Introduction: Remote Area Medical (RAM), a non-profit organization serving underserved populations, partnered with East Tennessee State University to provide a unique learning opportunity for student volunteers at a clinic in rural Appalachia. Interprofessional student teams were established with undergraduate and graduate students in multiple professions. This study examined the impact on attitudes of students who participated and the impact of student teams on the event, hypothesizing that a positive impact would be seen on both. COVID-19 adjustments made were also evaluated. Methods: Surveys of student participants were conducted electronically utilizing REDCap before and after participation in the event. Surveys included demographic questions, validated surveys, and open-ended questions. Demographic questions gauged personal background, level of education, and history of interprofessional education or events. The previously validated surveys utilized were the Interprofessional Collaborative Competency Attainment Scale-Revised (ICAAS-R) and the Student Perceptions of Interprofessional Clinical Education-Revised Instrument Version 2 (SPICE-R2). Quantitative data was analyzed with SPSS version 25. Qualitative data was analyzed with deductive coding. Interventions were tallied by student teams during the event. Results: Eighty-nine students participated logging 1,213 interventions and 84 completed portions of the survey (94% response rate). ICAAS-R (n=79) displayed mean increases from 4.19 out of 5 in the pre-survey to 4.58 in the post-survey (p Conclusion: Statistically significant quantitative findings and qualitative themes supported the hypothesis that working in interprofessional teams at a RAM event would positively impact student attitudes towards interprofessional practice, and that student teams would have a positive impact on the event. COVID-19 adjustments made were well perceived. Findings can be summarized with the I.M.P.A.C.T. neumonic.

SUMMARY This thesis addresses improvement capability at the front lines of healthcare with a focus on interprofessional health care improvement teams who provide care and improve care. The overall aim is to explore high performing clinical microsystems and evaluate interventions to cultivate health care improvement capabilities of frontline interprofessional teams. Methods Descriptive and evaluative study designs were employed in the five studies which comprise this thesis. A total of 495 interprofessional health care providers from a variety of health care contexts in the United States (Study I, II, III & IV) and Sweden (Study V) participated in the studies. The mixed methods research included qualitative observation, interviews, focus groups and surveys analyzed with qualitative manifest content analysis. The quantitative data were analyzed with statistics appropriate for non-parametric data. Findings Study I and II describe how leaders who understand health care improvement can create conditions for interprofessional teams to provide care and simultaneously improve care. Study III evaluates adapted clinical microsystem processes and tools successfully adapted in two different hospitals. Frontline staff reported that they needed help to balance providing care and improving care. Study IV and V explored and tested team coaching to help interprofessional teams to increase their improvement capabilities within improvement collaboratives. The participants perceived team coaching mostly positively and identified supportive coaching actions. In Study V an intervention with “The Team Coaching Model” was tested in Sweden and showed increased acquisition of improvement knowledge in the intervention teams compared to teams who did not receive the coaching model. Conclusions The thesis findings show leaders can help cultivate health care improvement capability by designing structures, processes and outcomes of their organizational systems to support health care improvement activities, setting clear improvement expectations of all staff, developing the knowledge of every staff member in the microsystem to know their operational processes and systems to promote action learning in their daily work, and providing help with team coaching using a Team Coaching Model.

During transitions of care, great opportunity exists for miscommunication, poor care coordination, adverse events, medication errors and unnecessary healthcare utilization costing billions of dollars annually. An Interprofessional Transitions of Care (IPTC) clinic was developed utilizing a Family Medicine team that included physicians, nurses, a clinical social worker, and a clinical pharmacist. The purpose of this study was to determine if utilization of an IPTC clinic prevented hospital readmission, and to identify factors that predict most benefit from an interprofessional approach to transitions of care. A retrospective chart review of 1,001 patients was completed. A treatment group (TG) of 501 patients were offered IPTC clinic appointments following hospital discharge. A control group (CG) of 500 patients were hospitalized and received traditional follow-up prior to development of the IPTC clinic. Traditional follow-up typically consisted of an automated appointment reminder and a physician office visit. Outcomes assessed included 30-day hospital readmission of TG versus CG, and whether patient characteristics predisposed specific patient groups to attend IPTC appointments or benefit more from IPTC participation. Compared with CG, patients who completed an IPTC appointment were 48% less likely to be readmitted to the hospital within 30 days. Patients with congestive heart failure and cellulitis particularly benefited from IPTC. Telephone contact within two business days of discharge was the greatest predictor of patients attending an IPTC appointment. These results demonstrate that an interprofessional approach to transitions in care effectively addresses this high risk for error and high cost time in the continuum of care.

People with serious mental illnesses (SMIs) (e.g., schizophrenia, major depressive disorder, bipolar disorder) receive inadequate medical care, which is associated with high rates of avoidable morbidity and premature mortality. Assertive Community Treatment (ACT) is an evidence-based service delivery model that provides intensive mental and social health support to clients with SMI. It has been suggested that ACT should provide primary care services to address client physical health, however, initiatives towards this and their implications are not well understood. I used a case study approach and semi-structured interviews to explore five ACT teams in the Ottawa region to discover team members’ mental models of primary care, relationships with external primary care providers, and the perceived impact COVID-19 has had on these mental models. I used Shared Mental Model (SMM) theory to frame data collection and a thematic analysis. The results showed that ACT team members similarly perceived primary care as important for the holistic health of their clients. They described ACT’s psychosocial scope and how they support clients’ access to external primary care services and their work to mitigate barriers. Teams did not share mental models about the basic primary care services they provided or which roles delivered them, due to differences in context and team members’ comfort. Team members also did not share beliefs about the future of ACT and primary care integration. Finally, the COVID-19 pandemic changed and challenged primary care delivery, with beliefs becoming more negative overall. This thesis provides insight into how primary care could be delivered to ACT clients and where challenges and improvements can be addressed.

Syftet var att studera hälso- och sjukvårdskuratorers erfarenheter av att arbeta i tvärprofessionella team samt hur det upplever sin egen yrkesroll. Vidare studerades deras erfarenheter av hur de upplevt att pandemin påverkat deras och teamets arbete. Informationen samlades in genom halvstrukturerade intervjuer med sex hälso- och sjukvårdskuratorer inom två olika verksamheter. Vår empiri analyserades med stöd av systemteori, interaktionsritualer och emotionell energi samt tidigare forskning. Av resultatet framgick å ena sidan att kuratorerna såg positivt på att ingå i tvärprofessionella team eftersom det var givande för både dem själva som professionella och för patienterna. Bidragande orsaker var bland annat patientcentrerad vård, emotionellt stöd, bredare kunskapsbas och främjandet av arbetsglädjen. Hög arbetsbelastning och tidsbrist visade sig å andra sidan vara en negativ faktor som kunde påverka samarbetet. Resultatet kunde urskilja att kuratorn inte hade någon tydlig arbetsbeskrivning och att konsekvenser av yrkesrollens otydlighet kunde orsaka en känsla av att vara vårdens slasktratt och en svårighet i att förstå rollens avgränsningar. Trots att kuratorerna upplevde en god kommunikation så nämndes försvårande omständigheter som för stora team, tidsbrist, förändrade kommunikationsvägar utifrån pandemin samt övergången till digitala möten i relation till fysiska. En slutsats vi gör är att ett samarbete kräver sociala relationer och sammanhållning och att en möjliggörande faktor till detta är mindre team med en balanserad samarbetsstruktur och tydlig arbetsbeskrivning för samtliga professioner i teamet.Hälsofrämjande aspekter behöver även få en högre prioritet i det digitala arbetssättet som pandemin bidragit till för att stärka sociala relationer och samarbetet i det tvärprofessionella teamet. / The aim was to study the experience of healthcare curators working in cross-professional teams and how they experience their own professional role. Furthermore, their experiences of how they experienced the pandemic affected their work and that of the team were studied. The information was collected through semi-structured interviews with six healthcare curators in two different activities. Our empirical data was analyzed using system theory, interaction rituals and emotional energy, as well as previous research. The results showed, on the one hand, that the curators were positive about being part of cross-professional teams because it was rewarding for both themselves as professionals and for patients. Contributing causes included patientcentred care, emotional support, a broader knowledge base and the promotion of job satisfaction. High workload and lack of time, on the other hand, proved to be a negative factor that could affect cooperation. The result could discern that the counsellor had no clear job description and that consequences of the ambiguity of the professional role could cause a feeling of being the sleagre steering wheel of care and a difficulty in understanding the boundaries of the role. Although the curators experienced good communication, aggravating circumstances such as magnifying teams, lack of time, changing communication paths based on the pandemic and the transition to digital meetings in relation to physical ones were mentioned. One conclusion we make is that collaboration requires social relationships and cohesion and that an enabling factor to this is smaller teams with a balanced collaboration structure and clear job description for all professions in the team. Health promotion aspects also need to be given a higher priority in the digital way of working that the pandemic has contributed to in order to strengthen social relations and cooperation in the cross-professional team.

For too many of us, the implications of a worldwide pandemic unfolded in graduated stages of understanding that seemed too sluggish for the opponent we faced. For too many of us, even those of us in health care, the unfolding was terrifying; we felt blindsided and unprepared. If coronavirus disease 2019 (COVID-19) were a bully picking a fight, they got the first punch in before we even raised a fist. Now, many rounds in, health care teams will have an opportunity to deploy a new weapon against COVID-19. Vaccines are coming. We do not know when, who will pay for them, or the logistical aspects (e.g., storage and administration). We do not even know how effective they will be. Moreover, we must plan for mass vaccination in a chaotic and politically charged context that bears little resemblance to the ones with which we have experience. Nevertheless, in this fight, vaccines could be our winning blow. We are getting better at working with unknowns and in disrupted environments during COVID-19. We have some time to prepare, and we have some extant knowledge and experience in vaccine distribution and uptake. Health care teams can use these to best their adversary, and we can and should begin now. The aim of this article is to discuss how to mobilize interprofessional teams within systems of care to engage best practices in vaccine dissemination and uptake in the unique COVID-19 context. We begin by discussing challenges to dissemination and uptake and then provide solutions using our experiences in the primary care system.

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