Medicine information exchange networks among healthcare professionals and prescribing in geriatric medicine wards

Chan, Bosco; Reeve, Emily; Matthews, Slade; Carroll, Peter R.; Long, Janet C.; Held, Fabian; Latt, Mark; Naganathan, Vasi; Caplan, Gideon A.; Hilmer, Sarah N.

doi:10.1111/bcp.13222

Cited by 19 publications

(19 citation statements)

References 42 publications

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“…Many of the factors (e.g. sharing the same values and goals, installing horizontal collaborative relationships) have been described already in literature using complexity theory or other conceptual frameworks [ 44 – 48 ]. Some factors however, such as contextual factors of extra fees or the dependency of nurses on doctors’ prescriptions for their job, are less known for influencing information exchange.…”

Section: Discussionmentioning

confidence: 99%

Healthcare teams as complex adaptive systems: understanding team behaviour through team members’ perception of interpersonal interaction

Pype

Mertens

Helewaut³

et al. 2018

BMC Health Serv Res

127

121

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BackgroundComplexity science has been introduced in healthcare as a theoretical framework to better understand complex situations. Interdisciplinary healthcare teams can be viewed as Complex Adaptive Systems (CAS) by focusing more on the team members’ interaction with each other than on the characteristics of individual team members. Viewing teams in this way can provide us with insights into the origins of team behaviour. The aim of this study is to describe the functioning of a healthcare team as it originates from the members’ interactions using the CAS principles as a framework and to explore factors influencing workplace learning as emergent behaviour.MethodsAn interview study was done with 21 palliative home-care nurses, 20 community nurses and 18 general practitioners in Flanders, Belgium. A two-step analysis consisted of a deductive approach, which uses the CAS principles as coding framework for interview transcripts, followed by an inductive approach, which identifies patterns in the codes for each CAS principle.ResultsAll CAS principles were identified in the interview transcripts of the three groups. The most prevalent principles in our study were principles with a structuring effect on team functioning: team members act autonomously guided by internalized basic rules; attractors shape the team functioning; a team has a history and is sensitive to initial conditions; and a team is an open system, interacting with its environment. The other principles, focusing on the result of the structuring principles, were present in the data, albeit to a lesser extent: team members’ interactions are non-linear; interactions between team members can produce unpredictable behaviour; and interactions between team members can generate new behaviour. Patterns, reflecting team behaviour, were recognized in the coding of each CAS principle. Patterns of team behaviour, identified in this way, were linked to interprofessional competencies of the Interprofessional Collaboration Collaborative. Factors influencing workplace learning were identified.ConclusionsThis study provides us with insights into the origin of team functioning by explaining how patterns of interactions between team members define team behaviour. Viewing healthcare teams as Complex Adaptive Systems may offer explanations of different aspects of team behaviour with implications for education, practice and research.

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Section: Discussionmentioning

confidence: 99%

Healthcare teams as complex adaptive systems: understanding team behaviour through team members’ perception of interpersonal interaction

Pype

Mertens

Helewaut³

et al. 2018

BMC Health Serv Res

127

121

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“…Each prescriber may not be aware of the whole picture of all diagnoses and medications, particularly because documentation and information transfer between settings can be imperfect. Miscommunication between settings and professionals contributes to medication‐related harm for older people both in Australia and internationally . Limited access to medication histories can result in prescriber reluctance to change medication regimens, for example when they are unable to ascertain the reason why a medication was originally prescribed .…”

Section: Fundingmentioning

confidence: 99%

“…The multiple components were emphasised in the Australian Pharmaceutical Advisory Council's 2005 Guiding Principles to Achieve Continuity in Medication Management, and again in more recent publications . An existing system‐wide Australian systems map was not identified, although an international attempt was retrieved in the grey literature . The system map was developed by the group, which illustrates some of the pathways older Australians may take through Australia's complex medication management system (Figure ).…”

Section: Fundingmentioning

confidence: 99%

Integrate healthcare to provide multidisciplinary consumer‐centred medication management: report from a working group formed from the National Stakeholders’ Meeting for the Quality Use of Medicines to Optimise Ageing in Older Australians

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Cross

Elliott

et al. 2018

Pharmacy Practice and Res

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A National Stakeholders' Meeting on Quality use of Medicines to Optimise Ageing in Older Australians was held in Sydney 2015 with the aim of setting an agenda to improve the quality use of medicines for older Australians. Multidisciplinary working groups were formed to address each of the eight key challenges identified. The aim of Working Group 2 was to develop recommendations to integrate the health care of older Australians across settings and practitioners to provide multidisciplinary consumer-centred care. A systems map was proposed to better understand the complex pathways older Australians take through health care. Working Group 2 members (consumer representatives and health professionals) met via teleconference and email, and contributed relevant literature identified during their work. They identified challenges to optimal medication management that were used to develop a systems map to illustrate the complex medication management pathways for older Australians. The working group generated 10 recommended strategies to facilitate multidisciplinary consumer-centred care that could improve the quality use of medicines. Medication management in Australia is complex, as highlighted by the systems map. Working Group 2 identified concrete strategies to improve the quality use of medicines by older adults through systemic policy and practice-based strategies.

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“…Face-to-face communication patterns may be directly observed (e.g., Obstfeld, 2005). Referral patterns, email communications, or collaboration may be gathered using a self-report survey (Bishop & Waring, 2012;Chan et al, 2016;Long, Hibbert, & Braithwaite, 2016) or documentary evidence (Fattore, Frosini, Salvatore, & Tozzi, 2009;Zheng, Padman, Krackhardt, Johnson, & Diamond, 2010).…”

Section: Social Network Conceptsmentioning

confidence: 99%

Social Network Research

Long

Bishop

2017

Handbook of Research Methods in Health Social Sciences

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Analysis of networks is increasingly seen as important for understanding the patterns, processes and consequences of social relationships in healthcare. Networks can be formal, mandated structures (e.g., a clinical network), can emerge from sharing a common passion, or from routine exchanges such as referrals. Braithwaite and colleagues call for the fostering of naturally emerging networks suggesting these underpin the delivery of healthcare and play an important role in driving quality and safety. Social network analysis (SNA) emphasizes patterns of relationships and interactions between network members (actors) rather than individual attributes/behaviours or abstract social structures. SNA conceptualizes networks as composed of nodes (the actors in the group) and ties (the relationship between the actors). Ties form the structure of the network and the nodes occupy positions within that structure. This proves a basis to investigate a wide range of issues, including communication pathways between actors (including gaps, bottlenecks or opportunities to increase connectivity), the presence of "tribes" or silos, key players, networks of social support, and patterns of social influences on behaviours. This also allows researchers to investigate relationships between network structures (e.g., communication flows) and important outcomes (e.g., rapid dissemination of ideas).In this chapter, we will introduce readers to key debates, concepts, methods and applications of SNA, drawing on the authors' own studies and the growing body of healthcare literature adopting this approach. This demonstrates the contribution of SNA to understanding different types of networks, including at the individual, group and organizational level.

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Medicine information exchange networks among healthcare professionals and prescribing in geriatric medicine wards

Abstract: Understanding MIE networks can identify gaps in multidisciplinary communication that can be addressed. Networks may identify targets for dissemination of interventions to improve prescribing.

Cited by 19 publications

References 42 publications

Healthcare teams as complex adaptive systems: understanding team behaviour through team members’ perception of interpersonal interaction

Healthcare teams as complex adaptive systems: understanding team behaviour through team members’ perception of interpersonal interaction

Integrate healthcare to provide multidisciplinary consumer‐centred medication management: report from a working group formed from the National Stakeholders’ Meeting for the Quality Use of Medicines to Optimise Ageing in Older Australians

Social Network Research

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