Cooperation in Care: Integration of care in networks by steering, coordination and learning

Integration of care delivery is a central theme in many Western countries. This is stimulated through various developments in health care and expectations of policy makers, managers, practitioners and researchers. First of all healthcare needs are changing and costs are rising because of an ageing population. Until 2010 major increases (25-60%) are expected in different forms of cancer, cardio-vascular disease (for example stroke), chronic heart failure, diabetes, dementia, asthma, chronic obstructive pulmonary disease, and muscoloskeletal disorders [1]. In general, these are chronic conditions resulting in disabilities influencing daily activities of living. That is why it is said a different organisation of care is needed in which prevention, cure, long-term care and social services are integrated [2] [3]. Secondly, not only needs are changing but also demands. Patients are becoming clients who expect value for money. According to policy advisers patients will demand more, better, faster and coordinated care [1]. Thirdly, it is said that perspectives in health care are broadening from a biological medical model of diagnosis and treatment towards a bio-psycho-social model with a more holistic view of the patient [1] [4]. Patient care is therefore no longer based on ad hoc encounters with individual care professionals but on multi-professional teamwork, usually with professionals working for different care organisations [5] [6]. Furthe

Transferring skills in quality collaboratives focused on improving patient logistics

Background: A quality improvement collaborative, often used by the Institute for Healthcare Improvement, is used to educate healthcare professionals and improve healthcare at the same time. However, no prior research has been done on the knowledge and skills healthcare professionals need to achieve improvements or the extent to which quality improvement collaboratives help enhance both knowledge and skills. Our research focused on quality improvement collaboratives aiming to improve patient logistics and tried to identify which knowledge and skills ar

Detach Yourself:The Positive Effect of Psychological Detachment on Patient Safety in Long-Term Care

OBJECTIVES: Delivering health care is emotionally demanding. Emotional competencies that enable caregivers to identify and handle emotions may be important to deliver safe care, as it improves resilience and enables caregivers to make better decisions. A relevant emotional competence could be psychological detachment, which refers to the ability to psychologically detach from work and patients in off-duty hours. The objective of this study was to examine the relationship between psychological detachment and patient safety. In addition, the ability of teams to create a safe environment to discuss errors and take personal risks, i.e., psychological safety, was explored as an underlying condition for psychological detachment. METHODS: A total of 1219 caregivers (response rate = 44%) from 229 teams in two long-term care organizations completed a survey on psychological safety and psychological detachment at T0. Team managers rated patient safety of those teams at two points in time (T0 and T1). RESULTS: Two-level regression analysis showed that both psychological safety (β = 0.72, P < 0.01) and psychological detachment (β = 0.54, P < 0.05) relate directly to patient safety. Psychological safety relates positively to psychological detachment (β = 0.48, P < 0.01) but was, however, not an underlying condition. CONCLUSIONS: Perceived patient safety is enhanced by emotional competencies, at individual level by psychological detachment and at team level by psychological safety. Caregivers should be aware of the important influence emotional competencies have on patient safety and be trained to develop these competencies. Future research should focus on exploring underlying conditions for emotional competencies

Factors and interventions determining the functioning of health care teams in county-level hospitals in less affluent areas of China:a qualitative study

Background: Teamwork is essential for the quality and safety of care, and researchon teamwork in health care has developed rapidly in many countries. However,evidence from less affluent, non-Western countries is scarce, while improvingteamwork may be especially relevant to be able to increase the quality of care inthese settings. This study aims to understand the main factors that influence, andinterventions used to improve, the functioning of health care teams in the contextof county-level hospitals in less affluent areas of China.Methods: We conducted semistructured interviews to explore the factors thatinfluence team functioning and the interventions implemented to improve teamfunctioning in these hospitals. 15 hospital presidents and 15 team leaders wereselected as respondents.Results: From the interviews, we have identified five main factors that influenceteam functioning in these hospitals: “stuck in the middle”, local county setting,difficulty in attracting and retaining talent, strong focus on task design, andstrong focus on leadership. The interventions for improving team functioningcan mostly be categorized as the following: 1) measures to attract and retaintalent (e.g., increase salary, train talent in national or provincial level hospitals,and provide fast-track promotions), 2) interventions focused on monodisciplinaryteams (e.g., changing the team structure and leadership, and skill training), and3) interventions to establish and improve multidisciplinary teams (e.g., simulationtraining and continuous team process improvements).Conclusion: With the introduction of multidisciplinary teams, interventions intoteam processes have started to receive more attention. The findings depict anoverview of the main factors and interventions as specifically relevant for teamfunctioning in county-level hospitals in less affluent areas of China and mayhelp these hospitals benefit from additional process interventions to improveteamwork and the quality of care

Similarities and Differences between Nurses' and Physicians' Clinical Leadership Behaviours:A Quantitative Cross-Sectional Study

Background:Being a nurse or physician in today's complex healthcare practice involves more than just responsibility for one aspect of care during one episode in a patient's care trajectory. Both professionals are expected to take on a clinical leadership role and contribute positively to the reduction of care fragmentation and help in spanning professional boundaries. Although nurses may be well placed to identify the needs for integration, they may lack the position and status (compared to physicians) to address those needs as leaders. The aim of this study is to analyse similarities and differences between nurses and physicians in clinical leadership roles within a hospital context and explore how this relates to their interdisciplinary collaborative behaviours and perception on their job. Method:A cross-sectional survey among physicians and nurses was conducted to measure clinical leadership, job satisfaction, workload, and interdisciplinary collaborative behaviours. Results:Our results suggest that nurses (n = 329) and physicians (n = 100) show similar clinical leadership behaviours, based on equivalent scores on the clinical leadership scale. However, physicians score higher on the global leadership scale indicating they are more likely to perceive themselves as leaders than nurses. As clinical leaders, both nurses and physicians are more likely to express interdisciplinary collaborative behaviours. Furthermore, physicians who scored higher on the clinical leadership scale reported higher satisfaction with their job, whereas, for nurses, their score on the clinical leadership scale did not relate to their job satisfaction. Conclusion:As nurses in hospitals have the most frequent and direct involvement with patients, it seems inevitable for them to act as clinical leaders to promote patient-centred care. However, nurses less often perceived themselves as clinical leaders while showing suitable behaviours. Future studies should focus on the strategies nurses use to exert their clinical leadership, and for example, if nurses require the use of more dominant strategies to effect change.</p

Organization and Outcomes of Integrated Inpatient Medical and Psychiatric Care Units:A Systematic Review

Abstract Objective: The goal of this review was to assess the relationships among aims, designs, and outcomes of integrated inpatient medical and psychiatric care units (IMPUs) and gather the evidence base on the effectiveness of these units. Methods: Using online searches of Embase, Medline, Web of Science, PsycINFO, Scopus, CINAHL, Cochrane, and Google Scholar, the authors identified and reviewed literature describing the aims and outcomes of specific IMPU designs. Results: The search yielded 55 studies, in which the authors identified 39 IMPUs that focused on patients with mood, psychotic, somatic symptom, substance use, organic, and personality disorders and a broad array of medical diagnoses. Most units were psychiatric-medical units and had medium medical and psychiatric acuity capabilities. The studies reviewed provided little information on the cost-effectiveness of various IMPU designs. Although some comparative studies indicated reductions in hospital length of stay (LOS), these studies were generally of low quality and rarely reported other intended outcomes. Conclusions: IMPUs may help shorten LOS. IMPUs should focus care on patients with complex conditions and high acuity to maximize health system value. Implementing compulsory admission facilities; qualified psychiatric, medical, and nursing staff involvement; and cross-disciplinary training may improve IMPUs’ capacity to treat high-acuity patients. Future research should relate IMPU designs to intended outcomes

Interventions to improve team effectiveness within health care

Background: A high variety of team interventions aims to improve team performance outcomes. In 2008, we conducted a systematic review to provide an overview of the scientific studies focused on these interventions. However, over the past decade, the literature on team interventions has rapidly evolved. An updated overview is therefore required, and it will focus on all possible team interventions without restrictions to a type of intervention, setting, or research design. Objectives: To review the literature from the past decade on interventions with the goal of improving team effectiveness within healthcare organizations and identify the "evidence base" levels of the research. Methods: Seven major databases were systematically searched for relevant articles published between 2008 and July 2018. Of the original search yield of 6025 studies, 297 studies met the inclusion criteria according to three independent authors and were subsequently included for analysis. The Grading of Recommendations, Assessment, Development, and Evaluation Scale was used to assess the level of empirical evidence. Results: Three types of interventions were distinguished: (1) Training, which is sub-divided into training that is based on predefined principles (i.e. CRM: crew resource management and TeamSTEPPS: Team Strategies and Tools to Enhance Performance and Patient Safety), on a specific method (i.e. simulation), or on general team training. (2) Tools covers tools that structure (i.e. SBAR: Situation, Background, Assessment, and Recommendation, (de)briefing checklists, and rounds), facilitate (through communication technology), or trigger (through monitoring and feedback) teamwork. (3) Organizational (re)design is about (re)designing structures to stimulate team processes and team functioning. (4) A programme is a combination of the previous types. The majority of studies evaluated a training focused on the (acute) hospital care setting. Most of the evaluated interventions focused on improving non-technical skills and provided evidence of improvements. Conclusion: Over the last decade, the number of studies on team interventions has increased exponentially. At the same time, research t

Do quality improvement collaboratives’ educational components match the dominant learning style preferences of the participants?

Background: Quality improvement collaboratives are used to improve healthcare by various organizations. Despite their popularity literature shows mixed results o