Submitted by Maike Costa (maiksebas@gmail.com) on 2016-03-10T12:45:28Z No. of bitstreams: 1 arquivototal.pdf: 1129934 bytes, checksum: a8d893fdd082e81d120f9afbe0400889 (MD5) / Made available in DSpace on 2016-03-10T12:45:29Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 1129934 bytes, checksum: a8d893fdd082e81d120f9afbe0400889 (MD5) Previous issue date: 2015-02-23 / The complexity of the health problems that are presented to family health teams requires more strongly the need for interdisciplinary actions, aiming at integral care. However, the formation of professionals that make up these teams, the overload work with which they live and the own organization of the work process does not always favor the achievement of these practices. This is the problem in which this study focuses. The objective of this study is to analyze the limits, and possibilities of interdisciplinary actions in professional practice of nurses, doctors and dentists in family health units. This is a cross-sectional study, exploratory, descriptive and inferential, developed from the qualitative and quantitative approaches. The sample consisted of Nurses, Physicians and Surgeon dentists of Family Health Teams in João Pessoa city. The questionnaire was constructed, validated and applied to all professionals by lot of the Family Health Teams. The qualitative part was made from participant observation during two months. The results of the questionnaires were submitted to Cluster Analysis. While the observation, thematic analysis was performed and the data were compared with quantitative results. The three professions had limitations on the interdisciplinary practice. The findings of this study show that the exercise of interdisciplinary professional practice depends on the objective order factors related to the labor process, and subjective factors inherent to the worker himself. / A complexidade dos problemas de saúde que se apresentam às equipes de saúde da família impõe mais fortemente a necessidade de ações interdisciplinares, visando ao cuidado integral. No entanto, a formação dos profissionais que compõem essas equipes, a sobrecarga de trabalho com a qual convivem e a própria organização do processo de trabalho nem sempre favorecem a realização dessas práticas. Esse é o problema sobre o qual o presente estudo se debruça. O objetivo deste estudo é analisar os limites e possibilidades de realização das ações interdisciplinares na prática profissional de enfermeiros, médicos e cirurgiões dentistas nas unidades de saúde da família. Trata-se de um estudo transversal, exploratório, descritivo e inferencial, desenvolvido a partir das abordagens qualitativa e quantitativa. A amostra foi composta por Enfermeiros, Médicos e Cirurgiões dentistas das Equipes de Saúde da Família do município de João Pessoa. O questionário foi construído, validado e aplicado mediante sorteio das Equipes de Saúde da Família. A parte qualitativa foi realizada a partir de Observação Participante, com duração de dois meses. Os resultados dos questionários foram submetidos à Análise de Agrupamento. Enquanto que para observação, foi realizada análise temática e os dados foram confrontados com os resultados quantitativos. As três profissões apresentaram limitações quanto à prática interdisciplinar. Os achados deste estudo evidenciam que o exercício da interdisciplinaridade na prática profissional depende de fatores de ordem objetiva, relacionados ao processo de trabalho, e de fatores subjetivos, inerentes ao próprio trabalhador.

A legalização do Sistema Único de Saúde (SUS), o qual preconiza uma visão ampliada de saúde, os setores da saúde e educação apontam para a necessidade de uma reforma na formação profissional. A Residência Integrada em Saúde (RIS) é uma modalidade de educação em serviço que objetiva especializar profissionais das diversas categorias desta área para atuarem em equipe, segundo os princípios do SUS. Esta dissertação tem a finalidade de contribuir para a reflexão sobre a formação de trabalhadores da área da saúde, através de uma pesquisa tipo Estudo de Caso sobre a RIS a partir da área de ênfase em intensivismo do GHC. Trata-se de uma abordagem qualitativa, descritiva, analítica que utiliza etapas da Avaliação de Quarta Geração. Os participantes deste estudo foram o grupo de interesse composto pelos residentes dessa área de ênfase. Para analisar as informações foi utilizada a análise proposta por Minayo. Os resultados desta pesquisa mostraram que a proposta da RIS é especializar profissionais da área da saúde para agirem em equipe interdisciplinar, visando formá-los com base em um perfil adequado a atuar no SUS para além da qualificação técnica curativa. A RIS diferencia-se das outras residências por ter como proposta a integração das diferentes áreas de conhecimento. Essa modalidade de ensino em serviço, em algum grau, tem atingido seus objetivos, porém ela tem apresentado dificuldades relacionadas à falta de conhecimento da proposta, à organização e estrutura dessa formação. As atividades interdisciplinares não estão dadas, assim como a metodologia problematizadora preconizada por esse programa leva a uma contínua reformulação das atividades para atingir os objetivos da formação. Esse caráter dinâmico pode dar um aspecto de desordem ao processo, todavia foi percebido que a proposta está continuamente sendo avaliada, reformulada e tem apresentado mudanças e crescimento em relação à sua criação. / With the legalized Brazilian Health System (SUS-Sistema Único de Saúde), which advocates a broader view of health, the health and education sectors indicate the need to remodel professional training. Integrated Health Residency (RIS-Residência Integrada em Saúde) is a modality of on-the-job training aiming at specializing professionals of different categories in this field to work as a team according to the SUS principles. The purpose of this thesis is to contribute to thinking about health care worker training, by performing a Case Study-type research on RIS based on an emphasis on intensive care at GHC. This is a qualitative, descriptive, analytical approach that uses stages of the Fourth Generation Evaluation. The participants in this study were the group of interest constituted by residents in this particular field. The method proposed by Minayo was used to analyse this information. The results of this research showed that the RIS proposal is to specialize health care professionals to work in a crossdisciplinary team, with a view to training them based on a profile appropriate to work at SUS beyond the curative technical qualification. RIS is different from other residencies because it proposes to integrate different fields of knowledge. This modality of on-the-job training has achieved its aims to some degree, but it has presented problems involving lack of knowledge about the proposal, the organization and structure of this training. Crossdisciplinary activities are not given, and the problematizing methodology advocated by this program leads to the continuous reformulation of activities to achieve the training objectives. This dynamic character could give the process a disorganized look, but it was noted that the proposal is continuously evaluated and reformulated, and it has presented changes and growth compared to when it was created. / La legalización del Sistema Único de Salud (SUS), lo cual preconiza una visión ampliada de salud, los sectores de la salud y educación apuntan para la necesidad de una reforma en la formación profesional. La Residencia Integrada en Salud (RIS) es una modalidad de educación en servicio que objetiva especializar profesionales de las diversas categorías de esta área para que actúen en equipo, según los principios del SUS. Esta disertación tiene la finalidad de contribuir para la reflexión sobre la formación de trabajadores del área de la salud, a través de una pesquisa tipo Estudio de Caso sobre la RIS a partir del área de énfasis en intensivismo del GHC. Se trata de un abordaje cualitativo, descriptivo, analítico que utiliza etapas de la Evaluación de Cuarta Generación. Los participantes de este estudio fueron el grupo de interés compuesto por los residentes de esa área de énfasis. Para analizar las informaciones fue utilizado el análisis propuesto por Minayo. Los resultados de esta pesquisa mostraron que la propuesta de la RIS es especializar profesionales del área de la salud para que obren en equipo interdisciplinar, visando formarlos con base en un perfil adecuado a actuar en el SUS para el más allá de la cualificación técnica curativa. La RIS se diferencia de las otras residencias por tener como propuesta la integración de las diferentes áreas de conocimiento. Esa modalidad de enseñanza en servicio, en algún grado, tiene atingido sus objetivos, sin embargo ella tiene presentado dificultades relacionadas a la falta de conocimiento de la propuesta, a la organización y estructura de esa formación. Las actividades interdisciplinares no están dadas, así como la metodología problematizadora preconizada por ese programa lleva a una continua reformulación de las actividades para atingir los objetivos de la formación. Ese carácter dinámico puede dar un aspecto de desorden al proceso, sin embargo fue percibido que la propuesta está continuamente siendo evaluada, reformulada y tiene presentado cambios y crecimiento en relación a su crianza.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Introduction.The study of quality of health services constitutes a major change tool and incentive for health care services, such as pharmaceutical services, meet minimum quality standards and promote a renewal of its work culture. In Brazil, however the development and evaluation of the quality of services such as Medication Review is still in its infancy and needs to be implemented aiming to improve the practices of patient care. Aim. Evaluate structure and process indicators in the implementation of Medication Review services of the ambulatory of a university hospital. Methods. The study was structured in three stages from February 2012 to March 2015. The first stage corresponded to a methodological development research, in which structure and process indicators were collected from national and international literature for use in evaluating the Medication Review services.The second stage corresponded to translation to Portuguese and the transcultural adaptation to Brazil of Scale of Attitudes Toward Physician-Pharmacist Collaboration . The third stage corresponded to a longitudinal study evaluating the process of a collaborative practice model of Medication Review service in the ambulatory of a University Hospital of Sergipe. Results. From the literature (stage 1) were surveyed in the study, 28 indicators divided into structure criteria: physical installations, human resources, material resources, documentation and financing. The evaluation of the structural indicators of Medication Review service showed that the ambulatory has met most of the criteria submitted. About the process was able to gather 54 indicators divided into two categories: 21 technical-managerial indicators and 33 technicalassistance indicators. The second stage resulted in a translated and adapted scale for the Portuguese of Brazil used to evaluate the collaborative attitudes of pharmacists and physicians. In the third stage, the analysis of Medication Review service found that 146 patients were treated on average 2.1 ± 1.1 times during the study.The prescriptions of these patients contained3,3±1,9 drugs and24,5% of them had five or more drugs. The study identified 366 drug therapy problems (DTPs) and most frequent was a indication category (67,5%) and it was observed that patients who have had four to five pharmaceutical consultations has 1.14 times more likely to have identified their DTPs (χ2= 33,83; p<0,0001). Moreover, the analysis showed that patients who had between 1-2 pharmaceutical consultations had 1.22 times more likely to have not resolved their DTPs when compared to the group with more than 3 pharmaceutical consultations (χ2= 3,44; p<0,05). This study also reported 173 pharmaceutical interventions, of which 52,6% were intended for physicians, 46,2% for students of medicine and the most of them were accepted (98,7%). Conclusion. The structure and process indicators may be used to evaluate the implementation of Medication Review service. The pharmacist can collaborate with physicians identifying and solving DTPs, as well as assisting in the monitoring and decision making on pharmacotherapy, benefiting the patient. / Introdução. O estudo da qualidade e da implementação de serviços de saúde configura um importante instrumento de mudança e incentivo para que os serviços de atenção à saúde, como os serviços farmacêuticos, cumpram padrões mínimos e promovam uma renovação da sua cultura de trabalho. No Brasil, entretanto o desenvolvimento e a avaliação da qualidade de serviços como a Revisão da Farmacoterapia ainda é incipiente e precisa ser implementada visando aprimorar as práticas de cuidado ao paciente. Objetivo. Avaliar indicadores de estrutura e processo na implementação de um serviço de Revisão da Farmacoterapia no ambulatório de um Hospital Universitário. Metodologia. O estudo foi estruturado em três etapas, de fevereiro de 2012 a março de 2015. A primeira correspondeu a uma pesquisa de desenvolvimento metodológico, na qual indicadores de estrutura e processo foram reunidos da literatura nacional e internacional para serem utilizados na avaliação do Serviço de Revisão da Farmacoterapia. A segunda etapa correspondeu tradução para o português e adaptação transcultural para o Brasil da Scale of Attitudes Toward Physician-Pharmacist Collaboration . A terceira etapa correspondeu a um estudo longitudinal que avaliou o processo de um modelo colaborativo de serviço de Revisão da Farmacoterapia no ambulatório de um Hospital Universitário de Sergipe. Resultados. A partir da literatura (etapa 1) foram levantados, no estudo, 28 indicadores de estrutura divididos nos critérios: instalações físicas, recursos humanos, recursos materiais, documentação e financiamento. A avaliação dos indicadores de estrutura do serviço de Revisão da Farmacoterapia do ambulatório estudado revelou que o mesmo atendeu a maioria dos critérios apresentados. Quanto ao processo foi possível reunir 54 indicadores divididos em duas categorias: 21 indicadores técnico-gerencias e 33 técnico-assistenciais. Da segunda etapa resultou uma escala traduzida e adaptada para o português do Brasil usada para avaliar as atitudes colaborativas de farmacêuticos e médicos. Na terceira etapa, a análise do serviço de Revisão da Farmacoterapia verificou que 146 pacientes foram atendidos em média 2,1±1,1 vezes durante o estudo. As prescrições médicas desses pacientes continham 3,3±1,9 medicamentos e 24,5% das mesmas tinham cinco ou mais medicamentos. No estudo foram identificados 366 problemas relacionados ao uso de medicamentos (PRMs) sendo a maioria de necessidade (67,5%) e foi observado que os pacientes que tiveram 4 a 5 atendimentos farmacêuticos tem 1,14 vezes mais probabilidade de terem seus PRMs identificados (χ2= 33,83; p<0,0001). Ademais, a análise demonstrou que os pacientes que tiveram entre 1 a 2 atendimentos farmacêuticos apresentaram 1,22 vezes mais probabilidade de não terem seus PRMs resolvidos quando comparado ao grupo com mais de 3 atendimentos farmacêuticos (χ2= 3,44; p<0,05). Neste estudo ainda foram notificadas 173 intervenções farmacêuticas, das quais 52,6% foram destinadas aos médicos, 46,2% aos estudantes de Medicina e a maioria delas (98,7%) foi aceita. Conclusão. Os indicadores de estrutura e processo reunidos podem ser utilizados para avaliar a implementação do Serviço de Revisão da Farmacoterapia. O farmacêutico pode colaborar com os médicos identificando e resolvendo PRMs, bem como auxiliando no monitoramento e na tomada de decisão sobre a farmacoterapia, beneficiando o paciente.

Objectives: The objectives of this research were to describe the interactions (formal and informal) in which macrocognitive functions occur and their location on a pediatric intensive care unit (PICU); describe challenges and facilitators of macrocognition using three constructs of space syntax (openness, connectivity, and visibility); and analyze the health care built environment (HCBE) using those constructs to explicate influences on macrocognition. Background: In high reliability, complex industries, macrocognition is an approach to develop new knowledge among interprofessional team members. Although macrocognitive functions have been analyzed in multiple health care settings, the effect of the HCBE on those functions has not been directly studied. The theoretical framework, “Macrocognition in the Health Care Built Environment” (m-HCBE) addresses this relationship. Methods: A focused ethnographic study was conducted, including observation and focus groups. Architectural drawing files used to create distance matrices and isovist field view analyses were compared to panoramic photographs and ethnographic data. Results: Neighborhoods comprised of corner configurations with maximized visibility enhanced team interactions as well as observation of patients, offering the greatest opportunity for informal situated macrocognitive interactions (SMIs). Conclusions: Results from this study support the intricate link between macrocognitive interactions and space syntax constructs within the HCBE. These findings help to advance the m-HCBE theory for improving physical space by designing new spaces or refining existing spaces, or for adapting IPT practices to maximize formal and informal SMI opportunities; this lays the groundwork for future research to improve safety and quality for patient and family care.

The aging population in the U.S. is dramatically increasing; it is predicted that not only will individuals live longer but also that they will live with multiple chronic diseases that could require high levels of medical and social resources. While the aging population increases, the number of health care providers choosing to specialize in caring for the elderly is decreasing just as dramatically. Teams are believed to be a possible response to more efficiently use the providers available, take advantage of alternative provider types, and integrate a range of health and social services to meet patient needs more effectively. Interdisciplinary teams are the best practice in the care of older adults, who require both medical and social services. However, maintaining functional collaborative teams has been an ever-present challenge to health and social care organizations. Research has found that institutional support is critical for teams to benefit patients and organizations alike. This study examined the role of institutional context in supporting interdisciplinary teams (IDT) in the care of older adults through interviews of the management and staff of the Program for All-Inclusive Care of the Elderly (PACE) in six states. PACE organizations must commit to an interdisciplinary model of care consisting of 11 different disciplines from across the professional spectrum. The research question posed for this study was: What elements of institutional context support the use of interdisciplinary teams in the care of older adults? Due to the standardized team structure used, PACE was selected as the model to see how institutions at macro and micro levels support the work done by PACE teams and possibly highlight where support is still lacking. A case study approach drawing upon qualitative methods was used to examine policy-regulative, cultural-cognitive, normative, relational, and procedural elements of institutional context and the extent to which they support collaborative teamwork. Thirty-two interviews were conducted with administrators and team members from seven PACE programs across the country. For these PACE programs, five elements and 14 categories of support were identified by the interviewees. Policy and regulatory elements constrain and systematize behavior. PACE IDT experience these constraints and systems through regulatory body practices, resource allocation, and quality measurement. Cultural-cognitive elements mediate between an IDT's external environmrder to make sense of what is happening. PACE IDTs create meaning through their interactions with their external environments through interdependence, demographic characteristics, and organizational structure. Normative findings constrain behavior and confer the rights and duties of IDT members, which arise from organizational mission and values, leadership, and professient and the response of the IDT in oonal boundaries. Relational elements emphasize relationships among IDT members and team interaction with the organization's environment. Social constructs within the team affect role definition and communication, which support IDT practice. Procedural support standardizes practices to maintain highly functional teams. In order to support IDT practice, PACE organizations highlighted recruitment and retention, time and space, and training and education as the primary ways to support IDTs. These categories illustrate the complexity of supporting teams and actualizing teamwork in practice. These findings suggest that PACE is succeeding in supporting the IDT model and provides lessons for other organizations that wish to do the same.

La collaboration est une compétence essentielle que les futurs médecins doivent développer. La détermination des niveaux de compétence est cruciale dans la planification de cet apprentissage. Les échelles descriptives suscitent un intérêt croissant, car elles décrivent en termes qualitatifs les performances attendues. Nous inspirant de la méthodologie mixte de Blais, Laurier, & Rousseau (2009), nous avons construit en cinq étapes une échelle de niveau de compétence de collaboration: 1) formulation d’une liste d’indicateurs situés à quatre niveaux de la formation médicale (préclinique, externat, résidence junior et sénior) par les chercheurs (n= 3) et un groupe d’éducateurs (n=7), leaders pédagogiques possédant une expertise pour la compétence de collaboration; 2) sondage en ligne comprenant quatre questionnaires portant sur les niveaux de 118 indicateurs, auprès d’enseignants cliniciens représentant les différentes spécialités (n=277); 3) analyse, avec le modèle partial credit de Rasch, des réponses aux questionnaires appariés par calibration concurrente; 4) détermination des niveaux des indicateurs par les éducateurs et les chercheurs; et 5) rédaction de l’échelle à partir des indicateurs de chaque niveau. L’analyse itérative des réponses montre une adéquation au modèle de Rasch et répartit les indicateurs sur l’échelle linéaire aux quatre niveaux. Les éducateurs déterminent le niveau des 111 indicateurs retenus en tenant compte des résultats du sondage et de la cohérence avec le curriculum. L’échelle comporte un paragraphe descriptif par niveau, selon trois capacités : 1) participer au fonctionnement d’une équipe; 2) prévenir et gérer les conflits; et 3) planifier, coordonner et dispenser les soins en équipe. Cette échelle rend explicites les comportements collaboratifs attendus à la fin de chaque niveau et est utile à la planification de l’apprentissage et de l’évaluation de cette compétence. La discordance entre les niveaux choisis par les éducateurs et ceux issus de l’analyse des réponses des enseignants cliniciens est principalement due au faible choix de réponse du niveau préclinique par les enseignants et aux problèmes d’adéquation pour les indicateurs décrivant la gestion des conflits. Cette recherche marque une avan- cée dans la compréhension de la compétence de collaboration et démontre l’efficacité de la méthodologie de Blais (2009) dans un contexte de compétence transversale, en sciences de la santé. Cette méthodologie pourrait aider à approfondir les trajectoires de développement d’autres compétences. / Being able to collaborate is a key competence that physicians need to learn. Determining competence levels is crucial to planning the learning process. By defining performance levels in qualitative terms, descriptive scales are a promising avenue. We developed a five-stage competence-level scale based on Blais, Laurier & Rousseau (2009) mixed methodology: 1) having researchers (n= 3) and a group of educators (n= 7), pedagogical leaders with expertise in the field of collaboration, list indicators that apply to the four training levels (preclinical, clerkship, junior and senior residencies); 2) conducting with clinician teachers, representative of various specialties (n= 277), an online survey that includes four questionnaires on the 118 indicator levels; 3) performing an analysis using the Rasch partial credit model on responses to questionnaires linked through concurrent calibration; 4) having educators and researchers determine the indicator levels; 5) creating a scale based on indicators at each level. The iterative analysis of the responses shows that it fits the Rasch model and distributes indicators on the linear scale on the four levels. The educators were responsible for determining the level of 111 selected indicators by taking into account the results of the survey and coherence with the curriculum. The scale includes a descriptive paragraph for each level as it applies to the 3 abilities : 1) taking part in running the team; 2) preventing and managing conflicts; 3) planning, coordinating and providing care as a team. The scale explains the collaborative behaviors expected at the end of each level and can be used to plan learning and evaluate competence. The source of disagreement between the levels set by the educators and those resulting from the analysis of clinician teacher responses are mostly explained by the low response by teachers at the preclinical level and misfit issues for the indicators describing conflict management. The research provided a broader understanding of collaboration competency and demonstrated the effectiveness of the Blais et al.1 methodology within the context of cross-curricular competency in health sciences. The methodology could be useful to go deaper into other competencies development path.

Whilst technology use has always been a part of the practice of health care delivery, more recently, information technology has been applied to aspects of clinical work concerned with documentation. This thesis presents an analysis of the ways that two professional groups, one clinical and one ancillary, at a single hospital cooperatively engage in a work practice that has recently been computerised. It investigates the way that a clinical group???s approach to and actual use of the system creates problems for the ancillary group. It understands these problems to arise from the contrasting ways that the groups position their use of documentation technology in their local definitions of professional status. The data on which analysis of these practices is based includes 16 hours of video recordings of the work practices of the two groups as they engage with the technology in their local work settings as well as video recordings of a reflexive viewing session conducted with participants from the ancillary group. Also included in the analysis are observational field notes, interviews and documentary analysis. The analysis aimed to produce a set of themes grounded in the specifics of the data, and drew on TLSTranscription?? software for the management and classification of video data. This thesis seeks to contribute to three research fields: health informatics, sociology of professions and social science research methodology. In terms of health informatics, this thesis argues for the necessity for health care information technology design to understand and incorporate the work practices of all professional groups who will be involved in using the technology system or whose work will be affected by its introduction. In terms of the sociology of professions, this thesis finds doctors and scientists to belong to two distinct occupational communities that each utilise documentation technology to different extents in their displays of professional competence. Thirdly, in terms of social science research methodology, this thesis speculates about the possibility for viewing the engagement of the groups with the research process as indicative of their reactions to future sources of outside perturbance to their work.

La collaboration est une compétence essentielle que les futurs médecins doivent développer. La détermination des niveaux de compétence est cruciale dans la planification de cet apprentissage. Les échelles descriptives suscitent un intérêt croissant, car elles décrivent en termes qualitatifs les performances attendues. Nous inspirant de la méthodologie mixte de Blais, Laurier, & Rousseau (2009), nous avons construit en cinq étapes une échelle de niveau de compétence de collaboration: 1) formulation d’une liste d’indicateurs situés à quatre niveaux de la formation médicale (préclinique, externat, résidence junior et sénior) par les chercheurs (n= 3) et un groupe d’éducateurs (n=7), leaders pédagogiques possédant une expertise pour la compétence de collaboration; 2) sondage en ligne comprenant quatre questionnaires portant sur les niveaux de 118 indicateurs, auprès d’enseignants cliniciens représentant les différentes spécialités (n=277); 3) analyse, avec le modèle partial credit de Rasch, des réponses aux questionnaires appariés par calibration concurrente; 4) détermination des niveaux des indicateurs par les éducateurs et les chercheurs; et 5) rédaction de l’échelle à partir des indicateurs de chaque niveau. L’analyse itérative des réponses montre une adéquation au modèle de Rasch et répartit les indicateurs sur l’échelle linéaire aux quatre niveaux. Les éducateurs déterminent le niveau des 111 indicateurs retenus en tenant compte des résultats du sondage et de la cohérence avec le curriculum. L’échelle comporte un paragraphe descriptif par niveau, selon trois capacités : 1) participer au fonctionnement d’une équipe; 2) prévenir et gérer les conflits; et 3) planifier, coordonner et dispenser les soins en équipe. Cette échelle rend explicites les comportements collaboratifs attendus à la fin de chaque niveau et est utile à la planification de l’apprentissage et de l’évaluation de cette compétence. La discordance entre les niveaux choisis par les éducateurs et ceux issus de l’analyse des réponses des enseignants cliniciens est principalement due au faible choix de réponse du niveau préclinique par les enseignants et aux problèmes d’adéquation pour les indicateurs décrivant la gestion des conflits. Cette recherche marque une avan- cée dans la compréhension de la compétence de collaboration et démontre l’efficacité de la méthodologie de Blais (2009) dans un contexte de compétence transversale, en sciences de la santé. Cette méthodologie pourrait aider à approfondir les trajectoires de développement d’autres compétences. / Being able to collaborate is a key competence that physicians need to learn. Determining competence levels is crucial to planning the learning process. By defining performance levels in qualitative terms, descriptive scales are a promising avenue. We developed a five-stage competence-level scale based on Blais, Laurier & Rousseau (2009) mixed methodology: 1) having researchers (n= 3) and a group of educators (n= 7), pedagogical leaders with expertise in the field of collaboration, list indicators that apply to the four training levels (preclinical, clerkship, junior and senior residencies); 2) conducting with clinician teachers, representative of various specialties (n= 277), an online survey that includes four questionnaires on the 118 indicator levels; 3) performing an analysis using the Rasch partial credit model on responses to questionnaires linked through concurrent calibration; 4) having educators and researchers determine the indicator levels; 5) creating a scale based on indicators at each level. The iterative analysis of the responses shows that it fits the Rasch model and distributes indicators on the linear scale on the four levels. The educators were responsible for determining the level of 111 selected indicators by taking into account the results of the survey and coherence with the curriculum. The scale includes a descriptive paragraph for each level as it applies to the 3 abilities : 1) taking part in running the team; 2) preventing and managing conflicts; 3) planning, coordinating and providing care as a team. The scale explains the collaborative behaviors expected at the end of each level and can be used to plan learning and evaluate competence. The source of disagreement between the levels set by the educators and those resulting from the analysis of clinician teacher responses are mostly explained by the low response by teachers at the preclinical level and misfit issues for the indicators describing conflict management. The research provided a broader understanding of collaboration competency and demonstrated the effectiveness of the Blais et al.1 methodology within the context of cross-curricular competency in health sciences. The methodology could be useful to go deaper into other competencies development path.

Whilst technology use has always been a part of the practice of health care delivery, more recently, information technology has been applied to aspects of clinical work concerned with documentation. This thesis presents an analysis of the ways that two professional groups, one clinical and one ancillary, at a single hospital cooperatively engage in a work practice that has recently been computerised. It investigates the way that a clinical group???s approach to and actual use of the system creates problems for the ancillary group. It understands these problems to arise from the contrasting ways that the groups position their use of documentation technology in their local definitions of professional status. The data on which analysis of these practices is based includes 16 hours of video recordings of the work practices of the two groups as they engage with the technology in their local work settings as well as video recordings of a reflexive viewing session conducted with participants from the ancillary group. Also included in the analysis are observational field notes, interviews and documentary analysis. The analysis aimed to produce a set of themes grounded in the specifics of the data, and drew on TLSTranscription?? software for the management and classification of video data. This thesis seeks to contribute to three research fields: health informatics, sociology of professions and social science research methodology. In terms of health informatics, this thesis argues for the necessity for health care information technology design to understand and incorporate the work practices of all professional groups who will be involved in using the technology system or whose work will be affected by its introduction. In terms of the sociology of professions, this thesis finds doctors and scientists to belong to two distinct occupational communities that each utilise documentation technology to different extents in their displays of professional competence. Thirdly, in terms of social science research methodology, this thesis speculates about the possibility for viewing the engagement of the groups with the research process as indicative of their reactions to future sources of outside perturbance to their work.

No / INTRODUCTION: Despite an explosion of interest in improving safety and reducing error in health care, one important aspect of patient safety that has received little attention is a systematic approach to education and training for the whole health care workforce. This article describes an evaluation of an innovative multiprofessional, team-based training program that embeds patient safety within quality improvement methods. METHODS: Kirkpatrick's "levels of evaluation" model was adopted to evaluate the program in health organizations across one city in the north of England. Questionnaires were used to assess reaction of participants to the program (Level 1). Improvements in patient safety knowledge and patient safety culture (Level 2) were assessed using a 12-item multiple-choice questionnaire and a culture questionnaire. Interviews and project-specific quantitative measurements were used to assess changes in professional practice and patient outcomes (Levels 3 and 4). RESULTS: All aspects of the program were positively received by participants. Few participants completed the MCQ at both time points, but those who did showed improvement in knowledge. There were some small but significant improvements in patient safety culture. Interviews revealed a number of additional benefits beyond the specific problems addressed. Most importantly, 8 of the 11 teams showed improvements in patient safety practices and/or outcomes. DISCUSSION: This program is an example of interprofessional education in practice and demonstrates that team-based learning using quality improvement methods is feasible and can be effective in improving patient safety, but requires time and space for participants. Alignment with continuing education arrangements could support mainstream adoption of this approach within organizations. / Introduction: Despite an explosion of interest in improving safety and reducing error in health care, one important aspect of patient safety that has received little attention is a systematic approach to education and training for the whole health care workforce. This article describes an evaluation of an innovative multiprofessional, team-based training program that embeds patient safety within quality improvement methods. Methods: Kirkpatrick's “levels of evaluation” model was adopted to evaluate the program in health organizations across one city in the north of England. Questionnaires were used to assess reaction of participants to the program (Level 1). Improvements in patient safety knowledge and patient safety culture (Level 2) were assessed using a 12-item multiple-choice questionnaire and a culture questionnaire. Interviews and project-specific quantitative measurements were used to assess changes in professional practice and patient outcomes (Levels 3 and 4). Results: All aspects of the program were positively received by participants. Few participants completed the MCQ at both time points, but those who did showed improvement in knowledge. There were some small but significant improvements in patient safety culture. Interviews revealed a number of additional benefits beyond the specific problems addressed. Most importantly, 8 of the 11 teams showed improvements in patient safety practices and/or outcomes. Discussion: This program is an example of interprofessional education in practice and demonstrates that teambased learning using quality improvement methods is feasible and can be effective in improving patient safety, but requires time and space for participants. Alignment with continuing education arrangements could support mainstream adoption of this approach within organizations.