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Analyzing the Interprofessional Working of a Home-Based Primary Care Team*

Published online by Cambridge University Press:  07 August 2014

Tracy Smith-Carrier*
Affiliation:
School of Social Work, King’s University College at Western University
Sheila Neysmith
Affiliation:
Factor-Inwentash Faculty of Social Work, University of Toronto
*
La correspondance et les demandes de tirés-à-part doivent être adressées à: / Correspondence and requests for offprints should be sent to:Tracy Smith-Carrier, Ph.D.School of Social WorkKing’s University College at Western University266 Epworth AvenueLondon, ON Canada N6A 2M3([email protected])

Abstract

Increasingly, interprofessional teams are responsible for providing integrated health care services. Effective teams, however, are not the result of chance but require careful planning and ongoing attention to team processes. Based on a case study involving interviews, participant observation, and a survey, we identified key attributes for effective interprofessional working (IPW) within a home-based primary care (HBPC) setting. Recognizing the importance of a theoretical model that reflects the multidimensional nature of team effectiveness research, we employed the integrated team effectiveness model to analyze our findings. The results indicated that a shared vision, common goals, respect, and trust among team members – as well as processes for ongoing communication, effective leadership, and mechanisms for conflict resolution – are vital in the development of a high-functioning IPW team. The ambiguity and uncertainty surrounding the context of service provision (clients’ homes), as well the negotiation of external relationships in the HBPC field, require further investigation.

Résumé

De plus en plus, les équipes interprofessionnelles sont chargées de fournir la prestation de services de soins de santé intégrés. Cependant, les équipes efficaces ne sont pas le fruit du hasard, mais nécessitent une planification minutieuse et une attention soutenue au processus de développer l’équipe. Basée sur une étude de cas portant sur des entretiens, l’observation participante, et une enquête, nous avons identifié les attributs clés pour le travail interprofessionnel efficace (TIE) dans le cadre de soins primaires à domicile (SPD). Reconnaissant l’importance d’un modèle théorique qui reflète la nature multi-dimensionnelle de la recherche sur l’efficacité de l’équipe, nous avons utilisé le modèle de l’efficacité de l’équipe integrée pour analyser nos résultats. Ces résultats indiquaient qu’une vision commune, des objectifs communs, le respect et la confiance entre les membres de l’équipe—ainsi que la communication continue, la direction efficace et des mécanismes de résolution des conflits—sont essentiels pour le développement d’une equipe de TIE qui fonctionne très bien. L’ambiguité et l’incertitude qui entoure le cadre de la prestation de services (à domicile), ainsi que la négociation des relations extérieures dans le domaine SPD, nécessitent la recherche plus approfondie.

Type
Articles
Copyright
Copyright © Canadian Association on Gerontology 2014 

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Footnotes

*

Funding: This research was funded by the Social Sciences and Humanities Research Council of Canada

References

Atwell, A., & Caldwell, K. (2006). Nurses’ perceptions of multidisciplinary team work in acute health-care. International Journal of Nursing Practice, 12(6), 359365.Google Scholar
Ayoko, O., Callan, V., & Hartel, C. E. J. (2008). The influence of team emotional intelligence climate on conflict and team members’ reactions to conflict. Small Group Research, 39(2), 121149.Google Scholar
Barr, H. (1994). NVQs and their implications for inter-professional collaboration. In Leathard, A. (Ed.), Going inter-professional: Working together for health and welfare (pp. 90108). London, UK: Routledge.Google Scholar
Baxter, S., & Brumfitt, S. (2008). Professional differences in interprofessional working. Journal of Interprofessional Care, 22(3), 239–239.CrossRefGoogle ScholarPubMed
Bechofer, F., & Patterson, L. (2000). Principles of research design in the social sciences. London, UK: Routledge.Google Scholar
Bleakley, A. (2013). Working in “teams” in an era of “liquid” healthcare: What is the use of theory? Journal of Interprofessional Care, 27, 1826.Google Scholar
Bronstein, L. R. (2003). A model for interdisciplinary collaboration. Social Work, 48(3), 297306.Google Scholar
Buljac-Samardzic, M., Dekker-van, Doorn, , C. M., van Wijngaarden, J. D. H., & van Wijk, , , K. P. (2010). Interventions to improve team effectiveness: A systematic review. Health Policy, 94(3), 183195.Google Scholar
CAIPE – Centre for the Advancement of Interprofessional Education. (2002). Defining IPE. Retrieved 11 January 2013 fromhttp://www.caipe.org.uk/about-us/defining-ipe/.Google Scholar
Cameron, A., Lart, R., Bostock, L., & Coomber, C. (2013, June). Factors that promote and hinder joint and integrated working between health and social care services: A review of research literature. Health & Social Care in the Community, 22(3), 225–33.Google Scholar
Canadian Medical Association. (2006). Teamwork: It’s not just for sports anymore. MD Lounge. Retrieved 13 January 2013 fromhttp://www.cma.ca/multimedia/CMA/Content_Images/Inside_cma/MDLounge/mdloungejun3.pdf.Google Scholar
Cashman, S. B., Reidy, P., Cody, K., & Lemay, C. A. (2004). Developing and measuring progress toward collaborative, integrated, interdisciplinary health care teams. Journal of Interprofessional Care, 18(2), 183196.Google Scholar
Challis, D., Abendstern, M., Clarkson, P., Hughes, J., & Sutcliffe, C. (2010). Comprehensive assessment of older people with complex care needs: The multi-disciplinarity of the Single Assessment Process in England. Ageing and Society, 30(7), 11151134.Google Scholar
Chavez, K. (2006). Constructing grounded theory: A practical guide through qualitative analysis. London, UK: Sage.Google Scholar
Cohen, S., & Bailey, D. (1997). What makes teams work: Group effectiveness research from the shop floor to the executive suite. Journal of Management, 23(3), 239290.CrossRefGoogle Scholar
Conference Board of Canada. (2011). Canada enters a period of government fiscal restraint. Retrieved 11 September 2012 fromhttp://www.conferenceboard.ca/press/newsrelease/11-03-31/canada_enters_a_period_of_government_fiscal_restraint.aspx.Google Scholar
Creswell, J. W. (1998). Qualitative inquiry and research design: Choosing among five traditions. Thousand Oaks, CA: Sage.Google Scholar
D’Amour, D., Ferrada-Videla, M., Rodriguez, L. S. M., & Beaulieu, M. (2005). The conceptual basis for interprofessional collaboration: Core concepts and theoretical frameworks. Journal of Interprofessional Care, 19(S1), 116131.CrossRefGoogle ScholarPubMed
DeCherrie, L. V., Soriano, T., & Hayashi, J. (2012). Home-based primary care: A needed primary-care model for vulnerable populations. The Mount Sinai Journal of Medicine, 79(4), 425432.Google Scholar
Decuyper, S., Dochy, F., & Bossche, P. V. (2010). Grasping the dynamic complexity of team learning: An integrative model for effective team learning in organisations. Educational Research Review, 5(2), 111133.Google Scholar
Delva, D., Jamieson, M., & Lemieux, M. (2008). Team effectiveness in academic primary health care teams. Journal of Interprofessional Care, 22(6), 598611.CrossRefGoogle ScholarPubMed
Desai, N. R., Smith, K. L., & Boal, J. (2008). The positive financial contribution of home-based primary care programs: The case of the Mount Sinai Visiting Doctors. Journal of the American Geriatrics Society, 56(4), 744749.Google Scholar
Farrell, P., Madeline, H., Schmitt, G. D., & Heinemann, M. (2001). Informal roles and the stages of interdisciplinary team development. Journal of Interprofessional Care, 15(3), 281295.Google Scholar
Freeth, D., Hammick, M., Reeves, S., Koppel, I., & Barr, H. (2005). Effective interprofessional education: Development, delivery and evaluation. London, UK: Blackwell.Google Scholar
Fried, B. J., Leatt, P., Deber, R., & Wilson, E. (1988). Multidisciplinary teams in health care: Lessons from oncology and renal teams. Health Care Management, 4, 2834.Google Scholar
Goldsmith, J., Wittenberg-Lyles, E., Rodriguez, D., & Sanchez-Reilly, S. (2010). Interdisciplinary geriatric and palliative care team narratives: Collaboration practices and barriers. Qualitative Health Research, 20(1), 93104.Google Scholar
Goodman, C., Drennan, V., Manthrope, J., Gage, H., Trivedi, D., Dhrushita, S., et al. (2012). A study of the effectiveness of interprofessional working for community-dwelling older people. National Institute for Health Research. Service Delivery and Organisation Programme. Retrieved 14 January 2013 fromhttp://eprints.kingston.ac.uk/24650/2/SDO_ES_08-1819-216_V01.pdf.Google Scholar
Goodman, C., Dreenan, V., Scheibl, F., Shah, D., Manthorpe, J., Gage, H., et al. (2011). Models of inter professional working for older people living at home: A survey and review of the local strategies of English health and social care statutory organisations. BMC Health Services Research, 11, 337348.Google Scholar
Greenfield, D. (2007). The enactment of dynamic leadership. Leadership in Health Services, 20(3), 159168.Google Scholar
Gum, L. F., Prideaux, D., Sweet, L., & Greenhill, J. (2012). From the nurses’ station to the health team hub: How can design promote interprofessional collaboration? Journal of Interprofessional Care, 26(1), 2127.Google Scholar
Hébert, R., Durand, P. J., Dubuc, N., Tourigny, A., & Group, T. P. (2003). PRISMA: A new model of integrated service delivery for the frail older people in Canada. International Journal of Integrated Care, 3(18), 18.Google Scholar
Horder, J. (2004). Interprofessional collaboration and interprofessional education. The British Journal of General Practice: The Journal of the Royal College of General Practitioners, 54(501), 243–243.Google Scholar
Huang, S., & Cummings, J. N. (2011). When critical knowledge is most critical: Centralization in knowledge-intensive teams. Small Group Research, 42(6), 669699.Google Scholar
Huberman, A. M., & Miles, M. B. (2002). The qualitative researcher’s companion. Thousand Oaks, CA: Sage.Google Scholar
Hurst, K., Ford, J., & Gleeson, C. (2002). Evaluating self-managed integrated community teams. Journal of Management in Medicine, 16(6), 463483.Google Scholar
Irvine, R., Kerridge, I., McPhee, J., & Freeman, S. (2002). Interprofessionalism and ethics: Consensus or clash of cultures? Journal of Interprofessional Care, 16(3), 199210.Google Scholar
Johansson, G., Eklund, K., & Gosman-Hedström, G. (2010). Multidisciplinary team, working with elderly persons living in the community: A systematic literature review. Scandinavian Journal of Occupational Therapy, 17(2), 101116.Google Scholar
Kilpatrick, K., Lavoie-Tremblay, M., Ritchie, J. A., Lamothe, L., & Doran, D. (2011). Boundary work and the introduction of acute care nurse practitioners in healthcare teams. Journal of Advanced Nursing, 68(7), 15041515.Google Scholar
Koch, T., & Harrington, A. (1998). Reconceptualizing rigour: The case for reflexivity. Journal of Advanced Nursing, 28(4), 882890.Google Scholar
Kodner, D. L., & Kyriacou, C. K. (2000). Fully integrated care for frail elderly: Two American models. International Journal of Integrated Care, 1(1), 119.CrossRefGoogle ScholarPubMed
Kodner, D. L., & Spreenwenber, C. (2002). Integrated care: Meaning, logic, applications and implications – A discussion paper. International Journal of Integrated Care, 2(14), 16.CrossRefGoogle ScholarPubMed
Leathard, A. (2011). Introduction. In Leathard, A. (Ed.), Interprofessional collaboration: From policy to practice in health and social care (pp. 311). East Sussex, UK: Routledge.Google Scholar
Leathard, A. (Ed.). (1994). Going inter-professional: Working together for health and welfare. London: Routledge.Google Scholar
Légaré, F., Stacey, D., Gagnon, S., Dunn, S., Pluye, P., Frosch, D., et al. (2011). Validating a conceptual model for an inter-professional approach to shared decision making: A mixed methods study. Journal of Evaluation in Clinical Practice, 17(4), 554564.CrossRefGoogle ScholarPubMed
Lemieux-Charles, L., & McGuire, W. (2006). What do we know about health care team effectiveness? A review of the literature. Medical Care Research & Review, 63(3), 263300.Google Scholar
Lingard, L., Schryer, C., Spafford, M., & Campbell, S. (2007). Negotiating the politics of identity in an interdisciplinary research team. Qualitative Research, 7(4), 501519.Google Scholar
Mathieu, J., Maynard, M. T., Rapp, T., & Gilson, L. (2008). Team effectiveness 1997-2007: A review of recent advancements and a glimpse into the future. Journal of Management, 34(3), 410476.Google Scholar
McPherson, K., Headrick, L., & Moss, F. (2001). Working and learning together: Good quality care depends on it, but how can we achieve it? Quality in Health Care, 10(Suppl. II), ii46–ii53.Google Scholar
Merriam, S. B. (1998). Qualitative research and case study applications in education (Revised and Expanded from Case study research in education). San Francisco: Jossey-Bass.Google Scholar
Mickan, S., & Rodger, S. (2000). Characteristics of effective teams: A literature review. Australian Health Review, 23(3), 201208.Google Scholar
Mitchell, R., Parker, V., & Giles, M. (2011). When do interprofessional teams succeed? Investigating the moderating roles of team and professional identity in interprofessional effectiveness. Human Relations, 64(10), 13211343.Google Scholar
Mukamel, D. B., Temkin-Greener, H., Delavan, R., Peterson, D. R., Gross, D., Kunitz, S., et al. (2006). Team performance and risk-adjusted health outcomes in the Program of All-Inclusive Care for the Elderly (PACE). The Gerontologist, 46(2), 227237.Google Scholar
Murphy, D. R., Reis, B., Kadiyala, H., Hirani, K., Sittig, D. F., Khan, M. M., et al. (2012). Electronic health record-based messages to primary care providers: Valuable information or just noise? Archives of Internal Medicine, 172(3), 283285.Google Scholar
O’Malley, A. S. (2011). Tapping the unmet potential of health information technology. The New England Journal of Medicine, 364(12), 10901091.Google Scholar
Opie, A. (1997a). Effective teamwork in health care: A review of issues discussed in recent research literature. Health Care Analysis, 5(1), 6270.Google Scholar
Opie, A. (1997b). Thinking teams thinking clients: Issues of discourse and representation in the work of health care teams. Sociology of Health & Illness, 19(3), 259280.Google Scholar
Øvretveit, J. (1996). Five ways to describe a multidisciplinary team. Journal of Interprofessional Care, 10(2), 163171.CrossRefGoogle Scholar
Øvretveit, J. (1999). A team quality improvement sequence for complex problems. Quality in Health Care, 8(4), 239246.Google Scholar
Øvretveit, J. (2008). Effective leadership of improvement: The research. The International Journal of Clinical Leadership, 16(2), 97–97.Google Scholar
Patton, M. Q. (1990). Qualitative research and evaluation methods. Newbury Park, CA: Sage.Google Scholar
Pecukonis, E., Doyle, O., & Bliss, D. L. (2008). Reducing barriers to interprofessional training: Promoting interprofessional cultural competence. Journal of Interprofessional Care, 22(4), 417428.Google Scholar
Poochikian-Sarkissian, S., Hunter, J., Tully, S., Lazar, N. M., Sabo, K., & Cursio, C. (2008). Developing an innovative care delivery model: Interprofessional practice teams. Healthcare Management Forum, 21(1), 611.Google Scholar
Raak, A. V., Paulus, A., Merode, F. V., & Mur-Veeman, I. (1999). Integrated care management: Applying control theory to networks. Journal of Management in Medicine, 13(6), 390404.Google Scholar
Reed, J., Cook, G., Childs, S., & McCormack, B. (2005). A literature review to explore integrated care for older people. International Journal of Integrated Care, 5(14), 18.Google Scholar
Reeves, S., Goldman, J., Gilbert, J., Tepper, J., Silver, I., Suter, E., et al. (2011). A scoping review to improve conceptual clarity of interprofessional interventions. Journal of Interprofessional Care, 25(3), 167174.CrossRefGoogle ScholarPubMed
Rentsch, J., Heffner, T., & Duffy, L. (1994). What you know is what you get from experience: Team experience related to teamwork schemas. Group & Organization Management, 19(4), 450474.Google Scholar
Rockmann, K. W., Pratt, M. G., & Northcraft, G. B. (2007). Divided loyalties: Determinants of identification in interorganizational teams. Small Group Research, 38(6), 727751.Google Scholar
San, Martin-Rodriguez, , L. S., Beaulieu, M., D’Amour, D., & Ferrada-Videla, M. (2005). The determinants of successful collaboration: A review of theoretical and empirical studies. Journal of Interprofessional Care, 19(S1), 132147.Google Scholar
Santana, C., Curry, L. A., Nembhard, I. M., Berg, D. N., & Bradley, E. H. (2011). Behaviors of successful interdisciplinary hospital quality improvement teams. Journal of Hospital Medicine, 6(9), 501506.Google Scholar
Sargeant, J., Loney, E., & Murphy, G. (2008). Effective interprofessional teams: “Contact is not enough” to build a team. The Journal of Continuing Education in the Health Professions, 28(4), 228234.Google Scholar
Schuetz, B., Mann, E., & Everett, W. (2010). Educating health professionals collaboratively for team-based primary care. Health Affairs (Project Hope), 29(8), 14761480.CrossRefGoogle ScholarPubMed
Schweikhart, S. B., & Smith-Daniels, V. (1996). Reengineering the work of caregivers: Roles, redefinition, team structures and organizational redesign. Hospital and Health Services Administration, 41(1), 1936.Google Scholar
Sicotte, C., D’Amour, D., & Moreault, M. (2002). Interdisciplinary collaboration within Quebec community health care centres. Social Science & Medicine, 55(6), 9911003.Google Scholar
Sinha, S. K. (2012). Living longer, living well. Report submitted to the Minister of Health and Long-Term Care and the Minister Responsible for Seniors on recommendations to inform a Seniors Strategy for Ontario. Retrieved 12 January 2013 fromhttp://health.gov.on.ca/en/common/ministry/publications/reports/seniors_strategy/docs/seniors_strategy_report.pdf.Google Scholar
Smith-Carrier, T. A., Nowaczynski, M., Akhtar, S., Pham, T.-N., & Sinha, S. K. (2012). Home-based primary care for frail older homebound adults: An innovative solution for a 21st-century challenge. Canadian Geriatrics Society Journal of CME, 2(1), 2629.Google Scholar
Stall, N., Nowaczynski, M., & Sinha, S. K. (2013). Back to the future: Home-based primary care for older homebound Canadians – Part 1: Where we are now. Canadian Family Physician, 59(3), 237240.Google Scholar
Taplin, S. H., Foster, M. K., & Shortell, S. M. (2013). Organizational leadership for building effective health care teams. Annals of Family Medicine, 11(3), 279281.Google Scholar
Temkin-Greener, H., Gross, D., Kunitz, S. J., & Mukamel, D. (2004). Measuring interdisciplinary team performance in a long-term care setting. Medicine, 42(5), 472481.Google Scholar
Thylefors, I. (2012). All professionals are equal but some professionals are more equal than others? Dominance, status and efficiency in Swedish interprofessional teams. Scandinavian Journal of Caring Sciences, 26(3), 505512.Google Scholar
Trivedi, D., Goodman, C., Gage, H., Baron, N., Scheibl, F., Iliffe, S., et al. (2013). The effectiveness of inter-professional working for older people living in the community: A systematic review. Health & Social Care in the Community, 21(2), 113128.Google Scholar
Weller, J. M., Barrow, M., & Gasquoine, S. (2011). Interprofessional collaboration among junior doctors and nurses in the hospital setting. Medical Education, 45(5), 478487.Google Scholar
West, M. A., & Markiewicz, L. (2004). Building team-based working: A practical guide to organizational transformation. Malden, MA: Blackwell.Google Scholar
West, M. A., & Poulton, B. C. (1997). A failure of function: Teamwork in primary health care. Journal of Interprofessional Care, 11(2), 205216.Google Scholar
Yin, R. K. (2003). Case study research: Design and methods (3rd ed.). Thousand Oaks, CA: Sage.Google Scholar
Zheng, N. T., & Temkin-Greener, H. (2010). End-of-life care in nursing homes: The importance of CNA staff communication. Journal of American Medical Directors Association, 11(7), 494499.Google Scholar