La revue des dysfonctionnements des collaborations : un outil pour améliorer les pratiques de soins ?

Abstract

IntroductionAs they go about their profession, every practitioner sits at the heart of a network of other professionals: colleagues, paramedics, social workers, etc. Over time, a relationship builds up between carers, paralleling the carer–patient relationship. The development of a relationship between carers is key in the field of addiction where treatment often requires intervention by several professionals. Aim of the studyIn this work, we offer a tool called “Cooperation Malfunction Review” (CMR), which is aimed at improving care practices by creating a discussion space on the topic of cooperation between professionals in their various practice settings: Private practice, hospital practice and the community health sector. Materials and methodsWe studied a typical “cooperative” network coordinating an addiction treatment strategy: Some ten meetings were held over the course of slightly more than a year. The clinical cases presented showed similar malfunctioning relationships between carers in monitoring situations in all participating institutions. The meetings were all structured along the same format: Initial greeting, review of the clinical situations presented at the previous session, report on one or two new situations, and a round table for general comments on how the meeting ran. Situations are presented on a voluntary basis and the analysis follows a typical format: What malfunction was revealed? Did the malfunction harm the patient? Did the malfunction harm the carer? Was the malfunction avoidable? What are potential avenues for improvement? ResultsOf the ten situations presented, eight were malfunctions in cooperation, six of them harming the patient and four of the total placing the carer in a difficult position creating a sense of failure. The partners do not all share the same concept of joint monitoring, which is sometimes perceived more as “referring” patients between professionals with no shared monitoring or discussion about how the overall situation is progressing. DiscussionConflicts that are poorly managed or not managed at all undermine the relationship between carers: Effective conflict management in carer relationships is a major factor in preserving the quality of those relationships. The CMR is an important tool for improving relationships and promoting trust among carers and among institutions. The possibility of having a moderating, mediating platform external to the care structures is interesting and important, as is alternating the meeting venues to visit each structure. We recommend alternating the CMR meetings, plus time to discuss other problems such as analysis of clinical cases and situations that went well, and post-graduate training sessions.