Effective Interprofessional Communication Research Articles

Hospital to community in Wales: What is the value of optometrists playing a greater role in managing neovascular AMD and glaucoma in primary care?

To evaluate the value of enhanced optometric services for managing neovascular age-related macular degeneration (nAMD) and glaucoma in primary care optometry services, instead of hospital eye services (HES). Seven enhanced optometric service pathways in primary care in Wales were assessed with a mixed-methods approach: three for nAMD and four for glaucoma. The methods were a patient-related experience measure (PREM), a Realist Review and Evaluation involving both patients and staff, a discrete event simulation model estimating the economic impact of the pathways and a workforce survey of optometrists to gauge capability and capacity. Patient-related experience measure responses (802) indicated that primary care experience was comparable to that of HES. Utilising enhanced optometric services in primary care resulted in reduced wait times compared with HES, with suspected nAMD shortened to 4-5 days and glaucoma monitoring to 5 days. Waiting lists were dramatically reduced with primary care-based services to just three people waiting for nAMD and five for glaucoma, compared with 216 and 5691 people, respectively, in HES. Consultant ophthalmologist time was reduced from 57% to 15%-16% for nAMD services and from 48% to 22%-23% for glaucoma services. Integrating enhanced optometric services into primary care incurred a similar cost. The workforce survey confirms that optometrists possess the skills and qualifications and are willing to deliver these enhanced optometric services. The Realist Review and Evaluation revealed that clear patient communication, effective coordination and strong interprofessional communication between optometrists and ophthalmologists along with a shared electronic record are crucial to the success of this change. Providing enhanced optometric services in primary care for nAMD and glaucoma brings substantial benefits for the UK National Health Service and patients, including reduced waiting times, waiting lists and released HES capacity. The success of this transition hinges on clear patient communication, administrative co-ordination and effective interprofessional communication.

SP7.10 - Awareness and Knowledge of Medical Coding Education Amongst Vascular Surgeons: A National Survey

Abstract Aims Accurate medical coding plays a critical role in optimising healthcare delivery, facilitating appropriate reimbursement, supporting research and data analysis, and providing a foundation for public healthcare databases and policies. This survey aims to explore the familiarity and comprehension of medical coding among vascular surgeons. Methods Ninety-five responses were gathered from participants across diverse levels of vascular surgery. A notable 77.7% (n=73) of respondents indicated a lack of formal training in medical coding. Additionally, 70.5% (n=67) of vascular surgeons advocated for including medical coding within surgical training programs. Regarding assessing medical coding proficiency, 61.1% (n=55) correctly identified ‘BSS’ as an example of non-medical coding classification. Moreover, 67.7% (n=63) accurately recognised ‘OPCS-4’ as the classification system employed by the NHS for coding surgical procedures. Results Ninety-five questionnaire responses were collected from participants working in vascular surgery of various levels. A notable 77.7% (n=73) of the participants reported receiving no formal training in medical coding. Additionally, 70.5% (n=67) of vascular surgeons expressed that medical coding should be included in surgical training. Regarding assessing medical coding knowledge, 61.1% (n=55) of respondents correctly identified ‘BSS’ as the non-example of medical coding classification. When asked about the classification system used by the NHS to code surgical procedures, 67.7% (n=63) correctly identified ‘OPCS-4.’ Conclusion The study's findings reveal the need for more awareness, knowledge, and formal training in medical coding. Augmented education and training in medical coding, potentially through concise courses, are imperative for ensuring equitable reimbursement for healthcare services, facilitating data analysis for research and quality enhancement endeavours, and fostering effective inter-professional communication within the healthcare domain.

Analysis of the National Formulary Drug Supply Chain with Its Availability in the Pharmacy Installation of the Government General Hospital (RSUD) Dr. Sitanala Tangerang City

This study explores the pharmaceutical supply chain management of the National Formulary at RSUP Dr. Sitanala in Tangerang City, aiming to identify obstacles to drug availability and formulate effective and efficient solutions. Acknowledging quality healthcare as a fundamental human right and a critical investment for a nation's future, this research emphasizes the importance of high-quality healthcare services. These services encompass not only treatment but also health promotion and disease prevention through the adoption of clean and healthy living habits. Drug availability is a major pillar in the provision of quality healthcare services. Effective and efficient management of the pharmaceutical supply chain, particularly regarding National Formulary drugs, is crucial in ensuring the availability of medications at healthcare facilities. This research employs a comprehensive analysis of the supply chain processes at RSUP Dr. Sitanala, examining stages such as drug selection, demand planning, procurement, receipt, storage, distribution, drug control, therapy monitoring, prescription preparation, drug dispensation, and medication administration. The study's methodology involves a case study approach, integrating theoretical management principles and interdisciplinary pharmacy management with compliance to regulations, as outlined in Permenkes No. 76 of 2016. Findings from RSUP Dr. Sitanala indicate that the hospital's pharmaceutical management practices align with contemporary health and pharmacy management theories, emphasizing structured systems, stringent verification, and effective interprofessional communication to ensure medication safety and efficacy. The study identifies challenges in information technology and interdisciplinary coordination as areas needing improvement. Nonetheless, a commitment to continuous improvement and adherence to regulatory standards reflects RSUP Dr. Sitanala's dedication to enhancing the quality of pharmaceutical management and healthcare services. The implications of this research extend beyond RSUP Dr. Sitanala, offering valuable recommendations for improving drug supply chain management in other healthcare institutions in Indonesia. By enhancing access to and the quality of healthcare services, this study contributes to the broader goal of achieving the highest possible level of health for individuals, reflecting the perspective of human rights and investment in the nation's future health.

Building Interprofessional Competencies Through a Collaborative Prescribing Activity With Osteopathic, Pharmacy, and Physician Assistant Students.

Medication errors can lead to significant adverse events. Nearly 50% of medication errors occur during the prescription-writing stage of the medication use process, and effective interprofessional collaboration and communication are key to reducing error in this process. We developed a three-part, 60-minute, interprofessional education activity providing medical, physician assistant, and pharmacy students the opportunity to practice collegial interprofessional communication surrounding prescribing practices. Learners met virtually initially as a large group and divided into small groups facilitated by a health professional. Part 1 involved reviewing two prescriptions prepared by learners; part 2 was a discussion about the education, roles, and responsibilities of each profession; and part 3 focused on identifying prescription errors in examples provided by faculty. Students completed a post-pre survey measuring their perception of learning the Interprofessional Collaborative Competency Attainment Survey (ICCAS) areas. Of 317 participants (151 doctor of osteopathy, 68 master of physician assistant studies, and 98 doctor of pharmacy students), 286 completed the post-pre survey, for a 90% response rate. Students reported statistically significant (p < .001) increases in all 20 questions spanning the six ICCAS areas. The virtual format allowed multiple institutions to participate from various locations. It broadened the learners' experience by fostering interaction among those with varied perspectives and allowed collaboration between locations and programs that otherwise could not have participated. The activity introduced students to virtual collaboration and key telehealth skills, enhancing their confidence and familiarity with virtual interactions in a professional setting.

Enhancing Patient Safety Through Effective Interprofessional Communication: A Focus on Medication Error Prevention.

Medication errors significantly impact patient safety and healthcare costs. This study investigates the influence of interprofessional communication on medication error rates, with a focus on identifying actionable strategies to improve communication efficacy among healthcare professionals. Utilizing a quantitative approach, this research distributed a detailed online questionnaire to a broad cohort of healthcare workers in various settings within Saudi Arabia. The survey encompassed sections on demographics, the frequency and quality of interprofessional communication, perceived barriers and facilitators to effective communication, and personal experiences with medication errors. Statistical analysis was performed using SPSS to derive descriptive and inferential statistics, alongside thematic analysis for qualitative responses. The survey attracted 1165 respondents, predominantly aged 20-30 (68.58%) and female (65.49%). Pharmacists constituted the largest professional group (40.34%). We identified a notable positive correlation (r = 0.16) between high-quality interprofessional communication and employment in hospital environments or having 5-20 years of experience. In contrast, negative correlations were observed with employment in non-traditional healthcare settings (r = -0.19) and professionals with less than five years of experience (r = -0.13), indicating communication challenges. The analysis also highlighted a concerning frequency of prescription and dispensing errors, with 52.70% of participants reporting prescription errors as the most common issue encountered. Effective interprofessional communication is pivotal in mitigating medication errors within healthcare settings. The study illuminates specific areas for improvement, including the need for targeted communication training, particularly for less experienced professionals and those in non-traditional settings. Enhancing communication channels and fostering an environment conducive to open, interdisciplinary dialogue are essential steps towards advancing patient safety and reducing medication errors.

Access to primary eye care for people living with dementia: a call to action for primary care practitioners to 'think vision'.

Access to allied health services offers significant benefits for people living with dementia, yet access is currently fragmented and inconsistent. The 2023-2024 budget allocated AU$445million to further enable general practice-led, multidisciplinary teams, with integrated care located within practices, including employment of allied health professionals. Such team care models are recognised by The Royal Australian College of General Practitioners as vital to delivery of high-quality care for older adults. They are especially relevant for over 250,000 Australians who live with dementia in the community. However, not all allied health professionals are currently based within general practices. Future, sustainable general practice-led models of multidisciplinary care that connect patients with external allied health providers could be considered for a comprehensive and collaborative approach to care. Our focus is on people living with dementia, who are at greater risk of preventable vision impairment. Poor vision and/or ocular health can be detected and managed through regular eye examinations, which are predominantly delivered by community-based optometrists in Australia, in a primary care capacity. However, people living with dementia are also less likely to have regular eye examinations. In this paper, we highlight the value of ensuring access to primary eye care services as part of post-diagnosis dementia care. We illustrate the important role of primary care practitioners in building and sustaining connections with allied health professions, like optometry, through effective referral and interprofessional communication systems. This can help break down access barriers to dementia-friendly eye care, through promoting the importance of regular eye tests for people living with dementia.

Older adults’ perceptions and experiences of interprofessional communication as part of the delivery of integrated care in the primary healthcare sector: a meta-ethnography of qualitative studies

BackgroundCommunication between patients and healthcare providers, and effective interprofessional communication, are essential to the provision of high-quality care. Implementing a patient-centred approach may lead to patients experiencing a sense of comfort, validation, and active participation in own healthcare. However, home-dwelling older adults’ perspectives on interprofessional communication (IPC) are lacking. The aim is therefore to explore how home-dwelling older adults experience communication in connection with the delivery of integrated care.MethodsThe meta-synthesis was conducted in line with Noblit and Hare’s seven phases of meta-ethnography. A systematic literature search was conducted by two university librarians in seven databases using the search terms ‘older adults’, ‘communication’, ‘integrated care’ and ‘primary care’. All articles were reviewed by two authors independently. 11 studies were included for analysis.ResultsOlder adults are aware of IPC and have preferences regarding how it is conducted. Three main themes were identified in the reciprocal analysis: (1) Inconsistent care perceived as lack of IPC, (2) individual preferences regarding involvement and awareness of IPC and (3) lack of IPC may trigger negative feelings.ConclusionsThis meta-ethnography shows the perspective of older adults on IPC as part of integrated care. Our study shows that older adults are concerned about whether healthcare personnel talk to each other or not and recognise IPC as fundamental in providing consistent care. The perspectives of older adults are relevant for clinicians and politicians, as well as researchers, when developing and implementing future integrated care services for home-dwelling older adults.

Developing and teaching an interprofessional service-learning undergraduate course for pre-health and human services students

This interprofessional service-learning course focused on exploring how social determinants of health such as economic stability, education, social and community environment, and health and health care affect populations. Through reading narratives and eliciting stories from participants and students during their volunteer hours at a local hospital, students increased their understanding of social determinants and learned effective interprofessional communication and collaboration strategies. The paper outlines the process and steps to building a partnership with a health care institution and supporting students as they engaged in service learning. Reflections from the instructors, facilitators, and students are discussed.

An interprofessional clinical experience to address social determinants of health.

The importance of effective interprofessional communication and collaboration as a strategy to improve patient outcomes has been documented in the literature. Efforts to integrate interprofessional education have been difficult to actualize due to myriad factors in academic and clinical settings. The COVID public health emergency presented an unexpected opportunity to address the needs of an underserved community through an interprofessional clinical experience between medical and APRN students. A screening tool and resource-driven algorithm were developed and launched by students in the college of medicine, for the patients of a university hospital clinic. This initiative helped meet the needs of the community, with the value-added benefit of an interprofessional clinical experience. Using a train-the-trainer model, students were oriented to the project and an online platform for real-time collaboration. Results of this initiative were positive. Approximately 100 medical and APRN students participated and contacted 1,489 patients in the community. Medical and social needs were addressed for 681 patients, and urgent social needs were addressed for 30 people. Students gained valuable clinical experience and had opportunities to identify and address social determinants of health while collaborating with medical student counterparts.

Physiotherapy private practitioners’ opinions regarding interprofessional collaborative practice: A qualitative study

ABSTRACT Physiotherapy private practitioners comprise a growing proportion of Australia’s primary care workforce, yet their views and experiences of interprofessional collaborative practice (IPCP) are poorly documented. The aim of this study was to explore Australian physiotherapy private practitioners’ opinions regarding IPCP. Twenty-eight semi-structured interviews were conducted with physiotherapists in 10 private practice sites in Queensland, Australia. Interviews were analyzed using reflexive thematic analysis. Data analysis produced five themes that characterized physiotherapists’ perceptions of IPCP: (a) quality of care considerations; (b) not a one-size-fits-all approach; (c) the need for effective interprofessional communication; (d) fostering a positive work culture; and (e) fear of losing clientele. The findings from this study suggest that physiotherapy private practitioners value IPCP because it can deliver superior client outcomes, can strengthen interprofessional relationships, and has the potential to enhance the professional reputation of the organizations within which they work. Physiotherapists also claimed that IPCP can contribute to poor client outcomes when performed inappropriately, while some reported approaching interprofessional referrals with caution following instances of lost clientele. The mixed views toward IPCP in this study highlight the need to explore the facilitators and barriers to IPCP in the Australian physiotherapy private practice setting.

Mapping objectives of a new interprofessional morbidity and mortality conference to ACGME core competencies in hematology/oncology.

11032 Background: Safety and quality improvement requirements are a part of the core competencies for ACGME-accredited hematology/oncology fellowships. The morbidity and mortality conference (MM) is a tool that has been used to identify safety issues and areas for improvement. The traditional format primarily includes an audience of clinicians. We sought to develop an interactive, interprofessional MM (i-MM), including institutional leadership, physicians, fellows, residents, advanced practice providers, nursing, and pharmacy, while meeting the ACGME Core competencies for Patient Safety and Quality Improvement in Hematology and Medical Oncology. Methods: A pilot i-MM was designed to create an enriching, interprofessional discussion regarding patient safety and quality improvement. We implemented a Plan-Do-Study-Act (PDSA) design to create the i-MM model that map to the core competencies. The first session was focused on two mortality events in immunocompromised hosts that triggered the sepsis bundle, one of which was due to toxic megacolon. The i-MM objectives were aligned with ACGME hematology/oncology fellowship requirements of quality and safety. The effectiveness of the pilot session was gauged via an anonymous post-session survey using a 4-point Likert scale. Results: A total of 32 people attended the pilot i-MM, including quality and safety leaders, faculty, fellows, medical residents, pharmacy, and nursing. A total of 10 participants across professions completed the post-i-MM survey. The survey demonstrated an average of 3.8/4 for all interprofessional educational goals, which included demonstration of mutual respect between healthcare professionals, engaging in effective interprofessional communication, and working within an interprofessional team. Content-specific aspects of the survey were rated with an average effectiveness of 3.60/4. Feedback on the survey recommended limiting i-MM to one case presentation instead of multiple. During the debrief session, it was reported that several nurses felt the moderated session was “inclusive and empowering”. Conclusions: The i-MM was an effective approach to meeting ACGME requirements for safety and quality learning objectives while creating an inclusive environment for all team members. Future PDSA cycles will continue to map i-MM learning objectives to ACGME hematology/oncology fellowship program core competencies in Section VI.A.1 and the section on Professionalism. Core competency mapping will guide future presentations that address issues on quality, safety, and health care disparities. Specific presenters and moderators from different professions will be chosen to lead each i-MM, with the goal of examining each case from different perspectives to provide a holistic interprofessional view of delivering quality medical care to patients.

Patient safety and staff psychological safety: A mixed methods study on aspects of teamwork in the operating room.

To predict the amount of teamwork that takes place throughout a surgery, based on performing a preoperative safety standards (surgical safety checklist and surgical count) and to explore factors affecting patient safety and staff psychological safety during a surgery, based on interprofessional teamwork. This mixed methods study included quantitative and qualitative analyses. Quantitative data included 2,184 direct observations of surgical cases with regard to the performance of safety standards during surgeries in 29 hospitals, analyzed using multivariate binary logistic regressions. Qualitative data were obtained from an analysis of 25 semi-structured interviews with operating room (OR) clinicians and risk managers, using an inductive thematic analysis approach. Analysis of the OR observations revealed that a lack of teamwork in the preoperative "sign-in" phase doubled the chances of there being a lack of teamwork during surgery [odds ratio = 1.972, 95% confidence interval (CI) 1.741, 2.233, p < 0.001] and during the "time-out" phase (odds ratio = 2.142, 95% CI 1.879, 2.441, p < 0.001). Consistent presence of staff during surgery significantly increased teamwork, by 21% for physicians and 24% for nurses (p < 0.05), but staff turnover significantly decreased teamwork, by 73% for physicians (p < 0.05). Interview data indicated that patient safety and staff psychological safety are related to a perception of a collaborative team role among OR staff, with mutual commitment and effective interprofessional communication. Healthcare organizations should consider the key finding of this study when trying to identify factors that affect teamwork during a surgery. Effective preoperative teamwork positively affects intraoperative teamwork, as does the presence of more clinicians participating in a surgery, with no turnover. Other factors include working in a fixed, designated team, led by a surgeon, which functions with effective interprofessional communication that promotes patient safety and staff psychological safety.

Using Fictional Medical Television Programs to Teach Interprofessional Communication to Graduating Fourth-Year Medical Students.

Effective interprofessional (IP) communication is crucial to high-quality patient care, but significant obstacles remain regarding implementing IP communication curricula for undergraduate medical students. As such, as part of a bootcamp required for University of Pittsburgh graduating medical students in 2021, we developed and evaluated a workshop using clips from medical television shows (eg, ER) to teach IP communication skills. The workshop was hosted on Zoom videoconferencing software and evaluated using pre- and postcurricular surveys that included adapted Communication Skills Attitude Scale (CSAS) and Student Perceptions of Interprofessional Clinical Education-Revised (SPICE-R) instruments. The postcurricular survey also included two open-ended items. We used Wilcoxon signed-rank tests to compare pre- and postcurricular CSAS and SPICE-R scores and used thematic analysis for qualitative data. Approximately 94% (n = 105) of assigned students attended the workshop. Comparison of pre- and postcurricular means for all CSAS and SPICE-R items indicated improvements in attitudes toward communication training and IP communication, with statistically significant (P < 0.05) changes for 4 of 10 (40%) CSAS items and 8 of 10 (80%) SPICE-R items. Thematic analysis of open-ended items suggests that the workshop is acceptable to students and may be efficacious at improving both their IP communication skills and skills related to addressing equity and bias. Results suggest that using clips from fictional medical television programs may be a valuable approach to teaching graduating medical students IP communication skills. Future research could examine whether improved attitudes are sustained over time and the influence of the workshop on clinical IP communication behavior.

Implementing a Novel Interprofessional Clinical Informatics Curriculum.

A novel interprofessional clinical informatics curriculum was developed, piloted, and implemented, using an academic medical record. Targeted learners included undergraduate, graduate, and professional students across five health science colleges. A team of educators and practitioners representing those five health science colleges was formed in 2016, to design, develop, and refine educational modules covering the essentials of clinical informatics. This innovative curriculum consists of 10 online learning modules and 18 unique imbedded exercises that use standardized patient charts and tailored user views. The exercises allow learners to adopt the role of various providers who document in EMRs. Students are exposed to the unique perspectives of an attending physician, nurse, radiological technician, and health information manager, with the goal of developing knowledge and skills necessary for efficient and effective interprofessional communication within the EMR. The campus-wide clinical informatics curriculum is online, flexible, asynchronous, and well-established within each college, allowing faculty to select and schedule content based on discipline-specific learner and course needs. Program modifications over the past 4 years have correlated with a positive impact on the students' experience.

Stakeholders’ perceptions of how nurse-physician communication may impact patient care: protocol for a concept mapping study

ABSTRACT Effective nurse-physician interprofessional communication is important to ensure that patients receive evidence-based care and treatment. There is a gap in knowledge about how nurse-physician communication impacts patient care. We propose using concept mapping to develop an in-depth understanding of patients, nurses, and physicians’ perspectives on how physician-nurse communication affects patient care. There are six phases to concept mapping: determining the focus, generating statements, structuring statements, producing the map, interpretating the map, and map utilization. We will use ‘Ariadne’, a concept mapping software package for data collection and analysis. The study outcome will be a two-dimensional concept map providing a visual representation of how nurse-physician communication influences patient care. We will report similarity and differences among three stakeholder groups. Our research will inform the development of testable hypotheses about nurse-physician communication and patient care.

Interprofessional discharge team communication and empathy in discharge planning activities: A narrative review

Poor communication is a main cause of poor discharge planning . Although empathic processes underlie communication competence, the extent to which discharge team empathy has been studied is unclear. This paper will summarize interventions that incorporate empathic processes for effective interprofessional team communication. Guided by the SANRA scale, this narrative review presents research (2013–2019) on interprofessional communication and empathy interventions during discharge planning activities. Database searches yielded 2357 abstracts; ten fulfilled inclusion criteria. Limited studies exist with diverse interventions (simulation, process observations, video-enhanced learning, or TeamSTEPPS) that were mostly atheoretical and quasi-experimental, and samples of pre- and post-licensure clinicians ranging in size from 7 to 132. Evidence suggests that there is benefit to engaging in team-based discharge planning simulation when that simulation includes content on roles, debriefing, exercises in self-reflection, and use of video-feedback. As guided by theory, further benefits can be gained by incorporating empathic processes into interprofessional communication interventions.

What do medical specialists think about a proposed academic, integrative health centre in Australia? A qualitative study

ObjectivesThis qualitative study aimed to explore medical specialists’ perspectives on a proposed academic integrative healthcare (IHC) centre to be established in their local district. MethodsA convenience sample of medical specialists were recruited via direct email invitations that was augmented with snowball sampling until data saturation was reached. The in-depth, semi-structured interviews were conducted via telephone, audio recorded and transcribed verbatim, followed by a thematic analysis. ResultsEight participants took part in the study. Three main themes emerged: 1) the benefits of an academic setting, 2) sound clinical governance, and 3) specialists in the field of traditional, complementary and integrative medicine (TCIM). Underpinning the three themes was the belief that patients were at risk of harm due to haphazard, unsupervised use of unproven TCIM. It was anticipated that an academic centre would address these issues with appropriate risk management protocols, effective interprofessional communication, and by upholding the principles of evidence- based practice to ensure safe and coordinated patient-centred care. Opportunities from collaborations within secondary care included centre being recognized as specialists in the field of TCIM, conducting research, and bidirectional learning. ConclusionsThe findings demonstrated that medical specialists acknowledged the need for a TCIM model of care that interfaces with the local secondary care landscape through the implementation of sound safeguards, credentialed practitioners, and evidence-based practice to adequately protect patients and clinicians. The findings will be amalgamated with the input from other stakeholder groups via a community-based participatory research framework to refine the model of care.

Exploring stakeholder roles in medication management for people living with dementia.

Therapeutic decision making, prescribing, administering and managing medications can be difficult for people with dementia. To explore stakeholder roles in medication management for people with dementia, including barriers and enablers to achieving those roles. Focus groups were held with stakeholders (consumers, general practitioners, nurses and pharmacists) from both rural and metropolitan communities in two Australian states. Focus groups were audio-recorded, transcribed and thematically analysed using an inductive approach. Nine focus groups were held with 55 participants. Four major themes were identified: supporting the role of the person with dementia, carer roles and challenges, health professional roles, and process and structure barriers to medication management. Stakeholders discussed the importance of advance care planning, and the potential benefits of early implementation of dose administration aids to support patients in self-managing their medication. Carers were seen to have a vital role as patient advocates, but carer burden and changes in the patient-carer roles acted as barriers to this role. General practitioners were perceived as the main care coordinator for a person with dementia, with effective interprofessional collaboration and communication with allied health professionals and specialists further enabling optimisation of medication use. A lack of evidence, guidelines and practitioner training to guide prescribing and deprescribing decisions in people with dementia were mentioned as barriers to medication management. Medication management is increasingly challenging for people with dementia and each stakeholder perceives that they have a different role and faces different barriers and enablers. Future research should focus on improving the evidence base to guide prescribing, facilitating stakeholder communication and ensuring early documentation of patient wishes for the future.

Patients' perspectives on interprofessional collaboration between health care professionals during hospitalization: a qualitative systematic review.

The objective of this review was to gain a better understanding of the interprofessional collaboration between health care professionals from the patients' point of view during hospitalisation; the influence of interprofessional collaboration on patient care, safety, and well-being; and patients' perspectives of their role in the interprofessional collaboration process. Interprofessional collaboration is a key factor in improving patient health care outcomes and safety through better communication between health care professionals, better teamwork, and better care coordination. However, implementing interprofessional collaboration in the clinical setting can prove complex. Patients are increasingly interested in becoming partners within the health care system. They have the potential to contribute to their own safety and to observe professionals during the care process, thus gaining a better understanding of the interprofessional collaboration process and facilitating changes in the behavior of health care professionals. This review considered qualitative research and mixed-method studies. Participants were hospitalized patients. Studies were included when they explored i) patients' perceptions of interprofessional collaboration, ii) the influence of interprofessional collaboration on patients' care, safety, or well-being, or iii) patients' perceptions of their own role in interprofessional collaboration. Qualitative studies focusing only on the care process or families' points of view were excluded. Searches of six databases including MEDLINE, CINAHL, Embase, Web of Science, PsycINFO, and Sociological Abstract, limited to English, French, and German were conducted from March 2017 to June 2018. Assessment of methodological quality of studies was performed using the JBI Qualitative Assessment and Review Instrument. Data were extracted using the standardized data extraction tool from JBI. Data synthesis following the JBI approach of meta-aggregation was performed. The level of confidence for each synthesized finding was established based on ConQual. A total of 22 studies were included, which resulted in 89 findings and 24 categories. Eight synthesized findings were generated: patients' perceptions of interprofessional collaboration based on personal experiences and observations; patients' experiences with effective or ineffective interprofessional communication; patients' experience with power imbalance and paternalistic attitudes; patients' perceptions of key factors for a confident relationship with the interprofessional health care team; patients' need for comprehension of discussions between health care professionals; patients' perceptions of their role in an interprofessional health care team; patients' perceptions of opportunities for empowerment in interprofessional health care teams; and patients' need for humanizing care from interprofessional health care teams. The level of confidence of synthesized findings varied from low to moderate according to ConQual. This systematic review synthesized the perspectives of hospitalized patients regarding interprofessional collaboration and their perceived role in collaborative practices. Hospitalized patients observe interprofessional collaboration, either directly or indirectly, and the way interprofessional collaboration is performed may impact both their care and their well-being. However, little evidence has been found regarding the impact of interprofessional collaboration on patient safety. Patients' perspectives on their perceived role is not unanimous; some patients want to play an active role in the collaborative process, whereas others prefer to trust the health care professionals' expertise. Health care professionals should consider patients' preferences and act accordingly regarding both the collaborative process and the inclusion of the patients in collaborative practices.

Collaborating across sectors to provide early intervention for Aboriginal and Torres Strait Islander children with disability and their families: a qualitative study of provider perspectives

ABSTRACTAboriginal and Torres Strait Islander children experience a higher prevalence of disability than other Australian children. Early intervention from across the health, education, and social service sectors is vital for improving outcomes, but families face lack of coordination between services. This study aimed to inform improvements in service access for families of urban-dwelling Aboriginal children with disability through exploring providers’ perceptions of factors that influenced working together across sectors. Semi-structured interviews were conducted. Data analysis was informed by the general inductive approach and the Collaborative Practice to Enhance Patient Care Outcomes framework. Twenty-four providers participated. Interprofessional collaborative practice was influenced by interdependent interactional and organizational factors. Interactional factors fit within one of two dimensions: the ability of providers to share common goals and vision within a complex cross-sector service landscape, and influence of interpersonal relationships on their sense of belonging working in a cross-cultural space. Organizational factors also fit within one of two dimensions: the influence of governance in relation to its role in coordination and unlocking the strength of schools as service settings, and the need to formalize processes for effective interprofessional communication. Interprofessional collaborative practice was managed within the context of systemic factors relating to policy and funding. These findings demonstrate the complex interplay of factors related to the cross-sector involvement of providers in early intervention service provision. Consideration of these factors is required to facilitate collaborative cross-sector responses to improve service access for Aboriginal families.Abbreviations: WHO: world health organization; ACCHS: aboriginal community controlled health service; GP: general practitioner; NDIS: national disability insurance scheme