Why the Interdisciplinary Team Approach Works: Insights from Complexity Science

Ciemins, Elizabeth L.; Brant, Jeannine M.; Kersten, Diane; Mullette, Elizabeth; Dickerson, Dustin

doi:10.1089/jpm.2015.0398

Cited by 41 publications

(31 citation statements)

References 10 publications

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“…For effective teamwork in specialist palliative care, leadership is crucial (Dahlin, Coyne, Goldberg, & Vaughan, ); however, defining and agreeing on what leadership comprises may be challenging. One reason for the focus on teamwork in palliative care is the potential for effectively combining diverse skills and perspectives to better meet the complex needs of patients and families facing life‐threatening illness and death (Ciemins, Brant, Kersten, Mullette, & Dickerson, ; Johansen & Ervik, ; Wagner, ). Gardner () has outlined the tasks of leadership as envisioning goals, affirming values, motivating, managing, achieving a workable unity, explaining, serving as a symbol, representing the group and renewing.…”

Section: Introductionmentioning

confidence: 99%

Leadership in specialist palliative home care teams: A qualitative study

et al. 2019

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Aim The aim of this study was to describe team leaders' experiences of facilitators and barriers of leadership in specialist palliative home care teams. Background For effective teamwork in specialist palliative care, leadership is crucial; however, defining and agreeing on what leadership comprises may be challenging. In palliative care, teamwork is recognized as imperative for multiprofessional perspectives to meet dying patients' and families' needs. Methods Qualitative interviews with 13 team leaders in specialist palliative home care were performed, using the Pettigrew and Whipp framework, and analysed with directed content analysis. Results Team leaders' experiences of conditions influencing the organisation and delivery of specialist palliative home care is multifaceted and leaders seem conflicted in their approach to the multiple levels of leadership, vision and responsibilities. Conclusion Team leaders in specialist palliative home care described goals of care on differing levels and, for some, fiscal restraints and external pressures influenced their vision and leadership. Team leaders experienced challenges of leadership in relation to organisational issues, feeling burdened by responsibilities, budget restraints and team size. Implications for Nursing Management Team leadership is demanding and complex. In specialist palliative home care, affirming values and enabling vision during times of fiscal strain and external pressures, is challenging. For successful leadership that develops both individuals and the health care team, leaders are recommended to adapt the leadership style to the present situation surrounding the team.

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Section: Introductionmentioning

confidence: 99%

Leadership in specialist palliative home care teams: A qualitative study

et al. 2019

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“…The application of a complex system theory approach as it pertains to the health human resource innovation of PA integration in Ontario is novel. Although complexity theory has not been explicitly applied to the PA profession, other research supports the use of CAS to explain why interdisciplinary teams are successful in the provision of services when cases are complex (26), and to explain how patterns of interactions between health team members define team behaviour (27). Complexity theory is well suited to explore PA role integration given the complexity of healthcare settings including multiple stakeholders, multifaceted issues, uncertainty, diverse agendas, and interconnected relationships.…”

Section: Discussionmentioning

confidence: 99%

Understanding health professional role integration in complex adaptive systems A multiple-case study of Physician Assistants in Ontario, Canada

Burrows

Abelson

Miller

et al. 2020

Preprint

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Background To meet the complex needs of healthcare delivery, the Ministry of Health and Long Term Care (MOHLTC) introduced Physician Assistants (PAs) into the Ontario health care system in 2006 to help increase access to care, decrease wait times, and improve continuity of care. Integration of new health professional roles is often stymied by role resistance and funding barriers. The characterization of healthcare organizations as complex adaptive systems (CAS) may offer insight into the relationships and interactions that optimize and restrict successful PA integration. The aim of this study is to explore the integration of PAs across multiple settings and to understand the PA role within complex adaptive systems. Methods An exploratory, multiple-case study was used to examine PA role integration in four settings: family medicine, emergency, general surgery, and inpatient medicine. Interviews were conducted with 46 healthcare providers and administrators across 13 hospitals and 6 family medicine clinics in Ontario, Canada. Analysis was conducted in three phases: inductive thematic analysis within each of the four cases; a cross-case thematic analysis; and a broader exploration of cross-case patterns pertaining to specific complexity theory principles of interest. Results Support for PA contributions across various health care settings, the importance of role awareness, supervisory relationship attributes, and role vulnerability (in relation to sustainability and funding) are interconnected and dynamic in hospital and community settings. Findings represent the experiences of PAs and other healthcare providers, and demonstrate how the PA’s willingness to work and ability to build relationships within existing health systems allows for the establishment of interprofessional, collaborative, and person-centered care. As a self-organizing agent in complex adaptive systems (i.e. health organizations), PA role exploration revealed patterns of team behavior, non-linear interconnections, open relationships, dynamic systems, and the legacy of role implementation as defined by complexity theory. Conclusions By exploring the role of PAs across multiple sites, the complexity theory lens concurrently fosters an awareness of emerging patterns, relationships and non-linear interactions within the defined context of the Ontario healthcare system. By establishing collaborative, interprofessional care models in community and hospital settings, PAs are making a significant contribution to Ontario healthcare settings.

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“…The application of a complex system theory approach as it pertains to the health human resource innovation of PA integration in Ontario is novel. Although complexity theory has not been explicitly applied to the PA profession, other research supports the use of CAS to explain why interdisciplinary teams are successful in the provision of services when cases are complex (30), and to explain how patterns of interactions between health team members define team behaviour (31). Complexity theory is well suited to explore PA role integration given the complexity of healthcare settings including multiple stakeholders, multifaceted issues, uncertainty, diverse agendas, and interconnected relationships.…”

Section: Discussionmentioning

confidence: 99%

Understanding health professional role integration in complex adaptive systems: A multiple-case study of Physician Assistants in Ontario, Canada

Burrows

Abelson

Miller

et al. 2020

Preprint

View full text Add to dashboard Cite

Background To meet the complex needs of healthcare delivery, the Ministry of Health and Long Term Care (MOHLTC) introduced Physician Assistants (PAs) into the Ontario health care system in 2006 to help increase access to care, decrease wait times, and improve continuity of care. Integration of new health professional roles is often stymied by role resistance and funding barriers. The characterization of healthcare organizations as complex adaptive systems (CAS) may offer insight into the relationships and interactions that optimize and restrict successful PA integration. The aim of this study is to explore the integration of PAs across multiple settings and to understand the PA role within complex adaptive systems. Methods An exploratory, multiple-case study was used to examine PA role integration in four settings: family medicine, emergency medicine, general surgery, and inpatient medicine. Interviews were conducted with 46 healthcare providers and administrators across 13 hospitals and 6 clinics in Ontario, Canada. Analysis was conducted in three phases: inductive thematic analysis within each of the four cases; a cross-case thematic analysis; and a broader exploration of cross-case patterns pertaining to specific complexity theory principles of interest. Results Support for PA contributions across various health care settings, the importance of role awareness, supervisory relationship attributes, and role vulnerability (in relation to sustainability and funding) are interconnected and dynamic in hospital and community settings. Findings represent the experiences of PAs and other healthcare providers, and demonstrate how the PA’s willingness to work and ability to build relationships within existing health systems allows for the establishment of interprofessional, collaborative, and person-centered care. As a self-organizing agent in complex adaptive systems (i.e. health organizations), PA role exploration revealed patterns of team behavior, non-linear interconnections, open relationships, dynamic systems, and the legacy of role implementation as defined by complexity theory. Conclusions By exploring the role of PAs across multiple sites, the complexity theory lens concurrently fosters an awareness of emerging patterns, relationships and non-linear interactions within the defined context of the Ontario healthcare system. By establishing collaborative, interprofessional care models in community and hospital settings, PAs are making a significant contribution to Ontario healthcare settings.

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Why the Interdisciplinary Team Approach Works: Insights from Complexity Science

Cited by 41 publications

References 10 publications

Leadership in specialist palliative home care teams: A qualitative study

Leadership in specialist palliative home care teams: A qualitative study

Understanding health professional role integration in complex adaptive systems A multiple-case study of Physician Assistants in Ontario, Canada

Understanding health professional role integration in complex adaptive systems: A multiple-case study of Physician Assistants in Ontario, Canada

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