Do multidisciplinary integrated care pathways improve interprofessional collaboration?

Abstract

Do multidisciplinary integrated care pathways improve interprofessional collaboration?This paper reports on the evaluation stage of an action research project on interprofessional collaboration in discharge planning. Findings from interviews with health care professionals working in the acute sector had revealed concerns about discharge planning and multidisciplinary teamwork. In the United Kingdom the National Health Service (NHS) Plan has reinforced the need for an integrated approach to health care. Effective health care integration requires effective communication, teamwork and the commitment to deliver integrated care. Integrated documentation is a key strategy for enhancing interprofessional collaboration and reducing the isolation of professionals, and has been successfully implemented in a range of health care settings. Presented with the concerns about the collaborative process in discharge planning, an action research strategy was chosen to bring about change in an orthopaedic ward in one London teaching hospital. This paper will evaluate the implementation of an integrated care pathway with fractured neck of femurs in one London teaching hospital. Care pathways facilitate the management of defined patient groups using interdisciplinary plans of care. The emphasis will be on understanding whether integrated care pathways enhance and develop interprofessional collaboration and enable effective information access and flow across the professions and the organization. The criteria for evaluation, forming the hypotheses of the study, were that interprofessional nonverbal and verbal communication would be enhanced and that interprofesisonal collaboration would increase. Methods of evaluation used were: (i) stakeholder interviews, (ii) interprofessional audit and (iii) analysis of the variances from the integrated care pathway. The evaluation revealed that although integrated care pathways led to improved outcomes for the health care trust there was little evidence to suggest that interprofessional relationships and communication were enhanced. Furthermore, key factors in discharge delays appeared to be organizational rather than professional.

Development and Testing of a Conceptual Framework for Interprofessional Collaborative Practice

“…The influence of personal factors/relational skills as critical antecedents to ICP is consistent with the literature (Atwal & Caldwell, 2002;CIHC, 2010;Gaboury et al, 2011;Havens et al, 2010;Safran et al, 2006;Temkin-Greener et al, 2004), andMcGrail et al (2009) indicated that without strong relational skills, ICP will not be as effective. Beliefs in interprofessional collaboration was not found to be a significant predictor of ICP, which was surprising in light of previous research.…”

“…Relational skills are a precursor to ICP (McGrail et al, 2009), and interprofessional practitioners must have already developed strong cooperation (Gaboury, Lapierre, Boon, & Moher, 2011) and communication skills (Atwal & Caldwell, 2002;Havens, Vasey, Gittell, & Lin, 2010). Trust is critical, and according to D' Amour, Goulet, Labadie, San Martin-Rodriguez, and Pineault (2008), ICP is possible only when there is trust in each other's competencies.…”

“…Leadership is also needed to create an empowering environment that includes having access to information, support, resources, and the opportunity for growth and mobility (Kanter, 1977;1997). Support structures necessary for ICP include having adequate time for sharing knowledge and patient-related information (Atwal & Caldwell, 2002;Clark, 2011;Gaboury, Bujold, Boon, & Moher, 2009) and integrating daily collaborative behaviors into dayto-day functioning (Ottawa Hospital, n.d.). Support can also take the form of emotional support, helpful advice, or hands-on assistance from superiors, peers, or interprofessional practitioners (Kanter, 1977;1997).…”

“…Respect for others and their knowledge is important (Clark, 2011), as well as an understanding of the value base of other professionals (Atwal & Caldwell, 2002). Interdependence and knowledge exchange among interprofessional practitioners and the patient is required for all three dimensions of RCC to be effective (Tresolini & Pew-Fetzer Task Force, 1994).…”

“…Collective ownership of goals is essential for effective ICP (Atwal & Caldwell, 2002). A vital component in developing and achieving healthcare goals is that patients and their families are active participants in the process (Bronstein, 2003).…”