Abstract
Cross-professional collaboration is considered a key element for providing high-quality comprehensive care by combining the expertise of various professions. In many countries, nurses are also being given new and more extensive responsibilities. Implemented concepts of collaborative care need to be analysed within the context of care concepts, organisational structures, and effective collaboration. Background review of primary care concepts (literature analysis, expert interviews), and evaluation of collaboration in 'best practice' health centres in certain regions of Slovenia and Spain. Qualitative content analysis of expert interviews, presentations, observations, and group discussions with professionals and health centre managers. Findings In Slovenian health centres, the collaboration between GPs and nurses has been strongly shaped by their organisation in separate care units and predominantly case-oriented functions. Conventional power structures between professions hinder effective collaboration. The introduction of a new cross-professional primary care concept has integrated advanced practice nurses into general practice. Conventional hierarchies still exist, but a shared vision of preventive care is gradually strengthening attitudes towards team-oriented care. Formal regulations or incentives for teamwork have yet to be implemented. In Spain, health centres were established along with a team-based care concept that encompasses close physician-nurse collaboration and an autonomous role for nurses in the care process. Nurses collaborate with GPs on more equal terms with conflicts centring on professional disagreements. Team development structures and financial incentives for team achievements have been implemented, encouraging teams to generate their own strategies to improve teamwork. Clearly defined structures, shared visions of care and team development are important for implementing and maintaining a good collaboration. Central prerequisites are advanced nursing education and greater acceptance of advanced nursing practice.
Highlights
The findings presented in this paper are focused on concepts and practices of cross-professional collaboration of GPs and nurses in Slovenian and Spanish health centres
They draw on a narrative review of literature available in English on the development of cross-professional primary health care in Slovenia and Spain combined with a qualitative analysis of the current situation in selected health centres based on semi-structured expert interviews, presentations, group discussions and recorded observations
Like many other countries today, Spain and Slovenia are faced with new challenges in primary care created by a changing spectrum of illness and disorders and the growing necessity to find needsbased solutions for complex, long-term health problems
Summary
The World Health Report 2008 (46f) indicated that primary care teams are better able to optimise the care process by assuming the coordinator role, avoiding task fragmentation and improving the continuity of care even for high-demand patients
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