This qualitative study explores how roles are constructed within interprofessional health care teams. It focuses on elucidating the different types of role boundaries, the influences on role construction and the implications for professionals and patients. A comparative case study was conducted with two interprofessional primary health care teams. The data collection included a total of 26 interviews (13 with each team) and non-participant observations of team meetings (2-3 meetings at each site). Thematic analysis was used to analyze the data and a model was developed to represent the emergent findings. The role boundaries are organized around interprofessional interactions (autonomous-collaborative boundaries) and the distribution of tasks (interchangeable-differentiated boundaries). Salient influences are categorized as structural, interpersonal and individual dynamics. The implications of role construction include professional satisfaction and more favourable wait times for patients. The elements in this conceptual model may be transferable to other interprofessional primary health care teams. It may benefit these teams by raising awareness of the potential impact of various within-team influences on role construction.

Tyrimo tikslas: ištirti netoli gydymo įstaigų dirbančių farmacijos specialistų požiūrį į esamą gydytojo ir vaistininko bendradarbiavimą bei jo galimybes ateityje. Uždaviniai: 1. Ištirti netoli gydymo įstaigų dirbančių farmacijos specialistų požiūrį į esamą gydytojo ir vaistininko bendradarbiavimą. 2. Nustatyti veiksnius, turinčius įtakos gydytojo ir vaistininko bendradarbiavimui ir problemas, su kuriomis susiduriama. 3. Atskleisti farmacijos specialistų nuomonę apie gydytojo ir vaistininko bendradarbiavimo galimybes ateityje. 4. Įvardinti sprendimus, kuriuos įgyvendinant, gydytojo ir vaistininko bendradarbiavimas galėtų būti pagerintas. Metodika: Tyrimo dalyviai – farmacijos specialistai, dirbantys Kauno miesto visuomenės vaistinėse, esančiose šalia ligoninės, poliklinikos, šeimos klinikos ar individualaus gydytojo kabineto. Tyrimo metodas – anoniminė anketinė apklausa. Iš viso išdalintos 188 anketos, pilnai užpildytos grąžintos 157 anketos, iš jų (atsakomumas 83,51proc.). Duomenų statistinė analizė atlikta naudojant SPSS (Statistical Package for Social Science) 20.0 programinį statistinės analizės paketą. Tyrimo rezultatai: 61,15 proc. respondentų esamą gydytojo-vaistininko bendradarbiavimą vertina kaip nepakankamą. Esamo gydytojo ir vaistininko bendradarbiavimo vertinimas skiriasi priklausomai nuo to, kokią dalį gydytojų, dirbančių šalia esančioje gydymo įstaigoje, farmacijos specialistas pažįsta (p<0,05). 48,08 proc. respondentų nurodė, kad jų praktikoje... [toliau žr. visą tekstą] / Aim: To analyze the attitude of pharmacy professionals working nearby to different medical institutions to the current physician-pharmacist collaboration and its future possibilities. Tasks: 1. To investigate the approach of pharmacy specialists working nearby different medical institutions to the current physician-pharmacist collaboration; 2. To identify the factors that influence the collaboration between a physician and a pharmacist and the problems encountered; 3. Reveal the opinion of pharmaceutical professionals on the possibilities of physician-pharmacist collaboration in the future; 4. Identify solutions which could improve the physician - pharmacist collaboration. Methods: The participants of the research project - pharmaceutical professionals working in the community pharmacies in the city of Kaunas, located near hospitals, clinics, family clinics or private doctors office. Test method - an anonymous questionnaire. In total there were 188 questionnaires distributed, out of which 157 were returned fully completed (response rate 83.51%). The statistical analysis was performed using SPSS (Statistical Package for Social Science) 20.0. Results: 61.15 % of respondents identify the existing physician-pharmacist collaboration as insufficient. The assessment of the current level of collaboration varies depending on the proportion of physicians working in a nearby treatment facility, pharmacy technician knows (p <0.05). 48.08 % of respondents indicated that in their... [to full text]

Objectives: Transitions of care (ToC) for a high-risk neonatal population, and in some cases inappropriate and early discharge, can have important implications for community and broader population health. As it is a key indicator of the efficiency of the system of health services, the ease of ToC has been a priority for improving care outcomes across all settings in our nation’s healthcare system. Research shows that inappropriate discharges can lead to negative outcomes for patients and their families, health professionals, and the health system. Collaboration amongst the health care professionals, the community, and the patient’s family is needed for an efficient transition. This research examined how interprofessional collaboration (IPC) can act as a catalyst for efficient and effective ToC from a high-risk neonatal unit to care back in the community. Approach: Twelve infants were observed from their admission on the Neonatal Intensive Care Unit (NICU) until their discharge home. The 12 consisted of four patients discharged directly home, four to another unit within the same hospital, and four to another institution. Stage one involved a document analysis of documents related to ToC policy on the NICU. Stage two involved observation. Stage three involved interviews with healthcare professionals (HCPs) in the hospital and community (n=30) and family members (n=12). Stage four consisted of deliberative workshops with the hospital management and research participants to share the results and obtain their feedback. Results: Including parents early in the ToC planning process helps parents feel they’re a part of the interprofessional care team, in-charge of their infant’s care and thus better equipped mentally to handle their infant’s ToC. Knowing early on their infant’s discharge plan allows parents the opportunity to ask questions regarding caring for the infant at home or to meet the new healthcare team at the new site (hospital/floor) prior to the transfer. Mechanisms need to be in place to ensure that communication regarding ToC is consistent and clear to and between all HCPs whether in the hospital (e.g. bedside nurse) or in the community (e.g. family doctor). Having a clear understanding of what information should be transferred during a ToC will prevent unnecessary tests and misunderstandings. Increasing HCPs’ knowledge of available community resources will aide in transitioning infants to community care and thus freeing bed space and decreasing unnecessary costs at the hospital (i.e. A feeding and growing baby can be weighed by family doctor or Rapid Response Nurse and not necessarily the neonatologist). A consistent ToC policy across all NICUs would also be beneficial to ensuring a smoother ToC of infants. Conclusion: It is believed that communication and education in an interprofessional context is critical for more efficient and effective ToC of neonates.

Philosophiae Doctor - PhD / The complexity of human health and its determinants has been developing gradually and the means to attend to them has gone beyond the scope of a specific health discipline. Advocacy is underway by health stakeholders such as the World Health Organisation (WHO), higher learning institutions and individual scholars to incorporate interprofessional practice initiatives in health as a means of ensuring that health practitioners share ideas communicate and collaborate in order to put forward a comprehensive management plan for patients. These initiatives seek to ensure that a problem that could hardly be solved uniprofessionally is shed light on. The University of the Western Cape (UWC) is among the universities in the world that have incorporated an Interdisciplinary Core Courses Curriculum to be undertaken by all undergraduate students enrolled in the Faculty of Community and Health Sciences (FCHS) hence aiming at producing graduates who are collaboration conscious in their practice. This effort adds into the UWC’s endeavor of producing socially responsible graduates. This study analysed the UWC curriculum in order to ascertain its cognitive rigor for delivery of the interprofessional competencies. It further sought to identify whether the effort that the FCHS is putting through the Interdisciplinary Core Courses in having an impact on the perceptions of final year students during their field work placements in various health care institutions. The study also sought to find out whether the health care institutions practice policies are interprofessional practice friendly. Finally, the views and perceptions towards interprofessional collaboration (IPC) of institutional manager’s for institutions where UWC places more than one discipline of students for practice were explored.

This qualitative study explores how roles are constructed within interprofessional health care teams. It focuses on elucidating the different types of role boundaries, the influences on role construction and the implications for professionals and patients. A comparative case study was conducted with two interprofessional primary health care teams. The data collection included a total of 26 interviews (13 with each team) and non-participant observations of team meetings (2-3 meetings at each site). Thematic analysis was used to analyze the data and a model was developed to represent the emergent findings. The role boundaries are organized around interprofessional interactions (autonomous-collaborative boundaries) and the distribution of tasks (interchangeable-differentiated boundaries). Salient influences are categorized as structural, interpersonal and individual dynamics. The implications of role construction include professional satisfaction and more favourable wait times for patients. The elements in this conceptual model may be transferable to other interprofessional primary health care teams. It may benefit these teams by raising awareness of the potential impact of various within-team influences on role construction.

Increasing collaborative working between GPs and community pharmacists has recently become a high priority for the NHS. Previous research suggests that interaction is limited and problematic between the two professions, forming a barrier to service provision. This PhD aimed to explore the level, nature and process of interaction between GPs and community pharmacists, using a social network analysis approach.The study focused on four geographically different case study areas and 90 GPs and community pharmacists participated in total. A two-stage design was adopted. Firstly data were collected through a network questionnaire and analysed using social network analysis. Secondly, qualitative interviews were conducted to provide narrative to the network findings and analysed using the framework approach.The nature of contact was characterised as mostly indirect through brokers, de-personalised and non-reciprocal and seemingly at odds with collaborative behaviour. A misalignment in responses pointed to asymmetry in the relationship, representing little commonality, knowing and understanding of each other. Through social network analysis, individuals and dyads in possession of strong ties were identified. Strong ties were not the norm and were characterised by more personalised forms of reciprocal contact. Qualitative interviews provided insight into the processes of interaction between the two professional groups. An approach to the interaction, which involved pharmacists tactically managing the potential conflict in the interaction through use of deferential and sometimes subservient behaviour, was conceptualised as the ‘pharmacist-GP game’. Those pharmacists with strong ties to GPs also, at times, adopted aspects of this approach but also attempted to set themselves apart from other pharmacists in order to develop and maintain their strong ties with GPs. However, possession of strong ties did not always lead to capitalisation, and the benefits of possessing these were often viewed as efficiency and convenience gains rather than anything more wide-reaching. Often, more isolated GPs and pharmacists did not view strong ties as a necessity, with the benefits of these not considered rewarding enough for the time and effort required to achieve them. This effort-reward conflict was identified as an important constraint faced by GPs and pharmacists in relation to transforming these loose connections into more integrated networks. Other micro and macro level constraints were also identified and a series of accompanying recommendations made for future practice and research.

My thesis examines the interprofessional collaboration between school-based educators and health professionals (HPs). Four research questions guided the study: 1) What is the current state of literature on interprofessional collaborations between school-based educators and HPs? 2) Based on the existing literature, how are school-based educators and HPs collaborating interprofessionally? 3) Based on the existing literature, what are the outcome(s) or impact(s) of interprofessional collaborations between school-based educators and HPs? and 4) Based on the current state of the literature, what areas are important to consider for future research on interprofessional collaborations between school-based educators and HPs? It is important for both school-based educators and HPs alike to consider answers to these questions as it can refine and strengthen their current and future practices in an effort to ultimately create a successful working and learning environment for themselves and for their students and patients. Systematic searches of four databases yielded 46 articles for inclusion, data extraction, and analysis. Through a thematic analysis of the literature, I found the following two overarching themes that govern the implementation of interprofessional collaboration: 1) time and 2) funding. In addition to these themes, I extracted two major themes and one minor theme from the literature that can guide current and future interprofessional collaborative practices. These themes included 1) pre-service training whereby a) everyone is involved, b) there is a mutual understanding between and of educators and HPs, c) both educators and HPs feel valued in their positions for their work, d) there is less sophisticated profession-specific jargon which can in turn open further dialogue between both teams of professionals, and e) a journal or frequent log can be kept to track the successes and challenges of and suggestions for the collaborative efforts as well as of student satisfaction; and 2) in-service training whereby a) educators and HPs are able to maintain consistency in their roles and responsibilities as well as for students educationally, and b) provide continued support for all. I discuss methods of how this interprofessional collaboration could be implemented, noting a) proximity (i.e., how closely, in what ways, and how frequently educators and HPs work together) and b) frequent meetings as essential to successful interprofessional collaboration. Finally, a minor theme emerged from the literature with suggestions for current and ongoing implementation of interprofessional collaboration which suggested a) increased and stronger liaison in schools and b) frequent meetings to establish and build upon a foundation that will foster further interprofessional collaboration. This review of the available literature on this topic, especially of the literature empirical in nature, worked to map key concepts, evidence, and main sources of information as well as synthesize a myriad of information (Arksey and O’Malley, 2005), fill a visible gap in the area of interprofessional collaboration among school-based educators and HPs specifically, and provide avenues for further study and practical application.

The purpose of this exploratory sequential mixed methods study was to explore organizational contextual factors important to successful interprofessional collaboration (IPC) among primary care teams. In Phase 1, a single embedded case study design was utilized to understand how primary care teams describe IPC, the organizational contextual factors identified as most important to successful IPC, and differences in context between teams. In Phase 2, a quantitative survey was administered to primary care team members at 10 organizations to objectively measure the relationship between contextual factors identified in Phase 1 and IPC. In Phase 1, primary care team members generally described IPC positively with notable challenges to consistently collaborating as a team. Teams varied in terms of their team structure, physical layout of the practice, and organizational hierarchy of the practice. Organizational contextual factors that were deemed most important included team structure and resources, including staff, time, and communication tools; supportive, patient-centered culture, including team member support and expectations for IPC as the way to provide the best care to patients; leadership, including organizational leadership support and provider leadership; and organizational structure and resources, including status as a federally qualified health center (FQHC) and academic facility. In Phase 2, a strong, positive relationship was found between IPC and team member support and provider leadership. A moderate, positive relationship was found between IPC and team resources, clan culture, and perceived organizational support. A weak, positive relationship was found between IPC and patient-centered values. No statistically significant relationship was found between IPC and status as a FQHC or presence of a physician residency program. The findings support the importance of organizational context for IPC and suggest that organizational culture and leadership hold particular importance for IPC success.

The overall purpose of this study was to examine the relevance of policy factors identified by Mulvale and Bourgeault (2007) on interprofessional collaboration in PHC, by soliciting stakeholders’ perspectives. / ABSTRACT Background: Interprofessional team-based approaches to primary health care (PHC) delivery have gained support in the literature. Interprofessional primary health care (IPC) models of service delivery allow for different professionals to work together to address patients’ needs. Family Health Teams (FHTs) are a newly introduced model of IPC delivery in Ontario. A variety of factors can influence collaboration between professionals in IPC teams. Purpose/Research Objectives: The purpose of this study was to examine stakeholders’ perspectives about policy factors that influence IPC team collaboration, using the example of FHTs in Ontario. Methods: This descriptive study employs semi-structured interviews with key informants from select Ontario FHTs. Directed content analysis was used to examine the Mulvale and Bourgeault (2007) framework. Interviews were conducted with FHT professionals to describe their perspectives on the influence of policy factors in shaping collaboration within their teams and whether identified policy factors acted to enhance or hinder collaboration. Findings: Key informants cited, with highest agreement, economic and regulatory factors as influencing collaboration. Factors agreed upon unanimously by all key informants included funding, provider payment/remuneration, and practice scope. Key informants identified a range of policy factors that hinder collaboration. These included provider payment/remuneration, legal accountability, and the existence of multiple governing bodies. Implications/Conclusion: A number of policy factors were reported to influence collaboration in FHTs in Ontario. Although the findings suggest that incremental reform is possible, widespread policy reform of physician incentives, a key barrier to collaboration, is unlikely. Prospects for reform of this factor may be more promising at an organizational level. / Thesis / Master of Science (MSc)

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