Social work supervision is a core component of the social work profession that is often absent for social workers in interprofessional teams. In capital defense practice settings, social workers are hired as mitigation specialists to work as members of the legal team. Informed by systems theory, the purpose of this action research study was to explore the practice challenges of social work mitigation specialists (SWMS) and how an interprofessional-focused supervision approach could be applied to resolve those issues. Six SWMS employed with capital defense agencies in Georgia and Texas were interviewed. Using a thematic coding analysis, several key themes emerged: (a) role navigation, (b) ethical dilemmas as practice challenges, (c) increased competence, and (d) team cohesion as dynamics that will improve with the implementation of an interprofessional-focused supervision approach. These findings provide understanding as to how supervision can be tailored to guide SWMS and other social workers in interprofessional settings. Recommendations for future research involve developing supervision guidelines for social work practice in interprofessional settings. Adhering to these suggestions might provide insight as to how interprofessional teams can work collaboratively, improving practice approaches and interventions to alter systems of service delivery and client outcomes. This provides the opportunity to effect social change by impacting individual practitioners and clients, as well as organizations, systems, and from a political perspective.

Masters Research - Master of Philosopy (MPhil) / For almost 20 years it has been known that the most common cause of preventable adverse events in hospital is communication problems between clinicians (1, 2). Within maternity services, ineffective communication has a strong relationship with adverse events for women and babies (3). Despite this knowledge, the ‘turf wars’ between some midwives and some doctors are a continuing concern. Although the link between poor communications and adverse events has been well known for a long time, no real change in how professions relate to each other has occurred. This dissertation describes a project that was designed to answer the research question: What factors affect interprofessional interaction in birthing units and how do these interactions impact on birthing outcomes? Midwives and doctors from 10 geographically diverse maternity units contributed to this qualitative research project. In-depth interviews were conducted. Analysis and theorizing was guided by feminist Interpretive Interactionism. New findings, about how health services can strengthen interprofessional collaboration in maternity services, are presented and explained. I argue that organisational factors are more important than the personalities of the individuals involved in the interactions because organisational factors frame, direct and limit what discourses and therefore behaviours, are possible. The dissertation ends with some procedural guidelines that show how administrators and clinical leaders can create and maintain collaborative work settings for public sector midwives and doctors.

Nurses and physicians in General Internal Medicine (GIM) work in a complex environment where patients present with complex (co)morbidities; management of such patients requires input from a full range of medical disciplines. In addition, there is regular resident physician changeover every 8-9 weeks in this teaching environment, and patient “flow” problems caused by overcrowding and placement issues. This complexity causes difficulties in the information exchange between nurses and physicians necessary to manage patient care. Multidisciplinary team meetings have been suggested as helpful to interprofessional communication, and in General Internal Medicine these take place in the form of daily “Bullet Rounds”. More recently the use of process engineering approaches has been suggested as a way to increase efficiency in healthcare; this dissertation evaluates its impact on communication between nurses and physicians. The initial observational field study showed that information exchange was the main focus of dialogue in Bullet Rounds, and identified information gaps between nurses and physicians. Script Theory (Schank and Abelson 1977) was used to propose that information gaps in Bullet Rounds are caused by different knowledge and goals, which result in inconsistent scripts. A process engineering intervention took place in General Internal Medicine. Process engineering methods have been proposed as being helpful in process design and improvement in healthcare but have not been systematically evaluated. The researcher conducted a pre and post intervention study of Bullet Rounds in order to identify and analyse the impacts of a process engineering intervention on information exchange between nurses and physicians. The results showed that information loss decreased after the intervention but that resident physicians were not satisfied with the nurses-physician information exchange. The staff and resident physicians appeared to have distinct and different information needs and perspectives, while the nurses felt that the Bullet Rounds process had improved, but that it needed revisiting, and were not aligned with staff physicians on respective roles and responsibilities. The overall results suggest that even after the process engineering intervention, there was still misalignment of goals and scripts between the two groups of physicians and between the physicians and nurses, and strategies for addressing these gaps are proposed.

Nurses and physicians in General Internal Medicine (GIM) work in a complex environment where patients present with complex (co)morbidities; management of such patients requires input from a full range of medical disciplines. In addition, there is regular resident physician changeover every 8-9 weeks in this teaching environment, and patient “flow” problems caused by overcrowding and placement issues. This complexity causes difficulties in the information exchange between nurses and physicians necessary to manage patient care. Multidisciplinary team meetings have been suggested as helpful to interprofessional communication, and in General Internal Medicine these take place in the form of daily “Bullet Rounds”. More recently the use of process engineering approaches has been suggested as a way to increase efficiency in healthcare; this dissertation evaluates its impact on communication between nurses and physicians. The initial observational field study showed that information exchange was the main focus of dialogue in Bullet Rounds, and identified information gaps between nurses and physicians. Script Theory (Schank and Abelson 1977) was used to propose that information gaps in Bullet Rounds are caused by different knowledge and goals, which result in inconsistent scripts. A process engineering intervention took place in General Internal Medicine. Process engineering methods have been proposed as being helpful in process design and improvement in healthcare but have not been systematically evaluated. The researcher conducted a pre and post intervention study of Bullet Rounds in order to identify and analyse the impacts of a process engineering intervention on information exchange between nurses and physicians. The results showed that information loss decreased after the intervention but that resident physicians were not satisfied with the nurses-physician information exchange. The staff and resident physicians appeared to have distinct and different information needs and perspectives, while the nurses felt that the Bullet Rounds process had improved, but that it needed revisiting, and were not aligned with staff physicians on respective roles and responsibilities. The overall results suggest that even after the process engineering intervention, there was still misalignment of goals and scripts between the two groups of physicians and between the physicians and nurses, and strategies for addressing these gaps are proposed.

Thesis (DClinPsychol)--Salomons Centre. BLDSC no. DX208132. / Consultation copy in 2 volumes.

Current literature regarding quality health services frequently identifies interprofessional collaboration (IPC) as essential to patient-centred care, sustainable health systems, and a productive workforce. The IPC literature tends to focus on interprofessionalism and collaboration and pays little attention to the concept of practice, which is thought to be a represented world of objects and processes that have pre-given characteristics practitioners can know cognitively and apply or manage correctly. Many strategies intended to support IPC simplify and codify the complex, contested, and unpredictable day-to-day interactions among interdependent agents that I argue constitute the practices of a community. These strategies are based in systems thinking, which understand the system as distinct from experience and subject to rational, linear logic. In this thinking, a leader can step outside of the system to develop an ideal plan, which is then implemented to unfold the predetermined ideal future. However, changes in health services and healthcare practices are often difficult to enact and sustain.This thesis problematises the concept of ‘practice’, and claims practices as thoroughly social and emergent phenomenon constituted by interdependent and iterative processes of representation (policies and practice guidelines), signification (sense making through negotiation and reflective and reflexive practices), and improvisation (acting into the circumstances that present at the point and in the moments of care). I argue that local and population-wide patterns are negotiated and iteratively co-expressed through relations of power, values, and identity. Moreover, practice (including the practice of leadership or consulting) is inherently concerned with ethics, which I also formulate as both normative and social/relational in nature. I argue that theory and practice are not separate but paradoxical phenomena that remain in generative tension, which in healthcare is often felt as tension between what we should do (best practice) and what we actually do (best possible practice in the contingent circumstances we find ourselves in). I articulate the implications this has for how knowledge and knowing are understood, how organisations change, and how the role of an internal practice consultant is understood. An important implication is that practice-based evidence and evidence-based practice are iterative and coexpressed(not sequential), and while practice is primordial, it is not privileged over theory.I propose that a practice consultant could usefully become a temporary participant in the practices of a particular community. Through a position of ‘involved detachment’, a consultant can more easily notice and articulate the practices of a community that for participants are most often implicit and taken for granted. Reflective and reflexive consideration of what is taken for granted may change conversations and thus be transformative.

No description available.

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.

Introduction: In the new century, worldwide health professionals face new pressures for changes towards more cost-effective and sustainable health care for all populations. Globalization creates daunting challenges as well as new opportunities for institutions and health professionals being more connected and rethink their strategies toward an interprofessional practice. Although Health professionals are paying increased attention to issues of global health, there are no current competency assessment tools appropriate for evaluating their competency in global health. This study aims to assess global health competencies of family medicine residents, nursing, physiotherapy and occupational therapy students in five universities across Ontario, Canada Methods: A total of 429 students participated in the Global Health Competency Survey, drawn from family medicine residency, nursing, physiotherapy and occupational therapy programs of five universities in Ontario, Canada. The surveys were evaluated for face and content validity and reliability. Results: Factor analysis was used to identify the main factors to be included in the reliability analysis. Content validity was supported with one floor effect in the “racial/ethnic disparities” variable (36.1%), and few ceiling effects. Seven of the twenty-two variables performed the best (between 34% and 59.6%). For the overall rating score, no participants had floor or ceiling effects. Five factors were identified which accounted for 95% of the variance. Cronbach’s alpha was >0.8 indicating that the survey items had good internal consistency and represent a homogeneous construct. The results of the survey demonstrated that self-reported knowledge confidence in global health issues and global health skills were low for family medicine residents, nursing, physiotherapy and occupational therapy’ students. The percentage of residents and students who self-reported themselves confident was less than 60% for all global health issues. Conclusion: The Global Health Competency Survey demonstrated good internal consistency and face and content validity. The new century requires professionals competent in global health. Improvements in the core competencies in global health can be a bridge to a more equal world. Institutions must offer interprofessional approaches and a curriculum that exposes them to a varied learning methods and opportunities to improve their knowledge and skills in global health.

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]