Sustainable interprofessional teamwork needs a team-friendly healthcare system: Experiences from a collaborative Dutch programme

The significance of effective interprofessional teamwork to improve the quality of care has been widely recognised. Effective interprofessional teamwork calls on good collaboration between professionals and patients, coordination between professionals, and the development of teamwork over time. Effective development of teams also requires support from the wider organisational context. In a Dutch village, healthcare professionals work closely together, and mutual consultations as well as interprofessional meetings take place on a regular basis. The network was created as a precondition for sustainable interprofessional teamwork in elderly care. However, several external barriers were experienced regarding the supportive structure and cooperative attitude of the healthcare insurer and municipality. The aim of the article is to examine these experience-based issues regarding internal organisation, perspective, and definition of effective teamwork. Complicating factors refer to finding the right key figures, and the different perspectives on team development and team effectiveness. Our conclusion is that the organisation of healthcare insurance companies needs to implement fundamental changes to facilitate an interprofessional care approach. Furthermore, municipalities should work on their vision of the needs and benefits of a fruitful collaboration with interprofessional healthcare teams. The challenge for healthcare teams is to learn to speak the language of external partners. To support the development of interprofessional teams, external parties need to recognise and trust in a shared aim to provide quality of care in an efficient and effective way

Implementing experience sampling technology for functional analysis in family medicine: a design thinking approach

Background: A paradigm shift in health care from illness to wellbeing requires new assessment technologies and intervention strategies. Self-monitoring tools based on the Experience Sampling Method (ESM) might provide a solution. They enable patients to monitor both vulnerability and resilience in daily life. Although ESM solutions are extensively used in research, a translation from science into daily clinical practice is needed. Objective: To investigate the redesign process of an existing platform for ESM data collection for detailed functional analysis and disease management used by psychological assistants to the general practitioner (PAGPs) in family medicine. Methods: The experience-sampling platform was reconceptualized according to the design thinking framework in three phases. PAGPs were closely involved in co-creation sessions. In the ‘understand’ phase, knowledge about end-users’ characteristics and current eHealth use was collected (nominal group technique – 2 sessions with N = 15). In the ‘explore’ phase, the key needs concerning the platform content and functionalities were evaluated and prioritized (empathy mapping – 1 session with N = 5, moderated user testing – 1 session with N = 4). In the ‘materialize’ phase, the adjusted version of the platform was tested in daily clinical practice (4 months with N = 4). The whole process was extensively logged, analyzed using content analysis, and discussed with an interprofessional project group. Results: In the ‘understand’ phase, PAGPs emphasized the variability in symptoms reported by patients. Therefore, moment-to-moment assessment of mood and behavior in a daily life context could be valuable. In the ‘explore’ phase, (motivational) functionalities, technological performance and instructions turned out to be important user requirements and could be improved. In the ‘materialize’ phase, PAGPs encountered barriers to implement the experience-sampling platform. They were insufficiently facilitated by the regional primary care group and general practitioners. Conclusion: The redesign process in co-creation yielded meaningful insights into the needs, desires and daily routines in family medicine. Severe barriers were encountered related to the use and uptake of the experience-sampling platform in settings where health care professionals lack the time, knowledge and skills. Future research should focus on the applicability of this platform in family medicine and incorporate patient experiences

Successful participation of patients in interprofessional team meetings: a qualitative study

Background: The number of people with multiple chronic conditions increases as a result of ageing. To deal with the complex health-care needs of these patients, it is important that health-care professionals collaborate in interprofessional teams. To deliver patient-centred care, it is often recommended to include the patient as a member of the team. Objective: To gain more insight into how health-care professionals and patients, who are used to participate in interprofessional team meetings, experience and organize patient participation in the team meetings. Methods: A qualitative study including observations of meetings (n=8), followed by semi-structured interviews with participating health-care professionals (n=8), patients and/or relatives (n=11). Professionals and patients were asked about their experiences of patient participation immediately after the team meetings. Results from both observations and interviews were analysed using content analysis. Results: The findings show a variety of influencing factors related to patient participation that can be divided into five categories: (i) structure and task distribution, (ii) group composition, (iii) relationship between professionals and patients or relatives, (iv) patients’ characteristics and (v) the purpose of the meeting. Conclusion: Patient participation during team meetings was appreciated by professionals and patients. A tailored approach to patient involvement during team meetings is preferable. When considering the presence of patients in team meetings, it is recommended to pay attention to patients’ willingness and ability to participate, and the necessary information shared before the meeting. Participating patients seem to appreciate support and preparation for the meeting

Development of a conversation approach for practice nurses aimed at making shared decisions on goals and action plans with primary care patients

Abstract Background Primary care nurses play a crucial role in setting personal goals and action plans together with chronically ill patients. This may be a challenge for practice nurses, who are often trained to adopt protocol-based work routines. The aim of this study was to systematically develop a conversation approach, and a corresponding training course, for practice nurses aimed at making shared decisions about goals and actions with their chronically ill patients. Methods The 6-step iterative Intervention Mapping protocol was used as a framework. This paper describes the first four steps of the protocol. After the first step, in which literature studies as well as qualitative studies were conducted, the overall aim and objectives for the approach were formulated (step 2). In step 3, methods and strategies for the approach were chosen, which were translated into practical components in step 4. In addition, a pilot study was conducted. Results The main objectives of the approach focus on the ability of practice nurses to explore the patients’ perspectives from a holistic point of view, to explicitly formulate goals and action plans, to tailor shared decision making about goals and action plans to individual patients, and to continuously reflect on work-related attitudes. The approach consists of a practical framework for shared decision making about goals and actions. The framework involves a tool for exploring patients’ perspectives and a tool for identifying patient profiles, to facilitate tailoring shared decision making. A comprehensive training course for practice nurses was developed. Conclusion We systematically developed a conversation approach, involving a practical framework with several tools, which aims to support practice nurses in making shared decisions about goals and actions with their patients. As practice nurses need support in their learning process to be able to share decisions with patients, we also developed a comprehensive training course for them. The approach and the training course were developed in close collaboration with important stakeholders. Some critical factors for the implementation of the approach were revealed. These factors will be addressed in the next step, a process evaluation (not part of this paper)

Wat maakt samen beslissen zo complex?: Evaluatie van een aanpak voor praktijkondersteuners

Inleiding Van praktijkondersteuners wordt verwacht dat zij samen met chronische zieke patiënten doelen en actieplannen formuleren. Dit vraagt een verandering van hun rol: van medisch expert naar coach. Wij onderzochten de ervaringen van praktijkondersteuners en patiënten met COACH, een nieuwe aanpak voor gezamenlijke besluitvorming, en hun mening over de implementatiemogelijkheden van deze aanpak. Methode Vijftien praktijkondersteuners in Noord-Limburg kregen een training in de nieuwe aanpak; 23 patiënten deden mee aan het onderzoek. De kwantitatieve en kwalitatieve procesevaluatie omvatte individuele interviews (n = 15), een focusgroep (n = 9) en vragenlijstonderzoek bij de praktijkondersteuners, interviews met patiënten (n = 10) en dertien audio-opnamen van een consult. Resultaten De praktijkondersteuners vonden COACH waardevol om tot persoonsgerichte doelen te komen, maar moeilijk te integreren in de bestaande werkroutines. Ze ervoeren een rolconflict ten aanzien van het medisch protocol en voelden zich daarin weinig ondersteund door de huisartsen. De helft van de geïnterviewde patiënten merkte geen verschil in de werkwijze van de praktijkondersteuner; de anderen meldden dat de praktijkondersteuner meer vragen had gesteld en dat zij meer inzicht in hun situatie hadden gekregen. Conclusie Om praktijkondersteuners daadwerkelijk te kunnen inschakelen bij gezamenlijke besluitvorming, zullen praktijkondersteuners en huisartsen samen moeten nadenken over een gezamenlijke rolopvatting

Patient involvement in interprofessional education: a qualitative study yielding recommendations on incorporating the patient’s perspective

Background: Patient involvement in interprofessional education (IPE) is a new approach in fostering person-centeredness and collaborative competencies in undergraduate students. We developed the Patient As a Person (PAP-)module to facilitate students in learning from experts by experience (EBEs) living with chronic conditions, in an interprofessional setting. This study aimed to explore the experiences of undergraduate students, EBEs and facilitators with the PAP-module and formulate recommendations on the design and organization of patient involvement in IPE. Methods: We collected data from students, EBEs and facilitators, through eight semi-structured focus group interviews and two individual interviews (N = 51). The interviews took place at Maastricht University, Zuyd University of Applied Sciences and Regional Training Center Leeuwenborgh. Conventional content analysis revealed key themes. Results: Students reported that learning from EBEs in an interprofessional setting yielded a more comprehensive approach and made them empathize with EBEs. Facilitators found it challenging to address multiple demands from students from different backgrounds and diverse EBEs. EBEs were motivated to improve the personcentredness of health care and welcomed a renewed sense of purpose. Conclusions: This study yielded six recommendations: (a) students from various disciplines visit an EBE to foster a comprehensive approach, (b) groups of at least two students visit EBEs, (c) students may need aftercare for which facilitators should be receptive, (d) EBEs need clear instruction on their roles, (e) multiple EBEs in one session create diversity in perspectives and (f) training programmes and peer-to-peer sessions for facilitators help them to interact with diverse students and EBEs

Involving patients in undergraduate health professions education:What's in it for them?

OBJECTIVES: Patients have become more involved in research, policy, and health professions education. They are involved in teaching students competencies required for person-centred care, but patient benefits have not received proper attention. This exploratory study identifies how patient involvement in health professions education help patients to practice self-management and shared decision-making. METHODS: Individual interviews were conducted with patients (hereafter 'experts by experience') (N = 11) who participated in the Patient As a Person Module, organised for students of health professions in The Netherlands. Additionally, one of their healthcare professionals (N = 10) and family members (N = 9) were interviewed. Directed content analysis was used. RESULTS: Participants reported that sharing lived experiences helped experts by experience to reflect on their preferences regarding health and healthcare, accept their changed selves, and obtain a renewed sense of purpose. They reported gaining insight into the perspectives of healthcare professionals, which yielded more equal healthcare professional-patient relationships. CONCLUSIONS: Sharing their lived experiences with health and health care with students could help patients in practising effective self-management and participate in shared decision-making. PRACTICE IMPLICATIONS: Approaching patient involvement in health professions education from both the perspectives of students and experts by experience, as opposed to students alone, optimises its societal impact