team skills such as communication and decision making through group discussion and activities. However, the usual 1-day course format is not always compatible with health care organizational routines. A modular training format, while theoretically sound, is untested for interprofessional team training. The aim of this study was to explore the potential for modularized CRM training to be delivered to a group of interprofessional learners. METHOD Modularized CRM training, consisting of two 2-hour workshops, was delivered to health care workers in an Australian tertiary hospital. Kirkpatrick's evaluation model provided a framework for the study. Baseline attitude surveys were conducted prior to each workshop. Participants completed a written questionnaire at the end of each workshop that examined their motivations, reactions to the training, and learner demographics. An additional survey, administered 6 weeks post training, captured self-assessed behavior data. RESULTS Twenty-three individuals from a range of professions and clinical streams participated. One in 5 participants (22%) reported that they translated teamwork skills to the workplace. While positive about the workshop format and content, many respondents identified personal, team, and organizational barriers to the application of the workshop techniques. DISCUSSION CRM training when delivered in a modular format has positive outcomes. Following the training, some respondents overcame workplace barriers to attempt to change negative workplace behavior. This progress provides cautious optimism for the potential for modular CRM training to benefit groups of interprofessional health staff.
Collapse
|
37
|
Gough S, Jones N, Hellaby M. Innovations in interprofessional learning and teaching: providing opportunities to embed patient safety within the pre-registration physiotherapy curriculum. A Pilot Study. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/1743288x13y.0000000103] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
38
|
Patterson C, Arthur H, Peachey G, Vohra J, Price D, Pearson D, Mariani R. Planning for interprofessional change in primary health care: exploring the use of the Interprofessional Resource Centre. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2013; 4:117-125. [PMID: 23901309 PMCID: PMC3726650 DOI: 10.2147/amep.s43462] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
IMPORTANCE Resources to support change are needed for solo practitioners who are transitioning to family health teams (FHTs) which involve multiple health disciplines working together to provide team-based care. OBJECTIVE THE PURPOSE OF THIS PROJECT WAS: (1) to explore the use of an online resource, the Interprofessional Resource Centre (IRC), when planning for interprofessional change and; (2) to explore the experience of planning interprofessional change. DESIGN AND SETTING Six FHTs organized under the structure of one Local Health Integrated Network (LHIN) in Ontario, Canada. INTERVENTION Participants in six FHTs were directed to the IRC to support planning interprofessional change. In addition, two of the six FHTs participated in pilot site meetings with investigators where they received in-person support to apply the information from the IRC to an interprofessional activity. RESULTS Pilot site participants reported the IRC was useful for planning, but they cited lack of time to use it as a key barrier. When planning for interprofessional change, providers experienced challenges with physician buy-in and team dynamics. As a strategy for change, providers would like to learn from other FHTs who have experienced success with interprofessional change; at the LHIN level, they saw a need for more educational opportunities. Participation was found to be low among those only receiving online support. CONCLUSION AND RELEVANCE Based on the results of the study, it appears that online resource centers do have some value in knowledge translation when combined with in-person meetings. In exploring the planning of interprofessional change in primary health care teams, it was found that buy-in with physicians is a key challenge.
Collapse
Affiliation(s)
- Christine Patterson
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Heather Arthur
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Heart and Stroke Foundation of Ontario/Michael G DeGroote Endowed Chair in Cardiovascular Nursing Research, McMaster University, Hamilton, ON, Canada
| | - Gladys Peachey
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Julie Vohra
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - David Price
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Dave Pearson
- Central West Local Health Integration Network, Brampton, ON, Canada
| | | |
Collapse
|
39
|
Deraas TS, Berntsen GR, Hasvold T, Ringberg U, Førde OH. Is a high level of general practitioner consultations associated with low outpatients specialist clinic use? A cross-sectional study. BMJ Open 2013; 3:bmjopen-2012-002041. [PMID: 23315519 PMCID: PMC3553391 DOI: 10.1136/bmjopen-2012-002041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To examine if increased general practice activity is associated with lower outpatient specialist clinic use. DESIGN Cross-sectional population based study. SETTING All 430 Norwegian municipalities in 2009. PARTICIPANTS All Norwegians aged ≥65 years (n=721 915; 56% women-15% of the total population). MAIN OUTCOME MEASURE Specialised care outpatient clinic consultations per 1000 inhabitants (OPC rate). Main explanatory: general practitioner (GP) consultations per 1000 inhabitants (GP rate). RESULTS In total, there were 3 339 031 GP consultations (57% women) and 1 757 864 OPC consultations (53% women). The national mean GP rate was 4625.2 GP consultations per 1000 inhabitants (SD 1234.3) and the national mean OPC rate was 2434.3 per 1000 inhabitants (SD 695.3). Crude analysis showed a statistically significant positive association between GP rates and OPC rates. In regression analyses, we identified three effect modifiers; age, mortality and the municipal composite variable of 'hospital status' (present/not present) and 'population size' (small, medium and large). We stratified manually by these effect modifiers into five strata. Crude stratified analyses showed a statistically significant positive association for three out of five strata. For the same three strata, those in the highest GP consultation rate quintile had higher mean OPC rates compared with those in the lowest quintile after adjustment for confounders (p<0.001). People aged ≥85 in small municipalities had approximately 30% lower specialist care use compared with their peers in larger municipalities, although the association between GP-rates and OPC-rates was still positive. CONCLUSIONS In a universal health insurance system with high GP-accessibility, a health policy focusing solely on a higher activity in terms of GP consultations will not likely decrease OPC use among elderly.
Collapse
Affiliation(s)
- Trygve S Deraas
- Center of Clinical Documentation and Evaluation, Northern Norway Regional Health Authority, Tromsø, Norway
| | - Gro R Berntsen
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway
| | - Toralf Hasvold
- Department of Community Medicine, University of Tromsø, Tromsø, Norway
| | - Unni Ringberg
- Department of Community Medicine, University of Tromsø, Tromsø, Norway
| | - Olav Helge Førde
- Department of Community Medicine, University of Tromsø, Tromsø, Norway
| |
Collapse
|
40
|
Braithwaite J, Westbrook M, Nugus P, Greenfield D, Travaglia J, Runciman W, Foxwell AR, Boyce RA, Devinney T, Westbrook J. Continuing differences between health professions' attitudes: the saga of accomplishing systems-wide interprofessionalism. Int J Qual Health Care 2012. [PMID: 23203766 DOI: 10.1093/intqhc/mzs071] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To compare four health professions' attitudes towards interprofessional collaboration (IPC) and their evaluations of a programme aimed at enhancing IPC across a health system. DESIGN Questionnaire survey. SETTING Australian Capital Territory health services. PARTICIPANTS Sample of medical (38), nursing (198), allied health (152) and administrative (30) staff. INTERVENTION s) A 4-year action research project to improve IPC. MAIN OUTCOME MEASURE Questionnaire evaluating the project and responses to the 'Attitudes toward Health Care Teams' and 'Readiness for Interprofessional Learning' scales. RESULTS Significant professional differences occurred in 90% of the evaluation items. Doctors were the least and administrative staff most likely to agree project aims had been met. Nurses made more favourable assessments than did allied health staff. Doctors made the most negative assessments and allied health staff the most neutral ratings. Improved interprofessional sharing of knowledge, teamwork and patient care were among the goals held to have been most achieved. Reduction in interprofessional rivalry and improved trust and communication were least achieved. Average assessment of individual goals being met was agree (31.9%), neutral (56.9%) and disagree (11.2%). On the two attitude scales, allied health professionals were most supportive of IPC, followed by nurses, administrators and doctors. CONCLUSIONS Although overall attitudes towards IPC were favourable, only a third of participants reported that project goals had been achieved indicating the difficulties of implementing systems change. The response profiles of the professions differed. As in the previous research, doctors were least likely to hold favourable attitudes towards or endorse benefits from social or structural interventions in health care.
Collapse
Affiliation(s)
- Jeffrey Braithwaite
- Australian Institute of Health Innovation, Centre for Clinical Governance Research, University of New South Wales, NSW 2052, Australia.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Widmark C, Tishelman C, Gustafsson H, Sharp L. 'Information on the fly': Challenges in professional communication in high technological nursing. A focus group study from a radiotherapy department in Sweden. BMC Nurs 2012; 11:10. [PMID: 22824412 PMCID: PMC3438026 DOI: 10.1186/1472-6955-11-10] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 07/23/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Radiotherapy (RT) units are high-tech nursing environments. In Sweden, RT registered nurses (RNs) provide and manage RT in close collaboration with other professional groups, as well as providing nursing care for patients with cancer. Communication demands on these RNs are thus particularly complex. In this study, we aimed to better understand problems, strengths and change needs related to professional communication with and within the RT department, as a basis for developing a situation-specific intervention. METHODS Focus groups discussions (FGDs) were conducted with different professional (RNs, assistant nurses, physicians, engineers and physicists) and user stakeholders. Transcripts of the FGDs were inductively analyzed by a team of researchers, to generate clinically relevant and useful data. RESULTS These findings give insight into RT safety climate and are presented under three major headings: Conceptualization of professional domains; Organization and leadership issues; and Communication forms, strategies and processes. The impact of existing hierarchies, including how they are conceptualized and acted out in practice, was noted throughout these data. Despite other differences, participating professionals agreed about communication problems related to RT, i.e. a lack of systems and processes for information transfer, unclear role differentiation, a sense of mutual disrespect, and ad hoc communication taking place 'on the fly'. While all professional groups recognized extensive communication problems, none acknowledged the potential negative effects on patient safety or care described in the FGD with patient representatives. While RNs often initially denied the existence of a hierarchy, they placed themselves on a hierarchy in their descriptions, describing their own role as passive, with a sense of powerlessness. Potential safety hazards described in the FGDs include not reporting medical errors and silently ignoring or actively opposing new guidelines and regulations. CONCLUSIONS There is a risk that RNs who view themselves as disenfranchised within an organization will act with passive resistance to change, rather than as change promoters. As interventions to strengthen teams cannot be stronger than the weakest link, RNs may need support in the transition "from silence to voice" in order to take a position of full professional responsibility in a multi-professional health care team.
Collapse
Affiliation(s)
- Catarina Widmark
- Dept. of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Dept. NVS, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
- Foundation Stockholms Sjukhem, R& D unit, Stockholm, Sweden
| | - Carol Tishelman
- Dept. of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Foundation Stockholms Sjukhem, R& D unit, Stockholm, Sweden
| | - Helena Gustafsson
- Dept. of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Lena Sharp
- Dept. of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Dept. of Oncology, Karolinska University Hospital, 171 76, Stockholm, Sweden
| |
Collapse
|