Background
Methods
Setting and participants
1. General Practitioners | 7. (District) Nurses |
2. General Practitioner Assistants | 8. Helping Assistants |
3. Physiotherapists | 9. Primary Care Psychologists |
4. Remedial Therapists | 10. Geriatric Specialized Practice Nurses |
5. Pharmacists | 11. Occupational Therapists |
6. Dieticians | 12. Speech Therapists |
Characteristic |
n
| % | |
Sex | |||
Male | 33 | 21.7 | |
Female | 119 | 78.3 | |
Education level completed | |||
Secondary school | 13 | 8.6 | |
Secondary vocational | 35 | 23 | |
Bachelor degree | 89 | 58.6 | |
Master degree | 14 | 9.2 | |
Other | 1 | 0.7 | |
Discipline | |||
Physiotherapist | 36 | 23.7 | |
Helping Assistant | 31 | 20.4 | |
Remedial Therapist | 22 | 14.5 | |
(District) Nurse | 19 | 12.5 | |
General Practitioner Assistant | 12 | 7.9 | |
General Practitioner | 9 | 5.9 | |
Primary Care Dermatologist | 6 | 3.9 | |
Geriatric Specialized Practice Nurse | 5 | 3.3 | |
Dietician | 5 | 3.3 | |
Occupational Therapist | 2 | 1.3 | |
Speech Therapist | 2 | 1.3 | |
Primary Care Psychologist | 2 | 1.3 | |
Other | 1 | 0.7 | |
Mean | SD | Range | |
Team tenure | 6 | 7.2 | 1–35 |
Age (years) | 40 | 12.1 | 21–64 |
Team size | 9.9 | 5.4 | 2–40 |
Team diversity | .46 | .30 | 0–.93 |
Note. SD = Standard deviation |
Variable | General Practitioner (n = 6) | Physio- therapist (n = 7) | Occupational therapist (n = 7) | (District) Nurse (n = 9) | Geriatric specialized practice nurse (n = 3) |
---|---|---|---|---|---|
Gender | |||||
Male | 2 | 2 | 0 | 1 | 0 |
Female | 4 | 5 | 7 | 8 | 3 |
Age in years | |||||
< 30 | 0 | 2 | 2 | 3 | 0 |
30–50 | 5 | 3 | 4 | 2 | 2 |
> 50 | 1 | 2 | 1 | 4 | 1 |
Work setting | |||||
Home care organization | 0 | 0 | 0 | 9 | 0 |
General practitioner centre | 2 | 0 | 0 | 0 | 2a
|
Physiotherapy centre | 0 | 3 | 0 | 0 | 0 |
Occupational therapy centre | 0 | 0 | 5 | 0 | 0 |
Primary health care centre | 4 | 4 | 2 | 0 | 1 |
Number of years practicing | |||||
< 15 | 2 | 3 | 3 | 5 | 1 |
15–30 | 1 | 2 | 3 | 1 | 2 |
> 30 | 3 | 2 | 1 | 3 | 0 |
Quantitative questionnaire
Qualitative interviews
Quantitative analysis
Qualitative analysis
Results
Quantitative results
Who is part of the team
Relational coordination
Qualitative results
Conceptualization of teams
“A team to me is when together you provide high quality care for a patient. A network is more like loose grains of sand. A real team is often the general practitioners, the home care organization and the practice nurses. And occasionally, other people [KD: disciplines] are flown in like a physiotherapist or an occupational therapist. But the core of the team really is the general practitioner and the home care organization.” (General practitioner 1)
However, most occupational therapists and physiotherapists felt that in the eyes of patients, they do belong to the core of the team around a patient, as their fields of expertise focus more on helping a patient with daily activities than treating their medical condition. According to the occupational therapists, knowing how to manage daily life and how to remain independent are important goals for patients.“For example, an occupational therapist can arrange walkers for patients with Parkinson’s. But long-term care, they don’t provide that. They are more or less flown in, do their business and fly out again. And it could very well be that you need them again later, but not structurally.” (General practitioner 2)
The extent to which participants felt that they were part of a team was divided and seemed to be related to the type of work structure (i.e., working within the same building or not). Professionals working within the same building often referred to each other as members of the same team. However, for professionals who work in a monodisciplinary centre, the team concept applies to professionals from the same disciplinary background.“Well, a social worker might be involved whom I have never spoken to or whose patient goals I might not know. That person will have a lower team familiarity towards me than the physiotherapist whom I regularly speak with regarding a client’s condition. That may be via phone or email, that’s not important to me. So in that sense there are multiple layers.” (Occupational therapist 1)
With regard to teamwork with professionals from other disciplinary backgrounds outside a formal structure or the same building, participants did not perceive to work as a team. These multidisciplinary collaborations were often described as “loose networks” around a single patient. The participants did not refer to these collaborations as teams because of the perceived incidental structure of the collaboration. Professionals who do not structurally work together for the same patient group are not perceived as a team.“The centre I am currently working in does feel like a team, but actually, my team members are merely my fellow general practitioners.” (General practitioner 3)
Although most participants felt that all professionals ultimately want the best care for their patients, the participants felt that professionals work individually with few mutual connections.“It [KD: collaboration with different disciplines] doesn’t feel like a team because it’s usually a one-time collaboration around a patient. And perhaps you meet the same people around another patient, but that doesn’t make it a team. It’s more an incidental collaboration around a patient. So it’s more like a network.” (Occupational therapist 4)
“When I look at the care for the elderly that we give, I feel that the older person is at the centre and we as professionals stand around the patient. And everybody does their own thing. But it would be very nice if all of those professionals had connections with each other.” (General practitioner 5)
Factors influencing the perception of working as team
“Well, there’s a difference between knowing each other in the sense of ‘I know the other person’s name’ and knowing in the sense of ‘I’ve seen his or her face’. If you recognize each other’s faces, the collaboration will be ten times better because usually right after five minutes you’ll know things like, ‘Oh, everything will be all right with that physiotherapist’, or ‘Oh, that general practitioner is very involved’.” (Occupational therapist 2)
The general practitioners also acknowledged the positive effects of knowing the other professionals, but mentioned a lack of time as a hindering factor. Additionally, the fact that multiple professionals represent the same discipline in care for the same patient was viewed as a barrier to getting to know each other. This was especially the case for (district) nurses working in the same home care organization, where multiple (district) nurses can be involved in the care for a single patient.“It does help a lot if you know each other. For example, the geriatric specialized nurse doesn’t work in this building, but since you know each other, you’ve already seen each other, and together you’ve invested time in knowing each other’s roles and expertise. You know what you can and can’t expect from each other. Or you can sometimes think along with another professional. That works really well, and I also think it’s important in elderly care.” (Physiotherapist 1)
THE NECESSITY FOR KNOWLEDGE EXCHANGE“What I notice with the elderly people whom I visit is that they like it very much when everyone involved in their care knows each other. For example, when I visit a patient, and they say “Yeah, my physiotherapist is M!”, then I would say “Oh, I know her. I just saw her at another patient’s home”. “Oh that’s great!” So you can see that they like it when they know that you know the other professionals.” (Occupational therapist 6)
As a side note, compared to the other disciplines, occupational therapists and physiotherapists found it more important to update the other disciplines on their tasks on a weekly basis, especially the general practitioners. These disciplines found it particularly important to keep the other disciplines informed, as they highly valued providing holistic care to patients. However, communication is often felt to be one-directional; the general practitioners rarely respond to their emails.“I think that everyone [KD: primary care professionals] is highly involved in the care for patients with multi-morbidity, so there’s no real necessity to have contact in any way. Look, as far as I’m concerned, when things go really wrong, then there’s a need to deliberate.” (General practitioner 1)
SHARING A HOLISTIC VIEW OF CAREGIVING“To me, it’s important that other professionals know how to find me if they have any questions regarding my treatment of a patient. For example, that they inform me when they see a patient goal related to occupational therapy. And that they share important developments in their own fields of expertise with me. I currently feel that I share what I am doing more often, that as an occupational therapist, I see patient goals within the field of expertise of other disciplines and make these disciplines aware of these goals than the other way around. That happens sometimes.” (Occupational therapist 4)
Some (district) nurses expressed a desire for more teamwork with general practitioners, but they felt that the general practitioners often prefer to work solo. The results from the general practitioners on this matter were mixed. Some expressed a wish for more teamwork between different disciplines on a regular and structured basis, while others felt that teamwork is only necessary on an incidental basis when a patient’s condition is unstable.“It really also depends on your own perspective, whether you see each other as complementary and see each other’s added value, or if you rather like to keep things to yourself.” (Physiotherapist 7)
“General practitioners always say “we are so busy”. Nobody else in the world is busy, but they are. If we work with a general practitioner, he visits a patient on his own time. He doesn’t adapt to my schedule. It doesn’t matter if I’m there or not. It makes me sad because sometimes the patient needs a bandage and he [KD: general practitioner] won’t do it. We [KD: (district) nurses] are like a necessary evil. Nothing comes from the general practitioners that says that they’re willing to collaborate. The love always needs to come from the other side.” ((District) nurse 2)