Background
Methods
Design
Participants
Measuring instruments
Interprofessional identity (IPI)
Team collaboration
1. Shared Values In interprofessional collaboration (IPC), it is important that the members together have and use the same principles and core values, also known as shared values. The questions are about these shared principles and values. 2. Context The second domain is about context (including assignment from the organization, expertise, and background of team members). Its influence turns out to be very important for cooperation. If team members are aware of their context, this appears to positively influence the effectiveness of collaboration. The questions provide insight into the context in which a team/network operates. 3. Structure and organization. Effective IPC also appears to be related to how it is organized. Consider questions such as: “Have we made good agreements? Are we using the right working procedures? What is the division of roles in the team? Do we regularly evaluate our collaboration? 4. Group dynamics and interaction Interprofessional cooperation becomes more effective when the interrelationships between members are positive, there is an open atmosphere and group climate, and when feedback is provided, and critical interaction is possible. The questions in this domain deal with what happens in the group and in the interpersonal interaction. 5. Entrepreneurship and management The last domain is about the preconditions for effective cooperation. Consider questions such as: Is the team up to date with recent laws and regulations? Is attention paid to public relations (PR) (Do we, as a team, make ourselves known to the outside world?) and marketing? Is there a business plan, agreement, or something similar that defines everyone’s hours commitment and tasking other facilitation? |
Team communication
Quality of care (ADL and inpatient days)
Training program
Team trainings
Webinars
Online sessions
Statistical analysis
Qualitative analysis
Researcher characteristics
Results
Response and characteristics
Pretest | Total | Team 1 | Team 2 | Team 3 | Team 4 | Team 5 | Team 6 | NS | TS | Woman | Man |
---|---|---|---|---|---|---|---|---|---|---|---|
N | 106 | 18 | 21 | 20 | 22 | 13 | 12 | 65 | 41 | 90 | 16 |
Age | 42.1 (11.6) | 41.7 (12.6) | 42.8 (11.8) | 42.4 (11.5) | 46.1 (10.9) | 37.0 (12.1) | 39.2 (10.6) | 41.9 (11.4) | 42.0 (12.2) | 41.9 (11.3) | 42.9 (13.2) |
EPIS | |||||||||||
Belonging | 17.0 (3.2) | 17.7 (2.3) | 17.8 (2.2) | 17.3 (2.9) | 16.0 (4.2) | 17.1 (3.3) | 15.9 (4.0) | 16.5 (3.3) | 17.7 (2.9) | 17.0 (3.1) | 17.6 (2.4) |
Commitment | 16.5 (3.4) | 17.1 (2.8) | 17.5 (2.7) | 16.6 (3.1) | 15.5 (3.9) | 16.2 (4.6) | 15.2 (3.9) | 15.9 (3.6) | 17.3 (3.0) | 16.4 (3.5) | 16.5 (3.1) |
Believes | 16.9 (3.0) | 18.4 (1.7) | 18.8 (1.9) | 16.2 (2.5) | 15.2 (3.2) | 16.8 (3.8) | 15.8 (4.0) | 16.8 (3.3) | 16.9 (2.5) | 16.9 (3.2) | 16.5 (2.2) |
EPIS Total | 50.6 (8.9) | 53.0 (6.3) | 53.7 (6.2) | 50.1 (7.7) | 47.9 (11.0) | 50.1 (11.5) | 46.9 (11.2) | 49.7 (7.7) | 51.8 (7.6) | 50.1 (9.5) | 50.7 (5.8) |
QS | |||||||||||
Shared Values | 3.2 (0.7) | 3.4 (0.9) | 3.6 (0.9) | 2.9 (0.5) | 3.1 (0.6) | 3.0 (0.6) | 3.2 (0.8) | 3.4 (0.8) | 2.9 (0.6) | 3.2 (0.7) | 3.3 (0.6) |
Context | 3.1 (0.7) | 3.3 (0.7) | 3.3 (0.7) | 3.0 (0.8) | 3.1 (0.6) | 3.3 (0.7) | 3.0 (0.6) | 3.2 (0.7) | 3.1 (0.6) | 3.1 (0.7) | 3.4 (0.6) |
Structure / Organization | 2.7 (0.7) | 2.8 (0.9) | 2.9 (0.9) | 2.6 (0.6) | 2.8 (0.5) | 2.6 (0.7) | 2.5 (0.5) | 2.8 (0.7) | 2.5 (0.7) | 2.7 (0.7) | 2.6 (0.7) |
Group dynamics / Interaction | 3.2 (0.7) | 3.2 (0.8) | 3.3 (0.8) | 3.2 (0.8) | 3.3 (0.8) | 3.1 (0.6) | 3.0 (0.5) | 3.1 (0.7) | 3.3 (0.8) | 3.2 (0.7) | 3.4 (1.0) |
Entrepreneurship / Management | 2.4 (0.8) | 2.4 (0.8) | 2.6 (0.8) | 2.4 (0.9) | 2.4 (0.7) | 1.7 (0.6) | 2.1 (0.8) | 2.4 (0.8) | 2.2 (0.8) | 2.4 (0.8) | 2.3 (0.9) |
Posttest | |||||||||||
N | 84 | 13 | 9 | 18 | 19 | 15 | 10 | 34 | 50 | 69 | 15 |
Age | 43.5 (11.6) | 46.4 (12.5) | 44.3 (10.1) | 46.2 (10.5) | 44.4 (12.4) | 38.4 (10.0) | 40.7 (13.9) | 41.9 (10.5) | 44.5 (12.3) | 43.6 (11.8) | 42.7 (11.3) |
EPIS | |||||||||||
Belonging | 18.3 (2.0) | 17.7 (1.9) | 18.3 (1.9) | 18.1 (3.0) | 18.7 (1.5) | 17.9 (1.8) | 19.3 (1.0) | 17.9 (1.8) | 18.6 (2.1) | 18.3 (2.1) | 18.1 (1.7) |
Commitment | 17.4 (2.2) | 16.5 (1.9) | 16.4 (2.4) | 17.5 (2.7) | 18.0 (1.6) | 16.9 (2.3) | 18.8 (1.9) | 17.1 (2.3) | 17.6 (2.2) | 17.5 (2.2) | 16.7 (2.5) |
Believes | 17.5 (2.6) | 17.5 (1.7) | 17.4 (2.4) | 17.5 (2.9) | 17.5 (2.0) | 16.7 (3.9) | 18.8 (2.1) | 17.4 (3.0) | 17.6 (2.4) | 17.5 (2.7) | 17.2 (2.0) |
EPIS Total | 53.2 (5.6) | 51.8 (4.4) | 52.2 (5.7) | 53.0 (7.7) | 54.1 (3.6) | 51.5 (5.7) | 56.9 (4.2) | 52.4 (5.4) | 53.7 (5.7) | 53.3 (5.7) | 52.1 (5.0) |
QS | |||||||||||
Shared Values | 3.5 (0.6) | 3.3 (0.6) | 3.0 (0.4) | 3.6 (0.6) | 3.5 (0.6) | 3.7 (0.8) | 3.9 (0.6) | 3.5 (0.7) | 3.5 (0.6) | 3.5 (0.6) | 3.2 (0.4) |
Context | 3.4 (0.5) | 3.3 (0.6) | 3.2 (0.6) | 3.4 (0.4) | 3.4 (0.5) | 3.5 (0.4) | 3.7 (0.7) | 3.4 (0.5) | 3.4 (0.5) | 3.4 (0.5) | 3.5 (0.4) |
Structure / Organization | 3.0 (0.7) | 3.1 (0.9) | 2.7 (0.7) | 2.9 (0.6) | 2.9 (0.7) | 3.1 (0.5) | 3.7 (0.5) | 3.0 (0.6) | 3.1 (0.7) | 3.0 (0.7) | 3.1 (0.5) |
Group dynamics / Interaction | 3.6 (0.5) | 3.5 (0.6) | 3.6 (0.6) | 3.5 (0.4) | 3.5 (0.6) | 3.5 (0.5) | 3.9 (0.5) | 3.4 (0.6) | 3.6 (0.5) | 3.5 (0.6) | 3.6 (0.3) |
Entrepreneurship / Management | 2.6 (0.7) | 2.6 (0.7) | 2.4 (0.5) | 2.5 (0.6) | 2.4 (0.8) | 2.7 (0.8) | 3.1 (0.5) | 2.5 (0.8) | 2.6 (0.6) | 2.6 (0.7) | 2.3 (0.7) |
Interprofessional identity (IPI)
Belonging | |||||||
---|---|---|---|---|---|---|---|
B | Std. Error | t | P value | 95% CI | |||
Lower limit. | Upper limit | ||||||
Intercept | 16.91 | .65 | 26.07 | < .001 | 15.63 | 18.19 | |
Training program | 1.39 | .42 | 3.33 | .001 | .57 | 2.21 | |
Commitment | |||||||
Intercept | 16.50 | .70 | 23.45 | < .001 | 15.12 | 17.88 | |
Training program | 1.01 | .45 | 2.23 | .027 | .12 | 1.90 | |
Beliefs | |||||||
Intercept | 16.89 | .66 | 25.75 | < .001 | 15.560 | 18.19 | |
Training program | .82 | .42 | 1.94 | .054 | − .01 | 1.65 | |
Total | |||||||
Intercept | 50.45 | 1.81 | 27.93 | < .001 | 46.88 | 54.01 | |
Training program | 2.91 | 1.16 | 2.51 | .013 | .62 | 5.20 |
Team collaboration
Shared values | ||||||
---|---|---|---|---|---|---|
B | Std. Error | t | P value | 95% CI | ||
Lower limit. | Upper limit | |||||
Intercept | 3.37 | .16 | 21.34 | < .001 | 3.06 | 3.68 |
Training program | .27 | .10 | 2.63 | .009 | .07 | .47 |
Context | ||||||
Intercept | 3.19 | .14 | 23.58 | < .001 | 2.93 | 3.46 |
Training program | .26 | .09 | 2.82 | .005 | .08 | .44 |
Structure and organization | ||||||
Intercept | 2.91 | .16 | 18.60 | < .001 | 2.60 | 3.22 |
Training program | .35 | .11 | 3.30 | .001 | .14 | .56 |
Group dynamics and interaction | ||||||
Intercept | 3.25 | .15 | 21.62 | < .001 | 2.95 | 3.54 |
Training program | .38 | .10 | 3.75 | < .001 | .18 | .58 |
Entrepreneurship and management | ||||||
Intercept | 2.45 | .18 | 13.75 | < .001 | 2.10 | 2.80 |
Training program | .25 | .12 | 2.08 | .039 | .01 | .48 |
Quality of care (ADL and inpatient days)
Inpatient days | |||||||
---|---|---|---|---|---|---|---|
B | Std. Error | t | P value | 95% CI | |||
Lower limit. | Upper limit | ||||||
Intercept | 88.59 | 4.58 | 19.33 | < .001 | 79.57 | 97.60 | |
Time | -11.82 | 2.80 | -4.22 | < .001 | -17.34 | -6.31 |
Qualitative results of the open questions of the QS
Relevant comments and quotes Main themes | ||||
---|---|---|---|---|
Subthemes | Desired eliminations | Desired retention | Desired changes | Required actions |
Shared values | Pretest The standard formulated goals/actions and insufficient focus on the patient wishes. | Pretest The wishes of the patient must be central. Working and communicating together in a shared DPF | Pretest Strengthen the shared values and propagate vision. That the team does not function as a unit. It was regularly stated that the patient should be more central with goals adapted to the individual wishes, and the family must be more involved. Approaching the patient from a more holistic view, pursuing the same goal together, clearer policy and clear agreements in the rehabilitation plan and more control for the patient in the rehabilitation process. “Now it is often a standard plan, concrete goals are missing and are too general”, “What is important for the patient?”, and “We should talk more with the patient and talk less about the patient”. | Pretest Clarity in shared values is being missed. Discussing what is the common mission/vision. Discussing the tension between the patient's wishes and financial constraints and other imposed demands. Take action to put the patient central, to involve them in the total rehabilitation process, and to work person centered. In doing so, better educate/inform the patient and family about the rehabilitation goals. |
Posttest - | Posttest Keeping the same goal in mind, creating independence for the patient The rehabilitation climate and the established more intensive contact with patient and family. | Posttest Points of attention included creating the rehabilitation plan interprofessional with the patient, making goals clear to the patient, and involving the family more. More structure in the MPC is still needed. | Posttest Further actions on expanding the rehabilitation climate across the department, a clearer rehabilitation plan and more pro-active involvement of the patient in the rehabilitation process. Continue to work on vision development. Improving the MPC. | |
Context | Pretest Team members need to know and make use of each other's qualities and expertise more and get a clearer picture of what is expected of each other. More clarity is needed about the expectations of a GRC team from the organization. | Pretest Indicate expectations and problems more clearly and investigate where collaboration can lead to quality improvement. There should also be more awareness about the social environment of the GRC team (facilities and organizations). | ||
Posttest Everyone should know each other’s expertise more. | Posttest Gain clarity in each other's expectations regarding MPC and collaboration | |||
Structure and organization | Pretest Team meetings without a clear structure and inefficient MPC. Not reflecting on collaboration. Two teams specifically stated that they want to eliminate the unrest that prevailed in the teams at that time due to the changing team composition. | Pretest Using measuring instruments during the MPC should be used to objectify goals. In doing so, obtaining a better picture of the goal/sub-goals and which concrete actions are needed and working more towards activities and participation: “What is important for the patient to be able to return home?”. During the MPC, team members no longer want to discuss everything but only the main goals. Agreements within the MPC must be fulfilled. | Pretest Reflecting on the MPC and discuss questions such as: “Is our goal to get the patient home as soon as possible or should the patient wishes be our goal?”. Planning reflection moments as an interprofessional team. To make use of prognostic measuring instruments and of the measuring instruments that have already been administered before admission to the GRC department. | |
Posttest Team meetings without a clear structure and inefficient MPC. | Posttest - | Posttest Continue to work on the joint responsibility | ||
Group dynamics and interaction | Pretest Lack of unity between disciplines, the perceived difference between the NS and TS and the feeling that some disciplines are more important than others. Matters appointed were “working on islands”, “thinking in boxes”, “not looking beyond one's own discipline”. Everyone doing things in their own way, not always being collegial, not working together enough, and not working according to the agreements made. A solution was also mentioned; “don't just name the negative, but look further into possible solutions, keep discussing”. | Pretest The short lines between the disciplines. Matters appointed were good/nice/collegiate/open atmosphere, trust, safety, good cooperation, accessibility, respect, solidarity, involvement, each other's expertise, and social interaction. In general, there is an environment in which the team members feel safe and in which cooperation between all disciplines is self-evident. | Pretest More intensive cooperation, unity (mutual trust) between the NS and TS. Forming one team again and improving mutual contacts and collegiality. Providing more feedback, questioning each other more, and having critical conversations. Reflect on the collaboration within the team and between other disciplines. Team members also want more case discussions with multiple disciplines and more meetings with a social purpose. | Pretest Approaching each other more to make optimal use of each other's expertise/qualities, involve disciplines earlier in case of problems, tackle tasks together as a team, helping each other and being more actively involved. Improve the contact and cooperation between the disciplines. There should be actions to improve consultation and communication but also being critical and addressing each other. Creating an atmosphere where everyone feels heard and seen. Share positive feedback, not just the negative. |
Posttest The perceived difference between the NS and TS is sometimes still present. | Posttest The pretest points should be retained. However, also mentioned was being there for each other, interprofessional collaboration, looking beyond your own expertise, being able to spar with each other without prejudice, asking each other for support or using each other's expertise. | Posttest The following points were identified that still need attention: listen better to each other, continue to give constructive feedback, and working according to agreements that have been made with each other. | Posttest Continue to work on team building. Occasionally sit together as a team to discuss team performance, reflect, give each other feedback, and learn from each other. | |
Entrepreneurship and management | Pretest There is a need for insight into the financial background of the GRC team. | Pretest Improvements must be made in terms of entrepreneurship and business operations and to function more like a company without forfeiting personal attention | ||
Posttest - | Posttest - |
Qualitative results of the MPC observation
Pretest | Posttest | |
---|---|---|
Procedure | ||
The agenda was known in advance (invitation via e-mail) | V | V |
A joint rehabilitation plan was used in an DPF with general goal, problem, action, and evaluation | V | V |
The rehabilitation plan was projected on a screen thereby visible to those present | V | V |
The rehabilitation plan was immediately updated by the physician or nurse practitioner | V | V |
All disciplines also worked with the rehabilitation plan on their own tablet/laptop | V | V |
Goals and actions were read at loud by the physician | V | V |
A nurse specialized in geriatrics was the chairperson | V | V |
The role of the chairperson was clear | V/X | V |
Content | ||
The entire rehabilitation plan was discussed with each other | V | V |
Goals and actions were stated by the physician and then the relevant discipline was asked how things were going with the patient and others supplemented this | V | V |
Goals and actions were made specific | X | V |
Concrete actions were discussed and immediately processed in the rehabilitation plan, including agreements for follow-up . | V | V |
Actions and goals were jointly determined | X | X |
The patients’ goals/preferences/values/needs were mentioned and were specifically stated in the joint rehabilitation plan | X | V/X |
The patient was introduced and information about the diagnosis and background was provided. | V/X | V |
Relevant problems and background information on the patient was discussed | X | V/X |
A provisional discharge date was determined based on consensus. | V/X | V |
The provisional discharge date was monitored by the entire team | X | V |
Patient present at the MPC | X | X |
The use of valid measuring instruments to support decision-making in the rehabilitation process | X | X |
Discussion about the content of actions regarding treatment intensity, frequency, or agreements about joint actions | X | V/X |
Interaction | ||
Disciplines communicated openly and there were short lines | V | V |
Disciplines know and recognize each other and there was clear mutual respect | V | V |
Equal involvement of all team members | X | V/X |
Interaction between team members | X | V |
Decision-making by entire team | X | V |
MPC evaluation | X | X |
Reflection on collaboration | X | V/X |