Do interprofessional teams matter? : A survey-based study of patients and team members in hospitals and rehabilitation centres in secondary health care in Western Norway.
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Background Health care today is becoming more complex, and patients must interact with an array of health care professionals working within and between various health care settings. Coordinated health services meeting the patients’ needs are certainly a major challenge for the modern society. Health care professionals working in interprofessional teams is a prioritised structure and are employed to ensure coordinated, collaborative care trajectories meeting the patients’ needs in hospitals and rehabilitation centres within secondary health care. Therefore, the overall aim of this thesis is to investigate specific team functions in interprofessional teams in hospitals and rehabilitation centres, as well as to examine how these team functions are associated with continuity of care, rehabilitation benefit, and changes in health and functioning, as reported by the patients. Materials and methods The first part of the thesis (Paper I) is based on data from a cross-sectional multi-centre study investigating the quality of communication and supportive relationships in teams working in various hospitals in secondary health care. In Paper I, these qualities in teams are explored by means of a Norwegian version of the Relational Coordination Survey (RCS) with data from 263 health care professionals working in 23 care processes. RCS data were collected in 2012 and 2013. The second part of this thesis (Papers II and III) utilises data from a longitudinal cohort study investigating associations between team functions in interprofessional rehabilitation teams and patient-reported outcomes in somatic rehabilitation centres. This section of the thesis also investigates associations between patient experienced interprofessional team functions, measured by Nijmegen Continuity Questionnaire-Norwegian version (NCQ-N), and changes in patient-reported health and functioning. RCS data were collected from 94 health care professionals working in 15 interprofessional teams in somatic rehabilitation centres in Western Norway in the first half of 2016 (Papers II and III). Patients were invited to participate when they were accepted for a rehabilitation stay at a somatic rehabilitation centre. Baseline data for the 701 included patients were collected during the first half of 2015, while follow-up data were collected one year after data collection at baseline. In the first section of this thesis, linear mixed-effect models and one-way analyses of variance were employed in the statistical analyses. In the second part of this thesis, linear models were utilised to assess associations between independent (RCS, Papers II and III and NCQ-N, Paper III) and dependent variables (the patient-reported outcomes). Results A main finding of this present study was that written clinical procedures describing the care process were associated with increased quality of communication in teams (Paper I). Another main finding was the positive association between interprofessional teams scoring high RCS supportive relationship scores and patient-reported team continuity (Paper II). Furthermore, high patients reported team, personal and cross-boundary continuity was associated with improved health for the patients (Paper III). The RCS subscale scores were significantly higher among health professionals holding similar occupational roles within the team, compared to communication and relationships between other members of the team (Paper I). However, the RCS quality of communication and supportive relationships in teams did not show significant associations with changes in patient-reported health and functioning (Paper III). Conclusions and implications Working in interprofessional teams with common strategies towards reaching the patients’ goals is the preferred way of delivering health care in hospitals and rehabilitation centres in secondary health care. This present study found that the quality of communication in interprofessional rehabilitation teams was associated with improved patient-reported team continuity, reflecting the current practice of interprofessional teamwork. In addition, this present study found that patients experiencing team continuity, personal and cross-boundary continuity in the rehabilitation process reported more improvement in their health state one year after rehabilitation. On the other hand, the quality of communication and relationships in teams as reported by professionals were not associated with improvements in patient-reported health and functioning. This finding could indicate that patient-reported measures of team continuity is a better predictor for the content of teamwork most important for positive rehabilitation outcomes compared to RCS subscales. Health care professionals having similar occupational roles had better communication and relationships with other professionals holding similar occupational roles. This finding could indicate that poor understanding of other team members’ roles that consequently hinders the quality of communication and relationships. Written clinical procedures were positively associated with increased quality of communication in teams. This finding indicates that written clinical procedures might increase the quality of health care delivery, improve continuity of care and be facilitated through the implementation of evidence-based clinical pathways.
Består avPaper I: Hustoft M, Hetlevik Ø, Aβmus J, Størkson S, Gjesdal S, & Biringer E. (2018). Communication and relational ties in inter-professional teams in Norwegian specialised health care: A multicentre study of relational coordination. International Journal of Integrated Care, 18(2), 9. The article is available in the main thesis. The article is also available at: http://doi.org/10.5334/ijic.3432
Paper II: Hustoft M, Biringer E, Gjesdal S, Aβmus J, & Hetlevik Ø. (2018). Relational coordination in interprofessional teams and its effect on patient-reported benefit and continuity of care: a prospective cohort study from rehabilitation centres in Western Norway. Journal of Biomedical Science Health Services Research, 18(1), 719. The article is available in the main thesis. The article is also available at: https://doi.org/10.1186/s12913-018-3536-5
Paper III: Hustoft M, Biringer E, Gjesdal S, Moen VP, Aβmus J, & Hetlevik Ø. (2019). The effect of team collaboration and continuity of care on health and functioning among rehabilitation patients: a longitudinal survey-based study from western Norway. Quality of Life Research, 28, 2773 – 2785. The article is available at: http://hdl.handle.net/1956/22291