The purpose of this study was to explore the relationship between the formalization of inter-organizational partnerships and collaboration among staff members working together across primary care, mental health and addition organizations to provide services to adults with complex mental health and addiction needs. Phase I of the study provided an environmental scan of existing partnerships among Family Health Teams (FHTs) and Community Health Centres (CHCs), and the Mental Health and/or Addiction (MHA) organizations they partner with, in the province of Ontario (Canada). Phase II explored the relationship between formalization and a) administrative collaboration and b) and service delivery collaboration. The hypotheses proposed that staff members who are part of formalized partnerships would report higher levels of collaboration. Phase III explored how formal and informal partnerships and collaboration are experienced by the administrative and service provider staff members who work across FHTs, CHCs and MHAs organizations. Using a mixed methods approach, data were collected using electronic surveys and telephone interviews. The results of Phase I indicated that FHTs and CHCs in Ontario have between 1-3 partnerships with MHA organizations. Most are informal partnerships, have existed for less than 5 years, and most staff members (partners) interact on a monthly basis. The quantitative results of Phase II showed no significant relationship between formalization and either form of collaboration. The qualitative findings from Phase III provide two key contributions. First, the results of the interviews may help explain why collaboration was not higher in formalized partnerships, as demonstrated by the range of advantages and disadvantages experienced by administrators and service providers in both formal and informal partnerships. Second, the findings illuminate factors related to the process of creating and/or formalizing partnerships, suggesting that there may be other factors that mediate or have a direct impact on the relationship between formalization and collaboration. By bringing together the study findings, the study addresses a gap in the literature by proposing a pathway through which formalization may be associated with collaboration. The results of the study provide opportunities for future research to help improve the quality and accessibility of services to adults with complex mental health and addiction needs.

Background: Considerable attention has been paid to evaluating the roles and relationships of professionals participating in team-based or collaborative practice; however, less attention has been paid to exploring the patients’ views and impact of such practice despite claims of it being patient-centred. Objectives: To examine the relationship between patient and provider characteristics and patients’ ratings of measures of quality of care and integration, and to explore the patient views of care delivered in a patient-centred collaborative study involving chiropractors and physicians. Design: Cross-sectional survey. Method: A mixed methods sequential approach with a quantitative priority was used in data analysis. Quantitative data were collected from 2597 patients participating in a collaborative study involving chiropractors and physicians and 530 patients attending chiropractors not involved in collaborative care. All participants presented with musculoskeletal pain. The Primary Care Assessment Survey (PCAS) was modified and scores from six of its scales were used to assess attributes of quality patient-centred care between the two study groups. Qualitative transcript-based data from six purposefully selected focus groups was analyzed using an interpretivist approach. Results: The revised PCAS demonstrated acceptable psychometric properties. Patients in both study groups received quality, patient-centred care. Patients’ reporting being completely satisfied and feeling improved by their care was positively associated with rating chiropractors as high performers on all scales. Survey findings were confirmed in focus groups of study patients. Patients appreciated positive interpersonal interactions, sharing in the treatment decision-making process, having a choice in provider and treatment, and the provision of holistic care. Patients perceived that collaboration between chiropractors and physicians varied, favouring those who were co-located. Patients with chronic or co-morbid conditions desired greater involvement in their care. Patients felt sharing of clinical information was more important than co-location as facilitating coordination and integration of collaborative care. Conclusion: The study suggests that patients suffering from musculoskeletal pain benefit from interprofessional collaborative care that includes improved access to and choice of providers and treatment options, as well as enhanced interprofessional communication and coordination of care.

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.

Syfte: Syftet med denna studie var att undersöka hur nöjda patienter var med den vård de fått på en klinisk utbildningsavdelning, KUA, och om det fanns skillnader mellan hur nöjda män och kvinnor var med vården. Metod: Data samlades in via enkäter där patienter fick skatta nio olika påståenden samt besvara tre frågor med egna ord. Enkäterna besvarades av 33 patienter. Svaren på de öppna frågorna analyserades med innehållsanalys. Deskriptiv statistik användes för att beskriva patienternas tillfredsställelse med vården. För att påvisa eventuella skillnader i upplevelsen av vårdkvalitet mellan män och kvinnor användes Mann Whitney U-test. Resultat: Resultatet visade att patienterna var mycket nöjda med vården de fått på KUA. Vårdkvaliteten skattades högt och patienterna upplevde framför allt att de blivit positivt bemötta, känt sig trygga vid provtagningar och undersökningar samt fått tillräckligt mycket information inför operationen. Det visade sig att det fanns en signifikant skillnad mellan hur män och kvinnor upplevde informationen de fått efter operationen. De kvinnliga patienterna upplevde i högre grad än männen att de fått tillräcklig information. Slutsats: Vårdkvaliteten på KUA var hög. Det fanns en signifikant skillnad mellan hur män och kvinnor upplevde informationen efter operationen men andra signifikanta skillnader i upplevelser saknades.

Hälso- och sjukvården är en stor och komplex organisation med många professioner och yrkesgrupper bundna till sig. För att skapa en patientcentrerad vård krävs att dessa samarbetar i interprofessionella team. Syftet var att öka kunskapen om hur interprofessionellt arbetssätt kan utvecklas inom hälso- och sjukvården. En litteraturstudie genomfördes med 17 vetenskapliga artiklar som granskades, analyserades och sammanställdes. Resultatet visade att interprofessionellt arbetssätt kunde utvecklas inom hälso- och sjukvården genom studenters och verksam personals interprofessionella lärande och med hjälp av flera metoder. Studenterna kunde utbildas i högskole- eller universitetsmiljö genom teori och simuleringsövningar, under grundutbildningens praktikplacering eller på en klinisk träningsavdelning. Det framkom att en kombination av teori och praktik var en effektiv metod. Utveckling av arbetssättet genom verksam personal kunde ske genom simuleringsövning, utveckling av ett kliniskt lärandecenter eller genom samarbete kring forskning. Ett interprofessionellt arbetssätt bör utvecklas inom hälso- och sjukvården för att bidra till en patientcentrerad vård och till ett fungerande samarbete mellan professioner. Både verksam personal och hälso- och sjukvårdsstudenter bör utbildas kring interprofessionellt arbetssätt. Vidare forskning kring hur arbetssättet kan utvecklas inom hälso- och sjukvården efterfrågas, särskilt gällande utbildningsmetoder för verksam personal. / Health care is a large and complex organization with many professions and other professionals bound to the organization. The aim was to increase the knowledge about how interprofessional working can be developed within health care. A literature study was conducted with 17 scientific articles that were examined, analyzed and compiled. Results showed that interprofessional working could be developed within health care through the learning of students and working personnel and through different methods. The students could be educated in college- and university environment through theory and simulation exercises, during the internship placement or on an interprofessional training unit. It was found that a combination of theory and practice was an effective method. The development through working personnel could be done through simulation exercises, development of a clinical learning unit, or through collaboration around research. Interprofessional working should be developed within health care to contribute to a patient-centered care and to a functioning collaboration between professions. Both working personnel and health care students should be educated about the interprofessional working. Further research into how interprofessional working could be developed in health care is requested, particularly in the training methods for working personnel.

Modern sjukvård har blivit fragmenterad vilket medför nackdelar för patienter och personal. Teamarbete över professionsgränserna har identifierats som ett sätt att motverka fragmentering och erbjuda god heltäckande vård. Detta har relevans för hörselvården där många patienter behöver insatser från olika professioner. Arbetets syfte var att göra en kartläggning av teamarbete inom svensk offentlig hörselvård samt att undersöka hur teamarbetet ser ut. En totalundersökning har gjorts av Sveriges 21 landsting/regioner. Strukturerade intervjuer har genomförts med personer med kunskap om teamarbete inom varje landsting/region. Resultatet visar att teamarbete förekommer inom samtliga landsting/regioner men att både antalet team och deras arbetssätt varierar. De vanligaste är barnteam och team för hörselnedsättning och ytterligare funktionsnedsättning. De flesta team gör målsättning, planering och utvärdering gemensamt. I två av tre team uppges teammedlemmarna delvis kunna ersätta varandra. Olika professioner förekommer i hörselvårdens team. De som förekommer i störst utsträckning är audionomer, pedagoger och kuratorer. 69 % av teamen har en formell teamledare. Audionomer, läkare, kuratorer respektive chefer är teamledare i ungefär samma utsträckning. Interprofessionella aspekter dominerar men det går inte att kategorisera teamen som multi-, inter- eller tvärprofessionella då deras arbetssätt överlappar. Teamarbete upplevs som väsentligt i den offentliga hörselvården och anses fördelaktigt för både patienter och personal.

When the population is getting older, the need for complex care and nursing interventions in elderly care increases. To create a holistic view of the elder and their life situation, interprofessional team collaboration is often desirable and necessary. Teamwork is often described in positive terms, but previous research has shown that this work method is complicated and requires constant reflection and development. The purpose of this study was to investigate how elderly care teamwork is formed in the interaction between representatives of different professionals. To accomplish this purpose, we have studied how the team members define a well-functioning teamwork and difficulties, and how consensus is achieved in the team. This qualitative case-study combines observation and semi-structured interviews with five informants from different professions working together in an elderly care team: one manager, one assistance case worker, one nurse, one physiotherapist and one of the nursing staff. The results of the study were then analyzed with the terms domain consensus and domain conflict taken from the new institutionalism. The study shows that the informants define a well-functioning teamwork as a work method where openness and mutual respect towards each other’s competence, creates a better holistic view of the elder and their needs. The informants also present teamwork difficulties as disagreements and gabble. The study finally suggests that there is a consensus regarding teamwork goals, and regarding who is entitled to claim knowledge in the different fields of the working area. / I takt med en åldrande befolkning ökar också behovet av komplexa vård- och omsorgsinsatser inom äldreomsorgen. Detta leder till att interprofessionell teamsamverkan i många fall är önskvärd och nödvändig för att skapa en helhetssyn över den äldre och dennes livssituation. Teamarbete beskrivs ofta i positiva ordalag, men tidigare forskning har visat att detta arbetssätt är komplicerat och kräver ständig reflektion och utveckling. Vårt syfte med denna studie har varit att studera hur teamarbete i äldreomsorgen formas i samspelet mellan representanter av olika yrkesgrupper. För att uppnå detta syfte har vi studerat hur teamets aktörer definierar ett väl fungerande teamarbete och svårigheter, samt på vilket sätt det råder samförstånd i teamet. Vi har genomfört en kvalitativ fallstudie där vi genom observation och fem intervjuer med yrkesgrupperna enhetschef, biståndshandläggare, sjuksköterska, sjukgymnast och undersköterska har studerat ett team inom äldreomsorgen. Studiens resultat analyserades sedan utifrån begreppen domänkonsensus och domänkonflikt hämtade ur den nyinstitutionella teorin. Studien visar att informanterna definierar ett väl fungerande teamarbete som ett arbetssätt där öppenhet och respekt gentemot varandras kompetenser bidrar till en ökad helhetssyn över den äldre och dennes behov. Informanterna beskrev i sina intervjuer även att svårigheter i form av meningsskiljaktigheter och ”kackel” kan förekomma. Studien visar slutligen att det råder samförstånd gällande teamarbetets mål, samt gällande vem som har rätt att göra anspråk på de olika kunskaperna inom verksamhetsområdet.

Addressing the sub-optimal breastfeeding initiation and duration rates has become a national priority. Inadequate support for addressing early breastfeeding challenges is compounded by a lack of collaboration between providers such as lactation professionals, nurses, pediatricians, and the family. The purpose of this exploratory study was to understand International Board Certified Lactation Consultants' (IBCLCs) perceived barriers to managing early breastfeeding problems. This qualitative study was guided by the symbolic interactionist framework through a grounded theory methodological approach. In-depth interviews were conducted with 30 IBCLCs from across Florida. IBCLCs were from a range of practice settings, including hospitals, WIC clinics, private practice, and pediatric offices. Data were digitally recorded, transcribed, and analyzed in Atlas.ti. A range of barriers were identified and grouped into the following categories: indirect barriers such as social norms, knowledge, attitudes; direct occupational barriers such as institutional constraints, lack of coordination, and poor service delivery; and direct individual barriers including social support and mother's self-efficacy. A model was developed to illustrate the factors that influence the role enactment of IBCLCs in terms of managing breastfeeding problems. IBCLCs overwhelmingly wish to be perceived as valued members of a health care team, but often find interprofessional collaboration is a struggle. However, IBCLCs find creative strategies to navigate challenges and describe their role as pivotal in empowering mothers and their families to meet their breastfeeding goals. Though rarely actualized, IBCLCs place strong value on coordinated, team approaches to breastfeeding management that employ transparent communication between providers and focus on empowering and educating mothers. Strategies for better collaboration and communication between IBCLCs and other providers are needed. Findings provide insight into the management issues of early breastfeeding problems and may lead to future interventions to reduce early weaning, thus increasing the lifelong health benefits of breastfeeding to the infant and mother.

Aim: To evaluate nurse student’s apprehension of an interprofessional seminar as part of training. Method: A descriptive, qualitative study built on the analysis of 43 questionnaires and one group interview with nurse student’s who participated in the seminar. For the analysis of the collected material we used the method of analysis of contents as described by Graneheim and Lundman. Primary results: The analysis highlights five different categories which show the nurse student’s apprehension of the seminar. From the analysis of contents it was established that questions remained unanswered after the seminar and that there remained some uncertainty as for the carrying through of the seminar. It was however also established that the seminar helped the students to gain insight about the profession of physiotherapists and the importance of cooperation. All in all, the students apprehended interprofessional education as a valid part of training. Conclusion: An interprofessional seminar together with physiotherapists was a great initiative taken by the responsible for the nursing course. It is important, however, that the information and the tasks are well prepared, and that there is valid follow-up to any interprofessional seminar, in order to make it as successful as possible. / Syfte: Utvärdera sjuksköterskestudenters uppfattning av interprofessionellt seminarium som utbildningsmoment. Metod: Deskriptiv studie med kvalitativ ansats med enkäter och en fokusgruppintervju. 43 enkäter och en fokusgruppintervju med sjuksköterskestudenter som deltog i det interprofessionella seminariet analyserades med hjälp av Graneheim och Lundmans innehållsanalys. Huvudresultat: Utifrån analysen framkom fem kategorier som belyser hur sjuksköterskestudenterna uppfattade det interprofessionella seminariet. Ur innehållsanalysen framkom att sjuksköterskestudenterna hade kvarstående frågor efter seminariet och att det fanns otydligheter kring seminariets genomförande. Det framkom även att seminariet gav insikt i betydelsen av samarbete, förståelse för sjukgymnasternas profession samt att studenterna upplevde interprofessionell utbildning som ett bra utbildningsmoment. Slutsats: Att genomföra ett interprofessionellt seminarium tillsammans med sjukgymnaster var ett bra initiativ av ansvariga på sjuksköterskeprogrammet. Det är dock viktigt att förberedelserna, informationen och uppgifterna är väl förberedda och att det finns en bra uppföljning, detta för att den interprofessionella utbildningen ska bli så bra som möjlig.

Changes to healthcare delivery models such as the promotion of an interdisciplinary team approach to patient care and increased hiring of unlicensed care providers have resulted in the need for knowledge about effective interdisciplinary teams. The purpose of this study was to describe student experiences in the development of team during an “interdisciplinary” clinical practicum. Participants were in first and third year of the Dalhousie baccalaureate nursing program, first year of the Nova Scotia Community College practical nursing diploma and at the end of the Nova Scotia Community College Continuing Care Assistant certificate program. Using a qualitative descriptive methodology, in-depth interviews were conducted with the eight participants to understand their experience of what made the team during an “Interdisciplinary” Collaborative Clinical Education Project (ICCEP) practicum. Thematic analysis revealed three themes; clinical instructor mentoring, peer attitudes of respect and acceptance, and mutual sharing of knowledge and skill.