Abstract
BackgroundThere is strong evidence that collaborative practice in mental healthcare improves outcomes for patients. The concept of collaborative practice can include collaboration between healthcare workers of different professional backgrounds and collaboration with patients, families and communities. Most models of collaborative practice were developed in Western and high-income countries and are not easily translatable to settings which are culturally diverse and lower in resources. This project aimed to develop a set of recommendations to improve collaborative practice in Malaysia.MethodsIn the first phase, qualitative research was conducted to better understand collaboration in a psychiatric hospital (previously published). In the second phase a local hospital level committee from the same hospital was created to act on the qualitative research and create a set of recommendations to improve collaborative practice at the hospital for the hospital. Some of these recommendations were implemented, where feasible and the outcomes discussed. These recommendations were then sent to a nationwide Delphi panel. These committees consisted of healthcare staff of various professions, patients and carers.ResultsThe Delphi panel reached consensus after three rounds. The recommendations include ways to improve collaborative problem solving and decision making in the hospital, ways to improve the autonomy and relatedness of patients, carers and staff and ways to improve the levels of resources (e.g. skills training in staff, allowing people with lived experience of mental disorder to contribute).ConclusionsThis study showed that the Delphi method is a feasible method of developing recommendations and guidelines in Malaysia and allowed a wider range of stakeholders to contribute than traditional methods of developing guidelines and recommendations.Trial registration Registered in the National Medical Research Register, Malaysia, NMRR-13-308-14792
Highlights
There is strong evidence that collaborative practice in mental healthcare improves outcomes for patients
Collaborative practice is defined by the World Health Organisation as: “when multiple health workers from different professional backgrounds work together with patients, families, carers and communities to deliver the highest quality of care” [1]
The committee were asked to create a set of recommendations for the hospital, based on qualitative research that had been conducted looking at collaborative practice in the hospital [8, 19]
Summary
There is strong evidence that collaborative practice in mental healthcare improves outcomes for patients. Most models of collaborative practice were developed in Western and high-income countries and are not translatable to settings which are culturally diverse and lower in resources. Developing collaborative practice in Malaysia was considered important because qualitative research showed that interactions were often hierarchical, rather than collaborative [8] This was sometimes having a negative effect on patient care, for example nurses not telling doctors if they believed a treatment plan would not work and patients not discussing with their doctors if they had stopped medication due to side effects. Cultural factors affect the way that people work together, and a model of care developed in a Western setting may not be the best model of care for an Asian context These models are complex, with many elements and it is difficult to know what the most important elements for effectiveness are
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