Interprofessional teamwork in decentralized child welfare in The Netherlands: A comparison between the cities of Amsterdam and Utrecht

The recent transformation of child welfare in the Netherlands has improved opportunities for interprofessional working. We compared two models of teamworking within newly established interprofessional teams in the cities of Amsterdam and Utrecht, conducting a secondary analysis of semi-structured interviews collected through three broader research projects. Respondents include seventeen interprofessional team members (six from Utrecht, eleven from Amsterdam), representing a variety of teams across city, as well as two policymakers from Utrecht and one from Amsterdam. Team members were approached using convenience sampling, policymakers were purposively recruited. In different rounds of open and focused coding, we found that differences in team organization between the two cities have led to differences in the quality of interprofessional teamworking. Teamworking is best developed in Utrecht partly because team members are recruited and employed by a single organization. This has enabled a more careful process of selection and team composition than in Amsterdam, where a delegation approach entailed fragmentation as well as the risk of divided loyalty between team and mother organization. In addition, while the development of interprofessional teamwork in Utrecht is served by certain structures, teams in Amsterdam have suffered from an imbalance between freedom and structure, causing insecurity amongst staff and reduced chances of interprofessional integration. Despite the apparent success of the Utrecht model of interprofessional teamworking, interprofessional collaboration across team boundaries might suffer from the fact that teams in Utrecht, unlike in Amsterdam, do not comprise representatives of relevant partner organizations.     

A network model of communication in an interprofessional team of healthcare professionals: A cross-sectional study of a burn unit

Healthcare teams consist of individuals communicating with one another during patient care delivery. Coordination of multiple specialties is critical for patients with complex health conditions, and requires interprofessional and intraprofessional communication. We examined a communication network of 71 health professionals in four professional roles: physician, nurse, health management, and support personnel (dietitian, pharmacist, or social worker), or other health professionals (including physical, respiratory, and occupational therapists, and medical students) working in a burn unit. Data for this cross-sectional study were collected by surveying members of a healthcare team. Ties were defined by asking team members whom they discussed patient care matters with on the shift. We built an exponential random graph model to determine: (1) does professional role influence the likelihood of a tie; (2) are ties more likely between team members from different professions compared to between team members from the same profession; and (3) which professions are more likely to form interprofessional ties. Health management and support personnel ties were 94% interprofessional while ties among nurses were 60% interprofessional. Nurses and other health professionals were significantly less likely than physicians to form ties. Nurses were 1.64 times more likely to communicate with nurses than non-nurses (OR = 1.64, 95% CI: 1.01–2.66); there was no significant role homophily for physicians, other health professionals, or health management and support personnel. Understanding communication networks in healthcare teams is an early step in understanding how teams work together to provide care; future work should evaluate the types and quality of interactions between members of interprofessional healthcare teams.     

Interprofessional working in hospice day care and the patients' experience of the service

This in-depth study of hospice day care considers professional team working and patient experience of the service. It includes an analysis of how patients' time is spent. The qualitative single case study design involved patient and staff interviews, observations and document analysis. A theoretical framework of interprofessional working informed the study. Analysis of the data revealed a range of goals, variable communication patterns and the existence of core and extended teams. The results challenge the theoretical literature by suggesting that the presence of a team structure alone did not promote interprofessional working. Patients were also seen as integral members of the team. Their experience of day care was a social one, with a wide range of patients identified unmet needs, day care was largely seen as positive. This was despite interprofessional working not clearly being identified in the results. Suggestions for future research are made and implications for practice discussed.     

The relationship between team climate and interprofessional collaboration: Preliminary results of a mixed methods study

ABSTRACT

Relational and organisational factors are key elements of interprofessional collaboration (IPC) and team climate. Few studies have explored the relationship between IPC and team climate. This article presents a study that aimed to explore IPC in primary healthcare teams and understand how the assessment of team climate may provide insights into IPC. A mixed methods study design was adopted. In Stage 1 of the study, team climate was assessed using the Team Climate Inventory with 159 professionals in 18 interprofessional teams based in São Paulo, Brazil. In Stage 2, data were collected through in-depth interviews with a sample of team members who participated in the first stage of the study. Results from Stage 1 provided an overview of factors relevant to teamwork, which in turn informed our exploration of the relationship between team climate and IPC. Preliminary findings from Stage 2 indicated that teams with a more positive team climate (in particular, greater participative safety) also reported more effective communication and mutual support. In conclusion, team climate provided insights into IPC, especially regarding aspects of communication and interaction in teams. Further research will provide a better understanding of differences and areas of overlap between team climate and IPC. It will potentially contribute for an innovative theoretical approach to explore interprofessional work in primary care settings.     

The impact of team processes on psychiatric case management

Title. The impact of team processes on psychiatric case management Aim. This paper is a report of a study to identify the structures and interactions within community mental health teams that facilitate or impede effective teamwork and psychiatric case management. Background. Effective case management requires close collaboration between case managers or care co‐ordinators and other members of the multidisciplinary mental health team, yet there has been little research into this relationship. Method. A multiple case study of seven United Kingdom community mental health teams was conducted between 1999 and 2001, using qualitative methods of participant observation, semi‐structured interviews and document review. Findings. Factors were identified that impacted on the ability of care co‐ordinators to act effectively: ‘structure and procedures’; ‘disrespect and withdrawal’; ‘humour and undermining’; ‘safety and disclosure’. Care co‐ordination was enhanced when team structures and policies were in place and where team interactions were respectful. Where members felt disrespected or undermined, communication, information sharing and collaboration were impaired, with a negative impact on the care provided to service users. Conclusions. Teams require clear operating procedures alongside interprofessional trust and respect to ensure that there is open, safe and reflective participation. Further research is required to identify how best to bring about collaborative, effective teamwork in mental healthcare.     

Nurses' perceptions of discharge planning in acute health care: a case study in one British teaching hospital

AIM OF THE STUDY: To provide an in-depth understanding of nurses' perceptions of the hospital discharge process in a London teaching hospital. BACKGROUND: Discharging patients from hospital is a key component of the nurse's role in acute health care settings. It is remarkable that despite government legislation and research, which stretches back over 20 years in both Europe and North America, discharge planning remains problematic. Furthermore, it is an activity that requires collaboration between health and social care agencies. In the United Kingdom there is a new emphasis and incentive on managing acute hospital beds, which in turn results in shorter stays in hospital. In London, discharge planners face additional problems because of social, economic and environmental factors. METHOD: Using a case study design, 19 nurses were interviewed using the critical incident approach to obtain their perceptions of the discharge process. Direct observation was conducted to record interactions between nurses and health care professionals in multidisciplinary teams. In total 14 meetings were attended in elder care and orthopaedics and 7 in acute medicine. FINDINGS: Aspects of the discharge process were often ignored or neglected and assessments were rarely co-ordinated. The nursing ward handover was regarded as a process that hindered communication. Lack of time was reported to be the biggest barrier that affected interprofessional working and hence the co-ordination of assessments. CONCLUSION: The findings have important implications for nurses, managers and educational establishments. It is essential that social and medical diagnoses run parallel and that accurate information is collated and communicated within the multidisciplinary team. Further research into the impact of time pressures on communication, interprofessional working and the discharge process is needed.     

Interprofessional empathy: A four-stage model for a new understanding of teamwork

ABSTRACT

Collaboration in healthcare implies that health providers share responsibility and partner with each other in order to provide comprehensive patient care. A review of the empirical literature on teamwork in healthcare settings suggests that the relationships between service providers remain conflictual and variable in commitment to interprofessional collaboration. Recently, social psychologists have given considerable attention to the possibility that empathy could be used to improve intergroup attitudes and relations. Although empathy may be referred to as a means to humanize healthcare practices, few published studies from the healthcare literature focus on the nature of interprofessional empathy. Understanding frameworks different from your own and empathizing with other members of the team is fundamental to collaborative practice. The aim of this study was to understand the nature of empathy among members of interprofessional teams within a hospital environment. This study followed the lived experience of 24 health professionals with their perspective of empathy on interprofessional teams. A two-step procedure was used consisting of semi-structured interviews and depth interviews. Phenomenological data analysis was used to identify common themes and meanings across interviews. From the findings, a four-stage developmental model of interprofessional empathy emerged: Stage 1 is engaging in conscious interactions; Stage 2 requires using dialogical communication; Stage 3 is obtained when healthcare professionals consolidate understanding through negotiating differences between each other; and Stage 4 shows mastery of nurturing the collective spirit. Knowledge of this stage model will provide clinicians with the information necessary to develop awareness of how day-to-day activities within their interprofessional teams influence the development of interprofessional empathy.     

Does time matter? Exploring the relationship between interdependent teamwork and time allocation in Swedish interprofessional teams

This paper explores the relationship between time allocation on formal and informal forms of contact within interprofessional teams and an interdependent collaboration. Data were collected by a questionnaire including items on work organization, team climate and time allocation that was responded to by 226 professionals from 44 interprofessional teams. An additional sample of 139 professionals from 18 teams responded to the same questionnaire except for the item on time allocation. The teams worked within occupational health care, psychiatry, rehabilitation and school health care. On average, team members spent about 22% of their available work time on internal meetings/consultations and they perceived their collaboration as fairly interdependent. No correlation was found between, on the one hand, time invested in meetings and informal consultations within the team and, on the other hand, degree of team interdependence. Instead, interdependence was predicted by team climate, followed by manager coordination and self-regulation. However, there may be a lower limit: all 44 teams allocated at least about 10% of their work time to internal meetings and consultations. The results suggest three ways to strengthen interprofessional team collaboration – development of team climate and communication and more opportunity for both manager coordination and self-regulation.     

Does time matter? Exploring the relationship between interdependent teamwork and time allocation in Swedish interprofessional teams

This paper explores the relationship between time allocation on formal and informal forms of contact within interprofessional teams and an interdependent collaboration. Data were collected by a questionnaire including items on work organization, team climate and time allocation that was responded to by 226 professionals from 44 interprofessional teams. An additional sample of 139 professionals from 18 teams responded to the same questionnaire except for the item on time allocation. The teams worked within occupational health care, psychiatry, rehabilitation and school health care. On average, team members spent about 22% of their available work time on internal meetings/consultations and they perceived their collaboration as fairly interdependent. No correlation was found between, on the one hand, time invested in meetings and informal consultations within the team and, on the other hand, degree of team interdependence. Instead, interdependence was predicted by team climate, followed by manager coordination and self-regulation. However, there may be a lower limit: all 44 teams allocated at least about 10% of their work time to internal meetings and consultations. The results suggest three ways to strengthen interprofessional team collaboration - development of team climate and communication and more opportunity for both manager coordination and self-regulation.     

Interprofessional education and practice guide: interprofessional team writing to promote dissemination of interprofessional education scholarship and products

ABSTRACT

Collaborations to develop, implement, evaluate, replicate, and write about interprofessional education (IPE) activities within and across institutions are wonderful opportunities to experience teamwork, team communication, ethics and values, and the roles and responsibilities of interprofessional team writing. Just as effective communication in interprofessional team-based care is essential for providing safe, high-quality health care, similar communication strategies are necessary to produce high-quality scholarship of IPE curricula and activities. Relationship and communication issues that affect health care teams’ abilities to work together effectively (e.g., hierarchy, exclusion, assumptions, non-responsiveness, biases, stereotypes and poor hand-offs of information) can also occur in interprofessional team writing. Between 1970 and 2010, interprofessional practice research publications increased by 2293%. Although there has been tremendous growth in the IPE literature, especially of articles that require collaborative writing, there have not been any papers addressing the challenges of interprofessional team writing. As more teams collaborate to develop IPE, there is a need to establish principles and strategies for effective interprofessional team writing. In this education and practice guide, a cross-institutional team of faculty, staff, and graduate students who have collaborated on externally funded IPE grants, conferences, products, and workshops will share lessons learned for successfully collaborating in interprofessional team writing.     

Exploring the importance of team psychological safety in the development of two interprofessional teams

It has been previously demonstrated that interactions within interprofessional teams are characterised by effective communication, shared decision-making, and knowledge sharing. This article outlines aspects of an action research study examining the emergence of these characteristics within change management teams made up of nurses, general practitioners, physiotherapists, care assistants, a health and safety officer, and a client at two residential care facilities for older people in Ireland. The theoretical concept of team psychological safety (TPS) is utilised in presenting these characteristics. TPS has been defined as an atmosphere within a team where individuals feel comfortable engaging in discussion and reflection without fear of censure. Study results suggest that TPS was an important catalyst in enhancing understanding and power sharing across professional boundaries and thus in the development of interprofessional teamwork. There were differences between the teams. In one facility, the team developed many characteristics of interprofessional teamwork while at the other there was only a limited shift. Stability in team membership and organisational norms relating to shared decision-making emerged as particularly important in accounting for differences in the development of TPS and interprofessional teamwork.     

Medical dominance in multidisciplinary teamwork: a case study of discharge decision-making in a geriatric assessment unit

AIM: To investigate the degree of medical dominance in multidisciplinary teams in a geriatric assessment unit by focusing on decision-making with regard to patient discharge. BACKGROUND: The persistence of medical dominance in multidisciplinary teamwork has been widely assumed but insufficiently researched, particularly through close observation of team practice. The present study seeks to rectify this by examining the extent of medical dominance in two multidisciplinary teams working in a hospital-based geriatric assessment unit. METHODS: Team practice was analysed by observing and audiotaping five case review meetings in each team and by semi-structured interviews with team members. RESULTS: In terms of level of contribution, the issues raised at meetings, and the team responses to discharge initiation, a lower than expected level of medical dominance was identified. This lower than expected level is related to consultants' views on the nature of rehabilitation, leading to a consensus amongst team members as to the purpose of geriatric assessment, and to a high level of team stability. CONCLUSION: Reducing the level of medical dominance encourages the contributions of all team members and thus enhances patient care. More training in team skills would also be beneficial, including interprofessional training.     

Nursing and medical students teaming up: Results of an interprofessional project

Health professions programmes are increasing the number of interprofessional events in their curricula. Many of these programmes are grounded in case study or simulation events in order to prepare students for eventual practice. We designed an interprofessional education collaborative practice (IPECP) that provides direct interprofessional practice experience while students are still in their health profession programmes. In our programme, teams of senior baccalaureate nursing and third-year medical students provided health coaching to patients in need of chronic disease management. The purpose of the project and study was to determine whether repeated exposure to opportunities for interprofessional communication would lead to improvement in the individual and team communication skills. Teams met with their assigned patients monthly to provide coaching and had follow-up conversations with the patients between meetings. Faculty were present at each meeting to review the healthcare and coaching plans, observe the teams’ interactions, and provide a debriefing after each meeting. Results demonstrated that both individual and team communication skills significantly increased over time. The IPECP project was successful in providing a context where students could develop and improve upon key interprofessional communication skills.     

Do all health and social care professionals interact equally: a study of interactions in multidisciplinary teams in the United Kingdom

Problems around deficits in interprofessional collaboration have been identified since the National Health Service (NHS) was introduced. It is within the context of the current policy focus on improving collaborative working that this study was undertaken. A direct observational study using the Bales' Interaction Process Analysis tool was carried out in two older persons teams to explore patterns of interaction in the multidisciplinary team meetings. Analysis revealed some key differences in the way in which different professions interacted. Occupational therapists, physiotherapists, social workers (SW) and nurses rarely asked for opinions and for orientation. The consultant (the individual in charge of the medical team) tended to have high rates for asking for orientation, giving opinions and giving orientation. Although some nurses did have high individual rates for the giving of orientation. The data from the research has highlighted that therapists, SWs and nurses are reluctance to voice their opinions in multidisciplinary teams and thus conformity may dominate its culture. It is suggested that therapists, SWs and nurses need to cite their opinions in teams more effectively if they are to be competent and committed patient-centred practitioners.     

Interprofessional information work: innovations in the use of the chart on internal medicine teams

An abundance of evidence suggests that communication in interprofessional healthcare teams is a complex endeavour. Even relatively simple communication processes involving information work - the gathering, storage, retrieval and discussion of patient information - may be fraught with pitfalls, and yet teams manage to conduct their daily information work, often with a high degree of effectiveness. In this article, we explore one commonplace dimension of information work - the use of patient charts to foster collaborative decision-making and care enactment - towards building an elaborated understanding of how teams innovate in the face of daily complexities in their information work processes. Drawing on results from an ethnographic study of team communication in two internal medicine inpatient wards, we describe the nature and use of patient charts, analyze recurrent problems, and explore adaptive strategies for carrying on team information work in the face of daily barriers.     

A Pilot for Understanding Interdisciplinary Teams in Rehabilitation Practice

Interdisciplinary teams in rehabilitation are effective for positive patient outcomes. They require skills in team building and interprofessional collaboration. The Institute of Medicine has interdisciplinary teams as one of the five core competencies for healthcare workers. In reviewing the literature on teams, several themes were developed, such as communication, collaboration, understanding of roles, and educational levels of team members. Using these themes, a survey was developed to assess perceptions of teams by rehabilitation nurses, physical therapists, and occupational therapists. Significant findings came from questions on educational levels of team members between nurses and occupational therapists and also within the nursing groups. Open‐ended questions asked about barriers and facilitators for effective teams. We hope that these pilot results will lead to discussions on how to improve interdisciplinary teams and make them more effective for better patient outcomes.     

Implementation of an electronic health records system within an interprofessional model of care

Abstract

Implementation of electronic health records (EHR) systems is challenging even in traditional healthcare settings, where administrative and clinical roles and responsibilities are clearly defined. However, even in these traditional settings the conflicting needs of stakeholders can trigger hierarchical decision-making processes that reflect the traditional power structures in healthcare today. These traditional processes are not structured to allow for incorporation of new patient-care models such as patient-centered care and interprofessional teams. New processes for EHR implementation and evaluation will be required as healthcare shifts to a patient-centered model that includes patients, families, multiple agencies, and interprofessional teams in short- and long-term clinical decision-making. This new model will be enabled by healthcare information technology and defined by information flow, workflow, and communication needs. We describe a model in development for the configuration and implementation of an EHR system in an interprofessional, interagency, free-clinic setting. The model uses a formative evaluation process that is rooted in usability to configure the EHR to fully support the needs of the variety of providers working as an interprofessional team. For this model to succeed, it must include informaticists as equal and essential members of the healthcare team.     

P46Sharing Information Via a Regional Web Site

The Trent Regional Transfusion Committee (RTC) identified that communication of information and best practice was a priority following feedback from an education day for hospital transfusion teams in July 2005. At this time there was no route of communication to the hospital transfusion teams other than via the RTC members. An RTC 'newsletter sub-group', co-ordinated by the NBS regional hospital liaison team, was established to produce a newsletter which was sent to members of hospital transfusion teams in the region. This was effective in providing information about the RTC, its members and its purpose. However the communication was one way and limited to the frequency of the production of newsletters. A further RTC 'web-site sub-group' was established and included multidisciplinary membership from the Trent region. A regional web-site was developed and hosted by United Lincolnshire Hospitals NHS Trust. The web site is accessible to hospital transfusion teams in the region and contains information regarding meetings, presentations, and regional initiatives together with a database of documents. The sub-groups of the RTC and members of hospital transfusion teams send information to the web master for inclusion on the web-site. The web-site was launched in June 2006 http://www.trtc.nhs.uk and a survey was conducted with members of the hospital transfusion teams to assess improvement in communication within the region. The survey has concluded that sharing of information and best practice has improved within the region. The web-site will be further developed and will have links to other web-sites and useful documents. This has been a successful project for the RTC, meeting local need and supporting networking between hospital trusts within the Trent region.