WorldWideScience

Sample records for health care team

  1. Your Health Care Team

    Science.gov (United States)

    ... Disease (Nephropathy) Gastroparesis Mental Health Step On Up Treatment & Care Blood Glucose Testing Medication Doctors, Nurses & More ... us get closer to curing diabetes and better treatments for those living with diabetes. Other Ways to ...

  2. Team effectiveness in academic primary health care teams.

    Science.gov (United States)

    Delva, Dianne; Jamieson, Margaret; Lemieux, Melissa

    2008-12-01

    Primary health care is undergoing significant organizational change, including the development of interdisciplinary health care teams. Understanding how teams function effectively in primary care will assist training programs in teaching effective interprofessional practices. This study aimed to explore the views of members of primary health care teams regarding what constitutes a team, team effectiveness and the factors that affect team effectiveness in primary care. Focus group consultations from six teams in the Department of Family Medicine at Queen's University were recorded and transcribed and qualitative analysis was used to identify themes. Twelve themes were identified that related to the impact of dual goals/obligations of education and clinical/patient practice on team relationships and learners; the challenges of determining team membership including nonattendance of allied health professionals except nurses; and facilitators and barriers to effective team function. This study provides insight into some of the challenges of developing effective primary care teams in an academic department of family medicine. Clear goals and attention to teamwork at all levels of collaboration is needed if effective interprofessional education is to be achieved. Future research should clarify how best to support the changes required for increasingly effective teamwork.

  3. Evaluating the effectiveness of health care teams.

    Science.gov (United States)

    Mickan, Sharon M

    2005-05-01

    While it is recognised that effective health care teams are associated with quality patient care, the literature is comparatively sparse in defining the outcomes of effective teamwork. This literature review of the range of organisational, team and individual benefits of teamwork complements an earlier article which summarised the antecedent conditions for (input) and team processes (throughput) of effective teams. This article summarises the evidence for a range of outcome measures of effective teams. Organisational benefits of teamwork include reduced hospitalisation time and costs, reduced unanticipated admissions, better accessibility for patients, and improved coordination of care. Team benefits include efficient use of health care services, enhanced communication and professional diversity. Patients report benefits of enhanced satisfaction, acceptance of treatment and improved health outcomes. Finally, team members report enhanced job satisfaction, greater role clarity and enhanced well-being. Due to the inherent complexity of teamwork, a constituency model of team evaluation is supported where key stakeholders identify and measure the intended benefits of a team.

  4. Mental health integration: normalizing team care.

    Science.gov (United States)

    Reiss-Brennan, Brenda

    2014-01-01

    This article examines the impact of integrating mental health into primary health care. Mental Health Integration (MHI) within Intermountain Healthcare has changed the culture of primary health care by standardizing a team-based care process that includes mental health as a normal part of the routine medical encounter. Using a quantitative statistical analysis of qualitative reports (mixed methods study), the study reports on health outcomes associated with MHI for patients and staff. Researchers interviewed 59 patients and 50 staff to evaluate the impact of MHI on depression care. Patients receiving MHI reported an improved relationship with caregivers (P approach to improve outcomes.

  5. The Mangle of Interprofessional Health Care Teams

    Directory of Open Access Journals (Sweden)

    Susan C. Sommerfeldt

    2015-01-01

    Full Text Available The aim of this study was to explore dimensions of relational work in interprofessional health care teams. Practitioners from a variety of disciplines came together to examine teamwork and cocreate knowledge about interprofessionalism using forum theater. Interviews held prior to the workshop to explore teamwork were foundational to structuring the workshop. The forum theater processes offered participants the opportunity to enact and challenge behaviors and attitudes they experienced in health care teams. Throughout the workshop, aspects of professional identity, power, trust, communication, system structures, and motivation were explored. The activities of the workshop were analyzed using Pickering’s theory, identifying three mangle strands found in being a team: organizational influences, accomplishing tasks, and an orientation to care. Performativity was identified as having a bearing on how teams perform and how teamwork is enacted. Practice components were seen as strands within a mangling of human and nonhuman forces that shape team performativity.

  6. The Mangle of Interprofessional Health Care Teams

    Directory of Open Access Journals (Sweden)

    Susan C. Sommerfeldt

    2015-01-01

    Full Text Available The aim of this study was to explore dimensions of relational work in interprofessional health care teams. Practitioners from a variety of disciplines came together to examine teamwork and cocreate knowledge about interprofessionalism using forum theater. Interviews held prior to the workshop to explore teamwork were foundational to structuring the workshop. The forum theater processes offered participants the opportunity to enact and challenge behaviors and attitudes they experienced in health care teams. Throughout the workshop, aspects of professional identity, power, trust, communication, system structures, and motivation were explored. The activities of the workshop were analyzed using Pickering’s theory, identifying three mangle strands found in being a team: organizational influences, accomplishing tasks, and an orientation to care. Performativity was identified as having a bearing on how teams perform and how teamwork is enacted. Practice components were seen as strands within a mangling of human and nonhuman forces that shape team performativity.

  7. Can health care teams improve primary care practice?

    Science.gov (United States)

    Grumbach, Kevin; Bodenheimer, Thomas

    2004-03-10

    In health care settings, individuals from different disciplines come together to care for patients. Although these groups of health care personnel are generally called teams, they need to earn true team status by demonstrating teamwork. Developing health care teams requires attention to 2 central questions: who is on the team and how do team members work together? This article chiefly focuses on the second question. Cohesive health care teams have 5 key characteristics: clear goals with measurable outcomes, clinical and administrative systems, division of labor, training of all team members, and effective communication. Two organizations are described that demonstrate these components: a private primary care practice in Bangor, Me, and Kaiser Permanente's Georgia region primary care sites. Research on patient care teams suggests that teams with greater cohesiveness are associated with better clinical outcome measures and higher patient satisfaction. In addition, medical settings in which physicians and nonphysician professionals work together as teams can demonstrate improved patient outcomes. A number of barriers to team formation exist, chiefly related to the challenges of human relationships and personalities. Taking small steps toward team development may improve the work environment in primary care practices.

  8. Cross-functional teams in health care organizations.

    Science.gov (United States)

    McKenzie, L

    1994-03-01

    Cross-functional teams in health care organizations provide a comprehensive view of problems and are highly useful in designing and implementing improvements in work processes. Several potential obstacles may impede team progress, but these can be overcome. Cross-functional teams must develop norms that guide the interactions of team members. Individual team members must display behaviors that serve task accomplishment and team spirit. The promise of cross-functional teams for health care organizations is great. These promises, however, will not be fulfilled without the positive support of health care supervisors.

  9. Advanced practice nursing, health care teams, and perceptions of team effectiveness.

    Science.gov (United States)

    Kilpatrick, Kelley; Lavoie-Tremblay, Mélanie; Ritchie, Judith A; Lamothe, Lise

    2014-01-01

    This article summarizes the results of an extensive review of the organizational and health care literature of advanced practice nursing (APN) roles, health care teams, and perceptions of team effectiveness. Teams have a long history in health care. Managers play an important role in mobilizing resources, guiding expectations of APN roles in teams and within organizations, and facilitating team process. Researchers have identified a number of advantages to the addition of APN roles in health care teams. The process within health care teams are dynamic and responsive to their surrounding environment. It appears that teams and perceptions of team effectiveness need to be understood in the broader context in which the teams are situated. Key team process are identified for team members to perceive their team as effective. The concepts of teamwork, perceptions of team effectiveness, and the introduction of APN roles in teams have been studied disparately. An exploration of the links between these concepts may further our understanding the health care team's perceptions of team effectiveness when APN roles are introduced. Such knowledge could contribute to the effective deployment of APN roles in health care teams and improve the delivery of health care services to patients and families.

  10. Does team training work? Principles for health care.

    Science.gov (United States)

    Salas, Eduardo; DiazGranados, Deborah; Weaver, Sallie J; King, Heidi

    2008-11-01

    Teamwork is integral to a working environment conducive to patient safety and care. Team training is one methodology designed to equip team members with the competencies necessary for optimizing teamwork. There is evidence of team training's effectiveness in highly complex and dynamic work environments, such as aviation and health care. However, most quantitative evaluations of training do not offer any insight into the actual reasons why, how, and when team training is effective. To address this gap in understanding, and to provide guidance for members of the health care community interested in implementing team training programs, this article presents both quantitative results and a specific qualitative review and content analysis of team training implemented in health care. Based on this review, we offer eight evidence-based principles for effective planning, implementation, and evaluation of team training programs specific to health care.

  11. Diagnosing and improving functioning in interdisciplinary health care teams.

    Science.gov (United States)

    Blackmore, Gail; Persaud, D David

    2012-01-01

    Interdisciplinary teams play a key role in the delivery of health care. Team functioning can positively or negatively impact the effective and efficient delivery of health care services as well as the personal well-being of group members. Additionally, teams must be able and willing to work together to achieve team goals within a climate that reflects commitment to team goals, accountability, respect, and trust. Not surprisingly, dysfunctional team functioning can limit the success of interdisciplinary health care teams. The first step in improving dysfunctional team function is to conduct an analysis based on criteria necessary for team success, and this article provides meaningful criteria for doing such an analysis. These are the following: a common team goal, the ability and willingness to work together to achieve team goals, decision making, communication, and team member relationships. High-functioning interdisciplinary teams must exhibit features of good team function in all key domains. If a team functions well in some domains and needs to improve in others, targeted strategies are described that can be used to improve team functioning.

  12. Organizational Leadership For Building Effective Health Care Teams

    OpenAIRE

    Taplin, Stephen H.; Foster, Mary K.; Shortell, Stephen M.

    2013-01-01

    The movement toward accountable care organizations and patient-centered medical homes will increase with implementation of the Affordable Care Act (ACA). The ACA will therefore give further impetus to the growing importance of teams in health care. Teams typically involve 2 or more people embedded in a larger social system who differentiate their roles, share common goals, interact with each other, and perform tasks affecting others. Multiple team types fit within this definition, and they al...

  13. [Community health in primary health care teams: a management objective].

    Science.gov (United States)

    Nebot Adell, Carme; Pasarin Rua, Maribel; Canela Soler, Jaume; Sala Alvarez, Clara; Escosa Farga, Alex

    2016-12-01

    To describe the process of development of community health in a territory where the Primary Health Care board decided to include it in its roadmap as a strategic line. Evaluative research using qualitative techniques, including SWOT analysis on community health. Two-steps study. Primary care teams (PCT) of the Catalan Health Institute in Barcelona city. The 24 PCT belonging to the Muntanya-Dreta Primary Care Service in Barcelona city, with 904 professionals serving 557,430 inhabitants. Application of qualitative methodology using SWOT analysis in two steps (two-step study). Step 1: Setting up a core group consisting of local PCT professionals; collecting the community projects across the territory; SWOT analysis. Step 2: From the needs identified in the previous phase, a plan was developed, including a set of training activities in community health: basic, advanced, and a workshop to exchange experiences from the PCTs. A total of 80 team professionals received specific training in the 4 workshops held, one of them an advanced level. Two workshops were held to exchange experiences with 165 representatives from the local teams, and 22 PCTs presenting their practices. In 2013, 6 out of 24 PCTs have had a community diagnosis performed. Community health has achieved a good level of development in some areas, but this is not the general situation in the health care system. Its progression depends on the management support they have, the local community dynamics, and the scope of the Primary Health Care. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  14. [Information in health care: the use of SIAB by the professional teams of Family Health Care].

    Science.gov (United States)

    Marcolino, Janaína Souza; Scochi, Maria José

    2010-06-01

    The remarkable expansion of Family Health Care Program and the discussion of issues related to the amount of the collected data stimulated the need for designing an information system that embraced the complex organization of basic health care. So, in 1998, the Basic Health Care Information System (SI4B) was founded. This research aimed to investigate the use of SIAB by the professional teams of the Family Health Care. A questionnaire was applied to 75 professionals belonging to 10 teams which were observed, one week each. The study evidenced that the Family Health Care teams that participated in this research have not used the available information for planning or assessing their health care services, and so, they have missed the opportunity of using the available information for health care local needs.

  15. Organizational leadership for building effective health care teams.

    Science.gov (United States)

    Taplin, Stephen H; Foster, Mary K; Shortell, Stephen M

    2013-01-01

    The movement toward accountable care organizations and patient-centered medical homes will increase with implementation of the Affordable Care Act (ACA). The ACA will therefore give further impetus to the growing importance of teams in health care. Teams typically involve 2 or more people embedded in a larger social system who differentiate their roles, share common goals, interact with each other, and perform tasks affecting others. Multiple team types fit within this definition, and they all need support from leadership to succeed. Teams have been invoked as a necessary tool to address the needs of patients with multiple chronic conditions and to address medical workforce shortages. Invoking teams, however, is much easier than making them function effectively, so we need to consider the implications of the growing emphasis on teams. Although the ACA will spur team development, organizational leadership must use what we know now to train, support, and incentivize team function. Meanwhile, we must also advance research regarding teams in health care to give those leaders more evidence to guide their work.

  16. Medical Team Training Programs in Health Care

    Science.gov (United States)

    2005-01-01

    DOM, renamed LifewingsTM), and Geriatric Interdisciplinary Team Training ( GITT )—from a comprehensive review of the literature (refer to Baker et al...response checklist,” which trainees are required to use in the OR. Geriatric Interdisciplinary Team Training ( GITT ) The primary purpose of GITT is to... GITT provides interdisciplinary team training for physicians, nurses, nurse practitioners, social workers, pharmacists, therapists, and

  17. The effects on team emotions and team effectiveness of coaching in interprofessional health and social care teams.

    Science.gov (United States)

    Dimas, Isabel Dórdio; Renato Lourenço, Paulo; Rebelo, Teresa

    2016-07-01

    The purpose of this study was to examine the effects of coaching behaviours provided by peers and by the leader on the emotions experienced by interprofessional health and social care teams and on members' satisfaction with the team, as well as on team performance. Data were obtained from a survey among 344 employees working in 52 interprofessional health and social care teams from nine Portuguese organizations. The results show that leader coaching and peer coaching have a positive effect on the level of team members' satisfaction with the team and on positive emotions, and a negative effect on negative emotions. Furthermore, coaching provided by peers presents a positive effect on team performance as assessed by the leader of the team. Our findings put forward the importance of engaging in coaching behaviours to promote quality of the team experience, as well as the achievement of team performance objectives. Further studies should explore how coaching behaviours impact the patient, whose well-being is the ultimate objective of a team in the health and social care system, namely in terms of the patient's perception of quality care or patient outcomes.

  18. Health care interprofessional education: encouraging technology, teamwork, and team performance.

    Science.gov (United States)

    2014-04-01

    It is critical to prepare nurses for future practice to work in teams by engaging students in interprofessional education (IPE) that fosters positive attitudes toward teamwork. The purpose of this study was to examine the effects of computer-supported IPE on students’ attitudes and perceptions toward health care teamwork and team performance. A hybrid approach to IPE was used to provide students with an educational experience that combined the benefits of traditional face-to-face communication methodology with a computer-mediated platform that focused on reflection and team building. A statistically significant difference was found in students’ perceptions of team performance after engaging in computer-supported IPE. No statistically significant difference in students’ pretest–posttest composite attitude toward teamwork scores was noted; however, there was a positive trend toward improved scores.

  19. Promotion of role clarification in the Health Care Team Challenge.

    Science.gov (United States)

    Hudson, C C; Gauvin, S; Tabanfar, R; Poffenroth, A M; Lee, J S; O'Riordan, A L

    2017-01-31

    Interprofessional collaboration has consistently been associated with positive client-care outcomes. Role clarification is one facet of interprofessional collaboration that is thought to be crucial for effective interprofessional team functioning. Given the positive outcomes associated with interprofessional collaboration, educators have begun to integrate formal interprofessional education events into healthcare curricula. The Health Care Team Challenge (HCTC) is a collaborative competition designed to promote interprofessional competencies among students in healthcare fields. The current study empirically investigated whether this event promoted role clarification among participants. Sixteen participants in five healthcare professions (occupational therapy, physiotherapy, clinical psychology, nursing, and medicine) completed two questionnaires to assess role clarification before and after participating in this event. Results indicate that participants' understanding of their own and other professions' roles improved after participating in this team activity. These results suggest that the HCTC is effective in promoting role clarification and collaboration among healthcare students.

  20. Interprofessional experiences and attitudes toward interprofessional health care teams among health sciences students.

    Science.gov (United States)

    Ko, Jungyai; Bailey-Kloch, Marie; Kim, Kyeongmo

    2014-01-01

    This study examined how the interprofessional experience, including education and practice, affects graduate health science students' attitudes toward interprofessional practice in health care teams. Data were collected from 227 graduate students, using the Attitudes toward Health Care Teams (ATHCT) scale. Both social work and other health science students had positive attitudes toward interprofessional collaboration with regard to its ability to improve the quality of a patient's care. The results from hierarchical linear regression analyses demonstrated that female students, older students, and students with longer interprofessional practice experiences had more positive attitudes toward interprofessional collaboration in health care teams. Based on these results, implications for interprofessional education are discussed.

  1. Bringing interdisciplinary and multicultural team building to health care education: the downstate team-building initiative.

    Science.gov (United States)

    Hope, Joanie Mayer; Lugassy, Daniel; Meyer, Rina; Jeanty, Freida; Myers, Stephanie; Jones, Sadie; Bradley, Joann; Mitchell, Rena; Cramer, Eva

    2005-01-01

    To evaluate the impact of the Downstate Team-Building Initiative (DTBI), a model multicultural and interdisciplinary health care team-building program for health professions students. A total of 65 students representing seven health disciplines participated in DTBI's first three years (one cohort per year since implementation). During the 18-session curriculum, students self-evaluated their group's progress through Tuckman's four team-development stages (FORMING, STORMING, NORMING, PERFORMING) on an 11-point scale. Students completed matched pre- and postintervention program evaluations assessing five variables: interdisciplinary understanding, interdisciplinary attitudes, teamwork skills, multicultural skills, and team atmosphere. After participation, students completed narrative follow-up questionnaires investigating impact one and two years after program completion. Each year's team development curve followed a similar logarithmic trajectory. Cohort 1 remained in team development stage 3 (NORMING) while Cohorts 2 and 3 advanced into the final stage-PERFORMING. A total of 34 matched pre- and postintervention evaluations showed significant change in all major variables: Team atmosphere and group teamwork skills improved most (48% and 44%, respectively). Interdisciplinary understanding improved 42%. Individual multicultural skills (defined by ability to address racism, homophobia, and sexism) started at the highest baseline and improved the least (13%). Group multicultural skills improved 36%. Of 23 responses to the follow-up surveys, 22 (96%) stated DTBI was a meaningful educational experience applicable to their current clinical surroundings. DTBI successfully united students across health discipline, ethnicity, socioeconomic class, gender, and sexual orientation into functioning teams. The model represents an effective approach to teaching health care team building and demonstrates benefits in both preclinical and clinical years of training.

  2. Twelve best practices for team training evaluation in health care.

    Science.gov (United States)

    Weaver, Sallie J; Salas, Eduardo; King, Heidi B

    2011-08-01

    Evaluation and measurement are the building blocks of effective skill development, transfer of training, maintenance and sustainment of effective team performance, and continuous improvement. Evaluation efforts have varied in their methods, time frame, measures, and design. On the basis of the existing body of work, 12 best practice principles were extrapolated from the science of evaluation and measurement into the practice of team training evaluation. Team training evaluation refers to efforts dedicated to enumerating the impact of training (1) across multiple dimensions, (2) across multiple settings, and (3) over time. Evaluations of efforts to optimize teamwork are often afterthoughts in an industry that is grounded in evidence-based practice. The best practices regarding team training evaluation are provided as practical reminders and guidance for continuing to build a balanced and robust body of evidence regarding the impact of team training in health care. THE 12 BEST PRACTICES: The best practices are organized around three phases of training: planning, implementation, and follow-up. Rooted in the science of team training evaluation and performance measurement, they range from Best Practice 1: Before designing training, start backwards: think about traditional frameworks for evaluation in reverse to Best Practice 7: Consider organizational, team, or other factors that may help (or hinder) the effects of training and then to Best Practice 12: Report evaluation results in a meaningful way, both internally and externally. Although the 12 best practices may be perceived as intuitive, they are intended to serve as reminders that the notion of evidence-based practice applies to quality improvement initiatives such as team training and team development as equally as it does to clinical intervention and improvement efforts.

  3. Balancing confidentiality and collaboration within multidisciplinary health care teams.

    Science.gov (United States)

    Van Liew, Julia R

    2012-12-01

    As multidisciplinary perspectives are increasingly integrated into the treatment of health problems, opportunities for clinical psychologists in medical settings are expanding. Although cross-discipline collaboration is at the core of multidisciplinary treatment models, psychologists must be particularly cautious about information sharing due to their profession's ethical standards regarding patient confidentiality. Psychologists' ethical obligations require them to achieve a delicate balance between contributing to the treatment team and protecting patient confidentiality. In the current review, relevant ethical standards and federal guidelines are applied to everyday practices of clinical psychologists in medical settings. Additionally, recommendations for individual psychologists, health care organizations, and graduate training programs are presented.

  4. Project #138. Coronary Care Education of Health Care Team. Final Report.

    Science.gov (United States)

    Saint Joseph Hospital, MO.

    The goal of this project was to develop, establish, and implement a system for the educational development of health care team members of the St. Joseph region in emergency and coronary care. Programs, curricula, and evaluation methodology were devised for four levels of critical care personnel: R.N.s emphasizing emergency and coronary care;…

  5. Health care professional development: Working as a team to improve patient care.

    Science.gov (United States)

    Babiker, Amir; El Husseini, Maha; Al Nemri, Abdurrahman; Al Frayh, Abdurrahman; Al Juryyan, Nasir; Faki, Mohamed O; Assiri, Asaad; Al Saadi, Muslim; Shaikh, Farheen; Al Zamil, Fahad

    2014-01-01

    In delivering health care, an effective teamwork can immediately and positively affect patient safety and outcome. The need for effective teams is increasing due to increasing co-morbidities and increasing complexity of specialization of care. Time has gone when a doctor or a dentist or any other health practitioner in whatsoever health organization would be able to solely deliver a quality care that satisfies his or her patients. The evolution in health care and a global demand for quality patient care necessitate a parallel health care professional development with a great focus on patient centred teamwork approach. This can only be achieved by placing the patient in the centre of care and through sharing a wide based culture of values and principles. This will help forming and developing an effective team able to deliver exceptional care to the patients. Aiming towards this goal, motivation of team members should be backed by strategies and practical skills in order to achieve goals and overcome challenges. This article highlights values and principles of working as a team and principles and provides team players with a practical approach to deliver quality patient care.

  6. Patterns for collaborative work in health care teams.

    Science.gov (United States)

    Grando, Maria Adela; Peleg, Mor; Cuggia, Marc; Glasspool, David

    2011-11-01

    (exceptional) scenarios. We show that although abstract, the proposed patterns can be instantiated in an executable COGENT prototype, and can be mapped into the Tallis tool that enacts PROforma language specifications of medical guidelines. The proposed patterns are generic and abstract enough to capture the normal and abnormal scenarios of assignment and delegation of tasks in collaborative work in health care teams. Copyright © 2011 Elsevier B.V. All rights reserved.

  7. Health care professionals in a heart failure team

    NARCIS (Netherlands)

    Jaarsma, T

    2005-01-01

    A heart failure team that treats heart failure patients often faces the challenge of managing multiple conditions requiring multiple medications and life style changes in an older patient group. A multidisciplinary team approach can optimally diagnose, carefully review and prescribe treatment, and

  8. Health care professionals in a heart failure team

    NARCIS (Netherlands)

    Jaarsma, T

    2005-01-01

    A heart failure team that treats heart failure patients often faces the challenge of managing multiple conditions requiring multiple medications and life style changes in an older patient group. A multidisciplinary team approach can optimally diagnose, carefully review and prescribe treatment, and e

  9. Health care professionals in a heart failure team

    NARCIS (Netherlands)

    Jaarsma, T

    2005-01-01

    A heart failure team that treats heart failure patients often faces the challenge of managing multiple conditions requiring multiple medications and life style changes in an older patient group. A multidisciplinary team approach can optimally diagnose, carefully review and prescribe treatment, and e

  10. Innovative health care delivery teams: learning to be a team player is as important as learning other specialised skills.

    Science.gov (United States)

    Fitzgerald, Anneke; Davison, Graydon

    2008-01-01

    The purpose of the paper is to show that free flowing teamwork depends on at least three aspects of team life: functional diversity, social cohesion and superordinate identity. The paper takes the approach of a discussion, arguing for a strong need to understand multidisciplinary and cross-functional barriers for achieving team goals in the context of health care. These barriers include a strong medically dominated business model, historically anchored delineations between professional identities and a complex organisational environment where individuals may have conflicting goals. The paper finds that the complexity is exacerbated by the differences between and within health care teams. It illustrates the differences by presenting the case of an operating theatre team. Whilst the paper recommends some ideas for acquiring these skills, further research is needed to assess effectiveness and influence of team skills training on optimising multidisciplinary interdependence in the health care environment. The paper shows that becoming a team member requires team membership skills.

  11. Behavioural health consultants in integrated primary care teams: a model for future care.

    Science.gov (United States)

    Dale, Hannah; Lee, Alyssa

    2016-07-29

    Significant challenges exist within primary care services in the United Kingdom (UK). These include meeting current demand, financial pressures, an aging population and an increase in multi-morbidity. Psychological services also struggle to meet waiting time targets and to ensure increased access to psychological therapies. Innovative ways of delivering effective primary care and psychological services are needed to improve health outcomes. In this article we argue that integrated care models that incorporate behavioural health care are part of the solution, which has seldom been argued in relation to UK primary care. Integrated care involves structural and systemic changes to the delivery of services, including the co-location of multi-disciplinary primary care teams. Evidence from models of integrated primary care in the United States of America (USA) and other higher-income countries suggest that embedding continuity of care and collaborative practice within integrated care teams can be effective in improving health outcomes. The Behavioural Health Consultant (BHC) role is integral to this, working psychologically to support the team to improve collaborative working, and supporting patients to make changes to improve their health across management of long-term conditions, prevention and mental wellbeing. Patients' needs for higher-intensity interventions to enable changes in behaviour and self-management are, therefore, more fully met within primary care. The role also increases accessibility of psychological services, delivers earlier interventions and reduces stigma, since psychological staff are seen as part of the core primary care service. Although the UK has trialled a range of approaches to integrated care, these fall short of the highest level of integration. A single short pilot of integrated care in the UK showed positive results. Larger pilots with robust evaluation, as well as research trials are required. There are clearly challenges in adopting

  12. [Communication within the health care team: doctors and nurses].

    Science.gov (United States)

    Kollár, János

    2016-04-24

    Proper communication within the health care team is especially important in terms of creating safe emotional and professional conditions for the team members and for quality healing. The aim of the study is to explore the factors that hinder appropriate communication between doctors and nurses and thus to make the effective elimination of the communication disturbances possible. Investigation in main medical databases and general search engines were used for analysing the phenomenon. It was revealed that communication between doctors and nurses is restrained by factors that can be observed on individual, professional and system levels as well. Role confusion, lack of trust, communication barriers arising from hierarchical inequalities, leadership problems, differences in qualifications, burnout and organizational problems can equally be found amongst them. The effectiveness of communication between nurses and doctors in Hungary is especially strongly influenced by the fear of losing jobs, the financial problems arising from different degree of gratuity and the phenomenon of burnout. Changes on individual, professional and system levels are equally important for significant improvement in the communication between doctors and nurses. Joint trainings based on strong organizational development skills and joint conferences could promote significantly better flow of information, mutual appreciation and harmonization.

  13. What do we know about health care team effectiveness? A review of the literature.

    Science.gov (United States)

    Lemieux-Charles, Louise; McGuire, Wendy L

    2006-06-01

    This review of health care team effectiveness literature from 1985 to 2004 distinguishes among intervention studies that compare team with usual (nonteam) care; intervention studies that examine the impact of team redesign on team effectiveness; and field studies that explore relationships between team context, structure, processes, and outcomes. The authors use an Integrated Team Effectiveness Model (ITEM) to summarize research findings and to identify gaps in the literature. Their analysis suggests that the type and diversity of clinical expertise involved in team decision making largely accounts for improvements in patient care and organizational effectiveness. Collaboration, conflict resolution, participation, and cohesion are most likely to influence staff satisfaction and perceived team effectiveness. The studies examined here underscore the importance of considering the contexts in which teams are embedded. The ITEM provides a useful framework for conceptualizing relationships between multiple dimensions of team context, structure, processes, and outcomes.

  14. Collaboration, credibility, compassion, and coordination: professional nurse communication skill sets in health care team interactions.

    Science.gov (United States)

    Apker, Julie; Propp, Kathleen M; Zabava Ford, Wendy S; Hofmeister, Nancee

    2006-01-01

    This study explored how nurses communicate professionalism in interactions with members of their health care teams. Extant research show that effective team communication is a vital aspect of a positive nursing practice environment, a setting that has been linked to enhanced patient outcomes. Although communication principles are emphasized in nursing education as an important component of professional nursing practice, actual nurse interaction skills in team-based health care delivery remain understudied. Qualitative analysis of interview transcripts with 50 participants at a large tertiary hospital revealed four communicative skill sets exemplified by nursing professionals: collaboration, credibility, compassion, and coordination. Study findings highlight specific communicative behaviors associated with each skill set that exemplify nurse professionalism to members of health care teams. Theoretical and pragmatic conclusions are drawn regarding the communicative responsibilities of professional nurses in health care teams. Specific interaction techniques that nurses could use in nurse-team communication are then offered for use in baccalaureate curriculum and organizational in-service education.

  15. Using Digital Crumbs from an Electronic Health Record to Identify, Study and Improve Health Care Teams

    Science.gov (United States)

    Gray, James E; Feldman, Henry; Reti, Shane; Markson, Larry; Lu, Xiaoning; Davis, Roger B.; Safran, Charles A

    2011-01-01

    We have developed a novel approach, the Digital Crumb Investigator, for using data collected as a byproduct of Electonic Health Record (EHR) use to help define care teams and care processes. We are developing tools and methods to utilize these routinely collected data to visualize and quantify care networks across acute care and ambulatory settings We have chosen a clinical care domain where clinicians use EHRs in their offices, on the maternity wards and in the neonatal intensive care units as a test paradigm for this technology. The tools and methods we deliver should readily translate to other health care settings that collect behind-the-scenes electronic metadata such as audit trails. We believe that by applying the methods of social networking to define clinical relationships around a patient’s care we will enable new areas of research into the usage of EHRs to promote patient safety and other improvements in care. PMID:22195103

  16. Military Interprofessional Health Care Teams: How USU is Working to Harness the Power of Collaboration.

    Science.gov (United States)

    D'Angelo, Matthew R; Saperstein, Adam K; Seibert, Diane C; Durning, Steven J; Varpio, Lara

    2016-11-01

    Despite efforts to increase patient safety, hundreds of thousands of lives are lost each year to preventable health care errors. The Institute of Medicine and other organizations have recommended that facilitating effective interprofessional health care team work can help address this problem. While the concept of interprofessional health care teams is known, understanding and organizing effective team performance have proven to be elusive goals. Although considerable research has been conducted in the civilian sector, scholars have yet to extend research to the military context. Indeed, delivering the highest caliber of health care to our service men and women is vitally important. This commentary describes a new initiative as the Uniformed Services University of the Health Sciences aimed at researching the characteristics of successful military interprofessional teams and why those characteristics are important. It also describes the interprofessional education initiative that Uniformed Services University is launching to help optimize U.S. military health care.

  17. Defragmenting care: testing an intervention to increase the effectiveness of interdisciplinary health care teams.

    Science.gov (United States)

    Kilgore, Rachel V; Langford, Rae W

    2010-06-01

    Few studies in the literature have examined the outcomes of health care interdisciplinary teams. Most existing studies have measured attributes of health care teams; however, none have implemented and examined outcomes of a team development intervention. This study was conducted to determine whether a development intervention used with an existing interdisciplinary team would reduce the length of stay for patients in an acute care setting. A quasi-experimental single-subject time series design was conducted with multiple measures of length of stay collected across baseline, intervention, and reversal phases of the study. Bronstein's Model for Interdisciplinary Collaboration provided the framework for this study. The components of this model were used to guide a team development intervention comprised of 4 consecutive weeks of classroom development sessions and 4 consecutive weeks of booster messaging. Length of stay (LOS) data were collected for each of the study phases to examine preintervention LOS and compare these data with LOS during the intervention and reversal phases. The results of this study revealed that the interdisciplinary team development intervention had no positive effect on the length of stay data. Baseline mean LOS across 12 baseline months was 4.83 days (SD=0.65) with monthly means ranging from 4.1 to 6.3 days. The mean LOS was 5.1 and 4.6 days for the intervention months of May and June and 6.0, 6.5, 5.7, and 5.4 days for the reversal months of July to October, respectively. All means in the intervention and reversal phases were higher than comparable months in the baseline phase. The pattern of the graphed trend was closely aligned with the seasonal variations seen during the baseline months. Although these results showed that the team development intervention provided for this interdisciplinary team had no positive effect on the LOS, there are many factors that may have influenced the results and may provide insights useful for future

  18. Interdisciplinary Collaboration in Gerontology and Geriatrics in Latin America: Conceptual Approaches and Health Care Teams

    Science.gov (United States)

    Gomez, Fernando; Curcio, Carmen Lucia

    2013-01-01

    The underlying rationale to support interdisciplinary collaboration in geriatrics and gerontology is based on the complexity of elderly care. The most important characteristic about interdisciplinary health care teams for older people in Latin America is their subjective-basis framework. In other regions, teams are organized according to a…

  19. Interdisciplinary Collaboration in Gerontology and Geriatrics in Latin America: Conceptual Approaches and Health Care Teams

    Science.gov (United States)

    Gomez, Fernando; Curcio, Carmen Lucia

    2013-01-01

    The underlying rationale to support interdisciplinary collaboration in geriatrics and gerontology is based on the complexity of elderly care. The most important characteristic about interdisciplinary health care teams for older people in Latin America is their subjective-basis framework. In other regions, teams are organized according to a…

  20. How Communication Among Members of the Health Care Team Affects Maternal Morbidity and Mortality.

    Science.gov (United States)

    Brennan, Rita Allen; Keohane, Carol Ann

    In the United States, rates of severe maternal morbidity and mortality have escalated in the past decade. Communication failure among members of the health care team is one associated factor that can be modified. Nurses can promote effective communication. We provide strategies that incorporate team training principles and structured communication processes for use by providers and health care systems to improve the quality and safety of patient care and reduce the incidence of maternal mortality and morbidity.

  1. Social networks in health care teams: evidence from the United States.

    Science.gov (United States)

    Poghosyan, Lusine; Lucero, Robert J; Knutson, Ashley R; W Friedberg, Mark; Poghosyan, Hermine

    2016-10-10

    Purpose The purpose of this paper is to synthesize existing evidence regarding health care team networks, including their formation and association with outcomes in various health care settings. Design/methodology/approach Network theory informed this review. A literature search was conducted in major databases for studies that used social network analysis methods to study health care teams in the USA between 2000 and 2014. Retrieved studies were reviewed against inclusion and exclusion criteria. Findings Overall, 25 studies were included in this review. Results demonstrated that health care team members form professional (e.g. consultation) and personal (e.g. friendship) networks. Network formation can be influenced by team member characteristics (i.e. demographics and professional affiliations) as well as by contextual factors (i.e. providers sharing patient populations and physical proximity to colleagues). These networks can affect team member practice such as adoption of a new medication. Network structures can also impact patient and organizational outcomes, including occurrence of adverse events and deficiencies in health care delivery. Practical implications Administrators and policy makers can use knowledge of health care networks to leverage relational structures in teams and tailor interventions that facilitate information exchange, promote collaboration, increase diffusion of evidence-based practices, and potentially improve individual and team performance as well as patient care and outcomes. Originality/value Most health services research studies have investigated health care team composition and functioning using traditional social science methodologies, which fail to capture relational structures within teams. Thus, this review is original in terms of focusing on dynamic relationships among team members.

  2. [A mental health multidisciplinary team for pain and somatic care].

    Science.gov (United States)

    Judice, Magali; Valoris, Jahida; Rullac, Maryse; Deveaux, Florence

    2014-05-01

    Patients suffering from mental illness or pervasive developmental disorders often resist examination and treatment. The Regional pain and somatic care in mental health centre of the Etampes public health institute (EPS) uses gas and air when carrying out nursing procedures. The nurses support patients with compassion, attentive to any nonverbal indication of pain.

  3. The Bone Health Team: A Team-Based Approach to Improving Osteoporosis Care for Primary Care Patients.

    Science.gov (United States)

    Lawrence, Phillip T; Grotzke, Marissa P; Rosenblum, Yanina; Nelson, Richard E; LaFleur, Joanne; Miller, Karla L; Ma, Junjie; Cannon, Grant W

    2017-07-01

    Significant improvements in secondary prevention of osteoporotic fractures have been noted with fracture liaison services. However, similar models for the primary prevention of such fractures have not been reported. To determine the impact of a Bone Health Team (BHT) on osteoporosis screening and treatment rates in U.S. veterans in primary care practices. Historical cohort study of a primary care-based intervention of a BHT from February 2013 to February 2015. Community-based outpatient clinics of the Salt Lake City Veterans Affairs Health Care System. Men aged 70 years and older and women aged 65 years and older. Enrollment in the BHT. Rates of dual energy x-ray absorptiometry (DXA) completion, chart diagnosis of osteoporosis or osteopenia, completion of vitamin D measurement, and initiation of fracture reducing medication. Our cohort consisted of 7644 individuals, 975 of whom were exposed to the BHT and 6669 of whom were not. Comparison of patients exposed to the BHT versus non-exposed subjects demonstrated a substantial increase in all outcome measures studied. Hazard ratios (HRs) from multivariable cox proportional hazard models were: measurement of vitamin D, HR = 1.619 ( P BHT produced significantly increased rates of intermediate osteoporosis outcome measures in US veterans in primary care practices. Additional research describing medication adherence rates and cost-effectiveness is forthcoming.

  4. What Should You Ask Your Health Care Team About Thyroid Cancer?

    Science.gov (United States)

    ... Should You Ask Your Health Care Team About Thyroid Cancer? As you deal with thyroid cancer and the ... ask are: When you’re told you have thyroid cancer What kind of thyroid cancer do I have? ...

  5. Your cancer care team

    Science.gov (United States)

    ... gov/ency/patientinstructions/000929.htm Your cancer care team To use the sharing features on this page, ... help your body heal. Working with Your Care Team Each member of your care team plays an ...

  6. Cross-functional, integrative team decision making: essential for effective QI in health care.

    Science.gov (United States)

    Fargason, C A; Haddock, C C

    1992-05-01

    Quality improvement methods first developed in industry can be applied in health care, but major adjustments in the traditional health care organization are needed for continuous improvement processes to work. One change is establishing cross-functional or multidisciplinary teams to carry out integrative decision making in the place of departmental hierarchical decision making within the functional areas and disciplines. This article cites examples from experience with one service process--delivery of care to newborns--and examines techniques from the group behavior and conflict resolution literature which could enhance the success of cross-functional teams in health care organizations.

  7. Adding dental therapists to the health care team to improve access to oral health care for children.

    Science.gov (United States)

    Nash, David A

    2009-01-01

    Oral Health in America: A Report of the Surgeon General, and the subsequent National Call to Action to Promote Oral Health, contributed significantly to raising awareness regarding the lack of access to oral health care by many Americans, especially minority and low-income populations, with resulting disparities in oral health. The problem is particularly acute among children. The current dental workforce in the United States is inadequate to meet the oral health care needs of children. It is inadequate in terms of numbers of dentists, as well as their geographic distribution, ethnicity, education, and practice orientation. Dental therapists, paraprofessionals trained in a 2 academic-year program of postsecondary education, have been employed internationally to improve access to oral health care for children. Research has documented that utilizing dental therapists is a cost-effective method of providing quality oral health care for children. Dental therapists have recently been introduced in Alaska by the Alaska Native Tribal Health Consortium. Dental therapists could potentially care for children in dental offices, public health clinics, and school systems, as well as in the offices of pediatricians and family physicians. Adding dental therapists to the health care team would be a significant strategy for improving access to care for children and reducing oral health disparities.

  8. Intervention in health care teams and working relationships

    Directory of Open Access Journals (Sweden)

    Laurenson M

    2012-09-01

    Full Text Available Mary Laurenson, Tracey Heath, Sarah GribbinUniversity of Hull, Faculty of Health and Social Care, Department of Health Professional Studies, Cottingham, Hull, United KingdomIntroduction: Communication is an intrinsic part of collaborative working but can be problematic when the complexities of professional and personal identities inhibit quality care provision. This paper investigates these complexities and recommends interventions to facilitate collaborative working.Methods: A qualitative comparative approach examined data collected from participants using purposive non-probability sampling. Perspectives were obtained from four professional groups (nurses, social workers, care managers, and police, from different organizations with different theoretical and practice frameworks, and from a fifth group (informal carers.Results: Curriculum change and leadership initiatives are required to address the complexities inhibiting collaborative working relationships. Integrating complexity theory, personality typology, and problem-based learning into the curriculum to understand behavioral actions will enable interventions to effect change and promote the centrality of those being cared for.Keywords: interprofessional education and working, complexity, communication, personality, problem-based learning

  9. A framework to support team-based models of primary care within the Australian health care system.

    Science.gov (United States)

    Naccarella, Lucio; Greenstock, Louise N; Brooks, Peter M

    2013-09-01

    Health systems with strong primary care orientations are known to be associated with improved equity, better access for patients to appropriate services at lower costs, and improved population health. Team-based models of primary care have emerged in response to health system challenges due to complex patient profiles, patient expectations and health system demands. Successful team-based models of primary care require a combination of interprofessional education and learning; organisational and management policies and systems; and practice support systems. To ensure evidence is put into practice, we propose a framework comprising five domains (theory, implementation, infrastructure, sustainability and evaluation) to assist policymakers, educators, researchers, managers and health professionals in supporting team-based models of primary care within the Australian health care system.

  10. The role of the multidisciplinary health care team in the management of patients with Marfan syndrome.

    Science.gov (United States)

    von Kodolitsch, Yskert; Rybczynski, Meike; Vogler, Marina; Mir, Thomas S; Schüler, Helke; Kutsche, Kerstin; Rosenberger, Georg; Detter, Christian; Bernhardt, Alexander M; Larena-Avellaneda, Axel; Kölbel, Tilo; Debus, E Sebastian; Schroeder, Malte; Linke, Stephan J; Fuisting, Bettina; Napp, Barbara; Kammal, Anna Lena; Püschel, Klaus; Bannas, Peter; Hoffmann, Boris A; Gessler, Nele; Vahle-Hinz, Eva; Kahl-Nieke, Bärbel; Thomalla, Götz; Weiler-Normann, Christina; Ohm, Gunda; Neumann, Stefan; Benninghoven, Dieter; Blankenberg, Stefan; Pyeritz, Reed E

    2016-01-01

    Marfan syndrome (MFS) is a rare, severe, chronic, life-threatening disease with multiorgan involvement that requires optimal multidisciplinary care to normalize both prognosis and quality of life. In this article, each key team member of all the medical disciplines of a multidisciplinary health care team at the Hamburg Marfan center gives a personal account of his or her contribution in the management of patients with MFS. The authors show how, with the support of health care managers, key team members organize themselves in an organizational structure to create a common meaning, to maximize therapeutic success for patients with MFS. First, we show how the initiative and collaboration of patient representatives, scientists, and physicians resulted in the foundation of Marfan centers, initially in the US and later in Germany, and how and why such centers evolved over time. Then, we elucidate the three main structural elements; a team of coordinators, core disciplines, and auxiliary disciplines of health care. Moreover, we explain how a multidisciplinary health care team integrates into many other health care structures of a university medical center, including external quality assurance; quality management system; clinical risk management; center for rare diseases; aorta center; health care teams for pregnancy, for neonates, and for rehabilitation; and in structures for patient centeredness. We provide accounts of medical goals and standards for each core discipline, including pediatricians, pediatric cardiologists, cardiologists, human geneticists, heart surgeons, vascular surgeons, vascular interventionists, orthopedic surgeons, ophthalmologists, and nurses; and of auxiliary disciplines including forensic pathologists, radiologists, rhythmologists, pulmonologists, sleep specialists, orthodontists, dentists, neurologists, obstetric surgeons, psychiatrist/psychologist, and rehabilitation specialists. We conclude that a multidisciplinary health care team is a means

  11. The role of the multidisciplinary health care team in the management of patients with Marfan syndrome

    Science.gov (United States)

    von Kodolitsch, Yskert; Rybczynski, Meike; Vogler, Marina; Mir, Thomas S; Schüler, Helke; Kutsche, Kerstin; Rosenberger, Georg; Detter, Christian; Bernhardt, Alexander M; Larena-Avellaneda, Axel; Kölbel, Tilo; Debus, E Sebastian; Schroeder, Malte; Linke, Stephan J; Fuisting, Bettina; Napp, Barbara; Kammal, Anna Lena; Püschel, Klaus; Bannas, Peter; Hoffmann, Boris A; Gessler, Nele; Vahle-Hinz, Eva; Kahl-Nieke, Bärbel; Thomalla, Götz; Weiler-Normann, Christina; Ohm, Gunda; Neumann, Stefan; Benninghoven, Dieter; Blankenberg, Stefan; Pyeritz, Reed E

    2016-01-01

    Marfan syndrome (MFS) is a rare, severe, chronic, life-threatening disease with multiorgan involvement that requires optimal multidisciplinary care to normalize both prognosis and quality of life. In this article, each key team member of all the medical disciplines of a multidisciplinary health care team at the Hamburg Marfan center gives a personal account of his or her contribution in the management of patients with MFS. The authors show how, with the support of health care managers, key team members organize themselves in an organizational structure to create a common meaning, to maximize therapeutic success for patients with MFS. First, we show how the initiative and collaboration of patient representatives, scientists, and physicians resulted in the foundation of Marfan centers, initially in the US and later in Germany, and how and why such centers evolved over time. Then, we elucidate the three main structural elements; a team of coordinators, core disciplines, and auxiliary disciplines of health care. Moreover, we explain how a multidisciplinary health care team integrates into many other health care structures of a university medical center, including external quality assurance; quality management system; clinical risk management; center for rare diseases; aorta center; health care teams for pregnancy, for neonates, and for rehabilitation; and in structures for patient centeredness. We provide accounts of medical goals and standards for each core discipline, including pediatricians, pediatric cardiologists, cardiologists, human geneticists, heart surgeons, vascular surgeons, vascular interventionists, orthopedic surgeons, ophthalmologists, and nurses; and of auxiliary disciplines including forensic pathologists, radiologists, rhythmologists, pulmonologists, sleep specialists, orthodontists, dentists, neurologists, obstetric surgeons, psychiatrist/psychologist, and rehabilitation specialists. We conclude that a multidisciplinary health care team is a means

  12. What are the critical success factors for team training in health care?

    Science.gov (United States)

    Salas, Eduardo; Almeida, Sandra A; Salisbury, Mary; King, Heidi; Lazzara, Elizabeth H; Lyons, Rebecca; Wilson, Katherine A; Almeida, Paula A; McQuillan, Robert

    2009-08-01

    Ineffective communication among medical teams is a leading cause of preventable patient harm throughout the health care system. A growing body of literature indicates that medical teamwork improves the quality, safety, and cost-effectiveness of health care delivery, and expectations for teamwork in health care have increased. Yet few health care professions' curricula include teamwork training, and few medical practices integrate teamwork principles. Because of this knowledge gap, growing numbers of health care systems are requiring staff to participate in formal teamwork training programs. Seven evidence-based, practical, systematic success factors for preparing, implementing, and sustaining a team training and performance improvement initiative were identified. Each success factor is accompanied by tips for deployment and a real-world example of application. (1) Align team training objectives and safety aims with organizational goals, (2) provide organizational support for the team training initiative, (3) get frontline care leaders on board, (4) prepare the environment and trainees for team training, (5) determine required resources and time commitment and ensure their availability, (6) facilitate application of trained teamwork skills on the job; and (7) measure the effectiveness of the team training program. Although decades of research in other high-risk organizations have clearly demonstrated that properly designed team training programs can improve team performance, success is highly dependent on organizational factors such as leadership support, learning climate, and commitment to data-driven change. Before engaging in a teamwork training initiative, health care organizations should have a clear understanding of these factors and the strategies for their establishment.

  13. An interdisciplinary-interuniversity health care team management decision-making case study course.

    Science.gov (United States)

    DeSalvo, R J; Arlinghaus, E J; Rowe, K W

    1985-01-01

    An elective case study course involving graduate students from various health profession disciplines from two universities was developed in order to provide a forum for health care teams to discuss the philosophical and functional impact of situations and their alternative solutions. The case studies stressed various aspects of the decision-making process and were nonclinical/technical but health care administratively oriented in nature. Course evaluations manifest that participants from each discipline improved their problem-solving and leadership abilities, and created a cross-fertilization of knowledge and understanding of the various health care disciplines and their perspectives that each brings to the health care system.

  14. An evaluation of the influence of primary care team functioning on the health of Medicare beneficiaries.

    Science.gov (United States)

    Roblin, Douglas W; Howard, David H; Junling Ren; Becker, Edmund R

    2011-04-01

    In service industries other than health care, unit employees who report a favorable service climate--characterized by commitment to a team concept and intrateam interactions that are supportive, collegial, and collaborative--have high levels of consumer satisfaction and work unit productivity. The authors evaluated whether similar primary care team (PCT) functioning influenced the short-term future health (SF-36) of elderly Medicare beneficiaries (N = 991) in a group model managed care organization (MCO). PCT functioning was assessed by surveys of practitioners and support staff on the MCO's 14 primary care practices and included measures of perceived task delegation, role collaboration, patient orientation, and team ownership. On average, patient physical and emotional health declined over 2 years. Medicare beneficiaries empanelled to relatively high functioning PCTs had significantly better physical and emotional health at 2 years following baseline assessment than those empanelled to relatively low functioning PCTs.

  15. Evaluating multidisciplinary health care teams: taking the crisis out of CRM.

    Science.gov (United States)

    Sutton, Gigi

    2009-08-01

    High-reliability organisations are those, such as within the aviation industry, which operate in complex, hazardous environments and yet despite this are able to balance safety and effectiveness. Crew resource management (CRM) training is used to improve the non-technical skills of aviation crews and other high-reliability teams. To date, CRM within the health sector has been restricted to use with "crisis teams" and "crisis events". The purpose of this discussion paper is to examine the application of CRM to acute, ward-based multidisciplinary health care teams and more broadly to argue for the repositioning of health-based CRM to address effective everyday function, of which "crisis events" form just one part. It is argued that CRM methodology could be applied to evaluate ward-based health care teams and design non-technical skills training to increase their efficacy, promote better patient outcomes, and facilitate a range of positive personal and organisational level outcomes.

  16. Mental health care: how can Family Health teams integrate it into Primary Healthcare?

    Science.gov (United States)

    Gryschek, Guilherme; Pinto, Adriana Avanzi Marques

    2015-10-01

    Mental health is one of the responsibilities of Brazil's Family Health system. This review of literature sought to understand what position Mental Health occupies in the practice of the Family Health Strategy. A search was made of the scientific literature in the database of the Virtual Health Library (Biblioteca Virtual de Saúde), for the keywords: 'Mental Health'; 'Family Health'; 'Primary Healthcare'. The criteria for inclusion were: Brazilian studies from 2009 through 2012 that contributed to understanding of the following question: "How to insert Mental health care into the routine of the Family Health Strategy?" A total of 11 articles were found, which identified difficulties and strategies of the professionals in Primary Healthcare in relation to mental health. Referral, and medicalization, were common practices. Matrix Support is the strategy of training and skill acquisition for teams that enables new approaches in mental health in the context of Primary healthcare. It is necessary for Management of the Health System to take an active role in the construction of healthcare networks in mental health.

  17. Integrating physiotherapists within primary health care teams: perspectives of family physicians and nurse practitioners.

    Science.gov (United States)

    Dufour, Sinéad Patricia; Brown, Judith; Deborah Lucy, S

    2014-09-01

    The international literature suggests a number of benefits related to integrating physiotherapists into primary health care (PHC) teams. Considering the mandate of PHC teams in Canada, emphasizing healthy living and chronic disease management, a broad range of providers, inclusive of physiotherapists is required. However, physiotherapists are only sparsely integrated into these teams. This study explores the perspectives of "core" PHC team members, family physicians and nurse practitioners, regarding the integration of physiotherapists within Ontario (Canada) PHC teams. Twenty individual semi-structured in-depth interviews were conducted, transcribed verbatim, and then analyzed following an iterative process drawing from an interpretive phenomenological approach. Five key themes emerged which highlighted "how physiotherapists could and do contribute as team members within PHC teams particularly related to musculoskeletal health and chronic disease management". The perceived value of physiotherapists within Ontario, Canada PHC teams was a unanimous sentiment particularly in terms of musculoskeletal health, chronic disease management and maximizing health human resources efficiency to ensure the right care, is delivered by the right practitioner, at the right time.

  18. Critical Care Team

    Science.gov (United States)

    ... Patients and Families > About Critical Care > Team Tweet Team Page Content ​The critical care team is a group of specially trained caregivers who ... help very ill patients get better. The care team often teach the patient and family strategies that ...

  19. Advancing team-based primary health care: a comparative analysis of policies in western Canada.

    Science.gov (United States)

    Suter, Esther; Mallinson, Sara; Misfeldt, Renee; Boakye, Omenaa; Nasmith, Louise; Wong, Sabrina T

    2017-07-17

    We analyzed and compared primary health care (PHC) policies in British Columbia, Alberta and Saskatchewan to understand how they inform the design and implementation of team-based primary health care service delivery. The goal was to develop policy imperatives that can advance team-based PHC in Canada. We conducted comparative case studies (n = 3). The policy analysis included: Context review: We reviewed relevant information (2007 to 2014) from databases and websites. Policy review and comparative analysis: We compared and contrasted publically available PHC policies. Key informant interviews: Key informants (n = 30) validated narratives prepared from the comparative analysis by offering contextual information on potential policy imperatives. Advisory group and roundtable: An expert advisory group guided this work and a key stakeholder roundtable event guided prioritization of policy imperatives. The concept of team-based PHC varies widely across and within the three provinces. We noted policy gaps related to team configuration, leadership, scope of practice, role clarity and financing of team-based care; few policies speak explicitly to monitoring and evaluation of team-based PHC. We prioritized four policy imperatives: (1) alignment of goals and policies at different system levels; (2) investment of resources for system change; (3) compensation models for all members of the team; and (4) accountability through collaborative practice metrics. Policies supporting team-based PHC have been slow to emerge, lacking a systematic and coordinated approach. Greater alignment with specific consideration of financing, reimbursement, implementation mechanisms and performance monitoring could accelerate systemic transformation by removing some well-known barriers to team-based care.

  20. [Involvement of health primary care teams in the control of tuberculosis].

    Science.gov (United States)

    Monroe, Aline Aparecida; Gonzales, Roxana Isabel Cardozo; Palha, Pedro Fredemir; Sassaki, Cinthia Midori; Ruffino Netto, Antonio; Vendramini, Silvia Helena Figueiredo; Villa, Tereza Cristina Scatena

    2008-06-01

    This study was aimed at analyzing the involvement of Health Primary Care teams in the tuberculosis control actions in the perception of the Tuberculosis Control Program coordinators of nine priority municipalities of the State of São Paulo. It is a qualitative research whose data were collected in June of 2005 through semistructured interviews with nine coordinators. The content thematic modality was used for the analysis of the data. The results pointed out to difficulties in the implementation of the tuberculosis control actions in primary care related to quantitative and qualitative deficiencies of human resources and to a centralized and fragmented view regarding the organization of these actions in the health system. The integration of tuberculosis control activities in primary care is possible provided the system is organized according to primary care principles and a policy of human resources that ensures continuous education and capacity-building of health teams is elaborated/implemented.

  1. Nurses' perceptions of multidisciplinary team work in acute health-care.

    Science.gov (United States)

    Atwal, Anita; Caldwell, Kay

    2006-12-01

    Multidisciplinary teamwork is viewed as one of the key processes through which care is managed in the British National Health Service, and yet is often viewed as one of the most problematic. Working in a multidisciplinary team requires many skills, which involves understanding not only one's own role but also the role of other professionals. The aim of this study was to explore nurses' perceptions of multidisciplinary teamwork in acute health-care. Nineteen nurses were interviewed using the critical incident approach to obtain their perceptions of multidisciplinary teamwork. Direct observation was conducted to record interactions between nurses and health-care professionals in multidisciplinary teams. In total, 14 meetings were attended in elder care and orthopaedics and seven in acute medicine. The findings of this study identified three barriers that hindered teamwork: (i) differing perceptions of teamwork; (ii) different levels of skills acquisitions to function as a team member; and (iii) the dominance of medical power that influenced interaction in teams. Thus, education establishments and nursing managers need to ensure that the acquisition of team-playing skills is an integral part of continued professional development.

  2. The knowledge of family health team on the action of physical therapist in primary care -

    Directory of Open Access Journals (Sweden)

    Greicimar de Oliveira

    2012-01-01

    Full Text Available Objective: To evaluate the knowledge of health team from Basic Health Units in the city of Coari-AM, Brazil, on the action of physical therapist in primary care. Methods: A quantitative, exploratory and descriptive study, like a field survey conducted in 11 primary care units in Coari, Amazonas state. The data were collected through a questionnaire comprising closed questions regarding the action of physical therapist in primary care. 76 professionals joined in the survey by category: (05 physicians, (10 nurses, (08 nursing technicians and (53 community health workers. Results: 61.64% (n = 45 of the professionals working in the family health team reported knowing the action of physical therapist in primary care; 79.45% (n = 58 referred it in secondary level and 69.86% (n = 51 at the tertiary level of health care. Conclusion: This work showed some knowledge of professionals on the professional action of physical therapists in primary care; however, the knowledge for this level presents itself disadvantaged in relation to other levels of health care. We demonstrated that a share of professionals presented difficulties to consider the possibility of physiotherapeutic intervention in diseases mostly worked in primary care, but the reference to the viability of action of physical therapist for different publics was satisfactory. This conclusion does not exhaust the possibility of discussing the proposed theme.

  3. Strategic re-design of team-based patient-focused health care services.

    Science.gov (United States)

    Tahara, Denise C; Green, Richard P

    2014-01-01

    This paper proposes an organizational change process to prepare physicians and other health professionals for their new roles in patient-centered medical homes (PCMHs). It provides physician-centered tools, models, concepts, and the language to implement transformational patient-centered medical care. To improve care delivery, quality, and patient engagement, a systems approach to care is required. This paper examines a systems approach to patient care where all inputs that influence patient interactions and participation are considered in the design of health care delivery and follow-up treatment plans. Applying systems thinking, organizational change models, and team-building, we have examined the continuum of this change process from ideation through the diffusion of new methods and behaviors. PCMHs make compelling business sense. Studies have shown that the PCMH improves patient satisfaction, clinical outcomes and reduces underuse and overuse of medical services. Patient-centered care necessitates transitioning from an adversarial to a collaborative culture. It is a transformation process predicated on strong leadership able to align an organization toward a vision of patient-centered care, creating a collaborative culture committed to health-goal achievement. This paper proposes that the PCMH is a rigorous team-building transformational organizational change, a radical departure from the current hierarchical, silo-oriented, medical practice model. It requires that participants within and across health care organizations learn new skills and behaviors to achieve the anticipated quality and efficiency improvements. It is an innovative health care organization model of the future whose success is premised on teams supplanting the individual as the building block and unit of health care performance.

  4. Reducing health care hazards: lessons from the commercial aviation safety team.

    Science.gov (United States)

    Pronovost, Peter J; Goeschel, Christine A; Olsen, Kyle L; Pham, Julius C; Miller, Marlene R; Berenholtz, Sean M; Sexton, J Bryan; Marsteller, Jill A; Morlock, Laura L; Wu, Albert W; Loeb, Jerod M; Clancy, Carolyn M

    2009-01-01

    The movement to improve quality of care and patient safety has grown, but examples of measurable and sustained progress are rare. The slow progress made in health care contrasts with the success of aviation safety. After a tragic 1995 plane crash, the aviation industry and government created the Commercial Aviation Safety Team to reduce fatal accidents. This public-private partnership of safety officials and technical experts is responsible for the decreased average rate of fatal aviation accidents. We propose a similar partnership in the health care community to coordinate national efforts and move patient safety and quality forward.

  5. Strategies for encouraging patient/family member partnerships with the health care team.

    Science.gov (United States)

    Ahmann, Elizabeth; Dokken, Deborah

    2012-01-01

    The 5th International Conference of the Institute for Patient- and Family-Centered Care (IPFCC), held in Washington, DC, from June 4-6, 2012, offered an opportunity for almost 1,000 conference participants to share and learn about exciting new patient- and family-centered initiatives occurring across the U.S. and in many other countries. One focus addressed by keynote and plenary speakers, as well as numerous conference sessions and poster presentations, was how nurses and other health care professionals can encourage patients and family members to become partners with their health care teams. Various presenters shared strategies ranging from initial approaches to acknowledging family members as part of the team and offering simple, non-threatening roles in care provision, to policies and approaches inviting increased participation in health care encounters, to higher level involvement in the care planning process, and to partnership roles extending beyond care of the individual child and family. A wealth of ideas can be implemented at various levels by individual nurses, units, and health care institutions.

  6. Joint working in community mental health teams: implementation of an integrated care pathway.

    Science.gov (United States)

    Rees, Gwyneth; Huby, Guro; McDade, Lian; McKechnie, L

    2004-11-01

    Abstract Integration of community mental health services is a key policy objective that aims to increase quality and efficiency of care. Integrated care pathways (ICPs) are a mechanism designed to formalise multi-agency working at an operational level and are currently being applied to mental health services. Evidence regarding the impact of this tool to support joint working is mixed, and there is limited evidence regarding the suitability of ICPs for complex, community-based services. The present study was set in one primary care trust (PCT) in Scotland that is currently implementing an ICP for community mental health teams (CMHTs) across the region. The aim of the study was to investigate professionals' experiences and views on the implementation of an ICP within adult CMHTs in order to generate learning points for other organisations which are considering developing and implementing such systems. The study used qualitative methods which comprised of individual interviews with three CMHT leaders and two service development managers, as well as group interviews with members of four adult CMHTs. Data was analysed using the constant comparison method. Participants reported positive views regarding joint working and the role of an ICP in theory. However, in practice, teams were not implementing the ICP. Lack of integration at higher organisational levels was found to create conflicts within the teams which became explicit in response to the ICP. Implementation was also hindered by lack of resources for ongoing support, team development and change management. In conclusion, the study suggests that operational systems such as ICPs do not address and cannot overcome wider organisational barriers to integration of mental health services. Integrated care pathways need to be developed with strategic input as well as practitioner involvement and ownership. Team development, education about integration and change management are essential if ICPs are to foster and support

  7. Doing Interdisciplinary Mixed Methods Health Care Research: Working the Boundaries, Tensions, and Synergistic Potential of Team-Based Research.

    Science.gov (United States)

    Hesse-Biber, Sharlene

    2016-04-01

    Current trends in health care research point to a shift from disciplinary models to interdisciplinary team-based mixed methods inquiry designs. This keynote address discusses the problems and prospects of creating vibrant mixed methods health care interdisciplinary research teams that can harness their potential synergy that holds the promise of addressing complex health care issues. We examine the range of factors and issues these types of research teams need to consider to facilitate efficient interdisciplinary mixed methods team-based research. It is argued that concepts such as disciplinary comfort zones, a lack of attention to team dynamics, and low levels of reflexivity among interdisciplinary team members can inhibit the effectiveness of a research team. This keynote suggests a set of effective strategies to address the issues that emanate from the new field of research inquiry known as team science as well as lessons learned from tapping into research on organizational dynamics. © The Author(s) 2016.

  8. Integrating TeamSTEPPS(®) into ambulatory reproductive health care: Early successes and lessons learned.

    Science.gov (United States)

    Paul, Maureen E; Dodge, Laura E; Intondi, Evelyn; Ozcelik, Guzey; Plitt, Ken; Hacker, Michele R

    2017-04-01

    Most medical teamwork improvement interventions have occurred in hospitals, and more efforts are needed to integrate them into ambulatory care settings. In 2014, Affiliates Risk Management Services, Inc. (ARMS), the risk management services organization for a large network of reproductive health care organizations in the United States, launched a voluntary 5-year initiative to implement a medical teamwork system in this network using the TeamSTEPPS model. This article describes the ARMS initiative and progress made during the first 2 years, including lessons learned. The ARMS TeamSTEPPS program consists of the following components: preparation of participating organizations, TeamSTEPPS master training, implementation of teamwork improvement programs, and evaluation. We used self-administered questionnaires to assess satisfaction with the ARMS program and with the master training course. In the first 2 years, 20 organizations enrolled. Participants found the preparation phase valuable and were highly satisfied with the master training course. Although most attendees felt that the course imparted the knowledge and tools critical for TeamSTEPPS implementation, they identified time restraints and competing initiatives as potential barriers. The project team has learned valuable lessons about obtaining buy-in, consolidating the change teams, making the curriculum relevant, and evaluation. Ambulatory care settings require innovative approaches to integration of teamwork improvement systems. Evaluating and sharing lessons learned will help to hone best practices as we navigate this new frontier in the field of patient safety. © 2017 American Society for Healthcare Risk Management of the American Hospital Association.

  9. Conflict on interprofessional primary health care teams--can it be resolved?

    Science.gov (United States)

    Brown, Judith; Lewis, Laura; Ellis, Kathy; Stewart, Moira; Freeman, Thomas R; Kasperski, M Janet

    2011-01-01

    Increasingly, primary health care teams (PHCTs) depend on the contributions of multiple professionals. However, conflict is inevitable on teams. This article examines PHCTs members' experiences with conflict and responses to conflict. This phenomenological study was conducted using in-depth interviews with 121 participants from 16 PHCTs (10 urban and 6 rural) including a wide range of health care professionals. An iterative analysis process was used to examine the verbatim transcripts. The analysis revealed three main themes: sources of team conflict; barriers to conflict resolution; and strategies for conflict resolution. Sources of team conflict included: role boundary issues; scope of practice; and accountability. Barriers to conflict resolution were: lack of time and workload; people in less powerful positions; lack of recognition or motivation to address conflict; and avoiding confrontation for fear of causing emotional discomfort. Team strategies for conflict resolution included interventions by team leaders and the development of conflict management protocols. Individual strategies included: open and direct communication; a willingness to find solutions; showing respect; and humility. Conflict is inherent in teamwork. However, understanding the potential barriers to conflict resolution can assist PHCTs in developing strategies to resolve conflict in a timely fashion.

  10. Pharmacist contributions for basic care from the perspective of professionals of familial health care teams

    Directory of Open Access Journals (Sweden)

    Gecioni Loch-Neckel

    2009-06-01

    Full Text Available This study aimed to investigate the social representations of professionals included in the team of Family Health Strategy (physicians, nurses and dentists respecting the action possibilities and contributions of the pharmacist for the basic care, and based on social psychology and, particularly, on the theory of social representations. The epistemological basis of the research is qualitative, and the data were collected by means of individual semi-structured interviews, which were submitted to analysis of categorical thematic content. Apparently, the majority of professionals already inserted in the team know and recognize the importance of professional pharmacists in the basic care, as well as their potential contribution to this topic. The representations were constructed according to the following parameters: a the study object and the intervention area, b the individual practice of every professional and c his/her action in specific cases. The quality of the professional or personal experience concerning the action of these professionals has contributed for the knowledge about the possibilities of pharmacists' intervention in basic care.Este estudo teve por objetivo investigar as representações sociais dos profissionais incluídos na equipe de Estratégia em Saúde da Família (médico, enfermeiro e odontólogo, sobre as possibilidades de atuação e as contribuições do farmacêutico na atenção básica, tendo por fundamento a psicologia social e, particularmente, a teoria das representações sociais. A base epistemológica da pesquisa é qualitativa, sendo os dados coletados por meio de entrevistas individuais semi-estruturadas e analisados por meio de análise de conteúdo categorial temático. Constatou-se que a maioria dos profissionais já inseridos na equipe conhece e reconhece a importância do profissional farmacêutico na atenção básica e as suas possibilidades de contribuição. As representações foram construídas a

  11. Multidisciplinary team care in rehabilitation

    DEFF Research Database (Denmark)

    Momsen, Anne-Mette; Rasmussen, Jens Ole; Nielsen, Claus Vinther

    2012-01-01

    Objectives: To systematically investigate current scientific evidence about the effectiveness of multidisciplinary team rehabilitation for different health problems. Data sources: A comprehensive literature search was conducted in Cochrane, Medline, DARE, Embase, and Cinahl databases, and research...... from existing systematic reviews was critically appraised and summarized. Study selection: Using the search terms "rehabilitation", "multidisciplinary teams" or "team care", references were identified for existing studies published after 2000 that examined multidisciplinary rehabilitation team care...... for adults, without restrictions in terms of study population or outcomes. The most recent reviews examining a study population were selected. Data extraction: Two reviewers independently extracted information about study populations, sample sizes, study designs, rehabilitation settings, the team...

  12. The effect of interprofessional education on interprofessional performance and diabetes care knowledge of health care teams at the level one of health service providing

    Directory of Open Access Journals (Sweden)

    Nikoo Yamani

    2014-01-01

    Conclusion: It seems that inter-professional education can improve the quality of health care to some extent through influencing knowledge and collaborative performance of health care teams. It also can make the health-related messages provided to the covered population more consistent in addition to enhancing self-confidence of the personnel.

  13. Communicating with Pet Owners About Obesity: Roles of the Veterinary Health Care Team.

    Science.gov (United States)

    Churchill, Julie; Ward, Ernie

    2016-09-01

    Obesity continues to be the most prevalent nutritional problem of dogs and cats as well as one of the most frustrating conditions to treat successfully. Educating and assigning roles to all members of the health care team will improve staff engagement and the consistency and effectiveness of nutritional counseling for preventive care and weight loss treatment plans. Excellent communication skills can be used to assess the client's ability to change and implement a weight loss plan at the right time in the right way to achieve better adherence and improve patient health.

  14. Improving post-stroke recovery: the role of the multidisciplinary health care team

    Directory of Open Access Journals (Sweden)

    Clarke DJ

    2015-09-01

    Full Text Available David J Clarke, Anne Forster Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford, UK Abstract: Stroke is a leading cause of serious, long-term disability, the effects of which may be prolonged with physical, emotional, social, and financial consequences not only for those affected but also for their family and friends. Evidence for the effectiveness of stroke unit care and the benefits of thrombolysis have transformed treatment for people after stroke. Previously viewed nihilistically, stroke is now seen as a medical emergency with clear evidence-based care pathways from hospital admission to discharge. However, stroke remains a complex clinical condition that requires health professionals to work together to bring to bear their collective knowledge and specialist skills for the benefit of stroke survivors. Multidisciplinary team working is regarded as fundamental to delivering effective care across the stroke pathway. This paper discusses the contribution of team working in improving recovery at key points in the post-stroke pathway. Keywords: stroke care, rehabilitation, multidisciplinary, interdisciplinary, team working

  15. The role of the multidisciplinary health care team in the management of patients with Marfan syndrome

    Directory of Open Access Journals (Sweden)

    von Kodolitsch Y

    2016-11-01

    health care team at the Hamburg Marfan center gives a personal account of his or her contribution in the management of patients with MFS. The authors show how, with the support of health care managers, key team members organize themselves in an organizational structure to create a common meaning, to maximize therapeutic success for patients with MFS. First, we show how the initiative and collaboration of patient representatives, scientists, and physicians resulted in the foundation of Marfan centers, initially in the US and later in Germany, and how and why such centers evolved over time. Then, we elucidate the three main structural elements; a team of coordinators, core disciplines, and auxiliary disciplines of health care. Moreover, we explain how a multidisciplinary health care team integrates into many other health care structures of a university medical center, including external quality assurance; quality management system; clinical risk management; center for rare diseases; aorta center; health care teams for pregnancy, for neonates, and for rehabilitation; and in structures for patient centeredness. We provide accounts of medical goals and standards for each core discipline, including pediatricians, pediatric cardiologists, cardiologists, human geneticists, heart surgeons, vascular surgeons, vascular interventionists, orthopedic surgeons, ophthalmologists, and nurses; and of auxiliary disciplines including forensic pathologists, radiologists, rhythmologists, pulmonologists, sleep specialists, orthodontists, dentists, neurologists, obstetric surgeons, psychiatrist/psychologist, and rehabilitation specialists. We conclude that a multidisciplinary health care team is a means to maximize therapeutic success. Keywords: multidisciplinary, Marfan syndrome, health care, team, profession, sociology, management

  16. [Self-perception of health care team leaders in Andalusia. A quantitative and qualitative study].

    Science.gov (United States)

    García-Romera, I; Danet, A; March-Cerdà, J C

    To determine the perception and self-assessment on leadership among health care team leaders in Andalusia. Design: Exploratory descriptive study using quantitative and qualitative methodology, developed between 2013 and 2015, using a questionnaire and semi-structured interviews. Andalusia. All health managers from the Primary Care Management Units and Health Management Areas of the Departments of Paediatrics, Emergency and Internal Medicine, for the quantitative study. A purposive sample of 24 health managers was used for the qualitative study. Descriptive statistical study and bivariate analysis of comparison of means. Content analysis of the semi-structured interviews: Codification, category tree, and triangulation of results. The best self-assessment dimension relates to support, and the worst to considering oneself as a 'good leader'. The definition of a 'good leader' includes: Honesty, trust, and attitudes of good communication, closeness, appreciation, and reinforcement of the health team members. Different leadership styles were perceived. Main difficulties for leadership are related to the economic crisis and the management of personal conflicts. Health managers describe an adaptive leadership style, based on personal and professional support, and using communication as the main cohesive element for the team project. More studies on leaders' perspectives are important, in order to better understand their experiences, needs and expectations. Copyright © 2016 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

  17. Improving post-stroke recovery: the role of the multidisciplinary health care team.

    Science.gov (United States)

    Clarke, David J; Forster, Anne

    2015-01-01

    Stroke is a leading cause of serious, long-term disability, the effects of which may be prolonged with physical, emotional, social, and financial consequences not only for those affected but also for their family and friends. Evidence for the effectiveness of stroke unit care and the benefits of thrombolysis have transformed treatment for people after stroke. Previously viewed nihilistically, stroke is now seen as a medical emergency with clear evidence-based care pathways from hospital admission to discharge. However, stroke remains a complex clinical condition that requires health professionals to work together to bring to bear their collective knowledge and specialist skills for the benefit of stroke survivors. Multidisciplinary team working is regarded as fundamental to delivering effective care across the stroke pathway. This paper discusses the contribution of team working in improving recovery at key points in the post-stroke pathway.

  18. Achieving Continuity of Care: Facilitators and Barriers in Community Mental Health Teams

    Directory of Open Access Journals (Sweden)

    Jones Ian Rees

    2011-03-01

    Full Text Available Abstract Background The integration of mental health and social services for people diagnosed with severe mental illness (SMI has been a key aspect of attempts to reform mental health services in the UK and aims to minimise user and carer distress and confusion arising from service discontinuities. Community mental health teams (CMHTs are a key component of UK policy for integrated service delivery, but implementing this policy has raised considerable organisational challenges. The aim of this study was to identify and explore facilitators and barriers perceived to influence continuity of care by health and social care professionals working in and closely associated with CMHTs. Methods This study employed a survey design utilising in-depth, semi-structured interviews with a proportionate, random sample of 113 health and social care professionals and representatives of voluntary organisations. Participants worked in two NHS Mental Health Trusts in greater London within eight adult CMHTs and their associated acute in-patient wards, six local general practices, and two voluntary organisations. Results Team leadership, decision making, and experiences of teamwork support were facilitators for cross boundary and team continuity; face-to-face communication between teams, managers, general practitioners, and the voluntary sector were facilitators for information continuity. Relational, personal, and longitudinal continuity were facilitated in some local areas by workforce stability. Barriers for cross boundary and team continuity were specific leadership styles and models of decision making, blurred professional role boundaries, generic working, and lack of training for role development. Barriers for relational, personal, and longitudinal continuity were created by inadequate staffing levels, high caseloads, and administrative duties that could limit time spent with users. Incompatibility of information technology systems hindered information

  19. 2015 ACC Health Policy Statement on Cardiovascular Team-Based Care and the Role of Advanced Practice Providers.

    Science.gov (United States)

    Brush, John E; Handberg, Eileen M; Biga, Cathleen; Birtcher, Kim K; Bove, Alfred A; Casale, Paul N; Clark, Michael G; Garson, Arthur; Hines, Jerome L; Linderbaum, Jane A; Rodgers, George P; Shor, Robert A; Thourani, Vinod H; Wyman, Janet F

    2015-05-19

    The mission of the American College of Cardiology is "to transform cardiovascular care and improve heart health." Cardiovascular team-based care is a paradigm for practice that can transform care, improve heart health, and help meet the demands of the future. One strategic goal of the College is to help members successfully transition their clinical practices to the future, with all its complexity, challenges, and opportunities. The ACC's strategic plan is aligned with the triple aim of improved care, improved population health, and lower costs per capita. The traditional understanding of quality, access, and cost is that you cannot improve one component without diminishing the others. With cardiovascular team-based care, it is possible to achieve the triple aim of improving quality, access, and cost simultaneously to also improve cardiovascular health. Striving to serve the best interests of patients is the true north of our guiding principles. Cardiovascular team-based care is a model that can improve care coordination and communication and allow each team member to focus more on the quality of care. In addition, the cardiovascular team-based care model increases access to cardiovascular care and allows expansion of services to populations and geographic areas that are currently underserved. This document will increase awareness of the important components of cardiovascular team-based care and create an opportunity for more discussion about the most creative and effective means of implementing it. We hope that this document will stimulate further discussions and activities within the ACC and beyond about team-based care. We have identified areas that need improvement, specifically in APP education and state regulation. The document encourages the exploration of collaborative care models that should enable team members to optimize their education, training, experience, and talent. Improved team leadership, coordination, collaboration, engagement, and efficiency

  20. Using the Communication and Teamwork Skills (CATS) Assessment to measure health care team performance.

    Science.gov (United States)

    Frankel, Allan; Gardner, Roxane; Maynard, Laura; Kelly, Andrea

    2007-09-01

    Patient safety administrators, educators, and researchers are striving to understand how best to monitor and improve team skills and determine what approaches to monitoring best suit their organizations. A behavior-based tool, based on principles of crisis resource management (CRM) in nonmedical industries, was developed to quantitatively assess communication and team skills of health care providers in a variety of real and simulated clinical settings. The Communication and Teamwork Skills (CATS) Assessment has been developed through rapid-cycle improvement and piloted through observation of videotaped simulated clinical scenarios, realtime surgical procedures, and multidisciplinary rounds. Specific behavior markers are clustered into four categories-coordination, cooperation, situational awareness, and communication. Teams are scored in terms of the occurrence and quality of the behaviors. The CATS Assessment results enable clinicians to view a spectrum of scores-from the overall score for the categories to specific behaviors. The CATS Assessment tool requires statistical validation and further study to determine if it reliably quantifies health care team performance. The patient safety community is invited to use and improve behavior-based observation measures to better evaluate their training programs, continue to research and improve observation methodology, and provide quantifiable, objective feedback to their clinicians and organizations.

  1. Team Interactions in Specialized Palliative Care Teams: A Qualitative Study

    OpenAIRE

    Klarare, Anna; Hagelin, Carina Lundh; Fürst, Carl Johan; Fossum, Bjoorn

    2013-01-01

    Background: Teamwork is a standard of care in palliative care and that is emphasized by leading organizations. When interdisciplinary teams communicate their varied assessments, outcomes may be more than additive due to the synthesis of information. Interprofessionality does not guarantee multidimensionality in health care interventions, however, and that interprofessional teams promote collaboration may be questioned. Aim: The aim was to explore team interaction among team members in special...

  2. Type 2 diabetes management: Patient knowledge and health care team perceptions, South Africa

    Directory of Open Access Journals (Sweden)

    Nombeko Mshunqane

    2012-10-01

    Full Text Available Background: South African research indicates that the highest death rates between 2004 and 2005 were from diabetes mellitus. There is minimal research information on interactions between what patients know about their disease and what health professionals perceive thatpatients should know to control their disease well.Objectives: This study determined the knowledge that patients with type 2 diabetes have about the management of their disease, as well as the perceptions of the health care team about the services given to patients.Method: Qualitative data were collected using two focus groups and in-depth interviews. Patient focus group (n = 10 explored patients’ knowledge about management of type 2 diabetes. Patients were recruited from Dr George Mukhari Hospital outpatients’ diabetes clinic. Professional focus group (n = 8 explored the health care team’s experiences, barriers and facilitators in managing the disease. Professional focus group participants were recruited because of their expertise in chronic disease management, working in the community (public health or working directly with patients with type 2 diabetes. Five health care professionals were interviewed using the same guide of questions as for the focus group.Results: Participants identified type 2 diabetes as a chronic disease that needs behaviour change for good control. Five major themes were identified: patients’ knowledge; education programmes; behaviour change; support; and a patient-centred approach.Conclusion: Management of type 2 diabetes may be enhanced by reinforcing patients’ knowledge, encouraging behaviour change whilst taking into consideration patients’ backgrounds. The health care team needs to utilise a patient-centred approach.

  3. Type 2 diabetes management: Patient knowledge and health care team perceptions, South Africa

    Directory of Open Access Journals (Sweden)

    Nombeko Mshunqane

    2012-02-01

    Full Text Available Background: South African research indicates that the highest death rates between 2004 and 2005 were from diabetes mellitus. There is minimal research information on interactions between what patients know about their disease and what health professionals perceive that patients should know to control their disease well.Objectives: This study determined the knowledge that patients with type 2 diabetes have about the management of their disease, as well as the perceptions of the health care team about the services given to patients.Method: Qualitative data were collected using two focus groups and in-depth interviews. Patient focus group (n = 10 explored patients’ knowledge about management of type 2 diabetes. Patients were recruited from Dr George Mukhari Hospital outpatients’ diabetes clinic. Professional focus group (n = 8 explored the health care team’s experiences, barriers and facilitators in managing the disease. Professional focus group participants were recruited because of their expertise in chronic disease management, working in the community (public health or working directly with patients with type 2 diabetes. Five health care professionals were interviewed using the same guide of questions as for the focus group.Results: Participants identified type 2 diabetes as a chronic disease that needs behaviour change for good control. Five major themes were identified: patients’ knowledge; education programmes; behaviour change; support; and a patient-centred approach.Conclusion: Management of type 2 diabetes may be enhanced by reinforcing patients’ knowledge, encouraging behaviour change whilst taking into consideration patients’ backgrounds. The health care team needs to utilise a patient-centred approach.

  4. [Satisfaction scales with health care to cardiovascular diseases: CARDIOSATIS--patient and team].

    Science.gov (United States)

    Cardoso, Clareci Silva; Bandeira, Marina; Ribeiro, Antonio Luiz Pinho; Oliveira, Graziella Lage; Caiaffa, Waleska Teixeira

    2011-01-01

    Satisfaction is an important measure of quality care, of adherence to the treatment and adequate use of health services. The objective here is to build two scales which evaluates team' and patients' satisfaction with cardiovascular disease treatment provided through a distance telecardiology project. The procedure followed international standards for development of measure instruments, including operational definition of satisfaction contents and its area for evaluation; item definition; pre-test and pilot study. The literature review, focal groups and discussion with specialists had delimited the domains to be included in the scales and the elaboration of its items. The CARDIOSATIS-Team included 15 items and the CARDIOSATIS-Patient included 11. Satisfaction was measured through a five-point Likert scale. The scales' items comprised satisfaction with physical structure, human resources, capacity of resolution, attention and care offered by the service and the satisfaction with the received/given care. The scales also included open questions. CARDIOSATIS scales have showed to be an easy and accessible instrument very well accepted by medical team and patients. Preliminary results presented good characteristics of validity and reliability.

  5. Preparing students to work effectively in interprofessional health and social care teams.

    Science.gov (United States)

    Stevenson, Keith; Seenan, Chris; Morlan, Gordon; Smith, Wendy

    2012-01-01

    Interprofessional education (IPE) has 'learning to work effectively in interprofessional teams' as one of its central learning outcomes. Whilst much is made in IPE of allocating health and social care students into interprofessional teams and setting them a task to complete, it has proved difficult to find a fair and equitable method of assessing how effective each individual has been in contributing to the task. This difficulty is compounded when the module is delivered predominantly online. This paper describes the recent push to establish meaningful educational outcomes for those involved in delivering IPE to pre-registration health and social care students. It then describes the use of a web-based peer assessment tool (Web PA) developed at Loughborough and Hull Universities (UK) which has been adapted by Glasgow Caledonian University (UK) for assessing the outcome of contributing effectively to IPE-related online group tasks. The paper outlines how the process of web-based peer assessment operates in theory and how it has been received in practice. An illustration is given that shows how the process successfully discriminates between those that are working effectively in interprofessional teams and those that are not. The value of the process is discussed.

  6. Improving Care Teams' Functioning: Recommendations from Team Science.

    Science.gov (United States)

    Fiscella, Kevin; Mauksch, Larry; Bodenheimer, Thomas; Salas, Eduardo

    2017-07-01

    Team science has been applied to many sectors including health care. Yet there has been relatively little attention paid to the application of team science to developing and sustaining primary care teams. Application of team science to primary care requires adaptation of core team elements to different types of primary care teams. Six elements of teams are particularly relevant to primary care: practice conditions that support or hinder effective teamwork; team cognition, including shared understanding of team goals, roles, and how members will work together as a team; leadership and coaching, including mutual feedback among members that promotes teamwork and moves the team closer to achieving its goals; cooperation supported by an emotionally safe climate that supports expression and resolution of conflict and builds team trust and cohesion; coordination, including adoption of processes that optimize efficient performance of interdependent activities among team members; and communication, particularly regular, recursive team cycles involving planning, action, and debriefing. These six core elements are adapted to three prototypical primary care teams: teamlets, health coaching, and complex care coordination. Implementation of effective team-based models in primary care requires adaptation of core team science elements coupled with relevant, practical training and organizational support, including adequate time to train, plan, and debrief. Training should be based on assessment of needs and tasks and the use of simulations and feedback, and it should extend to live action. Teamlets represent a potential launch point for team development and diffusion of teamwork principles within primary care practices. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.

  7. Health care multidisciplinary teams: The sociotechnical approach for an integrated system-wide perspective.

    Science.gov (United States)

    Marsilio, Marta; Torbica, Aleksandra; Villa, Stefano

    The current literature on the enabling conditions of multidisciplinary teams focuses on the singular dimensions of the organizations (i.e., human resources, clinical pathways, objects) without shedding light on to the way in which these organizational factors interact and mutually influence one another. Drawing on a system perspective of organizations, the authors analyze the organizational patterns that promote and support multidisciplinary teams and how they interrelate and interact to enforce the organization work system. The authors develop a modified sociotechnical system (STS) model to understand how the two dimensions of technical (devices/tools, layout/organization of space, core process standardization) and social (organizational structure, management of human resources and operations) can facilitate the implementation of multidisciplinary teams in health care. The study conducts an empirical analysis based on a sample of hospital adopters of transcatheter aortic valve implantation using the revised STS model. The modified STS model applied to the case studies improves our understanding of the critical implementation factors of a multidisciplinary approach and the importance of coordinating radical changes in the technical and the social subsystems of health care organizations. The analysis informs that the multidisciplinary effort is not a sequential process and that the interplay between the two subsystems needs to be managed efficaciously as an integrated organizational whole to deliver the goals set. Hospital managers must place equal focus on the closely interrelated technical and social dimensions by investing in (a) shared layouts and spaces that cross the boundaries of the specialized health care units, (b) standardization of the core processes through the implementation of local clinical pathways, (c) structured knowledge management mechanisms, (d) the creation of clinical directorates, and (e) the design of a planning and budgeting system that

  8. Community health worker integration into the health care team accomplishes the triple aim in a patient-centered medical home: a Bronx tale.

    Science.gov (United States)

    Findley, Sally; Matos, Sergio; Hicks, April; Chang, Ji; Reich, Douglas

    2014-01-01

    Community health workers are ideally suited to the care coordination niche within the patient-centered medical home (PCMH) team, but there are few case studies detailing how to accomplish this integration. This qualitative study documents how community health workers (CHWs) were integrated into a PCMH in South Bronx, New York. Results show that integration was linked to clear definition of their care coordination role within the care team, meticulous recruitment, training and supervision by a senior CHW, shared leadership of the care management team, and documented value for money. By helping the team understand patients' backgrounds, constraints, and preferences, they helped everyone genuinely focus on the patient.

  9. Core competencies in sexual and reproductive health for the interprofessional primary care team.

    Science.gov (United States)

    Cappiello, Joyce; Levi, Amy; Nothnagle, Melissa

    2016-05-01

    A primary care workforce that is well prepared to provide high-quality sexual and reproductive health (SRH) care has the potential to enhance access to care and reduce health disparities. This project aimed to identify core competencies to guide SRH training across the primary care professions. A six-member interprofessional expert working group drafted SRH competencies for primary care team members. Primary care providers including family physicians, nurses, nurse practitioners and certified nurse midwives, physician assistants and pharmacists were invited to participate in a three-round electronic Delphi survey. In each round, participants voted by email to retain, eliminate or revise each competency, with their suggested edits to the competencies incorporated by the researchers after each round. Fifty providers from six professions participated. In Round 1, 17 of 33 draft competencies reached the 75% predetermined agreement level to be accepted as written. Five were combined, reducing the total number to 28. Based on Round 2 feedback, 21 competencies were reworded, and 2 were combined. In Round 3, all 26 competencies reached at least 83.7% agreement, with 9 achieving 100% agreement. The 33 core competencies encompass professional ethics and reproductive justice, collaboration, SRH services and conditions affecting SRH. These core competencies will be disseminated and adapted to each profession's scope of practice to inform required curricula. SRH competencies for primary care can inform the required curricula across professions, filling the gap between an established standard of care necessary to meet patient needs and the outcomes of that care. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. [Organizational climate in management teams and its relationship with health care outcomes].

    Science.gov (United States)

    Peña-Viveros, Raúl; Hernández-Hernández, Dulce María; Vélez-Moreno, Ana María Luz; García-Sandoval, Martha Gabriela; Reyes-Tellez, María Araceli; Ureña-Bogarin, Enrique L

    2015-01-01

    To identify the relationship between organizational climate of management teams and the performance of health services. A transversal and analytical study was designed. The Organizational Climate Scale (OCS) was utilized and performance was assessed by the achievement indicators through correlation analysis and multiple regression. Thirty four medical benefits services headquarters (JSPM) were measured of the Mexican Social Security Institute. Of 862 participating, 238 (27.6%) evaluated the climate of their organizations with a high level; the maximal score was 56%. Average performance value was 0.79 ± 0.07 (minimal: 0.65; maximal: 0.92). A positive correlation was demonstrated between organizational climate level and performance (r=0.4; p=0.008). The organizational climate of the health services managers (JSPM) is directly related with performance in health care.

  11. Diarrhoea control: the experience of a health team in a primary care unit, Algeria.

    Science.gov (United States)

    Belhocine, Z; Mahiout, B; Laraba, A; Grangaud, J P

    1985-01-01

    This article reports the experiences of a primary health care unit located in Algeria's Zeralda district in the control of diarrhea. Curative and preventive care is provided to the adult and child populations of the district by a medical and paramedical team. The overall goal of the diarrheal control program, initiated in 1980, is to combat mortality from diarrhea in children under 2 years of age. Intermediate goals include improvement of care provided to infants with diarrhea, early hospitalization of cases of diarrhea, improvement of contacts between the primary care unit and the hospital, and prevention of diarrhea. Children in the target group are located through use of a register of children living in the district, and their families are sent cards containing information on diarrhea and its control. Children are followed from the 1st day of consultation for diarrhea until the 30th day after the episode. Record keeping and careful follow-up are stressed. In 1983, 335 children 18 months of age or younger (47% of the target population) consulted health structures in Zeralda for diarrhea. About 1/3 of children fail to return for follow-up visits. This is attributed both to long waits in the clinic and the fact that children are usually cured by the time of this visit. The number of children hospitalized for acute dehydration has declined from 33 in 1980 to 18 in 1983; the number of deaths from dehydration declined from 16 to 8 in this same period.

  12. Collective learning, change and improvement in health care: trialling a facilitated learning initiative with general practice teams.

    Science.gov (United States)

    Bunniss, Suzanne; Gray, Francesca; Kelly, Diane

    2012-06-01

    Many patients, families, health care professionals and politicians desire for quality improvement within the UK National Health Service. One way to achieve this change is for health care teams to work and learn together more effectively. This research aimed to design and trial a facilitated learning programme with the aim of supporting general practice teams in fostering the characteristics of learning organizations. This is an action research study. Qualitative data were captured during and after the trial from 40 participants in two multi-professional general practice teams within different Scottish health boards. Data were gathered using observations, semi-structured interviews and written learning notes. Taking part in the LPP was a positive experience of learning together as a practice and enhanced communication within the team was a particular outcome. External facilitation helped provide focus and reduce inter-professional barriers. Teams found working in small, mixed role discussion groups particularly valuable in understanding each others' perspectives. The active learning style of the LPP could be daunting at times but teams valued the chance to identify their own quality improvement goals. Teams introduced a number of changes to improve the quality of care within their practice as a result of their participation. This trial of the learning practice programme shows that, with facilitation and the appropriate input of resources, general practice teams can successfully apply learning organization principles to produce quality improvement outcomes. The study also demonstrates the value of action research in researching iterative change over time. © 2011 Blackwell Publishing Ltd.

  13. Workforce diversity: implications for the effectiveness of health care delivery teams.

    Science.gov (United States)

    Dreachslin, J L; Hunt, P L; Sprainer, E

    2000-05-01

    This paper examines the implications of racial diversity for the self-perceived communication effectiveness of nursing care teams. An RN leads the nursing care team (NCT) and delivers care in collaboration with two or more nonlicensed caregivers. Overlap is intentionally designed into the roles of NCT members and the range of duties the team performs is generally expanded to include functions previously performed by personnel from centralized departments. NCTs are highly reliant on mutual respect and effective communication among team members. Team conflict and miscommunication can be exacerbated by the strong correlation between role on the nursing care team (NCT) and race. Verbatim transcripts of fourteen focus groups from two study hospitals were used to develop a grounded theory of the role that race plays in the self-perceived communication effectiveness of nursing care teams. Two themes that emerged from the focus group discussions constitute the overarching framework within which racially diverse team members evaluate team communication effectiveness: different perspectives and alternative realities. Three additional themes, social isolation, selective perception and stereotypes, that serve as reinforcing factors were also identified, i.e., these factors deepen the conflict and dissatisfaction with team communication that occurs as a natural consequence of the overarching framework of different perspectives and alternative realities. Leadership emerged as a powerful mitigating factor in the model of how race influences the self-perceived communication effectiveness of nursing care teams. Leaders who can transcend racial identity as evidenced by the ability to validate alternative realities and appreciate different perspectives appear to moderate the potential negative effects of racial diversity on team communication processes and strengthen the positive aspects of diversity.

  14. [Characterization of the physical symptoms of stress in the emergency health care team].

    Science.gov (United States)

    Farias, Sílvia Maria de Carvalho; Teixeira, Olga Lúcia de Carvalho; Moreira, Walter; Oliveira, Márcia Aparecida Ferreira de; Pereira, Maria Odete

    2011-06-01

    Nursing professionals working in Emergency Care suffer from the physical symptoms of stress in their everyday activity. The objective of this study was to characterize these symptoms using the Occupational Stress Indicator, a semi-structured instrument. To do this, the authors created open questions that were applied in interviews that were recorded and analyzed. The researchers listed the following physical symptoms: headache, a sensation of fatigue, leg pain, and tachycardia. According to reports form the workers, pain always resulted from emotional stress or appeared after providing emergency care, which suggests the workers find it very difficult to differentiate physical from mental stress. The investigation found that there is a need for measures to follow workers in their working activity. A manual was created, containing basic suggestions to improve the quality of life of the health team.

  15. Language and Culture in Health Literacy for People Living with HIV: Perspectives of Health Care Providers and Professional Care Team Members.

    Science.gov (United States)

    Mogobe, Keitshokile Dintle; Shaibu, Sheila; Matshediso, Ellah; Sabone, Motshedisi; Ntsayagae, Esther; Nicholas, Patrice K; Portillo, Carmen J; Corless, Inge B; Rose, Carol Dawson; Johnson, Mallory O; Webel, Allison; Cuca, Yvette; Rivero-Méndez, Marta; Solís Báez, Solymar S; Nokes, Kathleen; Reyes, Darcel; Kemppainen, Jeanne; Reid, Paula; Sanzero Eller, Lucille; Lindgren, Teri; Holzemer, William L; Wantland, Dean

    2016-01-01

    Low health literacy has been linked to inadequate engagement in care and may serve as a contributor to poor health outcomes among people living with HIV and AIDS. The purpose of this paper was to examine the perspectives of health care providers and professional care team members regarding health literacy in HIV disease. A secondary data analysis was conducted from a qualitative study aimed at understanding factors that help an HIV positive person to manage their HIV disease. Data were collected from sites in Botswana, the US, and Puerto Rico. In the parent study, data were collected through focus group discussions with 135 people living with HIV, 32 HIV health care providers (HCPs), and 39 HIV professional care team members (PCTMs). SPSS was used to analyze quantitative data while ATLAS.ti was used to analyze qualitative data. The findings from analyses of the perspectives of HCPs/PCTMs suggested that linguistic and cultural factors were important themes in the exchange of HIV information between health care providers and PLHIV. These themes included ineffective communication, health seeking behavior, cultural facilitators, and complementary and alternative/traditional healing methods. Thus, this study suggests that language and culture have a major role in health literacy for PLHIV.

  16. Language and Culture in Health Literacy for People Living with HIV: Perspectives of Health Care Providers and Professional Care Team Members

    Directory of Open Access Journals (Sweden)

    Keitshokile Dintle Mogobe

    2016-01-01

    Full Text Available Low health literacy has been linked to inadequate engagement in care and may serve as a contributor to poor health outcomes among people living with HIV and AIDS. The purpose of this paper was to examine the perspectives of health care providers and professional care team members regarding health literacy in HIV disease. A secondary data analysis was conducted from a qualitative study aimed at understanding factors that help an HIV positive person to manage their HIV disease. Data were collected from sites in Botswana, the US, and Puerto Rico. In the parent study, data were collected through focus group discussions with 135 people living with HIV, 32 HIV health care providers (HCPs, and 39 HIV professional care team members (PCTMs. SPSS was used to analyze quantitative data while ATLAS.ti was used to analyze qualitative data. The findings from analyses of the perspectives of HCPs/PCTMs suggested that linguistic and cultural factors were important themes in the exchange of HIV information between health care providers and PLHIV. These themes included ineffective communication, health seeking behavior, cultural facilitators, and complementary and alternative/traditional healing methods. Thus, this study suggests that language and culture have a major role in health literacy for PLHIV.

  17. Interprofessional Care and Role of Team Leaders.

    Science.gov (United States)

    Kaini, B K

    2015-01-01

    Interprofessional care is an essential part of the health service delivery system. It helps to achieve improved care and to deliver the optimal and desired health outcomes by working together, sharing and learning skills. Health care organisation is a collective sum of many leaders and followers. Successful delivery of interprofessional care relies on the contribution of interprofessional care team leaders and health care professionals from all groups. The role of the interprofessional care team leader is vital to ensuring continuity and consistency of care and to mobilise and motivate health care professionals for the effective delivery of health services. Medical professionals usually lead interprofessional care teams. Interprofessional care leaders require various skills and competencies for the successful delivery of interprofessional care.

  18. Better team management--better team care?

    Science.gov (United States)

    Shelley, P; Powney, B

    1994-01-01

    Team building should not be a 'bolt-on' extra, it should be a well planned, integrated part of developing teams and assisting their leaders. When asked to facilitate team building by a group of NHS managers we developed a framework which enabled individual members of staff to become more effective in the way they communicated with each other, their teams and in turn within the organization. Facing the challenge posed by complex organizational changes, staff were able to use 3 training days to increase and develop their awareness of the principles of teamwork, better team management, and how a process of leadership and team building could help yield better patient care.

  19. Self-reported patient psychosocial needs in integrated primary health care: A role for social work in interdisciplinary teams.

    Science.gov (United States)

    Craig, Shelley; Frankford, Rachel; Allan, Kate; Williams, Charmaine; Schwartz, Celia; Yaworski, Andrea; Janz, Gwen; Malek-Saniee, Sara

    2016-01-01

    Despite being identified as significant determinants of health, depression and anxiety continue to be underdiagnosed and undertreated in primary care settings. This study examined the psychosocial health needs of patients at four urban interdisciplinary primary health teams. Quantitative analysis revealed that nearly 80% of patients reported anxiety and/or depression. Self-reported anxiety and depression was correlated with poor social relationships, compromised health status and underdeveloped problem-solving skills. These findings suggest that social workers have a vital role to play within interdisciplinary primary health teams in the amelioration of factors associated with anxiety and depression.

  20. Educational impact of an assessment of medical students' collaboration in health care teams.

    Science.gov (United States)

    Olupeliyawa, Asela; Balasooriya, Chinthaka; Hughes, Chris; O'Sullivan, Anthony

    2014-02-01

    This paper explores how structured feedback and other features of workplace-based assessment (WBA) impact on medical students' learning in the context of an evaluation of a workplace-based performance assessment: the teamwork mini-clinical evaluation exercise (T-MEX). The T-MEX enables observation-based measurement of and feedback on the behaviours required to collaborate effectively as a junior doctor within the health care team. The instrument is based on the mini-clinical evaluation exercise (mini-CEX) format and focuses on clinical encounters such as consultations with medical and allied health professionals, discharge plan preparation, handovers and team meetings. The assessment was implemented during a 6-week period in 2010 with 25 medical students during their final clinical rotation. Content analysis was conducted on the written feedback provided by 23 assessors and the written reflections and action plans proposed by the 25 student participants (in 88 T-MEX forms). Semi-structured interviews with seven assessors and three focus groups with 14 student participants were conducted and the educational impact was explored through thematic analysis. The study enabled the identification of features of WBA that promote the development of collaborative competencies. The focus of the assessment on clinical encounters and behaviours important for collaboration provided opportunities for students to engage with the health care team and highlighted the role of teamwork in these encounters. The focus on specific behaviours and a stage-appropriate response scale helped students identify learning goals and facilitated the provision of focused feedback. Incorporating these features within an established format helped students and supervisors to engage with the instrument. Extending the format to include structured reflection enabled students to self-evaluate and develop plans for improvement. The findings illuminate the mechanisms by which WBA facilitates learning. The

  1. Training the 21st-Century Health Care Team: Maximizing Interprofessional Education Through Medical-Legal Partnership.

    Science.gov (United States)

    Tobin-Tyler, Elizabeth; Teitelbaum, Joel

    2016-06-01

    For too long, many stakeholders in the health care delivery system have ignored the extent to which social determinants of health (SDH) are inextricably woven into and affect individual and population health. The health care system is undergoing a relatively rapid transformation, which has included in part an increasing recognition of SDH's effects. This recognition, in turn, has led to renewed calls for changing the way that physicians are trained and has accelerated medical education curricular reforms. This Perspective focuses on one such innovative method of team-based care and the opportunities for its integration into medical education: medical-legal partnership, a health care delivery model that embeds civil legal services into the spectrum of health care services provided to low-income or otherwise vulnerable patients and communities.

  2. Exploring primary care activities in ACT teams.

    Science.gov (United States)

    Vanderlip, Erik R; Williams, Nancy A; Fiedorowicz, Jess G; Katon, Wayne

    2014-05-01

    People with serious mental illness often receive inadequate primary and preventive care services. Federal healthcare reform endorses team-based care that provides high quality primary and preventive care to at risk populations. Assertive community treatment (ACT) teams offer a proven, standardized treatment approach effective in improving mental health outcomes for the seriously mentally ill. Much is known about the effectiveness of ACT teams in improving mental health outcomes, but the degree to which medical care needs are addressed is not established. The purpose of this study was to explore the extent to which ACT teams address the physical health of the population they serve. ACT team leaders were invited to complete an anonymous, web-based survey to explore attitudes and activities involving the primary care needs of their clients. Information was collected regarding the use of health screening tools, physical health assessments, provision of medical care and collaboration with primary care systems. Data was analyzed from 127 team leaders across the country, of which 55 completed the entire survey. Nearly every ACT team leader believed ACT teams have a role in identifying and managing the medical co-morbidities of their clientele. ACT teams report participation in many primary care activities. ACT teams are providing a substantial amount of primary and preventive services to their population. The survey suggests standardization of physical health identification, management or referral processes within ACT teams may result in improved quality of medical care. ACT teams are in a unique position to improve physical health care by virtue of having medically trained staff and frequent, close contact with their clients.

  3. Multidisciplinary team care in rehabilitation

    DEFF Research Database (Denmark)

    Momsen, A.-M.; Nielsen, C.V.; Rasmussen, J.O.

    2012-01-01

    Objectives: To systematically investigate current scientific evidence about the effectiveness of multidisciplinary team rehabilitation for different health problems. Data sources: A comprehensive literature search was conducted in Cochrane, Medline, DARE, Embase, and Cinahl databases, and research...... people with hip fracture, homeless people with mental illness, adults with multiple sclerosis, stroke, aquired brain injury, chronic arthropathy, chronic pain, low back pain, and fibromyalgia. Whereas evidence was not found for adults with amyetrophic lateral schlerosis, and neck and shoulder pain....... Conclusion: Although these studies included heterogeneous patient groups the overall conclusion was that multidisciplinary rehabilitation team care effectively improves rehabilitation intervention. However, further research in this area is needed. © 2012 The Authors....

  4. Problems Associated with Coordination and Role Definitions in Health Care Teams: A Hospice Program Evaluation and Intervention Case Study.

    Science.gov (United States)

    Berteotti, Carol R.; And Others

    Using an evaluation of a hospital-based hospice as a case study, this paper analyzes problematic issues surrounding health care teams (HCTs) in light of findings revealed in the literature concerning HCT structures and processes. The factors of coordination and role definitions in HCTs and their manifestations in a particular hospice HCT in terms…

  5. Alpers–Huttenlocher syndrome: the role of a multidisciplinary health care team

    Directory of Open Access Journals (Sweden)

    Saneto RP

    2016-07-01

    Full Text Available Russell P Saneto1,2 1Department of Neurology, University of Washington, 2Division of Pediatric Neurology, Seattle Children’s Hospital, Seattle, WA, USA Abstract: Alpers–Huttenlocher syndrome (AHS is a mitochondrial DNA-depletion syndrome. Age of onset is bimodal: early onset at 2–4 years and later adolescent onset at 17–24 years of age. Early development is usually normal, with epilepsy heralding the disorder in ~50% of patients. The onset of seizures is coupled with progressive cognitive decline. Hepatopathy is variable, and when present is a progressive dysfunction leading to liver failure in many cases. These features of seizures, cognitive degeneration, and hepatopathy represent the “classic triad” of AHS. However, most patients develop other system involvement. Therefore, although AHS is ultimately a lethal disorder, medical care is required for sustained quality of life. Frequently, additional organ systems – gastrointestinal, respiratory, nutritional, and psychiatric – abnormalities appear and need treatment. Rarely, cardiovascular dysfunction and even pregnancy complicate medical treatment. Optimal care requires a team of physicians and caretakers to make sure quality of life is optimized. The care team, together with the family and palliative care specialists, need to be in communication as the disease progresses and medical changes occur. Although the unpredictable losses of function challenge medical care, the team approach can foster the individual quality-of-life care needed for the patient and family. Keywords: Mitochondrial depletion syndrome, polymerase gamma 1, clinical care, mitochondria

  6. A transdisciplinary team approach to pain management in inpatient health care settings.

    Science.gov (United States)

    Gordon, Robert M; Corcoran, John R; Bartley-Daniele, Patricia; Sklenar, Dennis; Sutton, Phyllis Roach; Cartwright, Frances

    2014-03-01

    This paper will discuss the transition from multidisciplinary to interdisciplinary and transdisciplinary team approaches to pain management at New York University Langone Medical Center - Rusk Institute of Rehabilitation Medicine. A transdisciplinary team approach to pain management emphasizes mutual learning, training, and education, and the flexible exchange of discipline-specific roles. Clinicians are enabled to implement a unified, holistic, and integrated treatment plan with all members of the team responsible for the same patient-centered goals. The model promotes and empowers patient and family/support system goals within a cultural context. Topics of exploration include the descriptions of three team approaches to patient care, including their practical, philosophical, and historical basis, strengths and challenges, research support, and cultural diversity. Case vignettes will highlight the strengths and limitations of the transdisciplinary team approach to pain management throughout a broad and diverse continuum of care, including acute medical, palliative, and perioperative care and acute inpatient rehabilitation services. Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  7. Intraprofessional, team-based treatment planning for oral health students in the comprehensive care clinic.

    Science.gov (United States)

    Mattheos, Nikos; Storrs, Mark; Foster, Lea; Oberholzer, Theunis

    2012-12-01

    In 2009, Griffith University School of Dentistry and Oral Health, in Queensland, Australia, introduced into its various curricula the concept of team-based treatment planning (TBTP), aiming to facilitate intraprofessional, interdisciplinary training and peer learning among its students. Fifty student teams were organized, each of which included students from three programs (Dental Science, Oral Health Therapy, and Dental Technology) and three years of study (third-, fourth-, and fifth-year students). This study prospectively evaluated the impact of TBTP on students' perceptions and attitudes towards teamwork and their role in a team of peers. A total of 202 students who participated in fifty TBTP teams were prospectively surveyed at baseline and at six and twelve months after introduction of TBTP. "Reliable" and "responsible" were reported to be the most important qualities of both an effective team leader and member. Fifth-year students identified "hard-working" as an important quality of the ideal leader as opposed to the fourth-year students who ranked "supportive" higher. Attitudes of the fifth-year students towards TBTP appeared to have declined significantly from the previous years, while fourth-year students remained consistently more positive. In addition, fourth-year students appeared more likely to enjoy working in a team and considered themselves more effective in a team. No gender differences were observed, other than female students' appearing less confident to lead a team. It was concluded that the function of student-directed interdisciplinary, intraprofessional treatment planning teams might pose disproportionate strain on fifth-year students, impacting their attitudes to such modes of work.

  8. Team-Based Care: A Concept Analysis.

    Science.gov (United States)

    Baik, Dawon

    2016-12-09

    The purpose of this concept analysis is to clarify and analyze the concept of team-based care in clinical practice. Team-based care has garnered attention as a way to enhance healthcare delivery and patient care related to quality and safety. However, there is no consensus on the concept of team-based care; as a result, the lack of common definition impedes further studies on team-based care. This analysis was conducted using Walker and Avant's strategy. Literature searches were conducted using PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycINFO, with a timeline from January 1985 to December 2015. The analysis demonstrates that the concept of team-based care has three core attributes: (a) interprofessional collaboration, (b) patient-centered approach, and (c) integrated care process. This is accomplished through understanding other team members' roles and responsibilities, a climate of mutual respect, and organizational support. Consequences of team-based care are identified with three aspects: (a) patient, (b) healthcare professional, and (c) healthcare organization. This concept analysis helps better understand the characteristics of team-based care in the clinical practice as well as promote the development of a theoretical definition of team-based care. © 2016 Wiley Periodicals, Inc.

  9. Resilience of the health team in caring for people with mental disorders in a psychiatric hospital.

    Science.gov (United States)

    Brolese, Débora Felippe; Lessa, Greice; Santos, José Luís Guedes Dos; Mendes, Jucimara da Silva; Cunha, Kamylla Santos da; Rodrigues, Jeferson

    2017-08-17

    Evaluating and understanding the resilience process of the health team in caring for people with mental disorders in a psychiatric hospital. A mixed-method study with concomitant triangulation of data from a cross-sectional study, with health professionals, and Grounded Theory in the data. Quantitative data were collected using the Resilience Scale and analyzed using descriptive and inferential statistics. Qualitative data were obtained from interviews and analyzed using initial and focused coding. 40 health professionals participated in the study. Mean responses of the participants in the resilience scale were 99.80 ± 12.86 points, with a minimum of 35 and a maximum of 114 points. From the qualitative data, we can highlight the professionals' commitment in developing competencies in caring for people with mental disorders; valorization of teamwork and positive impact on work for the re-signification of the meaning of life. Understanding this process of resilience enables developing strategies to improve the quality of life of workers in psychiatric hospitals. Avaliar e compreender o processo de resiliência da equipe de saúde no cuidado a pessoas com transtornos mentais em um hospital psiquiátrico. Estudo de método misto com triangulação concomitante de dados de um estudo transversal, com profissionais de saúde, e uma Teoria Fundamentada nos Dados. Os dados quantitativos foram coletados a partir da Escala de Resiliência e analisados por meio de estatística descritiva e inferencial. Os dados qualitativos foram obtidos a partir de entrevistas e analisados mediante codificação inicial e focalizada. Participaram da pesquisa 40 profissionais de saúde. Na escala de resiliência, a média das respostas dos participantes foi 99,80±12,86 pontos, o mínimo foi de 35 e o máximo de 114 pontos. Nos dados qualitativos, destacaram-se o empenho dos profissionais para o desenvolvimento de competências para o cuidado de pessoas com transtornos mentais, a valoriza

  10. Delivery of Community-Based Care Through Inter-professional Teams in Brazil's Unified Health System (UHS): Comparing Perceptions Across Community Health Agents (CHAs), Nurses and Physicians.

    Science.gov (United States)

    Rahman, Rahbel; Pinto, Rogério Meireles; Zanchetta, Margareth Santos; Wall, Melanie M

    2017-05-27

    Given the shortage of medical providers and the need for medical decisions to be responsive to community needs, including lay health providers in health teams has been recommended as essential for the successful management of global health care systems. Brazil's Unified Health System (UHS) is a model for delivering community-based care through Family Health Strategy (FHS) interdisciplinary teams comprised of medical and lay health providers-Community Health Agents (CHAs), nurses, and physicians. This study aims to understand how medical and lay health providers' perceptions and attitudes could impact the delivery of community-based care. The study compares perceptions and attitudes of 168 CHAs, 62 nurses, and 32 physicians across their job context, professional capacities, professional skills, and work environment. Descriptive and bivariate analysis were performed. CHAs reported being the most efficacious amongst the providers. Physicians reported incorporating consumer-input to a lesser degree than nurses and CHAs. CHAs reported using a lesser variety of skills than physicians. A significant proportion of physicians compared to CHAs and nurses reported that they had decision-making autonomy. Providers did not report differences that lack of resources and poor work conditions interfered with their ability to meet consumer needs. This study offers technocratic perspectives of medical and lay health providers who as an inter-professional team provide community-based primary health care. Implications of the study include proposing training priorities and identifying strategies to integrate lay health providers into medical teams for Brazil's Unified Health System and other health systems that aim to deliver community-based care through inter-professional health teams.

  11. Comparing the implementation of team approaches for improving diabetes care in community health centers

    OpenAIRE

    Wees, P.J. van der; Friedberg, M.W.; Guzman, E.; Ayanian, J.Z.; Rodriguez, H.P.

    2014-01-01

    Background Patient panel management and community-based care management may be viable strategies for community health centers to improve the quality of diabetes care for vulnerable patient populations. The objective of our study was to clarify implementation processes and experiences of integrating office-based medical assistant (MA) panel management and community health worker (CHW) community-based management into routine care for diabetic patients. Methods Mixed m...

  12. Is there a role for pharmacists in multidisciplinary health-care teams at community outreach events for the homeless?

    Science.gov (United States)

    Chan, Vincent; Patounas, Marea; Dornbusch, Debbie; Tran, Hung; Watson, Patricia

    2015-01-01

    Homelessness is a significant public health problem. It is well-documented that people experiencing homelessness exhibit more serious illnesses and have poorer health than the general population. The provision of services and interventions by health-care professionals, including pharmacists, may make a simple yet important contribution to improved health outcomes in those experiencing homelessness, but evidence of roles and interventions is limited and variable. In Australia, the Queensland University of Technology Health Clinic connects with the homeless community by taking part in community outreach events. This paper provides details of one such event, as well as the roles, interventions and experiences of pharmacists. Participation and inclusion of pharmacists in a multidisciplinary health-care team approach at homeless outreach events should be supported and encouraged.

  13. Management of type 2 diabetes mellitus in the elderly: role of the pharmacist in a multidisciplinary health care team

    Directory of Open Access Journals (Sweden)

    Grossman S

    2011-05-01

    Full Text Available Samuel GrossmanDepartment of Veterans Affairs, New York Harbor Healthcare System, New York, NY, USA; Diabetes Care On-The-Go Inc, Brooklyn, NY, USA; Hunter-Bellevue School of Nursing, Hunter College, City University of New York, New York, NY, USA; Arnold and Marie Schwartz College of Pharmacy of Long Island University, Brooklyn, NY, USA; Garden State Association of Diabetes Educators, Edison, NJ, USAAbstract: Intensive glycemic control using insulin therapy may be appropriate for many healthy older adults to reduce premature mortality and morbidity, improve quality of life, and reduce health care costs. However, frail elderly people are more prone to develop complications from hypoglycemia, such as confusion and dementia. Overall, older persons with type 2 diabetes mellitus are at greater risk of death from cardiovascular disease (CVD than from intermittent hyperglycemia; therefore, diabetes management should always include CVD prevention and treatment in this patient population. Pharmacists can provide a comprehensive medication review with subsequent recommendations to individualize therapy based on medical and cognitive status. As part of the patient’s health care team, pharmacists can provide continuity of care and communication with other members of the patient’s health care team. In addition, pharmacists can act as educators and patient advocates and establish patient-specific goals to increase medication effectiveness, adherence to a medication regimen, and minimize the likelihood of adverse events.Keywords: glycemic control, hyperglycemia, continuity of care, hypertension and cardiovascular disease, elderly, type 2 diabetes, pharmacist

  14. Delivering Coordinated Cancer Care by Building Transactive Memory in a Team of Teams.

    Science.gov (United States)

    Henry, Elizabeth; Silva, Abigail; Tarlov, Elizabeth; Czerlanis, Cheryl; Bernard, Margie; Chauhan, Cynthia; Schalk, Denise; Stewart, Greg

    2016-11-01

    Cancer care delivery is highly complex. Treatment involves coordination within oncology health-care teams and across other teams of referring primary and specialty providers (a team of teams). Each team interfaces with patients and caregivers to offer component parts of comprehensive care. Because patients frequently obtain specialty care from divergent health-care systems resulting in cross-system health-care use, oncology teams need mechanisms to coordinate and collaborate within and across health-care systems to optimize clinical outcomes for all cancer patients. Transactive memory is one potential strategy that can help improve comprehensive patient care delivery. Transactive memory is a process by which two or more team professionals develop a shared system for encoding, storing, and retrieving information. Each professional is responsible for retaining only part of the total information. Applying this concept to a team of teams results in system benefits wherein all teams share an understanding of specialized knowledge held by each component team. The patient's role as the unifying member of the team of teams is central to successful treatment delivery. This clinical case presents a patient who is receiving oral treatment for advanced prostate cancer within two health systems. The case emphasizes the potential for error when multiple teams function without a point team (the team coordinating efforts of all other primary and specialty teams) and when the specialty knowledge of providers and patients is not well integrated into all phases of the care delivery process.

  15. What Should You Ask Your Health Care Team About Pancreatic Cancer?

    Science.gov (United States)

    ... back? Along with these sample questions, be sure to write down some of your own. Keep in mind ... Symptoms of Cancer Treatments & Side Effects Cancer Facts & Statistics News and Stories Glossary For Health Care Professionals ...

  16. Comparing the implementation of team approaches for improving diabetes care in community health centers

    NARCIS (Netherlands)

    Wees, P.J. van der; Friedberg, M.W.; Guzman, E.; Ayanian, J.Z.; Rodriguez, H.P.

    2014-01-01

    BackgroundPatient panel management and community-based care management may be viable strategies for community health centers to improve the quality of diabetes care for vulnerable patient populations. The objective of our study was to clarify implementation processes and experiences of integrating o

  17. Making surgical missions a joint operation: NGO experiences of visiting surgical teams and the formal health care system in Guatemala.

    Science.gov (United States)

    Roche, Stephanie; Hall-Clifford, Rachel

    2015-01-01

    Each year, thousands of Guatemalans receive non-emergent surgical care from short-term medical missions (STMMs) hosted by local non-governmental organizations (NGOs) and staffed by foreign visiting medical teams (VMTs). The purpose of this study was to explore the perspectives of individuals based in NGOs involved in the coordination of surgical missions to better understand how these missions articulate with the larger Guatemalan health care system. During the summers of 2011 and 2013, in-depth interviews were conducted with 25 representatives from 11 different Guatemalan NGOs with experience with surgical missions. Transcripts were analysed for major themes using an inductive qualitative data analysis process. NGOs made use of the formal health care system but were limited by several factors, including cost, issues of trust and current ministry of health policy. Participants viewed the government health care system as a potential resource and expressed a desire for more collaboration. The current practices of STMMs are not conducive to health system strengthening. The role of STMMs must be defined and widely understood by all stakeholders in order to improve patient safety and effectively utilise health resources. Priority should be placed on aligning the work of VMTs with that of the larger health care system.

  18. From the Team to the Table: Nursing Societies and Health Care Organizational Ethics.

    Science.gov (United States)

    Wiencek, Clareen; Lavandero, Ramón; Berlinger, Nancy

    2016-09-01

    Health care work is interprofessional work. Nurses and physicians, members of the professions whose close collaboration is foundational to health care delivery, continue to be educated separately in most academic institutions. Their work also is organized in ways that challenge interprofessional collaboration. Understanding workplace realities faced by nurses and physicians, separately and jointly, is a starting place for exploring how to support ethically sound interprofessional work. In this essay, we look most closely at the work of nurses and physicians who care for seriously ill hospitalized patients, a patient population closely associated with ethical challenges.

  19. Effectiveness of the Rural Trauma Team Development Course for Educating Nurses and Other Health Care Providers at Rural Community Hospitals.

    Science.gov (United States)

    Zhu, Thein Hlaing; Hollister, Lisa; Scheumann, Christopher; Konger, Jennifer; Opoku, Dazar

    2016-01-01

    The study evaluates (1) health care provider perception of the Rural Trauma Team Development Course (RTTDC); (2) improvement in acute trauma emergency care knowledge; and (3) early transfer of trauma patients from rural emergency departments (EDs) to a verified trauma center. A 1-day, 8-hour RTTDC was given to 101 nurses and other health care providers from nine rural community hospitals from 2011 to 2013. RTTDC participants completed questionnaires to address objectives (1) and (2). ED and trauma registry data were queried to achieve objective (3) for assessing reduction in ED time (EDT), from patient arrival to decision to transfer and ED length of stay (LOS). The RTTDC was positively perceived by health care providers (96.3% of them completed the program). Significant improvement in 13 of the 19 knowledge items was observed in nurses. Education intervention was an independent predictor in reducing EDT by 28 minutes and 95% confidence interval (CI) [-57, -0.1] at 6 months post-RTTDC, and 29 minutes and 95% CI [-53, -6] at 12 months post-RTTDC. Similar results were observed with ED LOS. The RTTDC is well-perceived as an education program. It improves acute trauma emergency care knowledge in rural health care providers. It promotes early transfer of severely injured patients to a higher level of care.

  20. How to manage organisational change and create practice teams: experiences of a South African primary care health centre.

    Science.gov (United States)

    Mash, B J; Mayers, P; Conradie, H; Orayn, A; Kuiper, M; Marais, J

    2008-07-01

    In South Africa, first-contact primary care is delivered by nurses in small clinics and larger community health centres (CHC). CHCs also employ doctors, who often work in isolation from the nurses, with poor differentiation of roles and little effective teamwork or communication. Worcester CHC, a typical public sector CHC in rural South Africa, decided to explore how to create more successful practice teams of doctors and nurses. This paper is based on their experience of both unsuccessful and successful attempts to introduce practice teams and reports on their learning regarding organisational change. An emergent action research study design utilised a co-operative inquiry group. The first nine months of inquiry focused on understanding the initial unsuccessful attempt to create practice teams. This paper reports primarily on the subsequent nine months (four cycles of planning, action, observation and reflection) during which practice teams were re-introduced. The central question was how more effective practice teams of doctors and nurses could be created. The group utilised outcome mapping to assist with planning, monitoring and evaluation. Outcome mapping defined a vision, mission, boundary partners, outcome challenges, progress markers and strategies for the desired changes and supported quantitative monitoring of the process. Qualitative data were derived from the co-operative inquiry group (CIG) meetings and interviews with doctors, nurses, practice teams and patients. The CIG engaged effectively with 68% of the planned strategies, and more than 60% of the progress markers were achieved for clinical nurse practitioners, doctors, support staff and managers, but not for patients. Key themes that emerged from the inquiry group's reflection on their experience of the change process dealt with the amount of interaction, type of communication, team resilience, staff satisfaction, leadership style, reflective capacity, experimentation and evolution of new

  1. An interprofessional team approach to fall prevention for older home care clients ‘at risk’ of falling: health care providers share their experiences

    Directory of Open Access Journals (Sweden)

    Pamela Baxter

    2009-05-01

    Full Text Available Background: Providing care for older home care clients ‘at risk’ of falling requires the services of many health care providers due to predisposing chronic, complex conditions. One strategy to ensure that quality care is delivered is described in the integrated care literature; interprofessional collaboration. Engaging in an interprofessional team approach to fall prevention for this group of clients seems to make sense. However, whether or not this approach is feasible and realistic is not well described in the literature. As well, little is known about how teams function in the community when an interprofessional approach is engaged in. The barriers and facilitators of such an approach are also not known. Purpose: The purpose of this qualitative study was to describe the experiences of five different health care professionals as they participated in an interprofessional team approach to care for the frail older adult living at home and at risk of falling. Methodology: This study took place in Hamilton, ON, Canada and was part of a randomized controlled trial, the aim of which was to determine the effects and costs of a multifactorial and interdisciplinary team approach to fall prevention for older home care clients ‘at risk’ of falling. The current study utilized an exploratory descriptive design to answer the following research questions: how do interprofessional teams describe their experiences when involved in a research intervention requiring collaboration for a 9-month period of time? What are the barriers and facilitators to teamwork? Four focus groups were conducted with the care-provider teams (n=9 6 and 9 months following group formation. Results: This study revealed several themes which included, team capacity, practitioner competencies, perceived outcomes, support and time. Overall, care providers were positive about their experiences and felt that through an interprofessional approach benefits could be experienced by both

  2. An interprofessional team approach to fall prevention for older home care clients ‘at risk’ of falling: health care providers share their experiences

    Directory of Open Access Journals (Sweden)

    Pamela Baxter

    2009-05-01

    Full Text Available Background: Providing care for older home care clients ‘at risk’ of falling requires the services of many health care providers due to predisposing chronic, complex conditions. One strategy to ensure that quality care is delivered is described in the integrated care literature; interprofessional collaboration. Engaging in an interprofessional team approach to fall prevention for this group of clients seems to make sense. However, whether or not this approach is feasible and realistic is not well described in the literature. As well, little is known about how teams function in the community when an interprofessional approach is engaged in. The barriers and facilitators of such an approach are also not known. Purpose: The purpose of this qualitative study was to describe the experiences of five different health care professionals as they participated in an interprofessional team approach to care for the frail older adult living at home and at risk of falling. Methodology: This study took place in Hamilton, ON, Canada and was part of a randomized controlled trial, the aim of which was to determine the effects and costs of a multifactorial and interdisciplinary team approach to fall prevention for older home care clients ‘at risk’ of falling. The current study utilized an exploratory descriptive design to answer the following research questions: how do interprofessional teams describe their experiences when involved in a research intervention requiring collaboration for a 9-month period of time? What are the barriers and facilitators to teamwork? Four focus groups were conducted with the care-provider teams (n=9 6 and 9 months following group formation. Results: This study revealed several themes which included, team capacity, practitioner competencies, perceived outcomes, support and time. Overall, care providers were positive about their experiences and felt that through an interprofessional approach benefits could be experienced by both

  3. Insights of health district managers on the implementation of primary health care outreach teams in Johannesburg, South Africa: a descriptive study with focus group discussions.

    Science.gov (United States)

    Moosa, Shabir; Derese, Anselme; Peersman, Wim

    2017-01-21

    Primary health care (PHC) outreach teams are part of a policy of PHC re-engineering in South Africa. It attempts to move the deployment of community health workers (CHWs) from vertical programmes into an integrated generalised team-based approach to care for defined populations in municipal wards. There has little evaluation of PHC outreach teams. Managers' insights are anecdotal. This is descriptive qualitative study with focus group discussions with health district managers of Johannesburg, the largest city in South Africa. This was conducted in a sequence of three meetings with questions around implementation, human resources, and integrated PHC teamwork. There was a thematic content analysis of validated transcripts using the framework method. There were two major themes: leadership-management challenges and human resource challenges. Whilst there was some positive sentiment, leadership-management challenges loomed large: poor leadership and planning with an under-resourced centralised approach, poor communications both within the service and with community, concerns with its impact on current services and resistance to change, and poor integration, both with other streams of PHC re-engineering and current district programmes. Discussion by managers on human resources was mostly on the plight of CHWs and calls for formalisation of CHWs functioning and training and nurse challenges with inappropriate planning and deployment of the team structure, with brief mention of the extended team. Whilst there is positive sentiment towards intent of the PHC outreach team, programme managers in Johannesburg were critical of management of the programme in their health district. Whilst the objective of PHC reform is people-centred health care, its implementation struggles with a centralising tendency amongst managers in the health service in South Africa. Managers in Johannesburg advocated for decentralisation. The implementation of PHC outreach teams is also limited by

  4. Team networking in palliative care

    Directory of Open Access Journals (Sweden)

    Odette Spruyt

    2011-01-01

    Full Text Available "If you want to travel quickly, go alone. But if you want to travel far, you must go together". African proverb. The delivery of palliative care is often complex and always involves a group of people, the team, gathered around the patient and those who are close to them. Effective communication and functional responsive systems of care are essential if palliative care is to be delivered in a timely and competent way. Creating and fostering an effective team is one of the greatest challenges for providers of palliative care. Teams are organic and can be life giving or life sapping for their members.

  5. Improving post-stroke recovery: the role of the multidisciplinary health care team

    OpenAIRE

    Clarke, DJ; Forster, A.

    2015-01-01

    David J Clarke, Anne Forster Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford, UK Abstract: Stroke is a leading cause of serious, long-term disability, the effects of which may be prolonged with physical, emotional, social, and financial consequences not only for those affected but also for their family and friends. Evidence for the effectiveness of stroke unit care and the benefits of thrombolysis have transformed treatment for people after ...

  6. Pharmacists belong in accountable care organizations and integrated care teams.

    Science.gov (United States)

    Smith, Marie; Bates, David W; Bodenheimer, Thomas S

    2013-11-01

    Effective health care workforce development requires the adoption of team-based care delivery models, in which participating professionals practice at the full extent of their training in pursuit of care quality and cost goals. The proliferation of such new models as medical homes, accountable care organizations, and community-based care teams is creating new opportunities for pharmacists to assume roles and responsibilities commensurate with their capabilities. Some challenges to including pharmacists in team-based care delivery models, including the lack of payment mechanisms that explicitly provide for pharmacist services, have yet to be fully addressed by policy makers and others. Nevertheless, evolving models and strategies reveal a variety of ways to draw on pharmacists' expertise in such critical areas as medication management for high-risk patients. As Affordable Care Act provisions are implemented, health care workforce projections need to consider the growing number of pharmacists expected to play an increasing role in delivering primary care services.

  7. Position statement on interdisciplinary team training in geriatrics: an essential component of quality health care for older adults.

    Science.gov (United States)

    2014-05-01

    Interdisciplinary team training (IDT) is an important component of ensuring quality geriatric care delivery, which can be complex and time intensive, requiring coordination of many medical, psychosocial, and therapeutic interventions and professionals. The Partnership for Health in Aging (PHA), a loose coalition of more than 30 organizations representing healthcare professionals who care for older adults supported by the American Geriatrics Society, identified IDT training in geriatrics as a priority area in addressing the geriatrics workforce shortage described in the 2008 Institute of Medicine report, Retooling for An Aging America: Building the Health Care Workforce. A PHA Workgroup on Interdisciplinary Team Training in Geriatrics was convened to review the literature focused on geriatrics IDT training and to develop a position statement that would inform and influence groups involved in the development and expansion of academic and continuing education programs in IDT training, including professional associations, credentialing and licensing bodies, accreditation organizations, and university administrators. There are significant challenges to expanding the development and implementation of geriatrics IDT training for health professionals, and such training will be successful only with substantial and sustained advocacy from the above professional groups. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

  8. [Response of primary care teams to manage mental health problems after the 2010 earthquake].

    Science.gov (United States)

    Vitriol, Verónica; Minoletti, Alberto; Alvarado, Rubén; Sierralta, Paula; Cancino, Alfredo

    2014-09-01

    Thirty to 50% of people exposed to a natural disaster suffer psychological problems in the ensuing months. To characterize the activities in mental health developed by Primary Health Care centers after the earthquake that affected Chile on february 27th, 2010. A cross-sectional study analyzing 16 urban centers of Maule Region, was carried out. A questionnaire was developed to know the preparatory and supportive activities directed to the community and the training and self-care activities directed to Health Care personnel that were made during the 12 months following the catastrophe. In addition, a questionnaire evaluating structural aspects was designed. Only 1/3 of the centers made some preparatory activity and none of them made a diagnosis of population vulnerability. The average of protective Mental Health interventions coverage reached 35% of the population estimated to be most affected. The activities lasted 31 to 62% of the optimal duration standards set by experts (according to the type of action). Important differences between centers in economic and geographical accessibility, construction and professional resources were found. This study shows the difficulties faced by urban centers of Maule Region to deal with mental health problems caused by the earthquake, which were attributable to the absence of local planning and drills, and to the lack of intra and inter sectorial coordination.

  9. [Recommendations on the relationship between surgeons and anesthesiologists as part of the health care team].

    Science.gov (United States)

    Daher, Michel

    2007-01-01

    Surgeon and anesthesiologist work as a team. Physicians of different but complementary specialties, they work jointly in the management of the patient during the pre, per and postoperative periods, with the main objective of ensuring the best quality of care and the greatest safety. However, the unprecedented development of new technologies during the last decades, deeply modified the conditions of exercise of these two specialities. Thus, the practice of anaesthesia is not only necessary for performing the surgical act, but also for diagnostic and therapeutic techniques using high technologies. So, from a traditional partner of the surgeon, the anesthetist became the privileged collaborator of a great number of specialists. Within these teams, the anesthetist must achieve his/her task in all independence, as stated in the Lebanese Code of Ethics. I will try in this message to point out the responsibilities of each of the two partners in this joint practice. The practice of a shared activity, in the same place, for the benefit of the patient, requires a preliminary definition of roles, in the mutual respect of competencies and responsibilities of each specialist, based on the respect of the rules edicted in the Code of Ethics.

  10. Teamwork in health care.

    Science.gov (United States)

    Landman, Natalie; Aannestad, Liv K; Smoldt, Robert K; Cortese, Denis A

    2014-01-01

    It is becoming increasingly clear that maintaining and improving the health of the population, and doing so in a financially sustainable manner, requires the coordination of acute medical care with long-term care, and social support services, that is, team-based care. Despite a growing body of evidence on the benefits of team-based care, the health care ecosystem remains "resistant" to a broader implementation of such care models. This resistance is a function of both system-wide and organizational barriers, which result primarily from fragmentation in reimbursement for health care services, regulatory restrictions, and the siloed nature of health professional education. To promote the broader adoption of team-based care models, the health care system must transition to pay for value reimbursement, as well as break down the educational silos and move toward team-based and value-based education of health professionals.

  11. COPD Multidisciplinary Team Meetings in the United Kingdom: Health Care Professionals' Perceptions of Aims and Structure.

    Science.gov (United States)

    Kruis, Annemarije L; Soljak, Michael; Chavannes, Niels H; Elkin, Sarah L

    2016-10-01

    Over the last 10 years, community and hospital-based multidisciplinary teams (MDTs) have been set up for the management of patients with chronic obstructive pulmonary disease (COPD) in the UK. Meetings of the MDTs have become a regular occurrence, mostly on healthcare professionals' own initiatives. There are no standardized methods to conduct an MDT meeting, and although cancer MDT meetings are widely implemented, the value and purpose of COPD MDT meetings are less clear. Therefore, the aim of this study was to conduct a cross-sectional descriptive online survey to explore COPD MDT members' perceptions of the purpose and usefulness of MDT meetings, and to identify suggestions or requirements to improve the meetings. In total, we received 68 responses from 10 MDTs; six teams (n = 36 members) were located in London and four (n = 32 members) outside. Analysis of the replies by two independent researchers found that MDT meetings aim to optimise management and improve pathways for respiratory patients by improving communication between providers across settings and disciplines. Education of the MDT members also occurs with the aim of safer practice. Discussed patients are characterised by (multiple) co-morbidities, frequent exacerbations and admissions, social and mental health problems, unclear diagnosis and suboptimal responses to interventions. Members reported participating in a COPD MDT as very useful (74%) or useful (20%). Meetings could be improved by ensuring attendance through requirement in job plans, by clear documentation and sharing of derived plans with a wider audience including general practitioners and patients.

  12. Collaborative and Bidirectional Feedback Between Students and Clinical Preceptors: Promoting Effective Communication Skills on Health Care Teams.

    Science.gov (United States)

    Myers, Kara; Chou, Calvin L

    2016-11-01

    Current literature on feedback suggests that clinical preceptors lead feedback conversations that are primarily unidirectional, from preceptor to student. While this approach may promote clinical competency, it does not actively develop students' competency in facilitating feedback discussions and providing feedback across power differentials (ie, from student to preceptor). This latter competency warrants particular attention given its fundamental role in effective health care team communication and its related influence on patient safety. Reframing the feedback process as collaborative and bidirectional, where both preceptors and students provide and receive feedback, maximizes opportunities for role modeling and skills practice in the context of a supportive relationship, thereby enhancing team preparedness. We describe an initiative to introduce these fundamental skills of collaborative, bidirectional feedback in the nurse-midwifery education program at the University of California, San Francisco. © 2016 by the American College of Nurse-Midwives.

  13. [Emotional map in Andalusian primary care teams].

    Science.gov (United States)

    March Cerdá, Joan Carles; Oviedo-Joekes, Eugenia; Romero Vallecillos, Manuel; Prieto Rodríguez, María Angeles; Danet, Alina

    2009-02-01

    To evaluate the dynamics and establish the emotional map of 8 primary care teams. Descriptive, cross-sectional and multi-site study. Primary care centers in Granada, Cádiz and Málaga, Spain. Simple random sampling of 8 health centers and 272 primary care professionals. A self administered questionnaire with 10 Likert-type questions. Answers were classified by items, media and mode. Leadership is not integrated (0.42 points). Relationships between workers show rivalry, burnout and little sensation of being part of a team, but they are united by support and trust. There is a moderate enthusiasm of team objectives (1.36 points). Professional self esteem is generally positive (1.89 points). Emotional climate of the teams recorded medium values. Aspects as regards integrating leadership and increased enthusiasm towards the common work project need to be improved, following the inter-professional collaborative care model.

  14. Developing quality indicators for family support services in community team-based mental health care.

    Science.gov (United States)

    Serene Olin, S; Kutash, Krista; Pollock, Michele; Burns, Barbara J; Kuppinger, Anne; Craig, Nancy; Purdy, Frances; Armusewicz, Kelsey; Wisdom, Jennifer; Hoagwood, Kimberly E

    2014-01-01

    Quality indicators for programs integrating parent-delivered family support services for children's mental health have not been systematically developed. Increasing emphasis on accountability under the Affordable Care Act highlights the importance of quality-benchmarking efforts. Using a modified Delphi approach, quality indicators were developed for both program level and family support specialist level practices. These indicators were pilot tested with 21 community-based mental health programs. Psychometric properties of these indicators are reported; variations in program and family support specialist performance suggest the utility of these indicators as tools to guide policies and practices in organizations that integrate parent-delivered family support service components.

  15. Barriers and facilitators of Canadian quality and safety teams: a mixed-methods study exploring the views of health care leaders

    Directory of Open Access Journals (Sweden)

    White DE

    2016-12-01

    Full Text Available Deborah E White,1 Jill M Norris,1 Karen Jackson,2 Farah Khandwala3 1Faculty of Nursing, University of Calgary, 2Workforce Research and Evaluation, Alberta Health Services, 3Cancer Care Services, Alberta Health Services, Calgary, AB, Canada Background: Health care organizations are utilizing quality and safety (QS teams as a mechanism to optimize care. However, there is a lack of evidence-informed best practices for creating and sustaining successful QS teams. This study aimed to understand what health care leaders viewed as barriers and facilitators to establishing/implementing and measuring the impact of Canadian acute care QS teams.Methods: Organizational senior leaders (SLs and QS team leaders (TLs participated. A mixed-methods sequential explanatory design included surveys (n=249 and interviews (n=89. Chi-squared and Fisher’s exact tests were used to compare categorical variables for region, organization size, and leader position. Interviews were digitally recorded and transcribed for constant comparison analysis.Results: Five qualitative themes overlapped with quantitative data: (1 resources, time, and capacity; (2 data availability and information technology; (3 leadership; (4 organizational plan and culture; and (5 team composition and processes. Leaders from larger organizations more often reported that clear objectives and physician champions facilitated QS teams (p<0.01. Fewer Eastern respondents viewed board/senior leadership as a facilitator (p<0.001, and fewer Ontario respondents viewed geography as a barrier to measurement (p<0.001. TLs and SLs differed on several factors, including time to meet with the team, data availability, leadership, and culture.Conclusion: QS teams need strong, committed leaders who align initiatives to strategic directions of the organization, foster a quality culture, and provide tools teams require for their work. There are excellent opportunities to create synergy across the country to address each

  16. A nurse practitioner patient care team: implications for pediatric oncology.

    Science.gov (United States)

    Golden, Julia Rose

    2014-01-01

    The role of the pediatric advanced practice registered nurse continues to evolve within the ever-changing field of health care. In response to increased demand for health care services and because of a variety of changes in the health care delivery system, nurse practitioner patient care teams are an emerging trend in acute care settings. Care provided by nurse practitioner teams has been shown to be effective, efficient, and comprehensive. In addition to shorter hospital stays and reduced costs, nurse practitioner teams offer increased quality and continuity of care, and improved patient satisfaction. Nurse practitioner patient care teams are well suited to the field of pediatric oncology, as patients would benefit from care provided by specialized clinicians with a holistic focus. This article provides health care professionals with information about the use of nurse practitioner patient care teams and implications for use in pediatric oncology.

  17. Revisiting empowerment: a study of improvement work in health care teams.

    Science.gov (United States)

    Müllern, Tomas; Nordin, Annika

    2012-01-01

    This article reports on a study of team empowerment in a large clinic at a Swedish hospital. The focus of the study was to understand how a high degree of empowerment enabled the teams to develop and sustain a high level of performance. More specifically, a model of empowerment was used to identify important factors that contribute to team empowerment in 3 teams at the clinic. In the analysis of the empirical data, 21 factors were identified and the degree of empowerment in the 3 teams was assessed.

  18. Violence at work and depressive symptoms in primary health care teams: a cross-sectional study in Brazil.

    Science.gov (United States)

    da Silva, Andréa Tenório Correia; Peres, Maria Fernanda Tourinho; Lopes, Claudia de Souza; Schraiber, Lilia Blima; Susser, Ezra; Menezes, Paulo Rossi

    2015-09-01

    Implementation of primary care has long been a priority in low- and middle-income countries. Violence at work may hamper progress in this field. Hence, we examined the associations between violence at work and depressive symptoms/major depression in primary care teams (physicians, nurses, nursing assistants, and community health workers). A cross-sectional study was undertaken in the city of Sao Paulo, Brazil. We assessed a random sample of Family Health Program teams. We investigated depressive symptoms and major depression using the nine-item Patient Health Questionnaire (PHQ-9), and exposure to violence at work in the previous 12 months using a standardized questionnaire. Associations between exposure to violence and depressive symptoms/major depression were analyzed using multinomial logistic regression. Of 3141 eligible workers, 2940 (93 %) completed the interview. Of these, 36.3 % (95 % CI 34.6-38.1) presented intermediate depressive symptoms, and 16 % (95 % CI 14.6-17.2), probable major depression. The frequencies of exposure to the different types of violence at work were: insults (44.9 %), threats (24.8 %), physical aggression (2.3 %), and witnessing violence (29.5 %). These exposures were strongly and progressively associated with depressive symptoms (adjusted odds ratio 1.67 for exposure to one type of violence; and 5.10 for all four types), and probable major depression (adjusted odds ratio 1.84 for one type; and 14.34 for all four types). Primary care workers presenting depressive symptoms and those who have experienced violence at work should be assisted. Policy makers should prioritize strategies to prevent these problems, since they can threaten primary care sustainability.

  19. Long-Term Impact of an Electronic Health Record-Enabled, Team-Based, and Scalable Population Health Strategy Based on the Chronic Care Model

    Science.gov (United States)

    Kawamoto, Kensaku; Anstrom, Kevin J; Anderson, John B; Bosworth, Hayden B; Lobach, David F; McAdam-Marx, Carrie; Ferranti, Jeffrey M; Shang, Howard; Yarnall, Kimberly S H

    2016-01-01

    The Chronic Care Model (CCM) is a promising framework for improving population health, but little is known regarding the long-term impact of scalable, informatics-enabled interventions based on this model. To address this challenge, this study evaluated the long-term impact of implementing a scalable, electronic health record (EHR)- enabled, and CCM-based population health program to replace a labor-intensive legacy program in 18 primary care practices. Interventions included point-of-care decision support, quality reporting, team-based care, patient engagement, and provider education. Among 6,768 patients with diabetes receiving care over 4 years, hemoglobin A1c levels remained stable during the 2-year pre-intervention and post-intervention periods (0.03% and 0% increases, respectively), compared to a 0.42% increase expected based on A1c progression observed in the United Kingdom Prospective Diabetes Study long-term outcomes cohort. The results indicate that an EHR-enabled, team- based, and scalable population health strategy based on the CCM may be effective and efficient for managing population health.

  20. Building the eye care team

    Directory of Open Access Journals (Sweden)

    Thulasiraj Ravilla

    2014-07-01

    Full Text Available Eye care services are people intensive. They require the right people (competence, in the right numbers (capacity, in the right mix (team with the right resources and processes (enabling conditions to ensure effective and sustainable delivery of patient care.

  1. Prevention, early detection and team management of skin cancer in primary care: contribution to The health of the nation objectives.

    Science.gov (United States)

    Jackson, A

    1995-02-01

    The incidence of all skin cancers is increasing. If The health of the nation targets are to be addressed, incidence figures need to be more accurate. Solar damage is the major causal factor in all skin cancers. Certain individual risk factors also play an important part, especially in the development of malignant melanoma. Prevention and early detection are crucial in reducing morbidity and mortality from skin cancer. This paper considers the role of primary care skin screening clinics and cutaneous surgery facilities in the early detection and management of skin cancer. It also illustrates the value of a team approach in primary care in the prevention and early detection of skin cancer and in the more accurate recording of incidence rates.

  2. [The implementation of interdisciplinarity in the work routine of the family health care team].

    Science.gov (United States)

    Scherer, Magda Duarte dos Anjos; de Pires, Denise Elvira Pires; Jean, Rémy

    2013-11-01

    Interdisciplinarity in the work routine of professionals of a Residency Course on Family Health in Southern Brazil was investigated in a qualitative study involving 11 residents and 5 supervisors of seven professions. Through interviews, observations and focal groups the existence of interdisciplinarity in practice was analyzed, duly identifying favorable and unfavorable aspects for its implementation. Interdisciplinarity was expressed as a complex process and concrete action, which occurs in the dramatic implications of its usage, in a dialectical relationship with the political and institutional context. The study revealed that working in family health care renders the work more complex and that the professionals experience difficulties in sharing knowledge and making the transition between multidisciplinarity and interdisciplinarity. The study concludes that interdisciplinarity requires the integrated use of knowledge in the multi-professional practice, the crossing of disciplinary boundaries, the development of competencies to address the challenges of the work environment and personal attitude as a basic component for professional action.

  3. Evaluation of community mental health services: comparison of a primary care mental health team and an extended day hospital service.

    Science.gov (United States)

    Secker, J; Gulliver, P; Peck, E; Robinson, J; Bell, R; Hughes, J

    2001-11-01

    Alongside mental health policies emphasising the need to focus on people experiencing serious, long-term problems, recent general healthcare policy is leading to the development in the UK of a primary care-led National Health Service. While most primary care-led mental health initiatives have focused on supporting general practitioners (GPs) in managing milder depression and anxiety, this article describes an evaluation comparing primary care-based and secondary care-based services for people with serious long-term problems. A survey of service users was carried out at three points in time using three measures: the Camberwell Assessment of Need, the Verona Satisfaction with Services Scales and the Lancashire Quality of Life Profile. Staff views were sought at two time intervals and carers' views were obtained towards the end of the 2-year study period. The results indicate that both services reduced overall needs and the users' need for information. The primary care service also reduced the need for help with psychotic symptoms whereas the secondary care service reduced users' need for help with benefits and occupation. There were no major differences in terms of satisfaction or quality of life. Primary care-based services therefore appear to have the potential to be as effective as more traditional secondary care services. However, a more comprehensive range of services is required to address the whole spectrum of needs, a conclusion supported by the views of staff and carers.

  4. [Association between coverage by oral health teams in the family health and the increase in dental care output in Brazilian municipalities, 1999 and 2011].

    Science.gov (United States)

    Corrêa, Gabriel Trevizan; Celeste, Roger Keller

    2015-12-01

    The aim of this study was to analyze the association between population coverage by oral health teams under the Family Health Strategy (FHS) and the difference in 1999 and 2011 in rates of use of public dental services in Brazilian municipalities. The sample included all 5,507 municipalities in both years. Data were used from government information systems to perform logistic regression for modeling the increase in procedure rates. By 2011, 85% of Brazil's municipalities had oral health teams under the FHS and there had been an increase in infrastructure, human and financial resources. Dental care output increased 49.5% from 1999 to 2011. Municipalities that incorporated more than 3 oral health teams per 10,000 inhabitants showed higher odds of increasing their rates of community procedures (OR = 1.61, 95%CI: 1.23-2.11), prophylactic procedures (OR = 2.05, CI95%: 1.56-2.69), restorations (OR = 2.07, 95%CI: 1.58-2.71), and extractions (OR = 1.53, 95%CI: 1.19-1.97) after adjusting for socio-demographic factors and variations in physical, human and financial resources. The incorporation of oral health teams into the FHS appears more effective for increasing indicators of the use of dental services.

  5. Team Performance and Risk-Adjusted Health Outcomes in the Program of All-Inclusive Care for the Elderly (PACE)

    Science.gov (United States)

    Mukamel, Dana B.; Temkin-Greener, Helena; Delavan, Rachel; Peterson, Derick R.; Gross, Diane; Kunitz, Stephen; Williams, T. Franklin

    2006-01-01

    Purpose: The Program of All-Inclusive Care for the Elderly (PACE) is a community-based program providing primary, acute, and long-term care to frail elderly individuals. A central component of the PACE model is the interdisciplinary care team, which includes both professionals and non-professionals. The purpose of this study was to examine the…

  6. Multiprofessional team approach in palliative care units in Japan.

    Science.gov (United States)

    Maeyama, Etsuko; Kawa, Masako; Miyashita, Mitsunori; Ozawa, Taketoshi; Futami, Noriko; Nakagami, Yuriko; Sugishita, Chieko; Kazuma, Keiko

    2003-08-01

    Health-care providers engaged in palliative care experience difficulty with the practice of team care. However, the details of the difficulties have not been not clarified. To obtain an overview of team care in the Japanese palliative inpatient care setting, a descriptive and cross-sectional study was performed. The participants were physicians, nurses, dietitians, medical social workers (MSWs), and pharmacists. A representative from each discipline was selected. They were asked about their participation in services provided by government-approved palliative care units (PCUs) and the practice of team care. A total of 38 institutions participated in this study. In these institutions, 97% of physicians, 37% of dietitians, 39% of MSWs, 27% of pharmacists, and 13% of physical therapists attended PCU care meetings once a week or more, and 35% of religious workers and 11% of counselors attended. About 70% of institutions held regular care meetings with more than three types of health-care providers. Physicians and nurses had different perceptions regarding the practice of team care. The former had a positive perception of team care and the latter had a negative perception. In addition, nurses' perception of overall team care was related to their perception of care meetings ( P=0.052) and the number of types of professional participating in care meetings ( P=0.054). To promote team care in the Japanese palliative care setting, it is necessary to consider a practical standard of team care, and to conduct effective care meetings.

  7. Team-based efforts to improve quality of care, the fundamental role of ethics, and the responsibility of health managers: monitoring and management strategies to enhance teamwork.

    Science.gov (United States)

    Kossaify, A; Hleihel, W; Lahoud, J-C

    2017-09-27

    Highlight the importance of teamwork in health care institutions by performing a review and discussion of the relevant literature. Review paper. A MEDLINE/Pubmed search was performed starting from 1990, and the terms 'team, teamwork, managers, healthcare, and cooperation' were searched in titles, abstracts, keywords, and conclusions; other terms 'patient safety, ethics, audits and quality of care' were specifically searched in abstracts and were used as additional filters criteria to select relevant articles. Thirty-three papers were found relevant; factors affecting the quality of care in health care institutions are multiple and varied, including issues related to individual profile, to administrative structure and to team-based effort. Issues affecting teamwork include mainly self-awareness, work environment, leadership, ethics, cooperation, communication, and competition. Moreover, quality improvement plans aiming to enhance and expand teams are essential in this context. Team monitoring and management are vital to achieve efficient teamwork with all the required qualities for a safer health system. In all cases, health managers' responsibility plays a fundamental role in creating and sustaining a teamwork atmosphere. Teamwork is known to improve outcomes in medicine, whether at the clinical, organizational, or scientific level. Teamwork in health care institutions must increasingly be encouraged, given that individual effort is often insufficient for optimal clinical outcome. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  8. Challenges to creating primary care teams in a public health centre ...

    African Journals Online (AJOL)

    Effective teamwork between doctors and clinical nurse practitioners (CNP) is essential to the ... A co-operative inquiry group, consisting of two facility managers, ... Results The CHC had established three practice teams, but met with limited success in ... Key lessons learnt included the need to engage with a transformational ...

  9. Goal-based design pattern for delegation of work in health care teams.

    Science.gov (United States)

    Grando, Adela; Peleg, Mor; Glasspool, David

    2010-01-01

    We show how a domain and language independent design pattern, defined as networks of tasks and goals, can be used to formally specify the transfer of responsibility and accountability when tasks are delegated in healthcare teams. The pattern is general enough to be applied unchanged across a broad range of different healthcare situations.

  10. Team structure, team climate and the quality of care in primary care: an observational study.

    Science.gov (United States)

    Bower, P; Campbell, S; Bojke, C; Sibbald, B

    2003-08-01

    To determine whether practice structure (for example, list size, number of staff) predicts team processes and whether practice structure and team process in turn predict team outcomes Observational study using postal questionnaires and medical note audit. Team process was assessed through a measure of "climate" which examines shared perceptions of organisational policies, practices, and procedures. Primary care. Members of the primary health care team from 42 practices. Objective measures of quality of chronic disease management, patients' evaluations of practices, teams' self-reported ratings of effectiveness, and innovation. Team climate was better in singlehanded practices than in partnerships. Practices with longer booking intervals provided superior chronic disease management. Higher team climate scores were associated with superior clinical care in diabetes, more positive patient evaluations of practice and self-reported innovation and effectiveness. Although the conclusions are preliminary because of the limited sample size, the study suggests that there are important relationships between team structure, process, and outcome that may be of relevance to quality improvement initiatives in primary care. Possible causal mechanisms that might underlie these associations remain to be determined.

  11. Community nurses working in piloted primary care teams: Irish Republic.

    Science.gov (United States)

    Burke, Triona; O'Neill, Catherine

    2010-08-01

    Primary care health services in the Irish Republic have undergone fundamental transformation with the establishment of multidisciplinary primary care teams nationwide. Primary care teams provide a community-based health service delivered through a range of health professionals in an integrated way. As part of this initiative ten pilot teams were established in 2003. This research was undertaken in order to gain an understanding of nurse's experiences of working in a piloted primary care team. The methodology used was a focus group approach. The findings from this study illustrated how community nurse's roles and responsibilities have expanded within the team. The findings also highlighted the benefits and challenges of working as a team with various other community-based health-care disciplines.

  12. Community nurses working in piloted primary care teams: Irish Republic.

    LENUS (Irish Health Repository)

    Burke, Triona

    2010-08-01

    Primary care health services in the Irish Republic have undergone fundamental transformation with the establishment of multidisciplinary primary care teams nationwide. Primary care teams provide a community-based health service delivered through a range of health professionals in an integrated way. As part of this initiative ten pilot teams were established in 2003. This research was undertaken in order to gain an understanding of nurse\\'s experiences of working in a piloted primary care team. The methodology used was a focus group approach. The findings from this study illustrated how community nurse\\'s roles and responsibilities have expanded within the team. The findings also highlighted the benefits and challenges of working as a team with various other community-based health-care disciplines.

  13. Innovating team-based outpatient mental health care in the Veterans Health Administration: Staff-perceived benefits and challenges to pilot implementation of the Behavioral Health Interdisciplinary Program (BHIP).

    Science.gov (United States)

    Barry, Catherine N; Abraham, Kristen M; Weaver, Kendra R; Bowersox, Nicholas W

    2016-05-01

    In the past decade, the demand for Veterans Health Administration (VHA) mental health care has increased rapidly. In response to the increased demand, the VHA developed the Behavioral Health Interdisciplinary Program (BHIP) team model as an innovative approach to transform VHA general outpatient mental health delivery. The present formative evaluation gathered information about pilot implementation of BHIP to understand the struggles and successes that staff experienced during facility transitions to the BHIP model. Using a purposive, nonrandom sampling approach, we conducted 1-on-1, semistructured interviews with 37 licensed and nonlicensed clinical providers and 13 clerical support staff assigned to BHIP teams in 21 facilities across the VHA. Interviews revealed that having actively involved facility mental health leaders, obtaining adequate staffing for teams to meet the requirements of the BHIP model, creating clear descriptions and expectations for team member roles within the BHIP framework, and allocating designated time for BHIP team meetings challenged many VHA sites but are crucial for successful BHIP implementation. Despite the challenges, staff reported that the transition to BHIP improved team work and improved patient care. Staff specifically highlighted the potential for the BHIP model to improve staff working relationships and enhance communication, collaboration, morale, and veteran treatment consistency. Future evaluations of the BHIP implementation process and BHIP team functioning focusing on patient outcomes, organizational outcomes, and staff functioning are recommended for fully understanding effects of transitioning to the BHIP model within VHA general mental health clinics and to identify best practices and areas for improvement. (PsycINFO Database Record

  14. A new role for primary care teams in the United States after “Obamacare:” Track and improve health insurance coverage rates

    Science.gov (United States)

    DeVoe, Jennifer; Angier, Heather; Hoopes, Megan; Gold, Rachel

    2017-01-01

    Maintaining continuous health insurance coverage is important. With recent expansions in access to coverage in the United States after “Obamacare,” primary care teams have a new role in helping to track and improve coverage rates and to provide outreach to patients. We describe efforts to longitudinally track health insurance rates using data from the electronic health record (EHR) of a primary care network and to use these data to support practice-based insurance outreach and assistance. Although we highlight a few examples from one network, we believe there is great potential for doing this type of work in a broad range of family medicine and community health clinics that provide continuity of care. By partnering with researchers through practice-based research networks and other similar collaboratives, primary care practices can greatly expand the use of EHR data and EHR-based tools targeting improvements in health insurance and quality health care.

  15. A new role for primary care teams in the United States after “Obamacare:” Track and improve health insurance coverage rates

    Directory of Open Access Journals (Sweden)

    Jennifer DeVoe

    2016-12-01

    Full Text Available Maintaining continuous health insurance coverage is important. With recent expansions in access to coverage in the United States after “Obamacare,” primary care teams have a new role in helping to track and improve coverage rates and to provide outreach to patients. We describe efforts to longitudinally track health insurance rates using data from the electronic health record (EHR of a primary care network and to use these data to support practice-based insurance outreach and assistance. Although we highlight a few examples from one network, we believe there is great potential for doing this type of work in a broad range of family medicine and community health clinics that provide continuity of care. By partnering with researchers through practice-based research networks and other similar collaboratives, primary care practices can greatly expand the use of EHR data and EHR-based tools targeting improvements in health insurance and quality health care.

  16. Utilizing Team Debate to Increase Student Abilities for Mentoring and Critical Appraisal of Global Health Care in Doctor of Nursing Practice Programs.

    Science.gov (United States)

    Elliott, Naomi; Farnum, Karen; Beauchesne, Michelle

    2016-01-01

    Although graduates of doctor of nursing practice (DNP) programs are expected to demonstrate competence in advanced clinical scholarship, mentoring, and leadership, little is published about how team debate on a global health care topic supports DNP student learning and skill development. This article reports on an illuminative evaluation of DNP student learning experiences of team debate in the context of a 2-week international school program in Ireland. A focused illuminative evaluation approach involving a cohort of seven DNP students, who had participated in an international school team debate, was used. Data were collected using a Web-based qualitative questionnaire designed to elicit in-depth reflective accounts of DNP students' learning experiences. Content analysis revealed that team debate on a global health care topic enhanced learning in relation to fostering critical thinking and critical appraisal skills; encouraging teamwork; providing opportunities for mentoring, relationship building, and socialization into profession; and, from the DNP student perspective, increasing knowledge and global understanding of health care. This evaluation provides insights for nurse educators into the benefits of introducing team debate as a group activity to enhancing scholarly inquiry and mentoring skills of DNP students. Further research to evaluate team debate in other nurse education programs is needed. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Adding a dietitian to a Danish Liaison-team after discharge of geriatric patients at nutritional risk may save health care costs

    DEFF Research Database (Denmark)

    Pohju, Anne; Belqaid, Kerstin; Brandt, Christopher Flintenborg

    2016-01-01

    Background: A previous study investigated the value of adding a dietitian to a geriatric discharge Liaison-Team. The scope of this study was to explore the possible economic savings of this. Methods: Patients, 70+ and at nutritional risk, were randomized to receive discharge Liaison-Team either......,416 compared to €1,150 (ONS only) in the CG. For hospitalizations, estimated cost was €92,020 in the IG and €220,025 in the CG. Cost savings added up to €3,048 per patient in the IG. Conclusion: Adding a dietitian to a Danish geriatric discharge Liaison-Team decreased health care costs...

  18. Occupational Health Screenings of Aeromedical Evacuation and Critical Care Air Transport Team Crew Members

    Science.gov (United States)

    2015-08-01

    posture overgarments were associated with increased likelihood for a PDMH condition within these critical care personnel [16]. These studies suggest...should also engage in group-specific outreach efforts that target alcohol and stimulant use (caffeinated beverages), sleep hygiene , occupational

  19. Learning through "huddles" for health care leaders: why do some work teams learn as a result of huddles and others do not?

    Science.gov (United States)

    Little, Johanna

    2014-01-01

    The health care industry embraces the concept that collective learning occurs through group social interactions and has been initiating huddles as an avenue for collaborative learning. During change of shift or prior to beginning daily tasks, a huddle is initiated and facilitated by the manager or frontline supervisor. Given that "shared knowledge is obtained through group-based learning," why are some teams learning and others are not? The phenomenon is perplexing, given that the same resources are provided to all teams. Based on the findings in the literature review on learning in groups, teams learn from huddles and others do not because of the following: communication style and dialogue among the group members, communication style and dialogue facilitated by the leader, team and member perceptions, and team membership. Teams that learn from huddles do so because of the elements within the dialogue between team members (reflexive questioning, redundancy of information, metaphors, analogies, dramatic dialogue, strategic meaning) and because the huddle team exhibits higher levels of collegiality, tenure, heterogeneity, team identification, and collective efficacy. Facilitators must encourage a conversation in order to encourage reframing of cognitive maps that encourage learning by huddle members.

  20. Primary health-care teams as adaptive organizations: exploring and explaining work variation using case studies in rural and urban Scotland.

    Science.gov (United States)

    Farmer, Jane; West, Christina; Whyte, Bruce; Maclean, Margaret

    2005-08-01

    It is acknowledged, internationally, that health-care practitioners' work differs between and urban areas. While several factors affect individual teams' activities, there is little understanding about how patterns of work evolve. Consideration of work in relation to local circumstances is important for training, devising contracts and redesigning services. Six case studies centred on Scottish rural and urban general practices were used to examine, in-depth, the activity of primary health-care teams. Quantitative workload data about patient contacts were collected over 24 months. Interviews and diaries revealed insightful qualitative data. Findings revealed that rural general practitioners and district nurses tended to conduct more consultations per practice patient compared with their urban counterparts. Conditions seen and work tasks varied between case study teams. Qualitative data suggested that the key reasons for variation were: local needs and circumstances; choices made about deployment of available time, team composition and the extent of access to other services. Primary care teams might be viewed as adaptive organization, with co-evolution of services produced by health professionals and local people. The study highlights limitations in the application of workload data and suggests that understanding the nature of work in relation to local circumstances is important in service redesign.

  1. [Work processes in Family Health Strategy team].

    Science.gov (United States)

    Pavoni, Daniela Soccoloski; Medeiros, Cássia Regina Gotler

    2009-01-01

    The Family Health Strategy requires a redefinition of the health care model, characterized by interdisciplinary team work. This study is aimed at knowiong the work processes in a Family Health Team. The research was qualitative, and 10 team members were interviewed. Results demonstrated that the nurse performs a variety of functions that could be shared with other people; this overloads him/her and makes inherent job task execution difficult. Task planning and performing are usually done in teams, but some professionals get more involved in these activities. It was concluded that there is a need for the team to reflect upon work process as well as reassess task assignment, so that each individual is able to perform the work and contribute for an integrated work.

  2. Improving recovery time following heart transplantation: the role of the multidisciplinary health care team

    OpenAIRE

    Roussel MG; Gorham N; Wilson L; Mangi AA

    2013-01-01

    Maureen G Roussel,1 Noreen Gorham,2 Lynn Wilson,2 Abeel A Mangi2 1Heart and Vascular Center, Yale-New Haven Hospital, New Haven, CT, USA; 2Center for Advanced Heart Failure, Mechanical Circulatory Support and Cardiac Transplantation, Yale New Haven Heart and Vascular Institute, Yale-New Haven Hospital, New Haven, CT, USA Background: The care of cardiac transplant patients is complex requiring a finely orchestrated endeavor to save a patient’s life. Given the chronic and complex nat...

  3. Integrated Care and the Evolution of the Multidisciplinary Team.

    Science.gov (United States)

    Dobbins, Mary Iftner; Thomas, Sheila A; Melton, Stacy L Stokes; Lee, Stacy

    2016-06-01

    The primary care medical home continues to adapt by applying new research to population health approaches to care. With the discovery that life experiences trigger a chain of biologic events linked to chronic illnesses, the role of patient-centered multidisciplinary care teams becomes of paramount importance. Subsequently, mental health professionals are being incorporated into the primary care setting, using their skills in nontraditional models to customize care for each patient. This "integration" of primary care and unique mental health services engenders opportunity for enhanced clinical care, professional workforce development and support, more effective population health initiatives, and informed health care policy.

  4. Increasing patient safety with neonates via handoff communication during delivery: a call for interprofessional health care team training across GME and CME.

    Science.gov (United States)

    Vanderbilt, Allison A; Pappada, Scott M; Stein, Howard; Harper, David; Papadimos, Thomas J

    2017-01-01

    Hospitals have struggled for years regarding the handoff process of communicating patient information from one health care professional to another. Ineffective handoff communication is recognized as a serious patient safety risk within the health care community. It is essential to take communication into consideration when examining the safety of neonates who require immediate medical attention after birth; effective communication is vital for positive patient outcomes, especially with neonates in a delivery room setting. Teamwork and effective communication across the health care continuum are essential for providing efficient, quality care that leads to favorable patient outcomes. Interprofessional simulation and team training can benefit health care professionals by improving interprofessional competence, defined as one's knowledge of other professionals including an understanding of their training and skillsets, and role clarity. Interprofessional teams that include members with specialization in obstetrics, gynecology, and neonatology have the potential to considerably benefit from training effective handoff and communication practices that would ensure the safety of the neonate upon birth. We must strive to provide the most comprehensive systematic, standardized, interprofessional handoff communication training sessions for such teams, through Graduate Medical Education and Continuing Medical Education that will meet the needs across the educational continuum.

  5. The multidisciplinary health care team in the management of stenosis in Crohn's disease

    OpenAIRE

    Gasparetto M; Angriman I; Guariso G

    2015-01-01

    Marco Gasparetto,1 Imerio Angriman,2 Graziella Guariso1 1Department of Women and Children's Health, Paediatric Gastroenterology Unit, Padua University Hospital, Padova, Italy; 2Department of Surgery, Gastroenterology and Oncology, Padua University, Padova, Italy Background: Stricture formation is a common complication of Crohn's disease (CD), occurring in approximately one-third of all patients with this condition. Our aim was to summarize the available epidemiology data on s...

  6. Increasing patient safety with neonates via handoff communication during delivery: a call for interprofessional health care team training across GME and CME

    Directory of Open Access Journals (Sweden)

    Vanderbilt AA

    2017-06-01

    Full Text Available Allison A Vanderbilt,1 Scott M Pappada,2 Howard Stein,3 David Harper,4 Thomas J Papadimos5 1Department of Family Medicine, 2Department of Anesthesiology, College of Medicine and Life Sciences, University of Toledo, 3Department of Pediatrics, ProMedica Toledo Children’s Hospital, 4Department of Obstetrics and Gynecology, ProMedica Toledo Hospital, 5Department of Anesthesiology, College of Medicine and the Life Sciences, University of Toledo, Toledo, OH, USA Abstract: Hospitals have struggled for years regarding the handoff process of communicating patient information from one health care professional to another. Ineffective handoff communication is recognized as a serious patient safety risk within the health care community. It is essential to take communication into consideration when examining the safety of neonates who require immediate medical attention after birth; effective communication is vital for positive patient outcomes, especially with neonates in a delivery room setting. Teamwork and effective communication across the health care continuum are essential for providing efficient, quality care that leads to favorable patient outcomes. Interprofessional simulation and team training can benefit health care professionals by improving interprofessional competence, defined as one’s knowledge of other professionals including an understanding of their training and skillsets, and role clarity. Interprofessional teams that include members with specialization in obstetrics, gynecology, and neonatology have the potential to considerably benefit from training effective handoff and communication practices that would ensure the safety of the neonate upon birth. We must strive to provide the most comprehensive systematic, standardized, interprofessional handoff communication training sessions for such teams, through Graduate Medical Education and Continuing Medical Education that will meet the needs across the educational continuum. Keywords

  7. Interprofessional Workplace Learning in Primary Care: Students from Different Health Professions Work in Teams in Real-Life Settings

    Science.gov (United States)

    Bondevik, Gunnar Tschudi; Holst, Lone; Haugland, Mildrid; Baerheim, Anders; Raaheim, Arild

    2015-01-01

    Interprofessional education may be defined as an occasion when two or more professions learn with, from, and about each other in order to improve collaboration and quality of care. We studied the self-reported experiences from Norwegian health care students participating in interprofessional workplace learning in primary care. We discuss the…

  8. Team-based primary care: The medical assistant perspective.

    Science.gov (United States)

    Sheridan, Bethany; Chien, Alyna T; Peters, Antoinette S; Rosenthal, Meredith B; Brooks, Joanna Veazey; Singer, Sara J

    2016-11-15

    Team-based care has the potential to improve primary care quality and efficiency. In this model, medical assistants (MAs) take a more central role in patient care and population health management. MAs' traditionally low status may give them a unique view on changing organizational dynamics and teamwork. However, little empirical work exists on how team-based organizational designs affect the experiences of low-status health care workers like MAs. The aim of this study was to describe how team-based primary care affects the experiences of MAs. A secondary aim was to explore variation in these experiences. In late 2014, the authors interviewed 30 MAs from nine primary care practices transitioning to team-based care. Interviews addressed job responsibilities, teamwork, implementation, job satisfaction, and learning. Data were analyzed using a thematic networks approach. Interviews also included closed-ended questions about workload and job satisfaction. Most MAs reported both a higher workload (73%) and a greater job satisfaction (86%) under team-based primary care. Interview data surfaced four mechanisms for these results, which suggested more fulfilling work and greater respect for the MA role: (a) relationships with colleagues, (b) involvement with patients, (c) sense of control, and (d) sense of efficacy. Facilitators and barriers to these positive changes also emerged. Team-based care can provide low-status health care workers with more fulfilling work and strengthen relationships across status lines. The extent of this positive impact may depend on supporting factors at the organization, team, and individual worker levels. To maximize the benefits of team-based care, primary care leaders should recognize the larger role that MAs play under this model and support them as increasingly valuable team members. Contingent on organizational conditions, practices may find MAs who are willing to manage the increased workload that often accompanies team-based care.

  9. Interprofessional Workplace Learning in Primary Care: Students from Different Health Professions Work in Teams in Real-Life Settings

    OpenAIRE

    Bondevik, Gunnar Tschudi; Holst, Lone; Haugland, Mildrid; Baerheim, Anders; Raaheim, Arild

    2015-01-01

    Interprofessional education may be defined as an occasion when two or more professions learn with, from, and about each other in order to improve collaboration and quality of care. We studied the self-reported experiences from Norwegian health care students participating in interprofessional workplace learning in primary care. We discuss the results particularly in light of self-determination theory. During 2012, 24 students from eight different health educations at the University of Bergen a...

  10. The social worker. A member of the primary care team?

    Science.gov (United States)

    Falloon, D

    1998-12-01

    The primary health care team at present does not include social workers as routine members. If however, we, accept the World Health Organization definition of health, which includes social well being, then it follows that the social worker should be considered as a member of the health team to attend to this aspect of health in the service delivery mix. This paper presents the experience of a social worker assigned to the August Town/Hermitage Type III health centre during the period March 1995 to February 1996 and her contribution to patient welfare. The expected roles of the social worker and his or her contribution to the health team are outlined.

  11. Aligning Provider Team Members With Polyvalent Community Health Workers.

    Science.gov (United States)

    Brooks, Beth A; Davis, Sheila; Kulbok, Pamela; Frank-Lightfoot, Loraine; Sgarlata, Lisa; Poree, Shawanda

    2015-01-01

    In light of the fragmentation of health care services and the need for health promotion and disease prevention, it is time to consider the important role community health workers (CHWs) could play as part of the health care team. Globally, CHWs tend to focus on a single patient condition, resulting in fragmented, uncoordinated health care services. Polyvalent (or multimodal) CHWs can provide a comprehensive, patient-centric range of care coordination services with other members of the health care team, ultimately improving patient outcomes and decreasing the cost of care. The potential benefits of the polyvalent CHW to the health care team are not widely understood in the United States. To fill this knowledge gap, a toolkit for nurse leaders in mainstream health care settings was created. The toolkit outlines the key elements essential to a successful CHW program and offers strategies for navigating the various challenges involved when integrating this new role into existing models of care.

  12. Collaborative transdisciplinary team approach for dementia care.

    Science.gov (United States)

    Galvin, James E; Valois, Licet; Zweig, Yael

    2014-01-01

    Alzheimer's disease (AD) has high economic impact and places significant burden on patients, caregivers, providers and healthcare delivery systems, fostering the need for an evaluation of alternative approaches to healthcare delivery for dementia. Collaborative care models are team-based, multicomponent interventions that provide a pragmatic strategy to deliver integrated healthcare to patients and families across a wide range of populations and clinical settings. Healthcare reform and national plans for AD goals to integrate quality care, health promotion and preventive services, and reduce the impact of disease on patients and families reinforcing the need for a system-level evaluation of how to best meet the needs of patients and families. We review collaborative care models for AD and offer evidence for improved patient- and family-centered outcomes, quality indicators of care and potential cost savings.

  13. ORGANIZATION AND PROCEDURES GUIDE FOR PERFORMING MAJOR AMBULATORY AND SHORT-STAY SURGERY IN COORDINATION WITH THE PRIMARY HEALTH CARE TEAM

    Directory of Open Access Journals (Sweden)

    Javier Cruz Rodríguez

    2015-11-01

    Full Text Available Currently, there are constraints on coordination between the primary and secondary levels of care, and we lack a regulatory document for surgical activity in major ambulatory and short-stay surgery, which affects the quality of this modality of care. Such reasons led to the design of the “Organization and Procedures Guide for Performing Major Ambulatory and Short-stay Surgery in Coordination with the Primary Health Care Team". The guide was assessed by 90 experts with experience in the primary and secondary levels of care, who endorsed the quality and relevance of the proposal. It contains recommendations to help primary and secondary care professionals involved in surgical care to select the most appropriate approach to conditions treated by means of ambulatory or short-stay surgery. The recommendations are based on the latest available scientific evidence supporting the use of ambulatory surgery, short-stay surgery and home hospitalization.

  14. Horizontal equity and mental health care: a study of priority ratings by clinicians and teams at outpatient clinics

    Directory of Open Access Journals (Sweden)

    Holman Per

    2012-06-01

    Full Text Available Abstract Background In Norway, admission teams at Community Mental Health Centres (CMHCs assess referrals from General Practitioners (GPs, and classify the referrals into priority groups according to treatment needs, as defined in the Act of Patient Rights. In this study, we analyzed classification of similar referrals to determine the reliability of classification into priority groups (i.e., horizontal equity. Methods Twenty anonymous case vignettes based on representative referrals were classified by 42 admission team members at 16 CMHCs in the South-East Health Region of Norway. All clinicians were experienced, and were responsible for priority setting at their centres. The classifications were first performed independently by the 42 clinicians (i.e., individual rating, and then evaluated utilizing team consensus within each CMHC (i.e., team rating. Interrater reliability was estimated using intraclass correlation coefficients (ICCs while the reliability of rating across raters and units (generalizability were estimated using generalizability analysis. Results The ICCs (2.1 single measure, absolute agreement varied between 0.40 and 0.51 using individual ratings and between 0.39 and 0.58 using team ratings. Our findings suggest a fair (low degree of interrater reliability, and no improvement of team ratings was observed when compared to individual ratings. The generalizability analysis, for one rater within each unit, yields a generalizability coefficient of 0.50 and a dependability coefficient of 0.53 (D study. These findings confirm that the reliability of ratings across raters and across units is low. Finally, the degree of inconsistency, for an average measurement, appears to be higher within units than between units (G study. Conclusion The low interrater reliability and generalizability found in our study suggests that horizontal equity to mental health services is not ensured with respect to priority. Priority -setting in teams provides

  15. [Interprofessional teamwork in health care].

    Science.gov (United States)

    Antoni, Conny H

    2010-01-01

    Providing health care requires the integrative co-operation of physicians, nurses and other professionals in the health care sector. The success of such interprofessional teamwork does not only rely on the team members' task knowledge, but also on their teamwork-related knowledge, their skills and attitudes. In this paper a theoretical framework for team effectiveness is developed and used to identify factors improving team success. Within this context interprofessional team composition is perceived as a characteristic of team diversity, which needs to be perceived as a chance for better patient care in order to be used effectively.

  16. The value of community mental health nurses based in primary care teams: 'switching the light on in a cellar'.

    Science.gov (United States)

    Crawford, P; Carr, J; Knight, A; Chambers, K; Nolan, P

    2001-06-01

    This paper explores the impact of placing Community Mental Health Nurses (CMHNs) at two primary care practices in South Staffordshire. Data were collected by means of a questionnaire which was sent to primary care personnel at these practices, to ascertain their opinions with respect to the contribution of practice-based CMHNs. Overall, primary care personnel were satisfied with the quality of the service received from the CMHNs, especially in terms of improved communication. They felt that the new arrangements enabled a quicker and more efficient access to the services of the CMHN. The results are discussed in terms of the value of having CMHNs within the primary care setting, and in terms of service planning and future recommendations for mental health services within primary care.

  17. [Burnout and teamwork in primary care teams].

    Science.gov (United States)

    Vilà Falgueras, Maite; Cruzate Muñoz, Carlota; Orfila Pernas, Francesc; Creixell Sureda, Joan; González López, María Pilar; Davins Miralles, Josep

    2015-01-01

    To estimate the prevalence of burnout and the perception of teamwork in Primary Care teams from Barcelona. Multicenter cross-sectional. Primary Health Care Teams from Barcelona. Institut Català de la Salut. All permanent employees or temporary professionals of all categories from 51 teams (N=2398). A total of 879 responses (36.7%) were obtained. The Maslach Burnout Inventory questionnaire, with 3 dimensions, was sent by emotional exhaustion (AE), depersonalization (DP), and personal accomplishment (RP). Burnout is considered present when two or more dimensions scored high marks. Perception of teamwork and evaluation of leaders was evaluated using an ad hoc questionnaire. The prevalence of burnout was17.2% (two or more dimensions affected), and 46.2% had at least one of the three dimensions with a high level. A high level of AE was found in 38.2%, of DP in 23.8%, and 7.7% had low RP. Almost half (49.2%) believe that teamwork is encouraged in their workplace. Social workers overall, have a higher average of dimensions affected at a high level, followed by administrative personnel, dentists, doctors and nurses (pteamwork had more emotional exhaustion, depersonalization and higher level of burnout in general (pTeamwork and appreciating their leaders protect from burnout. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

  18. 42 CFR 456.604 - Physician team member inspecting care of recipients.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Physician team member inspecting care of recipients... Intermediate Care Facilities and Institutions for Mental Diseases § 456.604 Physician team member inspecting care of recipients. No physician member of a team may inspect the care of a recipient for whom he...

  19. Palliative care in the community: setting practice guidelines for primary care teams.

    Science.gov (United States)

    Robinson, L; Stacy, R

    1994-01-01

    BACKGROUND. Previous studies have demonstrated deficiencies in palliative care in the community. One method of translating the results of research into clinical practice, in order to produce more effective health care, is the development of clinical guidelines. Setting standards for such care has been performed by care teams in both hospital and hospice settings but not in primary care. AIM. This study set out to develop guidelines for primary care teams to follow in the provision of palliative care in the community using facilitated case discussions with the members of such teams, as a form of internal audit. METHOD. Five practices were randomly chosen from the family health services authority medical list. Meetings between the facilitators and primary care teams were held over a period of one year. The teams were asked to describe good aspects of care, areas of concern and suggestions to improve these, in recent cases of patient deaths. RESULTS. In total 56 cases were discussed. All practices felt that cohesive teamwork, coordinated management, early involvement of nursing staff and the identification of a key worker were essential for good terminal care. Concerns arose in clinical and administrative areas but the majority were linked to poor communication, either between patient and professionals within the primary care team or between primary and secondary care. All the positive aspects of care, concerns and suggestions were collated by the facilitators into guidelines for teams to refer to from the initial diagnosis of a terminal illness through to the patient's death and care of the relatives afterwards. CONCLUSION. Developing multidisciplinary as opposed to medical guidelines for palliative care allows primary health care teams to create standards that are acceptable to them and stimulates individuals within the teams to accept responsibility for initiating the change necessary for more effective care. The process of facilitating teams to discuss their work

  20. Physician assistants in English primary care teams: a survey.

    Science.gov (United States)

    Drennan, Vari M; Chattopadhyay, Kaushik; Halter, Mary; Brearley, Sally; de Lusignan, Simon; Gabe, Jonathon; Gage, Heather

    2012-09-01

    Ensuring that health care teams have a mix of skilled professionals to meet patient need, safely and effectively, is a priority in all health services. The United Kingdom, like a number of other countries, have been exploring the contribution physician assistants, who are well established in the United States of America, can make to health care teams including primary care. This study investigated the employment of physician assistants in English primary care and their contribution through an electronic, self report, survey. Sixteen physician assistants responded, who were working in a variety of types of general practice teams. A range of activities were reported but the greatest proportion of their time was described as seeing patients in booked surgery appointments for same day/urgent appointments. The scope of the survey was limited and questions remain as to patient and professional responses to a new professional group within English primary care.

  1. Profile of patients undergoing treatment for tuberculosis in a health unit with a Family Health Care Team

    Directory of Open Access Journals (Sweden)

    Cássia Kirsch Lanes

    2011-04-01

    Full Text Available Introduction: Brasil is 14th amongst the 20 countries with 80% of tuberculosis cases (TB in the world, with annual incidence of 46 new cases/100,000 inhabitants. The Health Unit of Divina Providencia Hospital, of SSC/ GHC, is a reference for TB treatment in an area of about 6,000 inhabitants. It’s expected about 6 new cases a year in the population covered by the hospital, considered a historic series and incidence in Porto Alegre, which currently is of 100/100,000. Objective: To describe the profile of TB carriers from USDP, with data on incidence, type of TB, serology for HIV, age, sex and start of treatment. Methods: Review of the registered cases in the USDP archives and review of the patient charts. Results: Between February 2007 and February 2008, 14 new cases of TB were registered in USDP. The ages were among 13 to 67 years, 8 men and 6 women. The average age of men was 38.6 years old and of women was 35.6 years old. Five were HIV positive and one person refused to do the HIV exam. Ten cases were exclusively of pulmonary TB and four cases of extra-pulmonary TB. The 14 cases were treated with E1 (RHZ. Out of the patients treated, 6 were discharged by cure (42%, 1 from abandonment (7% and 1 death (7%, and 6 were still undergoing treatment by the end of the data collection (46.6%. Conclusion: the high incidence of TB, more than double than expected, in the USDP territory, indicates that these ratios need to be reviewed and compared to other Health Units that act in the same manner. The gathering of new cases through the search of respiratory symptomatics, as well as the vigilance of cases in treatment, is allowing for good detection and cure ratios, with good assent to treatment.

  2. The palliative care interdisciplinary team: where is the community pharmacist?

    Science.gov (United States)

    O'Connor, Moira; Pugh, Judith; Jiwa, Moyez; Hughes, Jeff; Fisher, Colleen

    2011-01-01

    Palliative care emphasizes an interdisciplinary approach to care to improve quality of life and relieve symptoms. Palliative care is provided in many ways; in hospices, hospital units, and the community. However, the greatest proportion of palliative care is in the community. In hospice and palliative care units in hospitals, clinical pharmacists are part of the interdisciplinary team and work closely with other health care professionals. Their expertise in the therapeutic use of medications is highly regarded, particularly as many palliative care patients have complex medication regimens, involving off-label or off-license prescribing that increases their risk for drug-related problems. However, this active involvement in the palliative care team is not reflected in the community setting, despite the community pharmacist being one of the most accessible professionals in the community, and visiting a community pharmacist is convenient for most people, even those who have limited access to private or public transport. This may be due to a general lack of understanding of skills and knowledge that particular health professionals bring to the interdisciplinary team, a lack of rigorous research supporting the necessity for the community pharmacist's involvement in the team, or it could be due to professional tensions. If these barriers can be overcome, community pharmacists are well positioned to become active members of the community palliative care interdisciplinary team and respond to the palliative care needs of patients with whom they often have a primary relationship.

  3. Working with a palliative care team.

    Science.gov (United States)

    Wiebe, Lauren A; Von Roenn, Jamie H

    2010-01-01

    The interdisciplinary team is fundamental to the successful delivery of quality palliative care. Ideally, the oncologist is an integral part of either the palliative care or hospice team and serves to maintain continuity of care through the end of life. In the United States, barriers can complicate the oncologist's easy integration into the hospice team as patients often remain at home. Also, there may be philosophical or clinical practice differences between oncology and palliative care at first glance. This article focuses on ways to overcome these potential obstacles and use differences in training to strengthen the team's impact. A significant part of oncology practice includes managing difficult symptoms, mitigating suffering, and discussing priorities of care--all elements of palliative medicine that oncologists perform daily. Participating on a palliative care team may be natural for oncologists, and some might elect to provide integrated palliative cancer care for patients throughout the course of their disease and at the end of life. Thus, there is a need to enrich the general oncologist's knowledge of specialized palliative medicine, as recommended by the major cancer organizations, including the American Society of Clinical Oncology and the European Society of Medical Oncology.It is important to know when to incorporate a palliative or hospice care team into the routine management of a cancer patient and what benefits these referrals can provide. Oncologists have an obligation to provide high-quality palliative care to all patients in an integrated fashion, including patients with advanced cancer enrolled in clinical trials for early therapeutics.

  4. Team-building through sailing: effects on health status, job satisfaction and work performance of health care professionals involved in organ and tissue donation.

    Science.gov (United States)

    Ponzin, Diego; Fasolo, Adriano; Vidale, Enrico; Pozzi, Annalaura; Bottignolo, Elisa; Calabrò, Francesco; Rupolo, Giampietro

    2015-01-01

    The aim of this study was to evaluate the effects of a team-building learning project on job satisfaction, psychological wellbeing, and performance of health care workers involved in the process of organ and tissue donation. The project was conducted between June and September 2011 and consisted of two one-day meetings and a one week sailing, involving 20 staff members. GHQ-12, MBI-HSS, and 25 items taken from the Multidimensional Organizational Health Questionnaire (MOHQ) were used to assess health status, burnout, and job satisfaction. Results of the descriptive analyses were expressed as mean ± SD and as counts and percentages; Chi-square test was used to evaluate statistical significance of differences before and after the initiative. 6 (30,0%) participants showed the likelihood to suffering from anxiety and depression (i.e. recognized as 'cases' by the GHQ-12), 3 (15.0%) of them at baseline and 3 (15.0%), different from the previous ones, in the post-intervention. The presence of stress was revealed in 9 (45.0%) and 12 subjects (60.0%) before and after the experience, respectively (6 subjects showed the presence of stress in both circumstances). We documented 4 burnout cases, 3 (15.0%) at baseline and 1 (5.0%) after the experience. Nevertheless, about 80% of the participants showed a high degree ofjob satisfaction, in terms of positive influence of job in the professional satisfaction and of clear satisfaction for the organization, during both evaluation. In respect to 2010, the number of organ donors and that of ocular tissue donors improved of about 16% and 10%, respectively, during the year of the project and in the following year (mean value). We recognize that our team-building project for personnel involved in the stressful and demanding setting of organ and tissue donation, worthwhile and recompensing at the same time, possibly influenced the personal commitment and the quality of job provided. The high level of stress showed by participants should be

  5. Training the eye care team: Principles and practice

    Directory of Open Access Journals (Sweden)

    Prashant Garg

    2014-01-01

    Full Text Available One of the crucial factors to make high quality eye care services available, accessible and affordable to all is the availability of appropriately trained human resources. Providing health through a health care team is a better and cost effective alternative. The concept of the team approach is based on the principles of working together; task shifting; and ensuring continuity of care. Composition of a team varies based on the community needs, population characteristics and disease burden. But for it to be effective, a team must possess four attributes - availability, competency, productivity, and responsiveness. Therefore, training of all team members and training the team to work together as a unit are crucial components in the success of this concept. Some of the critical attributes include: Training across the health spectrum through quality and responsive curricula administered by motivated teachers; accreditation of programs or institutions by national or international bodies; certification and recertification of team members; and training in working together as a team through inter- and intra- disciplinary workshops both during training and as a part of the job activity.

  6. Training the eye care team: principles and practice.

    Science.gov (United States)

    Garg, Prashant; Reddy, Snigdha; Nelluri, Chaitanya

    2014-01-01

    One of the crucial factors to make high quality eye care services available, accessible and affordable to all is the availability of appropriately trained human resources. Providing health through a health care team is a better and cost effective alternative. The concept of the team approach is based on the principles of working together; task shifting; and ensuring continuity of care. Composition of a team varies based on the community needs, population characteristics and disease burden. But for it to be effective, a team must possess four attributes - availability, competency, productivity, and responsiveness. Therefore, training of all team members and training the team to work together as a unit are crucial components in the success of this concept. Some of the critical attributes include: Training across the health spectrum through quality and responsive curricula administered by motivated teachers; accreditation of programs or institutions by national or international bodies; certification and recertification of team members; and training in working together as a team through inter- and intra- disciplinary workshops both during training and as a part of the job activity.

  7. Developing leadership in rural interprofessional palliative care teams.

    Science.gov (United States)

    Hall, Pippa; Weaver, Lynda; Handfield-Jones, Richard; Bouvette, Maryse

    2008-01-01

    This project brought together community-based practitioners and academics to develop and deliver interventions designed to enhance the leadership abilities of the designated leaders of seven rural/small town-based palliative care teams. Members of these community-based teams have already gained recognition for their teams' leadership and service delivery in their communities. All of the teams had worked closely with most members of the academic team prior to this project. The team members participated in a needs assessment exercise developed by the Sisters of Charity of Ottawa Health Service and University of Ottawa academic team. Results of the needs assessment identified leadership qualities that had contributed to their success, as well as their needs to further enhance their individual leadership qualities. The team effort, however, was the most important factor contributing to the success of their work. The interventions developed to address the identified needs had to be adapted creatively through the collaborative efforts of both the community and academic teams. The educational interventions facilitated the integration of learning at the individual and community level into the busy work schedules of primary health care providers.

  8. Improved clinical and laboratory skills after team-based, malaria case management training of health care professionals in Uganda

    Directory of Open Access Journals (Sweden)

    Namagembe Allen

    2012-02-01

    Full Text Available Abstract Background Deployment of highly effective artemisinin-based combination therapy for treating uncomplicated malaria calls for better targeting of malaria treatment to improve case management and minimize drug pressure for selecting resistant parasites. The Integrated Management of Malaria curriculum was developed to train multi-disciplinary teams of clinical, laboratory and health information assistants. Methods Evaluation of training was conducted in nine health facilities that were Uganda Malaria Surveillance Programme (UMSP sites. From December 2006 to June 2007, 194 health professionals attended a six-day course. One-hundred and one of 118 (86% clinicians were observed during patient encounters by expert clinicians at baseline and during three follow-up visits approximately six weeks, 12 weeks and one year after the course. Experts used a standardized tool for children less than five years of age and similar tool for patients five or more years of age. Seventeen of 30 laboratory professionals (57% were assessed for preparation of malaria blood smears and ability to interpret smear results of 30 quality control slides. Results Percentage of patients at baseline and first follow-up, respectively, with proper history-taking was 21% and 43%, thorough physical examination 18% and 56%, correct diagnosis 51% and 98%, treatment in compliance with national policy 42% and 86%, and appropriate patient education 17% and 83%. In estimates that adjusted for individual effects and a matched sample, relative risks were 1.86 (95% CI: 1.20,2.88 for history-taking, 2.66 (95%CI: 1.60,4.41 for physical examination, 1.77 (95%CI: 1.41,2.23 for diagnosis, 1.96 (95%CI: 1.46,2.63 for treatment, and 4.47 (95%CI: 2.68,7.46 for patient education. Results were similar for subsequent follow-up and in sub-samples stratified by patient age. Quality of malaria blood smear preparation improved from 21.6% at baseline to 67.3% at first follow-up (p p p p Conclusion A

  9. Delivering evidence-based smoking cessation treatment in primary care practice: experience of Ontario family health teams.

    Science.gov (United States)

    Papadakis, Sophia; Gharib, Marie; Hambleton, Josh; Reid, Robert D; Assi, Roxane; Pipe, Andrew L

    2014-07-01

    To report on the delivery of evidence-based smoking cessation treatments (EBSCTs) within a sample of 40 Ontario family health teams (FHTs). In each FHT, consecutive patients were screened for smoking status and eligible patients completed a questionnaire immediately following their clinic visits (index visits). Multilevel analysis was used to examine FHT-level, provider-level, and patient-level predictors of EBSCT delivery. Forty FHTs in Ontario. Across the 40 participating FHTs, 24,033 patients were screened and 2501 eligible patients contributed data. Provider performance in the delivery of EBSCTs during the preceding 12 months and during the index visits was assessed. The rate of provider delivery of EBSCT for the previous 12 months was 74.0% for the advise strategy. At the index visit, rates of EBSCT strategy delivery were 56.8% for ask; 46.9% for advise; 38.7% for assist; 11.6% for prescribing pharmacotherapy; and 11.3% for arrange follow-up. Significant intra-FHT and intraprovider variability in the rates of EBSCT delivery was identified. Family health teams with a physician champion (odds ratio [OR] 2.0; 95% CI 1.1 to 3.6; P < .01) and providers who highly ranked the importance of smoking cessation (OR 1.7; 95% CI 1.1 to 2.7; P < .01) were more likely to deliver EBSCTs. Patient readiness to quit (OR 1.6; 95% CI 1.3 to 1.9; P < .001), presence of smoking-related illness (OR 1.6; 95% CI 1.2 to 2.1; P < .01), and presenting for an annual health examination (OR 2.0; 95% CI 1.6 to 2.5; P < .001) were associated with the delivery of EBSCTs. Rates of smoking cessation advice were higher than previously reported for Canadian physicians; however, rates of assistance with quitting were lower. Future quality improvement initiatives should specifically target increasing the rates of screening and advising among low-performing FHTs and providers within FHTs, with a particular emphasis on doing so at all clinic appointments; and improving the rate at which assistance with

  10. Primary care team communication networks, team climate, quality of care, and medical costs for patients with diabetes: A cross-sectional study

    Science.gov (United States)

    Mundt, Marlon P.; Agneessens, Filip; Tuan, Wen-Jan; Zakletskaia, Larissa I.; Kamnetz, Sandra A.; Gilchrist, Valerie J.

    2016-01-01

    Background Primary care teams play an important role in providing the best quality of care to patients with diabetes. Little evidence is available on how team communication networks and team climate contribute to high quality diabetes care. Objective To determine whether primary care team communication and team climate are associated with health outcomes, health care utilization, and associated costs for patients with diabetes. Methods A cross-sectional survey of primary care team members collected information on frequency of communication with other care team members about patient care and on team climate. Patient outcomes (glycemic, cholesterol, and blood pressure control, urgent care visits, emergency department visits, hospital visit days, medical costs) in the past 12 months for team diabetes patient panels were extracted from the electronic health record. The data were analyzed using nested (clinic/team/patient) generalized linear mixed modeling. Participants 155 health professionals at 6 U.S. primary care clinics participated from May through December 2013. Results Primary care teams with a greater number of daily face-to-face communication ties among team members were associated with 52% (Rate Ratio=0.48, 95% CI: 0.22, 0.94) fewer hospital days and US$1220 (95% CI: -US$2416, -US$24) lower health-care costs per team diabetes patient in the past 12 months. In contrast, for each additional registered nurse (RN) who reported frequent daily face-to-face communication about patient care with the primary care practitioner (PCP), team diabetes patients had less-controlled HbA1c (Odds Ratio=0.83, 95% CI: 0.66, 0.99), increased hospital days (RR=1.57, 95% CI: 1.10, 2.03), and higher healthcare costs (β=US$877, 95% CI: US$42, US$1713). Shared team vision, a measure of team climate, significantly mediated the relationship between team communication and patient outcomes. Conclusions Primary care teams which relied on frequent daily face-to-face communication among more

  11. Conflict of roles: a conflict of ideas? The unsettled relations between care team staff and independent mental health advocates.

    Science.gov (United States)

    McKeown, Mick; Ridley, Julie; Newbigging, Karen; Machin, Karen; Poursanidou, Konstantina; Cruse, Kaaren

    2014-10-01

    Drawing on a national study of independent mental health advocacy, we explored the social relations of independent advocacy. The study was commissioned by the Department of Health (England), and involved a case study design covering eight different geographies and service configurations, and interviews or focus groups with a total of 289 stakeholders across two phases of inquiry. This paper focused on the analysis of qualitative data relevant to the relationship between mental health-care services and independent advocacy services, drawn from interviews with 214 participants in phase two of the study. Discussion of these particular findings affords insights into the working relations of independent advocacy within mental health services beset by reorganizational change and funding cuts, and increasing levels of legally-sanctioned compulsion and coercion. We offer a matrix, which accounts for the different types of working relationships that can arise, and how these are associated with various levels of understanding of independent advocacy and appreciation for the value of advocacy. The discussion is framed by the wider literature on advocacy and the claims by practitioners, such as nurses, for an advocacy role as part of their professional repertoire.

  12. Allied Health Field, Tenth Grade. Introduction to Allied Health and the Health Care Team. Operation TACT [Toward an Allied Health Career Today] Curriculum [and Teachers' Handbook].

    Science.gov (United States)

    Smith, Tracy

    The two-part set consists of a student handbook and a related teachers' handbook in allied health education for use at the tenth grade level. The student handbook consists of seven units which focus on the biology curriculum: (1) community water examination, (2) bacteriological examination of water, (3) the microscope, (4) microbes and man, (5)…

  13. Exploring the concept of a team approach to wound care: MANAGING WOUNDS AS A TEAM.

    Science.gov (United States)

    2014-05-01

    Background The growing prevalence and incidence of nonhealing acute and chronic wounds is a worrying concern. A major challenge is the lack of united services aimed at addressing the complex needs of individuals with wounds. However, the WHO argues that interprofessional collaboration in education and practice is key to providing the best patient care, enhancing clinical and health-related outcomes and strengthening the health system. It is based on this background that the team approach to wound care project was conceptualised. The project was jointly initiated and realised by the Association for the Advancement of Wound Care (AAWC-USA), the Australian Wound Management Association (AWMA) and the European Wound Management Association (EWMA). Aim The aim of this project was to develop a universal model for the adoption of a team approach to wound care. Objective The overarching objective of this project was to provide recommendations for implementing a team approach to wound care within all clinical settings and through this to develop a model for advocating the team approach toward decision makers in national government levels. Method An integrative literature review was conducted. Using this knowledge, the authors arrived at a consensus on the most appropriate model to adopt and realise a team approach to wound care. Results Eighty four articles met the inclusion criteria. Following data extraction, it was evident that none of the articles provided a definition for the terms multidisciplinary, interdisciplinary or transdisciplinary in the context of wound care. Given this lack of clarity within the wound care literature, the authors have here developed a Universal Model for the Team Approach to Wound Care to fill this gap in our current understanding. Conclusion We advocate that the patient should be at the heart of all decision-making, as working with the Universal Model for the Team Approach to Wound Care begins with the needs of the patient. To facilitate this

  14. Relations between mental health team characteristics and work role performance.

    Science.gov (United States)

    Fleury, Marie-Josée; Grenier, Guy; Bamvita, Jean-Marie; Farand, Lambert

    2017-01-01

    Effective mental health care requires a high performing, interprofessional team. Among 79 mental health teams in Quebec (Canada), this exploratory study aims to 1) determine the association between work role performance and a wide range of variables related to team effectiveness according to the literature, and to 2) using structural equation modelling, assess the covariance between each of these variables as well as the correlation with other exogenous variables. Work role performance was measured with an adapted version of a work role questionnaire. Various independent variables including team manager characteristics, user characteristics, team profiles, clinical activities, organizational culture, network integration strategies and frequency/satisfaction of interactions with other teams or services were analyzed under the structural equation model. The later provided a good fit with the data. Frequent use of standardized procedures and evaluation tools (e.g. screening and assessment tools for mental health disorders) and team manager seniority exerted the most direct effect on work role performance. While network integration strategies had little effect on work role performance, there was a high covariance between this variable and those directly affecting work role performance among mental health teams. The results suggest that the mental healthcare system should apply standardized procedures and evaluation tools and, to a lesser extent, clinical approaches to improve work role performance in mental health teams. Overall, a more systematic implementation of network integration strategies may contribute to improved work role performance in mental health care.

  15. Crossing boundaries, re-defining care: the role of the critical care outreach team.

    Science.gov (United States)

    Coombs, Maureen; Dillon, Ann

    2002-05-01

    There is clear indication that both government and professional policy in the United Kingdom supports a radical change in the role of healthcare practitioners, with a move towards a patient-focused service delivered by clinical teams working effectively together. Recent health service imperatives driving the agenda for flexible clinical teams have occurred simultaneously with an increased public and political awareness of deficits in availability of critical care services. Against this policy backdrop, working across professional and organizational boundaries is fundamental to supporting quality service improvements. In the acute care sector, the development of critical care outreach teams is an innovation that seeks to challenge the traditional support available for sick ward patients. Activity data and observations from the first 6-month evaluation of two critical care outreach teams identify the need for clinical support and education offered by critical care practitioners to ward-based teams. The experiences from such flexible clinical teams provides a foundation from which to explore key issues for intradisciplinary and interdisciplinary working across clinical areas and organizational boundaries. Adopting innovative approaches to care delivery, such as critical care outreach teams, can enable clinical teams and NHS trusts to work together to improve the quality of care for acutely ill patients, support clinical practitioners working with this client group, and develop proactive service planning.

  16. Interprofessional student teams augmenting service provision in residential aged care.

    Science.gov (United States)

    Kent, Fiona; Lai, Francis; Beovich, Bronwyn; Dodic, Miodrag

    2016-09-01

    The aim of this study was to determine the usefulness of student-led interprofessional consultations within residential aged care in augmenting patient care and enhancing student education. Volunteer fourth and final year health-care students conducted interprofessional consultations. In a mixed methods design, residents' health-care changes and perspectives were collected prospectively, and student and educator perceptions were measured by survey and interview. Sixteen aged care residents were consulted by interprofessional teams. Students identified two new health issues and proposed 17 recommendations for referrals and five changes to medication management. At six-weeks follow-up, two recommendations had been acted upon clinically, and two medication changes had been implemented. Reasons for the low uptake of recommendations were determined. Residents, students and educators reported high levels of satisfaction. Residential care facilities offer a useful interprofessional learning environment. Student consultations are positively regarded by patients, students and educators and may augment existing health services. © 2016 AJA Inc.

  17. Primary care team composition in 34 countries.

    NARCIS (Netherlands)

    Groenewegen, P.; Heinemann, S.; Greß, S.; Schäfer, W.

    2015-01-01

    Health care needs in the population change through ageing and increasing multimorbidity. Primary health care might accommodate to this through the composition of practices in terms of the professionals working in them. The aim of this article is to describe the composition of primary care practices

  18. Development of training-related health care software by a team of clinical educators: their experience, from conception to piloting

    Directory of Open Access Journals (Sweden)

    ap Dafydd D

    2016-11-01

    Full Text Available Derfel ap Dafydd,1 Ruth Williamson,2 Philip Blunt,3 Dominic M Blunt4 1Department of Radiology, Royal Marsden NHS Foundation Trust, London, 2Imaging Department, Royal Bornemouth Hospital, Bornemouth, 3Savernake IT Ltd, Marlborough, 4Imaging Department, Imperial College Healthcare NHS Trust, London, UK Abstract: The difficulties of producing useful, bespoke, and affordable information technology systems for large health care organizations are well publicized, following several high-profile endeavors in the UK. This article describes the experience of a small group of clinical radiologists and their collaborators in producing an information technology system – from conception to piloting. This system, called Trainee Tracker, enables automated target date recalculation of trainee milestones, depending on their work patterns and other individual circumstances. It utilizes an automated email alert system to notify the educational supervisors and trainees of approaching and elapsed target dates, in order to identify trainees in difficulty early and address their training needs accordingly. The challenges and advantages, both common to and contrasting with larger-scale projects, are also considered. The benefits of the development team’s “agile” approach to software development and the lessons learned will be of interest to medical educators, particularly those with expertise in e-portfolios and other training-related software. Keywords: training, appraisal, ARCP, Annual Review of Clinical Progression, portfolio, trainer

  19. A Multidisciplinary Health Care Team's Efforts to Improve Educational Attainment in Children with Sickle-Cell Anemia and Cerebral Infarcts

    Science.gov (United States)

    King, Allison; Herron, Sonya; McKinstry, Robert; Bacak, Stephen; Armstrong, Melissa; White, Desiree; DeBaun, Michael

    2006-01-01

    The primary objective of this study was to improve the educational success of children with sickle-cell disease (SCD) and cerebral infarcts. A prospective intervention trial was conducted; a multidisciplinary team was created to maximize educational resources for children with SCD and cerebral infarcts. Students were evaluated systematically…

  20. A Multidisciplinary Health Care Team's Efforts to Improve Educational Attainment in Children with Sickle-Cell Anemia and Cerebral Infarcts

    Science.gov (United States)

    King, Allison; Herron, Sonya; McKinstry, Robert; Bacak, Stephen; Armstrong, Melissa; White, Desiree; DeBaun, Michael

    2006-01-01

    The primary objective of this study was to improve the educational success of children with sickle-cell disease (SCD) and cerebral infarcts. A prospective intervention trial was conducted; a multidisciplinary team was created to maximize educational resources for children with SCD and cerebral infarcts. Students were evaluated systematically…

  1. Palliative care teams: effective through moral reflection.

    NARCIS (Netherlands)

    Hermsen, M.A.; Have, H.A.M.J. ten

    2005-01-01

    Working as a multidisciplinary or interdisciplinary team is an essential condition to provide good palliative care. This widespread assumption is based on the idea that teamwork makes it possible to address the various needs of the patient and family more effectively. This article is about teamwork

  2. Understanding Cleft and Craniofacial Team Care

    Science.gov (United States)

    ... treatment plan. You or your child may not need care from each type of specialist, but a treatment team may include: an audiologist (who assesses hearing); a surgeon (such as a plastic surgeon, an oral/maxillofacial surgeon, a craniofacial surgeon, or a neurosurgeon); ...

  3. Child Care Service Regional Team Mode on Improving Quality of Child Health Care%儿童保健区域团队服务模式与儿童保健质量分析

    Institute of Scientific and Technical Information of China (English)

    陈晓; 兰雅平

    2013-01-01

    目的 探讨儿童保健区域团队服务模式与儿童保健质量分析.方法 按地段划分区域,组建社区儿童保健区域团队,以深圳市第四人民医院23家社康中心0~2岁社区儿童为对象,每个社康中心抽取180名儿童,共计4140人,即从0,1,2岁组中随机抽取常住、暂住儿童各30名,其中女童2120人,男童2020人.结果 在儿童保健区域团队服务模式实施前后(第一、二、三阶段)儿童保健进行比较分析,儿童保健覆盖率、系统管理率、体弱儿管理率、特殊儿童发现率、相关业务完成指标和家长育儿知识知晓率均有显著提高,差异均有统计学意义(P<0.05).结论 儿童保健区域团队服务模式可以提高儿童保健的服务质量.%Objective To investigate the role of child care service regional team mode in improving the quality of child health care.Methods The child care service regional team was built according to the section of an area.The children aged 0 to 2 years from 23 community health service centers were investigated.180 children from each center and total 4140 children were sampled.There were 30 permanent children and 30 temporary children in 0,1 and 2 years age group,which included 2120 girls and 2020 boys.Results The health care coverage,rate of system management,management rate of frail children,detection rate of children with special needs,completion of the relevant business indicators,parenting knowledge awareness of parents were improved after the implementation of the child health regional team mode,and the differences were statistically significant(P < 0.05).Conclusion The child health regional team mode can improve the quality of child health services.

  4. Primary Care Teams, Composition, Roles, and Satisfaction of PA Students During Primary Care Rotations.

    Science.gov (United States)

    Kayingo, Gerald; Deon Kidd, Vasco; Gilani, Owais; Warner, Mary L

    2015-06-01

    The goal of t his study was to describe the characteristics of primary care teams, activities, and ro les of physician assistant (PA) students as they encounter various primary care sites. An electronic survey was distributed to second year PA students in 12 programs who had completed at least 4 weeks in a primary care rotation. Of the 179 students who responded (response rate 41 %), 88% had completed their primary care rotations in urban settings, mostly in private practices (53%). Physician assistant students reported encountering many types of health care providers on their teams, and the 2 most favored features of the rotations were the interactions with their supervising clinicians and clinical responsibilities. About 68% interacted with other health profession students during their rotation(interprofessional experiential learning). Almost all students completed histories, physical examinations, and treatment plans, but less than 30% reported involvement in billing or care coordination and less than 10% participated in quality improvement projects. More than 60% were satisfied with team-based and interprofessional practices encountered during their primary care rotations, and 39% were more than likely to pursue primary care careers. Team-based prima ry ca re had a positive impact on students, but more exposure to underserved clinical settings, care coordination, quality improvement, and billing is needed to prepare PA students for the practice of the future. This study is t he first of its kind to explore the relationship between primary care sites and PA training in the era of health care reform.

  5. Guiding Principles for Team-Based Pediatric Care.

    Science.gov (United States)

    Katkin, Julie P; Kressly, Susan J; Edwards, Anne R; Perrin, James M; Kraft, Colleen A; Richerson, Julia E; Tieder, Joel S; Wall, Liz

    2017-07-24

    The American Academy of Pediatrics (AAP) recognizes that children's unique and ever-changing needs depend on a variety of support systems. Key components of effective support systems address the needs of the child and family in the context of their home and community and are dynamic so that they reflect, monitor, and respond to changes as the needs of the child and family change. The AAP believes that team-based care involving medical providers and community partners (eg, teachers and state agencies) is a crucial and necessary component of providing high-quality care to children and their families. Team-based care builds on the foundation of the medical home by reaching out to a potentially broad array of participants in the life of a child and incorporating them into the care provided. Importantly, the AAP believes that a high-functioning team includes children and their families as essential partners. The overall goal of team-based care is to enhance communication and cooperation among the varied medical, social, and educational partners in a child's life to better meet the global needs of children and their families, helping them to achieve their best potential. In support of the team-based approach, the AAP urges stakeholders to invest in infrastructure, education, and privacy-secured technology to meet the needs of children. This statement includes limited specific examples of potential team members, including health care providers and community partners, that are meant to be illustrative and in no way represent a complete or comprehensive listing of all team members who may be of importance for a specific child and family. Copyright © 2017 by the American Academy of Pediatrics.

  6. Building collaborative teams in neonatal intensive care.

    Science.gov (United States)

    Brodsky, Dara; Gupta, Munish; Quinn, Mary; Smallcomb, Jane; Mao, Wenyang; Koyama, Nina; May, Virginia; Waldo, Karen; Young, Susan; Pursley, DeWayne M

    2013-05-01

    The complex multidisciplinary nature of neonatal intensive care combined with the numerous hand-offs occurring in this shift-based environment, requires efficient and clear communication and collaboration among staff to provide optimal care. However, the skills required to function as a team are not typically assessed, discussed, or even taught on a regular basis among neonatal personnel. We developed a multidisciplinary, small group, interactive workshop based on Team STEPPS to provide staff with formal teamwork skills, and to introduce new team-based practices; 129 (95%) of the eligible 136 staff were trained. We then compared the results of the pretraining survey (completed by 114 (84%) of staff) with the post-training survey (completed by 104 (81%) of participants) 2 years later. We found an improvement in the overall teamwork score from 7.37 to 8.08 (p=showing that staff had greater job fulfilment (p=<0.0001), believed that their abilities were being utilised properly (p=0.003), and felt more respected (p=0.0037). 90% of staff found the new practice of team meetings to help increase awareness of unit acuity, and 77% of staff noted that they had asked for help or offered assistance because of information shared during these meetings. In addition to summarising the results of our training programme, this paper also provides practical tools that may be of use in developing team training programmes in other neonatal units.

  7. The Importance of Team Health Climate for Health-Related Outcomes of White-Collar Workers

    Science.gov (United States)

    Schulz, Heiko; Zacher, Hannes; Lippke, Sonia

    2017-01-01

    Occupational health researchers and practitioners have mainly focused on the individual and organizational levels, whereas the team level has been largely neglected. In this study, we define team health climate as employees’ shared perceptions of the extent to which their team is concerned, cares, and communicates about health issues. Based on climate, signaling, and social exchange theories, we examined a multilevel model of team health climate and its relationships with five well-established health-related outcomes (i.e., subjective general health, psychosomatic complaints, mental health, work ability, and presenteeism). Results of multilevel analyses of data provided by 6,449 employees in 621 teams of a large organization showed that team health climate is positively related to subjective general health, mental health, and work ability, and negatively related to presenteeism, above and beyond the effects of team size, age, job tenure, job demands, job control, and employees’ individual perceptions of health climate. Moreover, additional analyses showed that a positive team health climate buffered the negative relationship between employee age and work ability. Implications for future research on team health climate and suggestions for occupational health interventions in teams are discussed. PMID:28194126

  8. The Importance of Team Health Climate for Health-Related Outcomes of White-Collar Workers.

    Science.gov (United States)

    Schulz, Heiko; Zacher, Hannes; Lippke, Sonia

    2017-01-01

    Occupational health researchers and practitioners have mainly focused on the individual and organizational levels, whereas the team level has been largely neglected. In this study, we define team health climate as employees' shared perceptions of the extent to which their team is concerned, cares, and communicates about health issues. Based on climate, signaling, and social exchange theories, we examined a multilevel model of team health climate and its relationships with five well-established health-related outcomes (i.e., subjective general health, psychosomatic complaints, mental health, work ability, and presenteeism). Results of multilevel analyses of data provided by 6,449 employees in 621 teams of a large organization showed that team health climate is positively related to subjective general health, mental health, and work ability, and negatively related to presenteeism, above and beyond the effects of team size, age, job tenure, job demands, job control, and employees' individual perceptions of health climate. Moreover, additional analyses showed that a positive team health climate buffered the negative relationship between employee age and work ability. Implications for future research on team health climate and suggestions for occupational health interventions in teams are discussed.

  9. Physician experiences with clinical pharmacists in primary care teams.

    Science.gov (United States)

    Moreno, Gerardo; Lonowski, Sarah; Fu, Jeffrey; Chon, Janet S; Whitmire, Natalie; Vasquez, Carolina; Skootsky, Samuel A; Bell, Douglas S; Maranon, Richard; Mangione, Carol M

    2017-08-12

    Improving medication management is an important component of comprehensive care coordination for health systems. The Managing Your Medication for Education and Daily Support (MyMeds) medication management program at the University of California Los Angeles addresses medication management issues by embedding trained clinical pharmacists in primary care practice teams. The aim of this work was to examine and explore physician opinions about the clinical pharmacist program and identify common themes among physician experiences as well as barriers to integration of clinical pharmacists into primary care practice teams. We conducted a mixed quantitative-qualitative methods study consisting of a cross-sectional physician survey (n = 69) as well as semistructured one-on-one physician interviews (n = 13). Descriptive statistics were used to summarize survey responses, and standard qualitative content-analysis methods were used to identify major themes from the interviews. The survey response rate was 61%; 13 interviews were conducted. Ninety percent of survey respondents agreed or strongly agreed that having the pharmacist in the office makes management of the patient's medication more efficient, 93% agreed or strongly agreed that pharmacist recommendations are clinically helpful, 71% agreed or strongly agreed that having access to a pharmacist has increased their knowledge about medications they prescribe, and 75% agreed or strongly agreed that having a pharmacist as part of the primary care team has made their job easier. Qualitative interviews corroborated survey findings, and physicians highlighted the value of the clinical pharmacist's communication, team care and expanded roles, and medication management. Primary care physicians valued the integrated pharmacy program highly, particularly its features of strong communication, expanded roles, and medication management. Pharmacists were viewed as integral members of the health care team. Copyright © 2017 American

  10. Improving Team Performance for Public Health Preparedness.

    Science.gov (United States)

    Peck, Megan; Scullard, Mickey; Hedberg, Craig; Moilanen, Emily; Radi, Deborah; Riley, William; Bowen, Paige Anderson; Petersen-Kroeber, Cheryl; Stenberg, Louise; Olson, Debra K

    2017-02-01

    Between May 2010 and September 2011, the University of Minnesota School of Public Health partnered with the Minnesota Department of Health (MDH) to assess the effect of exercises on team performance during public health emergency response. Participants were divided into 3 research teams exposed to various levels of intervention. Groups consisted of a control group that was given standard MDH training exercises, a didactic group exposed to team dynamics and communication training, and a treatment group that received the didactic training in addition to a post-exercise facilitated debriefing. To assess differences in team performance, teams engaged in 15 functional exercises. Differences in team performance across the 3 groups were identified, although there was no trend in team performance over time for any of the groups. Groups demonstrated fluctuation in team performance during the study period. Attitudinal surveys demonstrated an increase in workplace satisfaction and confidence in training among all groups throughout the study period. Findings from this research support that a critical link exists between training type and team performance during public health emergency response. This research supports that intentional teamwork training for emergency response workers is essential for effective public health emergency response. (Disaster Med Public Health Preparedness. 2017;11:7-10).

  11. Teaching quality essentials: the effectiveness of a team-based quality improvement curriculum in a tertiary health care institution.

    Science.gov (United States)

    Majka, Andrew J; Cook, Katlyn E; Lynch, Stacia L; Garovic, Vesna D; Ghosh, Amit K; West, Colin P; Feyereisn, Wayne L; Paat, John J; Williams, Brandon J; Hale, Curt W; Botz, Catherine T; Phul, Ashley E; Mueller, Paul S

    2013-01-01

    A unique quality improvement (QI) curriculum was implemented within the Division of General Internal Medicine to improve QI knowledge through multidisciplinary, team-based education, which also met the QI requirement for the American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) and the Mayo Quality Fellows program. Participants completed up to 4 QI learning modules, including pretest and posttest assessments. A participant who successfully completed all 4 modules received certification as a Silver Quality Fellow and credit toward the quality requirement for ABIM MOC. Of 62 individuals invited to participate, 33 (53%) completed all 4 modules and corresponding pretests and posttests. Participants substantially improved knowledge in all 4 quality modules. Study group participants' pretest scores averaged 71.0%, and their posttest scores averaged 92.7%. Posttest scores of reference group participants compared favorably, averaging 89.2%. Initial assessments showed substantial knowledge improvements and successful implementation of staff-developed QI projects.

  12. Principles supporting dynamic clinical care teams: an American College of Physicians position paper.

    Science.gov (United States)

    Doherty, Robert B; Crowley, Ryan A

    2013-11-05

    The U.S. health care system is undergoing a shift from individual clinical practice toward team-based care. This move toward team-based care requires fresh thinking about clinical leadership and responsibilities to ensure that the unique skills of each clinician are used to provide the best care for the patient as the patient's needs dictate, while the team as a whole must work together to ensure that all aspects of a patient's care are coordinated for the benefit of the patient. In this position paper, the American College of Physicians offers principles, definitions, and examples to dissolve barriers that prevent movement toward dynamic clinical care teams. These principles offer a framework for an evolving, updated approach to health care delivery, providing policy guidance that can be useful to clinical teams in organizing the care processes and clinician responsibilities consistent with professionalism.

  13. Team work of care workers in residential care institutions

    OpenAIRE

    Mišković, Svjetlana

    2014-01-01

    In my diploma thesis special attention is given to care workers that work with a group of youth in extrafamilial residential institutions. They are defined as a team or work group, depending on the work structure. I am aware of the difficulty of educational team work and that is why I want to define and research their experiencing team or group work. At the beginning of the theoretical part I define educational work in educational institutions and youth homes, then continue with the definitio...

  14. Work-Related Depression in Primary Care Teams in Brazil.

    Science.gov (United States)

    da Silva, Andréa Tenório Correia; Lopes, Claudia de Souza; Susser, Ezra; Menezes, Paulo Rossi

    2016-11-01

    To identify work-related factors associated with depressive symptoms and probable major depression in primary care teams. Cross-sectional study among primary care teams (community health workers, nursing assistants, nurses, and physicians) in the city of São Paulo, Brazil (2011-2012; n = 2940), to assess depressive symptoms and probable major depression and their associations with job strain and other work-related conditions. Community health workers presented higher prevalence of probable major depression (18%) than other primary care workers. Higher odds ratios for depressive symptoms or probable major depression were associated with longer duration of employment in primary care; having a passive, active, or high-strain job; lack of supervisor feedback regarding performance; and low social support from colleagues and supervisors. Observed levels of job-related depression can endanger the sustainability of primary care programs. Public Health implications. Strategies are needed to deliver care to primary care workers with depression, facilitating diagnosis and access to treatment, particularly in low- and middle-income countries. Preventive interventions can include training managers to provide feedback and creating strategies to increase job autonomy and social support at work.

  15. Primary care teams: New Zealand's experience with community-governed non-profit primary care.

    Science.gov (United States)

    Crampton, Peter; Davis, Peter; Lay-Yee, Roy

    2005-05-01

    Community-governed non-profit primary care organisations started developing in New Zealand in the late 1980s with the aim to reduce financial, cultural and geographical barriers to access. New Zealand's new primary health care strategy aims to co-ordinate primary care and public health strategies with the overall objective of improving population health and reducing health inequalities. The purpose of this study is to carry out a detailed examination of the composition and characteristics of primary care teams in community-governed non-profit practices and compare them with more traditional primary care organisations, with the aim of drawing conclusions about the capacity of the different structures to carry out population-based primary care. The study used data from a representative national cross-sectional survey of general practitioners in New Zealand (2001/2002). Primary care teams were largest and most heterogeneous in community-governed non-profit practices, which employed about 3% of the county's general practitioners. Next most heterogeneous in terms of their primary care teams were practices that belonged to an Independent Practitioner Association, which employed the majority of the country's general practitioners (71.7%). Even though in absolute and relative terms the community-governed non-profit primary care sector is small, by providing a much needed element of professional and organisational pluralism and by experimenting with more diverse staffing arrangements, it is likely to continue to have an influence on primary care policy development in New Zealand.

  16. What is the impact of multidisciplinary team simulation training on team performance and efficiency of patient care? An integrative review.

    Science.gov (United States)

    Murphy, Margaret; Curtis, Kate; McCloughen, Andrea

    2016-02-01

    In hospital emergencies require a structured team approach to facilitate simultaneous input into immediate resuscitation, stabilisation and prioritisation of care. Efforts to improve teamwork in the health care context include multidisciplinary simulation-based resuscitation team training, yet there is limited evidence demonstrating the value of these programmes.(1) We aimed to determine the current state of knowledge about the key components and impacts of multidisciplinary simulation-based resuscitation team training by conducting an integrative review of the literature. A systematic search using electronic (three databases) and hand searching methods for primary research published between 1980 and 2014 was undertaken; followed by a rigorous screening and quality appraisal process. The included articles were assessed for similarities and differences; the content was grouped and synthesised to form three main categories of findings. Eleven primary research articles representing a variety of simulation-based resuscitation team training were included. Five studies involved trauma teams; two described resuscitation teams in the context of intensive care and operating theatres and one focused on the anaesthetic team. Simulation is an effective method to train resuscitation teams in the management of crisis scenarios and has the potential to improve team performance in the areas of communication, teamwork and leadership. Team training improves the performance of the resuscitation team in simulated emergency scenarios. However, the transferability of educational outcomes to the clinical setting needs to be more clearly demonstrated. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

  17. A human factors systems approach to understanding team-based primary care: a qualitative analysis.

    Science.gov (United States)

    Mundt, Marlon P; Swedlund, Matthew P

    2016-12-01

    Research shows that high-functioning teams improve patient outcomes in primary care. However, there is no consensus on a conceptual model of team-based primary care that can be used to guide measurement and performance evaluation of teams. To qualitatively understand whether the Systems Engineering Initiative for Patient Safety (SEIPS) model could serve as a framework for creating and evaluating team-based primary care. We evaluated qualitative interview data from 19 clinicians and staff members from 6 primary care clinics associated with a large Midwestern university. All health care clinicians and staff in the study clinics completed a survey of their communication connections to team members. Social network analysis identified key informants for interviews by selecting the respondents with the highest frequency of communication ties as reported by their teammates. Semi-structured interviews focused on communication patterns, team climate and teamwork. Themes derived from the interviews lent support to the SEIPS model components, such as the work system (Team, Tools and Technology, Physical Environment, Tasks and Organization), team processes and team outcomes. Our qualitative data support the SEIPS model as a promising conceptual framework for creating and evaluating primary care teams. Future studies of team-based care may benefit from using the SEIPS model to shift clinical practice to high functioning team-based primary care. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  18. The Association of Team-Specific Workload and Staffing with Odds of Burnout Among VA Primary Care Team Members.

    Science.gov (United States)

    Helfrich, Christian D; Simonetti, Joseph A; Clinton, Walter L; Wood, Gordon B; Taylor, Leslie; Schectman, Gordon; Stark, Richard; Rubenstein, Lisa V; Fihn, Stephan D; Nelson, Karin M

    2017-07-01

    Work-related burnout is common in primary care and is associated with worse patient safety, patient satisfaction, and employee mental health. Workload, staffing stability, and team completeness may be drivers of burnout. However, few studies have assessed these associations at the team level, and fewer still include members of the team beyond physicians. To study the associations of burnout among primary care providers (PCPs), nurse care managers, clinical associates (MAs, LPNs), and administrative clerks with the staffing and workload on their teams. We conducted an individual-level cross-sectional analysis of survey and administrative data in 2014. Primary care personnel at VA clinics responding to a national survey. Burnout was measured with a validated single-item survey measure dichotomized to indicate the presence of burnout. The independent variables were survey measures of team staffing (having a fully staffed team, serving on multiple teams, and turnover on the team), and workload both from survey items (working extended hours), and administrative data (patient panel overcapacity and average panel comorbidity). There were 4610 respondents (estimated response rate of 20.9%). The overall prevalence of burnout was 41%. In adjusted analyses, the strongest associations with burnout were having a fully staffed team (odds ratio [OR] = 0.55, 95% CI 0.47-0.65), having turnover on the team (OR = 1.67, 95% CI 1.43-1.94), and having patient panel overcapacity (OR = 1.19, 95% CI 1.01-1.40). The observed burnout prevalence was 30.1% lower (28.5% vs. 58.6%) for respondents working on fully staffed teams with no turnover and caring for a panel within capacity, relative to respondents in the inverse condition. Complete team staffing, turnover among team members, and panel overcapacity had strong, cumulative associations with burnout. Further research is needed to understand whether improvements in these factors would lower burnout.

  19. [The coordination of care in health centres].

    Science.gov (United States)

    Ribardière, Olivia

    2016-06-01

    Health centres are structurally designed to facilitate the coordination of care. However, evolutions in society have resulted in forms of consumption of health care which are not necessarily compatible with efficient care coordination. On a local level, teams are nevertheless organising and structuring themselves to offer the right form of care, to the right patient and at the right time.

  20. [Team building in health care by means of outdoor training. Evaluation of the experience of a Local Health Authority of Pinerolo].

    Science.gov (United States)

    Cominetti, Laura; Dimonte, Valerio

    2011-01-01

    It is always difficult to measure the quality and efficacy of a formative event. The event assessed in this study was an outdoor course and the aspects considered were the degree of satisfaction, the increase of knowledge, modifications in behavior and working actions and organized change (4 levels according to Kirkpatrick). Data were collected by means of a questionnaire which the 28 course participants were asked to fill in. Some aspects were statistically tested to evaluate eventual associations between the role of the participant and the answer given but these were not found to be significant. Results showed a good levels of satisfaction and knowledge increase which, in terms of working procedures and individual behavior, resulted in better team-building and mutual appreciation, whereas organizational changes were rather limited and sometimes reflected disappointment. The study made the Health Authority aware of the value of human resources and of the fact that a formative event which acts on feelings and behavior may be the key to success in bringing about deep and lasting changes.

  1. [Working in multiprofessional teams: the perspectives of family health residents].

    Science.gov (United States)

    Ferreira, Ricardo Corrêa; Varga, Cássia Regina Rodrigues; da Silva, Roseli Ferreira

    2009-10-01

    Brazilian medical residency is increasingly specializing physicians in his practices undervaluing the multiprofessional practices that guide the integrality in health. Aiming at changing this practice, the multiprofessional residency in family health was proposed to prepare professionals searching for a comprehensive health care to the general public. In this context, in 2003, Faculdade de Medicina de Marília started this residency program having as the main idea the multiprofessional work in family health teams. The study shows the perception of family health residents at Faculdade de Medicina de Marília regarding the multiprofessional work developed in the Family Health Program. The method used in this research was the qualitative approach. The collected data had been interpreted through a thematic content analysis, building three empirical categories: Anchors and markers of an interdisciplinary view on team work that permeate the Family Health residency perspective; Conflicts and paradoxes of team work and the maintenance of an assembly line; Dilemmas of the team work facing an hierarchical structure. The data analysis points to an advancement that multiprofessional team work brings to the medical formation, once it allows perspectives that would not be possible without a team.

  2. [Palliative care in patients without cancer: Impact of the end-of-life care team].

    Science.gov (United States)

    Nishikawa, Mitsunori; Yokoe, Yuriko; Kubokawa, Naomi; Hukuda, Koji; Hattori, Hideyuki; Hong, Young-Jae; Miura, Hisayuki; Shibasaki, Masataka; Endo, Hidetoshi; Takeda, Jun; Odate, Mitsuru; Senda, Kazuyoshi; Nakashima, Kazumitsu

    2013-01-01

    Palliative care improves the quality of life of patients and their families facing problems associated with life-threatening illnesses by promoting the prevention and relief of suffering. Palliative care in Japan has been developed mainly for cancer patients. At the National Center for Geriatrics and Gerontology, an end-of-life care team (EOLCT) has been developed to promote palliative care for patients without cancer. In the first 6 months of its operation, 109 requests were received by the team, 40% of which were for patients without cancer or related disease, including dementia, frailty due to advanced age, chronic respiratory failure, chronic heart failure, and intractable neurologic diseases. The main purpose of the EOLCT is to alleviate suffering. The relevant activities of the team include the use of opioids, providing family care, and giving support in decision-making (advance care planning) regarding withholding; enforcement; and withdrawal of mechanical ventilators, gastric feeding tubes, and artificial alimentation. The EOLCT is also involved in ongoing discussions of ethical problems. The team is actively engaged in the activities of the Japanese Geriatric Society and contributes to the development of decision-making guidelines for end-of-life by the Ministry of Health, Labour and Welfare. The EOLCT can be helpful in promoting palliative care for patients with diseases other than cancer. The team offers support during times of difficulty and decision-making.

  3. Psychometric properties of a Mental Health Team Development Audit Tool.

    LENUS (Irish Health Repository)

    Roncalli, Silvia

    2013-02-01

    To assist in improving team working in Community Mental Health Teams (CMHTs), the Mental Health Commission formulated a user-friendly but yet-to-be validated 25-item Mental Health Team Development Audit Tool (MHDAT).

  4. Structure and characteristics of community-based multidisciplinary wound care teams in Ontario: an environmental scan.

    Science.gov (United States)

    Abrahamyan, Lusine; Wong, Josephine; Pham, Ba'; Trubiani, Gina; Carcone, Steven; Mitsakakis, Nicholas; Rosen, Laura; Rac, Valeria E; Krahn, Murray

    2015-01-01

    Multidisciplinary team approach is an essential component of evidence-based wound management in the community. The objective of this study was to identify and describe community-based multidisciplinary wound care teams in Ontario. For the study, a working definition of a multidisciplinary wound care team was developed, and a two-phase field evaluation was conducted. In phase I, a systematic survey with three search strategies (environmental scan) was conducted to identify all multidisciplinary wound care teams in Ontario. In phase II, the team leads were surveyed about the service models of the teams. We identified 49 wound care teams in Ontario. The highest ratio of Ontario seniors to wound team within each Ontario health planning region was 82,358:1; the lowest ratio was 14,151:1. Forty-four teams (90%) participated in the survey. The majority of teams existed for at least 5 years, were established as hospital outpatient clinics, and served patients with chronic wounds. Teams were heterogeneous in on-site capacity of specialized diagnostic testing and wound treatment, team size, and patient volume. Seventy-seven percent of teams had members from three or more disciplines. Several teams lacked essential disciplines. More research is needed to identify optimal service models leading to improved patient outcomes.

  5. Cooperating with a palliative home-care team

    DEFF Research Database (Denmark)

    Goldschmidt, Dorthe; Groenvold, Mogens; Johnsen, Anna Thit

    2005-01-01

    BACKGROUND: Palliative home-care teams often cooperate with general practitioners (GPs) and district nurses. Our aim was to evaluate a palliative home-care team from the viewpoint of GPs and district nurses. METHODS: GPs and district nurses received questionnaires at the start of home-care and one...... month later. Questions focussed on benefits to patients, training issues for professionals and cooperation between the home-care team and the GP/ district nurse. A combination of closed- and open-ended questions was used. RESULTS: Response rate was 84% (467/553). Benefits to patients were experienced....... Dissatisfaction was caused mainly by lack of information from the home-care team to primary-care professionals. CONCLUSION: GPs and district nurses welcomed the palliative home-care team and most experienced benefits to patients. Strengthened communication, initiated by the home-care team would enhance...

  6. Cooperating with a palliative home-care team

    DEFF Research Database (Denmark)

    Goldschmidt, Dorthe; Groenvold, Mogens; Johnsen, Anna Thit

    2005-01-01

    BACKGROUND: Palliative home-care teams often cooperate with general practitioners (GPs) and district nurses. Our aim was to evaluate a palliative home-care team from the viewpoint of GPs and district nurses. METHODS: GPs and district nurses received questionnaires at the start of home-care and one...... month later. Questions focussed on benefits to patients, training issues for professionals and cooperation between the home-care team and the GP/ district nurse. A combination of closed- and open-ended questions was used. RESULTS: Response rate was 84% (467/553). Benefits to patients were experienced....... Dissatisfaction was caused mainly by lack of information from the home-care team to primary-care professionals. CONCLUSION: GPs and district nurses welcomed the palliative home-care team and most experienced benefits to patients. Strengthened communication, initiated by the home-care team would enhance...

  7. 社区医护团队的自我和谐现状研究%Current Status of Self Consistency and Congruence of Community Health Care Team

    Institute of Scientific and Technical Information of China (English)

    罗春玲; 黄莲; 叶巧如; 吴翠红; 苏芬; 苏春波

    2012-01-01

    To study the present situation of self consistency and congruence of the community health care team, to investigate the factors influencing the self consistency and congruence and how to improve its degree. Methods Self consistency and congruence scale ( SCCS ) was taken to investigate 245 members of the staff in the community health services centers under the Longhua People's Hospital of Bao'an District of Shenzhen. Results There was no difference of SCCS score between the community doctor and the community nurse ( P > 0. 05 ). The average total score of SCCS for community health care staff was ( 99. 96 ± 10. 85 ), of which the score of self - experience inconsistence was ( 48. 84 ± 7. 59 ), the self flexibility score was (41. 98 ±5. 53 ), and the self - stereotypes score was ( 21. 22 ± 3. 75 ), with statistically significant differences as compared with the nom of college students ( P < 0. 05 ) . Conclusion The community health care staffs are of lower self consistency and congruence. They need enhanced mental health education given by relevant management departments.%目的 了解社区医护团队的自我和谐现状,探讨影响社区医护团队自我和谐的因素及采取何种应对方式来提高社区医护团队的自我和谐程度.方法 采用自我和谐量表,对在深圳市宝安区龙华人民医院下属的社区卫生服务中心工作的245名医护人员进行调查.结果 社区医生和护士的自我和谐得分间差异无统计学意义(P>0.05).社区医护团队自我和谐量表总分均值为(99.96±10.85)分,其中自我与经验的不和谐得分为(48.84±7.59)分,自我的灵活性得分为(41.98±5.53)分,自我的刻板性得分为(21.22±3.75)分,与大学生常模比较差异均有统计学意义(P<0.05).结论 社区医护团队的自我和谐程度偏低,管理部门应加强对社区医护团队的心理健康教育.

  8. Team dynamics, clinical work satisfaction, and patient care coordination between primary care providers: A mixed methods study.

    Science.gov (United States)

    Song, Hummy; Ryan, Molly; Tendulkar, Shalini; Fisher, Josephine; Martin, Julia; Peters, Antoinette S; Frolkis, Joseph P; Rosenthal, Meredith B; Chien, Alyna T; Singer, Sara J

    Team-based care is essential for delivering high-quality, comprehensive, and coordinated care. Despite considerable research about the effects of team-based care on patient outcomes, few studies have examined how team dynamics relate to provider outcomes. The aim of this study was to examine relationships among team dynamics, primary care provider (PCP) clinical work satisfaction, and patient care coordination between PCPs in 18 Harvard-affiliated primary care practices participating in Harvard's Academic Innovations Collaborative. First, we administered a cross-sectional survey to all 548 PCPs (267 attending clinicians, 281 resident physicians) working at participating practices; 65% responded. We assessed the relationship of team dynamics with PCPs' clinical work satisfaction and perception of patient care coordination between PCPs, respectively, and the potential mediating effect of patient care coordination on the relationship between team dynamics and work satisfaction. In addition, we embedded a qualitative evaluation within the quantitative evaluation to achieve a convergent mixed methods design to help us better understand our findings and illuminate relationships among key variables. Better team dynamics were positively associated with clinical work satisfaction and quality of patient care coordination between PCPs. Coordination partially mediated the relationship between team dynamics and satisfaction for attending clinicians, suggesting that higher satisfaction depends, in part, on better teamwork, yielding more coordinated patient care. We found no mediating effects for resident physicians. Qualitative results suggest that sources of satisfaction from positive team dynamics for PCPs may be most relevant to attending clinicians. Improving primary care team dynamics could improve clinical work satisfaction among PCPs and patient care coordination between PCPs. In addition to improving outcomes that directly concern health care providers, efforts to

  9. Transforming care teams to provide the best possible patient-centered, collaborative care.

    Science.gov (United States)

    Sevin, Cory; Moore, Gordon; Shepherd, John; Jacobs, Tracy; Hupke, Cindy

    2009-01-01

    Patient experience of care is now a crucial parameter in assessing the quality of healthcare delivered in the United States. Continuity, patient-driven access to care, and being "known" by a provider or practice, particularly for patients with chronic diseases, have been shown to enhance patient satisfaction with care and health outcomes. Healthcare systems are challenged to effectively meet the wants and needs of patients by tailoring interventions based on each person's unique set factors-his or her strengths, preferences, and personal and social context. Creating care teams, a coordinated multidisciplinary group of healthcare professionals, enables a practice to take advantage of the skill sets represented and redesign care delivery with the patient and community as the focal point. This article describes the attributes of highly functioning care teams, how to measure them, and guidance on creating them. A case example illustrates how these ideas work in practice.

  10. Criteria for successful multiprofessional cooperation in palliative care teams.

    Science.gov (United States)

    Jünger, S; Pestinger, M; Elsner, F; Krumm, N; Radbruch, L

    2007-06-01

    Team work is considered a central component of palliative care. Within this comparatively young field of medicine, the emergence of new institutions (eg, palliative care units) highlights the challenge of establishing a completely new team. This study focuses on the factors, which enhance both the success and outcome criteria of good team work from the perception of team members in a palliative care unit. The palliative care team at the University Hospital of Aachen (n = 19) was interviewed 1 year after the unit's startup by the means of semistructured interviews. Interview texts were analysed using qualitative content analysis. Factors crucial to cooperation in the team members' views were close communication, team philosophy, good interpersonal relationships, high team commitment, autonomy and the ability to deal with death and dying. Moreover, close communication was by far the most frequently mentioned criteria for cooperation. Team performance, good coordination of workflow and mutual trust underpin the evaluation of efficient team work. Inefficient team work is associated with the absence of clear goals, tasks and role delegation, as well as a lack of team commitment. In a new team, close communication is particularly important for staff as they reorientate themselves to the dynamics of a new peer group. The results confirm the overwhelming importance of clarity, commitment and close, positive exchange among team members for successful team work.

  11. [Malpractice in health care teams].

    Science.gov (United States)

    Pizarro, Carlos

    2011-05-01

    To be successful, modern medical acts require the participation of several professionals and assistants and, as such, there has been a steady trend from individual medicine to the collective practice of the profession. This format raises issues in determining when a medical professional or other practitioner is liable for the acts of a colleague. This thesis proposes to resolve the problems involved in the collective practice of medicine by restricting liability to a physician responsible for another practitioner, only to those cases where he/she has been willingly introduced into the medical act.

  12. Helping primary care teams emerge through a quality improvement program.

    Science.gov (United States)

    Hilts, Linda; Howard, Michelle; Price, David; Risdon, Cathy; Agarwal, Gina; Childs, Anne

    2013-04-01

    Approaches to improving the quality of health care recognize the need for systems and cultures that facilitate optimal care. Interpersonal relationships and dynamics are a key factor in transforming a system to one that can achieve quality. The Quality in Family Practice (QIFP) program encompasses clinical and practice management using a comprehensive tool of family practice indicators. The objective of this study was to explore and describe the views of staff regarding changes in the clinical practice environment at two affiliated academic primary care clinics (comprising one Family Health Team, FHT) who participated in QIFP. An FHT in Hamilton, Canada, worked through the quality tool in 2008/2009. A qualitative exploratory case study approach was employed to examine staff perceptions of the process of participating. Semi-structured interviews were conducted in early 2010 with 43 FHT staff with representation from physicians, nurses, allied health professionals, support staff and managers. Interviews were audio-taped and transcribed verbatim. A modified template approach was used for coding, with a complexity theory perspective of analysis. Themes included importance of leadership, changes to practice environment, changes to communication, an increased understanding of team roles and relationships, strengthened teamwork, flattening of hierarchy through empowerment, changes in clinical care and clinical impacts, challenges and rewards and sustainability. The program resulted in perceived changes to relationships, teamwork and morale. Addressing issues of leadership, role clarity, empowerment, flattening of hierarchy and teamwork may go a long way in establishing and maintaining a quality culture.

  13. Team care of type 2 diabetes mellitus in Taiwan.

    Science.gov (United States)

    Wang, Chih-Yuan; Yu, Neng-Chun; Sheu, Wayne Huey-Herng; Tsai, Shih-Tzer; Tai, Tong-Yuan

    2014-12-01

    Type 2 diabetes mellitus (T2DM) is a global health-care and national policy issue. As fluctuating glycemic control in diabetes often results in serious complications, we must encourage the diabetes educators' efforts at long-term follow-up among patients with T2DM. Therefore, certified diabetes educators (CDEs) play the most pivotal roles as life-long protectors for patients with T2DM. In the past 15 years, more than 4,000 CDEs have been trained and qualified, including health professionals such as physicians, nurses, dieticians, and pharmacists. The most important initiation of diabetes share care in Taiwan was originated in I-Lan County. Initiated to provide regional diabetes care, the name of this program is the Lan-Yang Diabetes Shared Care System. In 2006, the Taiwanese Association of Diabetes Educators (TADE) carried out a nationwide survey to evaluate the status of diabetes control in Taiwan, focusing on the "ABC" goal (A: HbA1c Five years later, in 2011, TADE compared two nationwide surveys and found total ABC attainment rates of 4.1% and 8.6%, respectively. The team-care approach to T2DM has been underway for over 20 years in Taiwan. Future interventions and treatment algorithms with team-based education should aim at preventing acute and chronic complications, which remains a long-term challenge in Taiwan.

  14. Cooperating with a palliative home-care team

    DEFF Research Database (Denmark)

    Goldschmidt, Dorthe; Groenvold, Mogens; Johnsen, Anna Thit;

    2005-01-01

    BACKGROUND: Palliative home-care teams often cooperate with general practitioners (GPs) and district nurses. Our aim was to evaluate a palliative home-care team from the viewpoint of GPs and district nurses. METHODS: GPs and district nurses received questionnaires at the start of home-care and one...... by 91 %, mainly due to improvement in symptom management, 'security', and accessibility of specialists in palliative care. After one month, 57% of the participants reported to have learnt aspects of palliative care, primarily symptom control, and 89% of them found cooperation satisfactory....... Dissatisfaction was caused mainly by lack of information from the home-care team to primary-care professionals. CONCLUSION: GPs and district nurses welcomed the palliative home-care team and most experienced benefits to patients. Strengthened communication, initiated by the home-care team would enhance...

  15. Regional Primary Care Team to Deliver Best-Practice Diabetes Care

    Science.gov (United States)

    Segal, Leonie; Leach, Matthew J.; May, Esther; Turnbull, Catherine

    2013-01-01

    OBJECTIVE Best-practice diabetes care can reduce the burden of diabetes and associated health care costs. But this requires access to a multidisciplinary team with the right skill mix. We applied a needs-driven evidence-based health workforce model to describe the primary care team required to support best-practice diabetes care, paying particular attention to diverse clinic populations. RESEARCH DESIGN AND METHODS Care protocols, by number and duration of consultations, were derived for twenty distinct competencies based on clinical practice guidelines and structured input from a multidisciplinary clinical panel. This was combined with a previously estimated population profile of persons across 26 patient attributes (i.e., type of diabetes, complications, and threats to self-care) to estimate clinician contact hours by competency required to deliver best-practice care in the study region. RESULTS A primary care team of 22.1 full-time-equivalent (FTE) positions was needed to deliver best-practice primary care to a catchment of 1,000 persons with diabetes with the attributes of the Australian population. Competencies requiring greatest contact time were psychosocial issues and dietary advice at 3.5 and 3.3 FTE, respectively (1 FTE/∼300 persons); home (district) nursing at 3.2 FTE; and diabetes education at 2.8 FTE. The annual cost of delivering care was estimated at just over 2,000 Australian dollars (∼2,090 USD) (2012) per person with diabetes. CONCLUSIONS A needs-driven approach to primary care service planning identified a wider range of competencies in the diabetes primary and community care team than typically described. Access to psychosocial competences as well as medical management is required if clinical targets are to be met, especially in disadvantaged groups. PMID:23393210

  16. Analyzing the Interprofessional Working of a Home-Based Primary Care Team.

    Science.gov (United States)

    Smith-Carrier, Tracy; Neysmith, Sheila

    2014-09-01

    Increasingly, interprofessional teams are responsible for providing integrated health care services. Effective teams, however, are not the result of chance but require careful planning and ongoing attention to team processes. Based on a case study involving interviews, participant observation, and a survey, we identified key attributes for effective interprofessional working (IPW) within a home-based primary care (HBPC) setting. Recognizing the importance of a theoretical model that reflects the multidimensional nature of team effectiveness research, we employed the integrated team effectiveness model to analyze our findings. The results indicated that a shared vision, common goals, respect, and trust among team members – as well as processes for ongoing communication, effective leadership, and mechanisms for conflict resolution – are vital in the development of a high-functioning IPW team. The ambiguity and uncertainty surrounding the context of service provision (clients' homes), as well the negotiation of external relationships in the HBPC field, require further investigation.

  17. Effects of Primary Care Team Social Networks on Quality of Care and Costs for Patients With Cardiovascular Disease

    Science.gov (United States)

    Mundt, Marlon P.; Gilchrist, Valerie J.; Fleming, Michael F.; Zakletskaia, Larissa I.; Tuan, Wen-Jan; Beasley, John W.

    2015-01-01

    PURPOSE Cardiovascular disease is the leading cause of mortality and morbidity in the United States. Primary care teams can be best suited to improve quality of care and lower costs for patients with cardiovascular disease. This study evaluates the associations between primary care team communication, interaction, and coordination (ie, social networks); quality of care; and costs for patients with cardiovascular disease. METHODS Using a sociometric survey, 155 health professionals from 31 teams at 6 primary care clinics identified with whom they interact daily about patient care. Social network analysis calculated variables of density and centralization representing team interaction structures. Three-level hierarchical modeling evaluated the link between team network density, centralization, and number of patients with a diagnosis of cardiovascular disease for controlled blood pressure and cholesterol, counts of urgent care visits, emergency department visits, hospital days, and medical care costs in the previous 12 months. RESULTS Teams with dense interactions among all team members were associated with fewer hospital days (rate ratio [RR] = 0.62; 95% CI, 0.50–0.77) and lower medical care costs (−$556; 95% CI, −$781 to −$331) for patients with cardiovascular disease. Conversely, teams with interactions revolving around a few central individuals were associated with increased hospital days (RR = 1.45; 95% CI, 1.09–1.94) and greater costs ($506; 95% CI, $202–$810). Team-shared vision about goals and expectations mediated the relationship between social network structures and patient quality of care outcomes. CONCLUSIONS Primary care teams that are more interconnected and less centralized and that have a shared team vision are better positioned to deliver high-quality cardiovascular disease care at a lower cost. PMID:25755035

  18. Team management in community mental health.

    Science.gov (United States)

    McGuinness, M

    2000-02-01

    The community mental health team is now the established model for mental health service delivery in the community. Managing CMHTs requires a diverse range of managerial skills, role clarity and authority. More research needs to be undertaken on the role and effectiveness of the CMHT manager.

  19. Interdisciplinary care team adoption of electronic point-of-care documentation systems: an unrealized opportunity.

    Science.gov (United States)

    Sockolow, Paulina S; Bowles, Kathryn H; Rogers, Michelle; Adelsberger, Marguerite C; Chittams, Jesse L; Liao, Cindy

    2013-01-01

    We conducted three health care evaluation studies in community and hospital settings to examine adoption of point-of-care documentation systems among interdisciplinary care team clinicians. Both community studies used a mixed methods design to assess actual system usage and clinician satisfaction. In the hospitals, scenario testing was used. Results indicated clinician adoption of the systems was universal, although not always timely with: (1) a mismatch between system functionality and workflow which was a barrier to clinician system access during patient care and reduced clinician efficiency; (2) no increase in interdisciplinary team communication; and (3) no impact on patient outcomes identified by clinicians. To facilitate adoption, clinicians should see the value of using the system as intended by receiving patient care and patient safety feedback that uses system data.

  20. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    the_monk

    payment for health care services; a widely used strategy to supplement ... and opportunities for sustainable health care financing for low income communities in sub-. Saharan ..... funding and rising costs for health care services, More so, evidence from research studies have ... provider payment method has the potential to.

  1. Organizational Learning in Health Care Organizations

    Directory of Open Access Journals (Sweden)

    Savithiri Ratnapalan

    2014-02-01

    Full Text Available The process of collective education in an organization that has the capacity to impact an organization’s operations, performance and outcomes is called organizational learning. In health care organizations, patient care is provided through one or more visible and invisible teams. These teams are composed of experts and novices from diverse backgrounds working together to provide coordinated care. The number of teams involved in providing care and the possibility of breakdowns in communication and coordinated care increases in direct proportion to sophisticated technology and treatment strategies of complex disease processes. Safe patient care is facilitated by individual professional learning; inter-professional team learning and system based organizational learning, which encompass modified context specific learning by multiple teams and team members in a health care organization. Organizational learning in health care systems is central to managing the learning requirements in complex interconnected dynamic systems where all have to know common background knowledge along with shared meta-knowledge of roles and responsibilities to execute their assigned functions, communicate and transfer the flow of pertinent information and collectively provide safe patient care. Organizational learning in health care is not a onetime intervention, but a continuing organizational phenomenon that occurs through formal and informal learning which has reciprocal association with organizational change. As such, organizational changes elicit organizational learning and organizational learning implements new knowledge and practices to create organizational changes.

  2. Teamwork education improves trauma team performance in undergraduate health professional students.

    Science.gov (United States)

    Baker, Valerie O'Toole; Cuzzola, Ronald; Knox, Carolyn; Liotta, Cynthia; Cornfield, Charles S; Tarkowski, Robert D; Masters, Carolynn; McCarthy, Michael; Sturdivant, Suzanne; Carlson, Jestin N

    2015-01-01

    Effective trauma resuscitation requires efficient and coordinated care from a team of providers; however, providers are rarely instructed on how to be effective members of trauma teams. Team-based learning using Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) has been shown to improve team dynamics among practicing professionals, including physicians and nurses. The impact of TeamSTEPPS on students being trained in trauma management in an undergraduate health professional program is currently unknown. We sought to determine the impact of TeamSTEPPS on team dynamics among undergraduate students being trained in trauma resuscitation. We enrolled teams of undergraduate health professional students from four programs: nursing, physician assistant, radiologic science, and respiratory care. After completing an online training on trauma resuscitation principles, the participants completed a trauma resuscitation scenario. The participants then received teamwork training using TeamSTEPPS and completed a second trauma resuscitation scenario identical to the first. All resuscitations were recorded and scored offline by two blinded research assistants using both the Team Emergency Assessment Measure (TEAM) and Trauma Team Performance Observation Tool (TPOT) scoring systems. Pre-test and post-test TEAM and TPOT scores were compared. We enrolled a total of 48 students in 12 teams. Team leadership, situational monitoring, and overall communication improved with TeamSTEPPS training (P=0.04, P=0.02, and P=0.03, respectively), as assessed by the TPOT scoring system. TeamSTEPPS also improved the team's ability to prioritize tasks and work together to complete tasks in a rapid manner (PTEAM. Incorporating TeamSTEPPS into trauma team education leads to improved TEAM and TPOT scores among undergraduate health professionals.

  3. Wound-care teams for preventing and treating pressure ulcers.

    Science.gov (United States)

    Moore, Zena E H; Webster, Joan; Samuriwo, Ray

    2015-09-16

    Pressure ulcers, which are localised injury to the skin or underlying tissue, or both, occur when people are unable to reposition themselves to relieve pressure on bony prominences. Pressure ulcers are often difficult to heal, painful and impact negatively on the individual's quality of life. The cost implications of pressure ulcer treatment are considerable, compounding the challenges in providing cost effective, efficient health service delivery. International guidelines suggest that to prevent and manage pressure ulcers successfully a team approach is required. Therefore, this review has been conducted to clarify the role of wound-care teams in the prevention and management of pressure ulcers. To assess the impact of wound-care teams in preventing and treating pressure ulcers in people of any age, nursed in any healthcare setting. In April 2015 we searched: The Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE and EBSCO CINAHL. There were no restrictions with respect to language, date of publication or study setting. We considered RCTs that evaluated the effect of any configuration of wound-care teams in the treatment or prevention of pressure ulcers. Two review authors independently assessed titles and, where available, abstracts of the studies identified by the search strategy for their eligibility. We obtained full versions of potentially relevant studies and two review authors independently screened these against the inclusion criteria. We identified no studies that met the inclusion criteria. We set out to evaluate the RCT evidence pertaining to the impact of wound-care teams on the prevention and management of pressure ulcers. However, no studies met the inclusion criteria. There is a lack of evidence concerning whether wound-care teams make a difference to the incidence or healing of pressure

  4. Implementing UK Autism Policy & National Institute for Health and Care Excellence Guidance--Assessing the Impact of Autism Training for Frontline Staff in Community Learning Disabilities Teams

    Science.gov (United States)

    Clark, Alex; Browne, Sarah; Boardman, Liz; Hewitt, Lealah; Light, Sophie

    2016-01-01

    UK National Autism Strategy (Department of Health, 2010 and National Institute for Health and Care Excellence guidance (NICE, 2012) states that frontline staff should have a good understanding of Autism. Fifty-six clinical and administrative staff from a multidisciplinary community Learning Disability service completed an electronic questionnaire…

  5. Primary care team working in Ireland: a qualitative exploration of team members' experiences in a new primary care service.

    Science.gov (United States)

    Kennedy, Norelee; Armstrong, Claire; Woodward, Oonagh; Cullen, Walter

    2015-07-01

    Team working is an integral aspect of primary care, but barriers to effective team working can limit the effectiveness of a primary care team (PCT). The establishment of new PCTs in Ireland provides an excellent opportunity to explore team working in action. The aim of this qualitative study was to explore the experiences of team members working in a PCT. Team members (n = 19) from two PCTs were interviewed from May to June 2010 using a semi-structured interview guide. All interviews were audio-recorded and transcribed. Data were analysed using NVivo (version 8). Thematic analysis was used to explore the data. We identified five main themes that described the experiences of the team members. The themes were support for primary care, managing change, communication, evolution of roles and benefits of team working. Team members were generally supportive of primary care and had experienced benefits to their practice and to the care of their patients from participation in the team. Regular team meetings enabled communication and discussion of complex cases. Despite the significant scope for role conflict due to the varied employment arrangements of the team members, neither role nor interpersonal conflict was evident in the teams studied. In addition, despite the unusual team structure in Irish PCTs - where there is no formally appointed team leader or manager - general issues around team working and its benefits and challenges were very similar to those found in other international studies. This suggests, in contrast to some studies, that some aspects of the leadership role may not be as important in successful PCT functioning as previously thought. Nonetheless, team leadership was identified as an important issue in the further development of the teams.

  6. Supporting recovery in patients with psychosis through care by community-based adult mental health teams (REFOCUS): a multisite, cluster, randomised, controlled trial.

    Science.gov (United States)

    Slade, Mike; Bird, Victoria; Clarke, Eleanor; Le Boutillier, Clair; McCrone, Paul; Macpherson, Rob; Pesola, Francesca; Wallace, Genevieve; Williams, Julie; Leamy, Mary

    2015-06-01

    Mental health policy in many countries is oriented around recovery, but the evidence base for service-level recovery-promotion interventions is lacking. We did a cluster, randomised, controlled trial in two National Health Service Trusts in England. REFOCUS is a 1-year team-level intervention targeting staff behaviour to increase focus on values, preferences, strengths, and goals of patients with psychosis, and staff-patient relationships, through coaching and partnership. Between April, 2011, and May, 2012, community-based adult mental health teams were randomly allocated to provide usual treatment plus REFOCUS or usual treatment alone (control). Baseline and 1-year follow-up outcomes were assessed in randomly selected patients. The primary outcome was recovery and was assessed with the Questionnaire about Processes of Recovery (QPR). We also calculated overall service costs. We used multiple imputation to estimate missing data, and the imputation model captured clustering at the team level. Analysis was by intention to treat. This trial is registered, number ISRCTN02507940. 14 teams were included in the REFOCUS group and 13 in the control group. Outcomes were assessed in 403 patients (88% of the target sample) at baseline and in 297 at 1 year. Mean QPR total scores did not differ between the two groups (REFOCUS group 40·6 [SD 10·1] vs control 40·0 [10·2], adjusted difference 0·68, 95% CI -1·7 to 3·1, p=0·58). High team participation was associated with higher staff-rated scores for recovery-promotion behaviour change (adjusted difference -0·4, 95% CI -0·7 to -0·2, p=0·001) and patient-rated QPR interpersonal scores (-1·6, -2·7 to -0·5, p=0·005) at follow-up than low participation. Patients treated in the REFOCUS group incurred £1062 (95% CI -1103 to 3017) lower adjusted costs than those in the control group. Although the primary endpoint was negative, supporting recovery might, from the staff perspective, improve functioning and reduce needs

  7. Self-reported teamwork in family health team practices in Ontario: organizational and cultural predictors of team climate.

    Science.gov (United States)

    Howard, Michelle; Brazil, Kevin; Akhtar-Danesh, Noori; Agarwal, Gina

    2011-05-01

    To determine the organizational predictors of higher scores on team climate measures as an indicator of the functioning of a family health team (FHT). Cross-sectional study using a mailed survey. Family health teams in Ontario. Twenty-one of 144 consecutively approached FHTs; 628 team members were surveyed. Scores on the team climate inventory, which assessed organizational culture type (group, developmental, rational, or hierarchical); leadership perceptions; and organizational factors, such as use of electronic medical records (EMRs), team composition, governance of the FHT, location, meetings, and time since FHT initiation. All analyses were adjusted for clustering of respondents within the FHT using a mixed random-intercepts model. The response rate was 65.8% (413 of 628); 2 were excluded from analysis, for a total of 411 participants. At the time of survey completion, there was a median of 4 physicians, 11 other health professionals, and 4 management and clerical staff per FHT. The average team climate score was 3.8 out of a possible 5. In multivariable regression analysis, leadership score, group and developmental culture types, and use of more EMR capabilities were associated with higher team climate scores. Other organizational factors, such as number of sites and size of group, were not associated with the team climate score. Culture, leadership, and EMR functionality, rather than organizational composition of the teams (eg, number of professionals on staff, practice size), were the most important factors in predicting climate in primary care teams.

  8. Multidisciplinary team approach to improved chronic care management for diabetic patients in an urban safety net ambulatory care clinic.

    Science.gov (United States)

    Tapp, Hazel; Phillips, Shay E; Waxman, Dael; Alexander, Matthew; Brown, Rhett; Hall, Mary

    2012-01-01

    Since the care of patients with multiple chronic diseases such as diabetes and depression accounts for the majority of health care costs, effective team approaches to managing such complex care in primary care are needed, particularly since psychosocial and physical disorders coexist. Uncontrolled diabetes is a leading health risk for morbidity, disability and premature mortality with between 18-31% of patients also having undiagnosed or undertreated depression. Here we describe a team driven approach that initially focused on patients with poorly controlled diabetes (A1c > 9) that took place at a family medicare office. The team included: resident and faculty physicians, a pharmacist, social worker, nurses, behavioral medicine interns, office scheduler, and an information technologist. The team developed immediate integrative care for diabetic patients during routine office visits.

  9. Health care operations management

    NARCIS (Netherlands)

    Carter, M.W.; Hans, Elias W.; Kolisch, R.

    2012-01-01

    Health care operations management has become a major topic for health care service providers and society. Operations research already has and further will make considerable contributions for the effective and efficient delivery of health care services. This special issue collects seven carefully

  10. The 'Dream Team' for sexual, reproductive, maternal, newborn and adolescent health: an adjusted service target model to estimate the ideal mix of health care professionals to cover population need.

    Science.gov (United States)

    Ten Hoope-Bender, Petra; Nove, Andrea; Sochas, Laura; Matthews, Zoë; Homer, Caroline S E; Pozo-Martin, Francisco

    2017-07-04

    A competent, enabled and efficiently deployed health workforce is crucial to the achievement of the health-related sustainable development goals (SDGs). Methods for workforce planning have tended to focus on 'one size fits all' benchmarks, but because populations vary in terms of their demography (e.g. fertility rates) and epidemiology (e.g. HIV prevalence), the level of need for sexual, reproductive, maternal, newborn and adolescent health (SRMNAH) workers also varies, as does the ideal composition of the workforce. In this paper, we aim to provide proof of concept for a new method of workforce planning which takes into account these variations, and allocates tasks to SRMNAH workers according to their competencies, so countries can assess not only the needed size of the SRMNAH workforce, but also its ideal composition (the 'Dream Team'). An adjusted service target model was developed, to estimate (i) the amount of health worker time needed to deliver essential SRMNAH care, and (ii) how many workers from different cadres would be required to meet this need if tasks were allocated according to competencies. The model was applied to six low- and middle-income countries, which varied in terms of current levels of need for health workers, geographical location and stage of economic development: Azerbaijan, Malawi, Myanmar, Peru, Uzbekistan and Zambia. Countries with high rates of fertility and/or HIV need more SRMNAH workers (e.g. Malawi and Zambia each need 44 per 10,000 women of reproductive age, compared with 20-27 in the other four countries). All six countries need between 1.7 and 1.9 midwives per 175 births, i.e. more than the established 1 per 175 births benchmark. There is a need to move beyond universal benchmarks for SRMNAH workforce planning, by taking into account demography and epidemiology. The number and range of workers needed varies according to context. Allocation of tasks according to health worker competencies represents an efficient way to allocate

  11. Interprofessional Teamwork and Collaboration Between Community Health Workers and Healthcare Teams

    OpenAIRE

    Franklin, Catherine M.; Jean M. Bernhardt; Ruth Palan Lopez; Ellen R. Long-Middleton; Sheila Davis

    2015-01-01

    Objectives: Community Health Workers (CHWs) serve as a means of improving outcomes for underserved populations. However, their relationship within health care teams is not well studied. The purpose of this integrative review was to examine published research reports that demonstrated positive health outcomes as a result of CHW intervention to identify interprofessional teamwork and collaboration between CHWs and health care teams. Methods: A total of 47 studies spanning 33 years were reviewed...

  12. Interprofessional Teamwork and Collaboration Between Community Health Workers and Healthcare Teams

    OpenAIRE

    Catherine M. Franklin; Jean M. Bernhardt; Ruth Palan Lopez; Ellen R. Long-Middleton; Sheila Davis

    2015-01-01

    Objectives: Community Health Workers (CHWs) serve as a means of improving outcomes for underserved populations. However, their relationship within health care teams is not well studied. The purpose of this integrative review was to examine published research reports that demonstrated positive health outcomes as a result of CHW intervention to identify interprofessional teamwork and collaboration between CHWs and health care teams. Methods: A total of 47 studies spanning 33 years were reviewed...

  13. [The role of the mobile palliative care team nurse].

    Science.gov (United States)

    Chrétien, Sophie

    2015-11-01

    The mobile palliative care and support team nurse works in different departments within the hospital. The clinical situation of a patient enables the team to identify in what ways she is declining and thereby participate in the care management in order to favour the patient's return home.

  14. The multidisciplinary team in palliative care: A case reflection

    Directory of Open Access Journals (Sweden)

    Liza Bowen

    2014-01-01

    Full Text Available This essay is a reflection on the multidisciplinary team in palliative care, from the perspective of a final year MBBS student from the UK spending one month with an Indian pain and palliative care team at Institute Rotary Cancer Hospital (IRCH, AIIMS, New Delhi.

  15. Spina Bifida: Guidelines of Care for Children with Special Health Care Needs.

    Science.gov (United States)

    Minnesota State Dept. of Health, Minneapolis. Services for Children with Handicaps.

    These guidelines were written to help families coordinate the health care that may be needed by a child with spina bifida. The booklet begins with general information about spina bifida. It then discusses the goals of health care, the health care team, the importance of periodic health care, and record keeping procedures. The child's health care…

  16. National Health Care Survey

    Science.gov (United States)

    This survey encompasses a family of health care provider surveys, including information about the facilities that supply health care, the services rendered, and the characteristics of the patients served.

  17. [Involvement of medical representatives in team medical care].

    Science.gov (United States)

    Hirotsu, Misaki; Sohma, Michiro; Takagi, Hidehiko

    2009-04-01

    In recent years, chemotherapies have been further advanced because of successive launch of new drugs, introduction of molecular targeting, etc., and the concept of so-called Team Medical Care ,the idea of sharing interdisciplinary expertise for collaborative treatment, has steadily penetrated in the Japanese medical society. Dr. Naoto Ueno is a medical oncologist at US MD Anderson Cancer Center, the birthplace of the Team Medical Care. He has advocated the concept of ABC of Team Oncology by positioning pharmaceutical companies as Team C. Under such team practice, we believe that medical representatives of a pharmaceutical company should also play a role as a member of the Team Medical Care by providing appropriate drug use information to healthcare professionals, supporting post-marketing surveillance of treated patients, facilitating drug information sharing among healthcare professionals at medical institutions, etc.

  18. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    the_monk

    Department of Community Health & Primary Care, College of Medicine, University of Lagos, Idi-Araba, P.M.B. ... the child's health, culturally based beliefs and ..... immunization safety as this was a rural ... Charles SW, Olalekan AU, Peter MN,.

  19. 'The unknown becomes the known': collective learning and change in primary care teams.

    Science.gov (United States)

    Bunniss, Suzanne; Kelly, Diane R

    2008-12-01

    The growing emphasis on teamwork within the National Health Service (NHS) has made it a priority to understand how health care teams learn together and cope with change. This study aimed to explore how collective learning and change happen in primary care teams and how the process varies across the disciplines of general medical practice, pharmacy and dentistry. This study reports on qualitative data gathered from 10 primary care teams over 1 year, by means of observational visits and 38 semi-structured interviews. Informal collective learning is a powerful team coping mechanism that develops through experiential, evolving and implicit learning processes. These processes are predominantly relational in that they rely on the extent to which team members know and understand one another as people. This makes shared learning an effective but 'messy' dynamic, the motivation for which is internally generated by the team itself. Teams report that if they cannot learn together, they cannot meet patient needs. These findings demonstrate that teams share their knowledge because they believe it has value, not because they are driven by external incentives or are monitored. This challenges the prevailing assumption that, to be effective, interprofessional learning should be externally managed. As health care develops, it will become increasingly important to consider how to support the internal learning processes of care teams as they navigate complex organisational changes and the shared learning experiences that characterise those changes. Those who support learning and development within the NHS should therefore focus on how relational processes, as well as educational content, contribute to a team's collective learning capability and the quality of care its members provide.

  20. Crisis management teams in health organisations.

    Science.gov (United States)

    Canyon, Deon V

    2012-01-01

    Crisis management teams (CMT) are necessary to ensure adequate and appropriate crisis management planning and response to unforeseen, adverse events. This study investigated the existence of CMTs, the membership of CMTs, and the degree of training received by CMTs in Australian health and allied health organisations. This cross-sectional study draws on data provided by executive decision makers in a broad selection of health and allied health organisations. Crisis management teams were found in 44.2 per cent of the health-related organisations surveyed, which is ten per cent lower than the figure for business organisations. Membership of these CMTs was not ideal and did not conform to standard CMT membership profiles. Similarly, the extent of crisis management training in health-related organisations is 20 per cent lower than the figure for business organisations. If organisations do not become pro-active in their crisis management practices, the onus is on government to improve the situation through regulation and the provision of more physical, monetary and skill resources to ensure that the health services of Australia are sufficiently prepared to respond to adverse events.

  1. Congenital Heart Disease: Guidelines of Care for Children with Special Health Care Needs.

    Science.gov (United States)

    Minnesota State Dept. of Health, Minneapolis. Services for Children with Handicaps.

    These guidelines were written to help families coordinate the health care that may be needed by a child with congenital heart disease. The booklet begins with general information about congenital heart disease. It then discusses the goals of health care, the health care team, the importance of periodic health care, and record keeping procedures.…

  2. "They have no idea of what we do or what we know": Australian graduates' perceptions of working in a health care team.

    Science.gov (United States)

    Ebert, Lyn; Hoffman, Kerry; Levett-Jones, Tracy; Gilligan, Conor

    2014-09-01

    Globally it has been suggested that interprofessional education can lead to improvements in patient safety as well as increased job satisfaction and understanding of professional roles and responsibilities. In many health care facilities staff report being committed to working collaboratively, however their practice does not always reflect their voiced ideologies. The inability to work effectively together can, in some measure, be attributed to a lack of knowledge and respect for others' professional roles, status and boundaries. In this paper, we will report on the findings of an interpretative study undertaken in Australia, focussing specifically on the experiences of new graduate nurses, doctors and pharmacists in relation to 'knowing about' and 'working with' other health care professionals. Findings indicated there was little understanding of the roles of other health professionals and this impacted negatively on communication and collaboration between and within disciplines. Furthermore, most new graduates recall interprofessional education as intermittent, largely optional, non-assessable, and of little value in relation to their roles, responsibilities and practice as graduate health professionals. Interprofessional education needs to be integrated into undergraduate health programs with an underlying philosophy of reciprocity, respect and role valuing, in order to achieve the proposed benefits for staff and patients.

  3. Interprofessional learning objectives for health team simulations.

    Science.gov (United States)

    Greidanus, Elaine; King, Sharla; LoVerso, Tatiana; Ansell, L Dawn

    2013-06-01

    Interprofessional health team simulations are often developed using learning objectives that relate to competency statements. Educators then assume these learning objectives are relevant to students participating in the simulation. However, evaluating the link between learning objectives and outcomes is often difficult in authentic simulation environments with multiple human factors. This article suggests one process for revising learning objectives based on review of the simulation, the debriefing, and the student feedback on reported learning. Implications for curriculum integration are discussed. Copyright 2013, SLACK Incorporated.

  4. Conditional shared confidentiality in mental health care.

    Science.gov (United States)

    Liégeois, Axel; Eneman, Marc

    2015-05-01

    Because of the development towards community care, care providers not only exchange information in a team, but increasingly also in networks. This is a challenge to confidentiality. The ethical question is how care providers can keep information about the care receiver confidential, whilst at the same time exchanging information about that care receiver in a team or network? Can shared confidentiality be extended from a team to a network? To clarify this question, the article refers to the advice of an expert ethics committee in mental health care. The advice regards exchange of information in a network as a further step in enhancing collaboration among care providers. Therefore, the good and evident practice of shared confidentiality in a team can be extended to a network if the same conditions are met. First, the care providers participate in a clearly defined and identifiable team or network. Secondly, they have a shared care responsibility. Thirdly, they have a duty of confidentiality. Fourth, they dialogue with the care receiver and obtain his or her consent. Finally, they apply the filter of relevance. Hence, conditional shared confidentiality is an ethical justification for the exchange of information in a team or network.

  5. Skill mix, roles and remuneration in the primary care workforce: who are the healthcare professionals in the primary care teams across the world?

    Science.gov (United States)

    Freund, Tobias; Everett, Christine; Griffiths, Peter; Hudon, Catherine; Naccarella, Lucio; Laurant, Miranda

    2015-03-01

    World-wide, shortages of primary care physicians and an increased demand for services have provided the impetus for delivering team-based primary care. The diversity of the primary care workforce is increasing to include a wider range of health professionals such as nurse practitioners, registered nurses and other clinical staff members. Although this development is observed internationally, skill mix in the primary care team and the speed of progress to deliver team-based care differs across countries. This work aims to provide an overview of education, tasks and remuneration of nurses and other primary care team members in six OECD countries. Based on a framework of team organization across the care continuum, six national experts compare skill-mix, education and training, tasks and remuneration of health professionals within primary care teams in the United States, Canada, Australia, England, Germany and the Netherlands. Nurses are the main non-physician health professional working along with doctors in most countries although types and roles in primary care vary considerably between countries. However, the number of allied health professionals and support workers, such as medical assistants, working in primary care is increasing. Shifting from 'task delegation' to 'team care' is a global trend but limited by traditional role concepts, legal frameworks and reimbursement schemes. In general, remuneration follows the complexity of medical tasks taken over by each profession. Clear definitions of each team-member's role may facilitate optimally shared responsibility for patient care within primary care teams. Skill mix changes in primary care may help to maintain access to primary care and quality of care delivery. Learning from experiences in other countries may inspire policy makers and researchers to work on efficient and effective teams care models worldwide. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

  6. Adaptive practices in heart failure care teams: implications for patient-centered care in the context of complexity

    Directory of Open Access Journals (Sweden)

    Tait GR

    2015-08-01

    Full Text Available Glendon R Tait,1 Joanna Bates,2 Kori A LaDonna,3 Valerie N Schulz,4 Patricia H Strachan,5 Allan McDougall,3 Lorelei Lingard3 1Department of Psychiatry and Division of Medical Education, Dalhousie University, Halifax, NS, 2Centre for Health Education Scholarship, Vancouver General Hospital, Vancouver, BC, 3Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, 4Palliative Care, London Health Sciences Centre, University Hospital, London; 5School of Nursing, McMaster University, Hamilton, ON, Canada Background: Heart failure (HF, one of the three leading causes of death, is a chronic, progressive, incurable disease. There is growing support for integration of palliative care’s holistic approach to suffering, but insufficient understanding of how this would happen in the complex team context of HF care. This study examined how HF care teams, as defined by patients, work together to provide care to patients with advanced disease. Methods: Team members were identified by each participating patient, generating team sampling units (TSUs for each patient. Drawn from five study sites in three Canadian provinces, our dataset consists of 209 interviews from 50 TSUs. Drawing on a theoretical framing of HF teams as complex adaptive systems (CAS, interviews were analyzed using the constant comparative method associated with constructivist grounded theory. Results: This paper centers on the dominant theme of system practices, how HF care delivery is reported to work organizationally, socially, and practically, and describes two subthemes: “the way things work around here”, which were commonplace, routine ways of doing things, and “the way we make things work around here”, which were more conscious, effortful adaptations to usual practice in response to emergent needs. An adaptive practice, often a small alteration to routine, could have amplified effects beyond those intended by the innovating team

  7. Geriatrics, interprofessional practice, and interorganizational collaboration: a knowledge-to-practice intervention for primary care teams.

    Science.gov (United States)

    Ryan, David; Barnett, Robert; Cott, Cheryl; Dalziel, William; Gutmanis, Iris; Jewell, David; Kelley, Mary Lou; Liu, Barbara; Puxty, John

    2013-01-01

    Caring for frail seniors requires health professionals with skills and knowledge in 3 core competencies: geriatrics, interprofessional practice, and interorganizational collaboration. Despite a growing population of frail seniors in all developed countries, significant gaps exist in preparation of health professionals in these skills. To help close these gaps, a knowledge-to-practice (KTP) process was undertaken to increase the capacity of newly created family health teams and longer standing Community Health Centers in the Province of Ontario, Canada. Each team identified a staff member to become its facilitator in the 3 core skill sets. Guided by a KTP framework, a set of training modules were created, compiled into a digital toolkit for transfer into practice, translated in a multimethods workshop, and implemented using a variety of strategies to optimize practice change. Staff from 82% of the targeted primary care teams learned to use the toolkit in a train-the-facilitator process that was highly valued, and prompted a range of changes in personal and team practice. A digital toolkit for primary care teams remains an enduring and often used resource. Closing the knowledge gap in the core competencies for frailty focused care is complex. A KTP framework helped guide a staged multimethod process that produced both individual and team practice change and on online toolkit that has a continuing influence. Copyright © 2013 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.

  8. Understanding Cleft and Craniofacial Team Care

    Science.gov (United States)

    ... Donor Spotlight Fundraising Ideas Vehicle Donation Volunteer Efforts Cleft Lip/Palate & Craniofacial Specialists in Your Area skip to submenu Parents & Individuals Cleft Lip/Palate & Craniofacial Specialists in Your Area Team Disclaimer States: ...

  9. The RCGP Quality Practice Award for primary care teams.

    Science.gov (United States)

    Ring, Nicola

    2003-03-01

    Accreditation is a means of improving quality through the process of externally reviewing performance against written standards. Following the introduction of clinical governance, participation in quality accreditation schemes has been encouraged. The Royal College of General Practitioners' Quality Practice Award (QPA) is an example of a quality accreditation scheme for primary care practice teams. QPA applies to the wider primary care team and is directly relevant to nursing and midwifery staff employed by or attached to practice teams. QPA supports evidence-based and reflective practice, continuing professional development and team working, all of which are integral to current nursing and midwifery practice. Nurses and midwives working in primary care teams must be aware of QPA and, where necessary, actively and collaboratively participate in this process.

  10. Care planning and decision-making in teams in Swedish elderly care: a study of interprofessional collaboration and professional boundaries.

    Science.gov (United States)

    Duner, Anna

    2013-05-01

    In front-line practice, joint working between different professionals in health/social care and rehabilitation is regarded as a means to reach a comprehensive assessment of the needs of the older care recipients, leading to decisions on appropriate care and services. The aim of this study was to examine professional collaboration and professional boundaries in interprofessional care planning teams. Two different care planning teams were studied, one performing care planning in the homes of older individuals and the other performing care planning for older people in hospital wards. The empirical data consisted of audio-recorded care planning meetings and interviews with the professionals in the teams. The integration between the professionals involved was most noticeable in the investigation and assessment phase, while it was lower in the planning phase and almost non-existent in decision-making. The home care planning team tended to work in a more integrated manner than the discharge planning team. The importance of clarifying the roles of all professions concerned with needs assessment and care planning for older people became evident in this study.

  11. Team meetings in specialist palliative care: Asking questions as a strategy within interprofessional interaction

    OpenAIRE

    Arber, A

    2008-01-01

    In this article, I explore what happens when specialist palliative care staff meet together to discuss patients under their care. Many studies (e.g., Atkinson) have discussed how health care practitioners in various settings use rhetorical strategies when presenting cases in situations such as ward rounds and team meetings. Strategies for arguing and persuading are central to medical practice in the interprofessional context. The context of specialist palliative care is an interesting place...

  12. 儿童保健团队在社区卫生服务中的作用分析%Analysis of child health care team in community health service

    Institute of Scientific and Technical Information of China (English)

    李静; 余信国; 赵鹏

    2011-01-01

    目的:为提高社区健康服务中心的管理内涵,以试点方式探讨儿童保健团队建设在社区健康服务中的作用.方法:以深圳市宝安区西乡人民医院颐康园社区健康服务中心为试点现场,通过儿童保健团队的建设、工作任务和流程的制订,研究现场的试点,并对试点前抽样调查430名儿童和试点1年后抽样调查436名儿童的相关情况进行调查、统计和分析.结果:试点前后常住、暂住和流动儿童计划免疫规范接种率分别为32.55%、28.02%、9.49%和53.33%、45.41%、30.47%,较规范种率分别为23.26%、36.71%、32.12%和45.56%、50.46%、61.72%,前后比较差异均有高度统计学意义(P<0.01);试点前后常住、暂住和流动儿童体检达标率分别为30.23%、26.09%、4.38%和48.89%、42.66%、29.69%,基本达标率分别为32.56%、27.05%、27.74%和46.67%、54.13%、64.06%,前后比较差异具有高度统计学意义(P<0.01);试点前后儿童保健系统管理率分别为48.37%和95.64%,儿童保健覆盖率分别为74.19%和99.08%.结论:儿童保健团队式服务模式,有利于推进社区基本医疗和公共卫生服务的进一步落实,使社区儿童在成长过程中能够享受到可及性、连续性和综合性的社区卫生服务,具有一定的推广价值.%Objective: To discuss the effect of child health care team in communily health service in the pilot way for the improvement of the management connotation. Methods: Yikangyuan community health service center in Shenzhen city was chosen as study fields by formulating the construction, working task and process of child health care team and a sampling survey to 430 children before pilol project and 436 cases after pilot project for 1 year for investigation, the relevant situation of the children were analyzed. Results: Before pilot and after pilot project, the rate of EPI standard among the permanent, temporary and floating children were 32.55%, 28.02%, 9.49% and 53.33%, 45

  13. How best to structure interdisciplinary primary care teams: the study protocol for a systematic review with narrative framework synthesis.

    Science.gov (United States)

    Wranik, W Dominika; Hayden, Jill A; Price, Sheri; Parker, Robin M N; Haydt, Susan M; Edwards, Jeanette M; Suter, Esther; Katz, Alan; Gambold, Liesl L; Levy, Adrian R

    2016-10-04

    Western publicly funded health care systems increasingly rely on interdisciplinary teams to support primary care delivery and management of chronic conditions. This knowledge synthesis focuses on what is known in the academic and grey literature about optimal structural characteristics of teams. Its goal is to assess which factors contribute to the effective functioning of interdisciplinary primary care teams and improved health system outcomes, with specific focus on (i) team structure contribution to team process, (ii) team process contribution to primary care goals, and (iii) team structure contribution to primary care goals. The systematic search of academic literature focuses on four chronic conditions and co-morbidities. Within this scope, qualitative and quantitative studies that assess the effects of team characteristics (funding, governance, organization) on care process and patient outcomes will be searched. Electronic databases (Ovid MEDLINE, Embase, CINAHL, PAIS, Web of Science) will be searched systematically. Online web-based searches will be supported by the Grey Matters Tool. Studies will be included, if they report on interdisciplinary primary care in publicly funded Western health systems, and address the relationships between team structure, process, and/or patient outcomes. Studies will be selected in a three-stage screening process (title/abstract/full text) by two independent reviewers in each stage. Study quality will be assessed using the Mixed Methods Assessment Tool. An a priori framework will be applied to data extraction, and a narrative framework approach is used for the synthesis. Using an integrated knowledge translation approach, an electronic decision support tool will be developed for decision makers. It will be searchable along two axes of inquiry: (i) what primary care goals are supported by specific team characteristics and (ii) how should teams be structured to support specific primary care goals? The results of this evidence

  14. Cognitive systems engineering in health care

    CERN Document Server

    Bisantz, Ann M; Fairbanks, Rollin J

    2014-01-01

    Cognitive Engineering for Better Health Care Systems, Ann M. Bisantz, Rollin J. Fairbanks, and Catherine M. BurnsThe Role of Cognitive Engineering in Improving Clinical Decision Support, Anne Miller and Laura MilitelloTeam Cognitive Work Analysis as an Approach for Understanding Teamwork in Health Care, Catherine M. BurnsCognitive Engineering Design of an Emergency Department Information System, Theresa K. Guarrera, Nicolette M. McGeorge, Lindsey N. Clark, David T. LaVergne, Zachary A. Hettinger, Rollin J. Fairbanks, and Ann M. BisantzDisplays for Health Care Teams: A Conceptual Framework and Design Methodology, Avi ParushInformation Modeling for Cognitive Work in a Health Care System, Priyadarshini R. PennathurSupport for ICU Clinician Cognitive Work through CSE, Christopher Nemeth, Shilo Anders, Jeffrey Brown, Anna Grome, Beth Crandall, and Jeremy PamplinMatching Cognitive Aids and the "Real Work" of Health Care in Support of Surgical Microsystem Teamwork, Sarah Henrickson Parker and Shawna J. PerryEngageme...

  15. Improving the Transition From Oncology to Primary Care Teams: A Case for Shared Leadership.

    Science.gov (United States)

    Tremblay, Dominique; Latreille, Jean; Bilodeau, Karine; Samson, Arnaud; Roy, Linda; L'Italien, Marie-France; Mimeault, Christine

    2016-11-01

    This article discusses the case of a 47-year-old woman who underwent primary therapy with curative intent for breast cancer. The case illustrates a number of failure events in transferring information and responsibility from oncology to primary care teams. The article emphasizes the importance of shared leadership, as multiple team members, dispersed in time and space, pursue their own objectives while achieving the common goal of coordinating care for survivors of cancer transitioning across settings. Shared leadership is defined as a team property comprising shared responsibility and mutual influence between the patient and the patient's family, primary care providers, and oncology teams, whereby they lead each other toward quality and safety of care. Teams, including the patient-family, should achieve leadership when their contribution is relevant in managing task interdependence during transition. Shared leadership fosters coordinated actions to enable functioning as an integrated team-of-teams. This article illustrates how shared leadership can make a difference to coordinate interfaces and pathways, from therapy with curative intent to the follow-up and management of survivors of breast cancer. The detailed case is elaborated as a clinical vignette. It can be used by care providers and researchers to consider the need for new models of care for survivors of cancer by addressing the following questions. Who accepts shared leadership, how, with whom, and under what conditions? What is the evidence that supports the answers to these questions? The detailed case is also valuable for medical and allied health professional education.

  16. Extending the team component of the Latimer ethical decision-making model for palliative care

    Directory of Open Access Journals (Sweden)

    Purkis ME

    2011-04-01

    Full Text Available Mary Ellen Purkis1, Elizabeth Borycki1,2, Craig Kuziemsky3, Fraser Black4, Denise Cloutier-Fisher5, Lee Ann Fox6, Patricia MacKenzie7, Ann Syme1,8, Coby Tschanz1,41School of Nursing, 2School of Health Information Science, University of Victoria, Victoria, British Columbia; 3Telfer School of Management, University of Ottawa, Ottawa, Ontario; 4Victoria Hospice Society, Victoria, British Columbia; 5Department of Geography, University of Victoria, Victoria, British Columbia; 6Kingston General Hospital, Kingston, Ontario; 7School of Social Work, University of Victoria, Victoria, British Columbia; 8British Columbia Cancer Agency, Vancouver Island Centre, Victoria, British Columbia, CanadaBackground: Each year more than 240,000 Canadians die from terminal and chronic illnesses. It is estimated that 62% of those deaths require palliative care. Palliative care is a specialized domain of health professional team practice that requires discipline-specific knowledge, skills, judgment, and expertise in order to address patient hopes, wishes, symptoms, and suffering. With the emergence of palliative care as a specialized area of interdisciplinary practice, new practice models have also emerged, eg, the Latimer ethical decision-making model for palliative care. The purpose of this research was to undertake a descriptive ethnographic field study of palliative care team practices to understand better the interdisciplinary team communication and the issues that arise when members of different health professions work together as a team.Methods: Study data were collected by observing and videotaping palliative care team meetings. Data were then analyzed using direct content analysis.Results: The study findings substantiated many of the team practice concepts outlined in Latimer's model. Palliative care teams engage in a number of processes that address patient symptoms, suffering, hopes, and plans. However, several new findings also emerged from the data that were

  17. [Work relations in interdisciplinary teams: contributions towards new forms of work organization in health].

    Science.gov (United States)

    Matos, Eliane; de Pires, Denise Elvira Pires; de Sousa, Gastão Wagner

    2010-01-01

    This is a qualitative study developed with the interdisciplinary health care teams of two public hospitals in Brazil. One team gave palliative care to cancer patients and the other gave care to the elderly. The study contributes to thinking about work relationships in the health care sector upon analyzing the contribution of these experiences for the constitution of new forms of health care work organization. The results reveal that the interdisciplinary perspective of performance in health care makes better work relationships possible among professionals and between professionals and patients/family, as well as approximates the professionals to the needs of the patient, beyond contributing to better quality care. We conclude that interdisciplinary practice approximates new forms of work organization and, upon favoring these links, reception, and access, contributes to the greater efficiency of the Brazilian National Health Care System.

  18. Primary care teams: are we there yet? Implications for workforce planning.

    Science.gov (United States)

    Grover, Atul; Niecko-Najjum, Lidia M

    2013-12-01

    Recent studies suggest that team-based primary care models could contribute to eliminating the predicted physician shortages. In this article, the authors explore existing team-based clinical care delivery models, comparing specialist and primary care teams, that include patient-centered medical homes and accountable care organizations. Next, the authors describe the barriers to adopting these models on a large scale, particularly the regulatory, financial, and cultural factors as well as scope of practice considerations for nonphysician providers. The authors' aim is not to evaluate the merits of team-based primary care models but, rather, to ascertain whether such models should be at the center of current physician workforce planning policies. The authors argue that although emerging evidence indicates that primary care teams can improve patient outcomes, few data exist to suggest that these models will drastically reduce the need for additional physicians or other providers. Thus, the authors conclude that additional research is needed to evaluate the ability of such models to alleviate provider deficits. And, while policy makers should work toward their ideal health care system, they also must expand the physician workforce to meet the growing demand for health care services in the existing one.

  19. Team Cognition As a Means to Improve Care Delivery in Critically Ill Patients With Cancer After Hematopoietic Cell Transplantation.

    Science.gov (United States)

    McNeese, Nathan J; Khera, Nandita; Wordingham, Sara E; Arring, Noel; Nyquist, Sharon; Gentry, Amy; Tomlinson, Brian; Cooke, Nancy J; Sen, Ayan

    2016-11-01

    Hematopoietic cell transplantation (HCT) is an important and complex treatment modality for a variety of hematologic malignancies and some solid tumors. Although outcomes of patients who have undergone HCT and require care in intensive care units (ICUs) have improved over time, mortality rates remain high and there are significant associated costs. Lack of a team-based approach to care, especially during critical illness, is detrimental to patient autonomy and satisfaction, and to team morale, ultimately leading to poor quality of care. In this manuscript, we describe the case of a patient who had undergone HCT and was in the ICU setting, where inconsistent team interaction among the various stakeholders delivering care resulted in a lack of shared goals and poor outcomes. Team cognition is cognitive processing at the team level through interactions among team members and is reflected in dynamic communication and coordination behaviors. Although the patient received multidisciplinary care as needed in a medically complicated case, a lack of team cognition and, particularly, inconsistent communication among the dynamic teams caring for the patient, led to mixed messages being delivered with high-cost implications for the health-care system and the family. This article highlights concepts and recommendations that begin a necessary in-depth assessment of implications for clinical care and initiate a research agenda that examines the effects of team cognition on HCT teams, and, more generally, critical care of the patient with cancer.

  20. The Times They Are a Changin': Neuropsychology and Integrated Care Teams.

    Science.gov (United States)

    Kubu, Cynthia S; Ready, Rebecca E; Festa, Joanne R; Roper, Brad L; Pliskin, Neil H

    2016-01-01

    To gather illustrative data from clinical neuropsychologists who are working in integrated care settings in order to provide an initial blueprint for moving forward in this new era of health care. A survey was designed to illustrate the ways in which neuropsychologists are participating in integrated care teams and distributed on major neuropsychology listservs. The survey evaluated the settings, roles, services provided, practice issues, remuneration, and impact of neuropsychologists' participation in integrated care teams with respect to patient care and health outcomes. Frequencies were used to summarize the findings as well as qualitative coding of narrative responses. There were 412 respondents to the survey and 261 of those indicated that they worked in at least one integrated care setting. Neuropsychologists work in a variety of integrated care settings and provide diverse services which contribute to improved patient care and outcomes. Three primary themes emerge from the findings with regard to the engagement and teams: advocacy, collaboration, and communication. We argue for the need for more easily accessible outcome studies illustrating the clinical benefits and cost-savings associated with inclusion of neuropsychologists in integrated care teams. In addition, educational and training initiatives are needed to better equip current and future clinical neuropsychologists to function effectively in integrated care settings.

  1. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    adedamla

    catastrophic health expenditures (CHE) and risk of being impoverished as a result of cost of care were assessed. Statistical ... Impact and contributors to cost of managing long term conditions in a ... sectors is ongoing, it has become clear that.

  2. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    Journal of Community Medicine and Primary Health Care. ... This is one of the factors that determine whether or ..... Expired vaccines found in fridge / cold box .... date vaccine temperature monitoring charts. were stored on refrigerator door ...

  3. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    user

    This was a cross-sectional, multi clinic study involving 265 mothers whose children had erupted at least a tooth and attending the ... parents, health care workers and personal experiences were the sources of beliefs ..... Ethiopians abroad.

  4. Interprofessional primary care team meetings: a qualitative approach comparing observations with personal opinions

    Science.gov (United States)

    van Dongen, Jerôme Jean Jacques; van Bokhoven, Marloes Amantia; Daniëls, Ramon; Lenzen, Stephanie Anna; van der Weijden, Trudy; Beurskens, Anna

    2017-01-01

    Background. The number of people with multiple chronic conditions requiring primary care services increases. Professionals from different disciplines collaborate and coordinate care to deal with the complex health care needs. There is lack of information on current practices regarding interprofessional team (IPT) meetings. Objectives. This study aimed to improve our understanding of the process of interprofessional collaboration in primary care team meetings in the Netherlands by observing the current practice and exploring personal opinions. Methods. Qualitative study involving observations of team meetings and interviews with participants. Eight different IPT meetings (n = 8) in different primary care practices were observed by means of video recordings. Experiences were explored by conducting individual semi-structured interviews (n = 60) with participants (i.e. health care professionals from different disciplines) of the observed team meetings. The data were analysed by means of content analysis. Results. Most participants expressed favourable opinions about their team meetings. However, observations showed that team meetings were more or less hectic, and lacked a clear structure and team coordinator or leader. There appears to be a discrepancy between findings from observations and interviews. From the interviews, four main themes were extracted: (1) Team structure and composition, (2) Patient-centredness, (3) Interaction and (4) Attitude and motivation. Conclusion. IPT meetings could benefit from improvements in structure, patient-centredness and leadership by the chairpersons. Given the discrepancy between observations and interviews, it would appear useful to improve team members’ awareness of aspects that could be improved before training them in dealing with specific challenges. PMID:28122925

  5. [Education in health: perspectives of the Family Health Strategy team under Paulo Freire's view].

    Science.gov (United States)

    Fernandes, Maria Clara Porto; Backes, Vânia Marli Schubert

    2010-01-01

    Qualitative study whose research subjects were the members of a Health Family Strategy. and has as purpose to know their perspectives about health education and presents them through the dialogical conception of Paulo Freire. In the circles of culture, four themes emerged: family health team, health education, health education practice in team work and how to improve the stock of existing health education, were encode, decode and critically unveiled its concepts, challenges, opportunities and expectations of their educational practices. The field research was the development of a Primary Care Unit of Health of Cachoeira do Campo, Minas Gerais. The results showed that health education is recognized by the subjects as a liability, but its practice is facing cultural barriers, and receives little emphasis in the daily work.

  6. Knowledge translation: An interprofessional approach to integrating a pain consult team within an acute care unit.

    Science.gov (United States)

    Feldman, Kira; Berall, Anna; Karuza, Jurgis; Senderovich, Helen; Perri, Giulia-Anna; Grossman, Daphna

    2016-11-01

    Management of pain in the frail elderly presents many challenges in both assessment and treatment, due to the presence of multiple co-morbidities, polypharmacy, and cognitive impairment. At Baycrest Health Sciences, a geriatric care centre, pain in its acute care unit had been managed through consultations with the pain team on a case-by-case basis. In an intervention informed by knowledge translation (KT), the pain specialists integrated within the social network of the acute care team for 6 months to disseminate their expertise. A survey was administered to staff on the unit before and after the intervention of the pain team to understand staff perceptions of pain management. Pre- and post-comparisons of the survey responses were analysed by using t-tests. This study provided some evidence for the success of this interprofessional education initiative through changes in staff confidence with respect to pain management. It also showed that embedding the pain team into the acute care team supported the KT process as an effective method of interprofessional team building. Incorporating the pain team into the acute care unit to provide training and ongoing decision support was a feasible strategy for KT and could be replicated in other clinical settings.

  7. Health care utilization

    DEFF Research Database (Denmark)

    Jacobsen, Christian Bøtcher; Andersen, Lotte Bøgh; Serritzlew, Søren

    An important task in governing health services is to control costs. The literatures on both costcontainment and supplier induced demand focus on the effects of economic incentives on health care costs, but insights from these literatures have never been integrated. This paper asks how economic cost...... make health professionals provide more of this service to each patient, but that lower user payment (unexpectedly) does not necessarily mean higher total cost or a stronger association between the number of patients per supplier and the health care utilization. This implies that incentives...... are important, but that economics cannot alone explain the differences in health care utilization....

  8. Evaluation of interprofessional education: lessons learned through the development and implementation of an interprofessional seminar on team communication for undergraduate health care students in Heidelberg – a project report

    Directory of Open Access Journals (Sweden)

    Berger, Sarah

    2016-04-01

    Full Text Available Introduction: This project report describes the development, “piloting” and evaluation of an interprofessional seminar on team communication bringing together medical students and Interprofessional Health Care B.Sc. students at the Medical Faculty of Heidelberg University, Germany.Project Description: A five-member interprofessional team collaborated together on this project. Kolb’s concept formed the theoretical foundation for the seminar, which explored three interprofessional competency areas: team work, communication and values/ethics. Evaluation for the purposes of quality assurance and future curricula development was conducted using two quantitative measures: Results: The key finding from the standardized course evaluation was that the interprofessional seminars were rated more positively [M=2.11 (1 most positive and 5 most negative, SD=1, n=27] than the monoprofessional seminars [M=2.55, SD=0.98, n=90]. The key finding from the UWE-IP-D survey, comparing pre and post scores of the interprofessional (IP (n=40 and monoprofessional (MP groups (n=34, was that significant positive changes in mean scores for both groups towards communication, teamwork and interprofessional learning occurred. Conclusions: Lessons learnt included: a recognising the benefit of being pragmatic when introducing interprofessional education initiatives, which enabled various logistical and attitudinal barriers to be overcome; b quantitative evaluation of learning outcomes alone could not explain positive responses or potential influences of interprofessional aspects, which highlighted the need for a mixed methods approach, including qualitative methods, to enrich judgment formation on interprofessional educational outcomes.

  9. Art Therapy with an Oncology Care Team

    Science.gov (United States)

    Nainis, Nancy A.

    2005-01-01

    Oncology nurses are particularly vulnerable to "burnout" syndrome due to the intensity of their work and the ongoing losses they experience while providing oncology care to their patients. High levels of stress in the workplace left untended lead to high job turnover, poor productivity, and diminished quality of care for patients.…

  10. Equity in health care.

    Science.gov (United States)

    La Rosa-Salas, Virginia; Tricas-Sauras, Sandra

    2008-01-01

    It has long been known that a segment of the population enjoys distinctly better health status and higher quality of health care than others. To solve this problem, prioritization is unavoidable, and the question is how priorities should be set. Rational priority setting would seek equity amongst the whole population, the extent to which people receive equal care for equal needs. Equity in health care is an ethical imperative not only because of the intrinsic worth of good health, or the value that society places on good health, but because, without good health, people would be unable to enjoy life's other sources of happiness. This paper also argues the importance of the health care's efficiency, but at the same time, it highlights how any innovation and rationalization undertaken in the provision of the health system should be achieved from the consideration of human dignity, making the person prevail over economic criteria. Therefore, the underlying principles on which this health care equity paper is based are fundamental human rights. The main aim is to ensure the implementation of these essential rights by those carrying out public duties. Viewed from this angle, equity in health care means equality: equality in access to services and treatment, and equality in the quality of care provided. As a result, this paper attempts to address both human dignity and efficiency through the context of equity to reconcile them in the middle ground.

  11. The role of dentist in palliative care team

    Directory of Open Access Journals (Sweden)

    Rani P Mol

    2010-01-01

    Full Text Available The palliative doctor gives the ′touch of God′ as he/she takes care of the terminally ill patient. The oncologist encounters great difficulties in managing oral cavity problems of these patients. A trained dental doctor can help other doctors in dealing with these situations. But the general dental surgeon does not have enough idea about his part in these treatments. The community is also unaware of the role that a nearby dentist can play. Adequate training programs have to be conducted and awareness has to be created. A trained dentist will be a good team mate for the oncologist or radiotherapist or other doctors of the palliative care team. In this paper, a brief attempt is made to list a few areas in which a palliative care dentist can help other members of the palliative care team and also the patient in leading a better life.

  12. Interprofessional and Team-Based Continuing Education For Health Professionals

    Directory of Open Access Journals (Sweden)

    Biljana Gjorgjeska

    2012-10-01

    Full Text Available The benefits of implementing interprofessional and team­based programs are well recognized. However, for interprofes­ sional education to  be effective and broadly implemented, the health professions, policymakers, insurers, academic institutions, health care providers, and regulatory bodies should embrace and adopt a new, interprofessional education framework. These stakeholders should create a shared value and vision for interprofessional health professions’ educa­ tion, research, and practice. This vision should be patient­oriented and contain a measurable component across the entire educational continuum, from admission into a health professional program through retirement. Such a framework would maximize and value the strengths of individual professions in the integrated delivery of high quality care. Finally, in creating a successful model, a series of questions should be considered: how  best can team competence be measured, how should individual behavioral changes be documented when we think of individual rather than team­level changes, how do we create and measure performance criteria based on shared understanding and experience in the practice setting? Within academic settings, there are more specific barriers including a lack of administrative support, financial and human resources for interprofessional education, conflicts in schedules and health professions’ curricula, and limitations to the time required to plan and implement faculty development for interprofessional learning. Finally, despite progress, there remain regulatory and professional barriers to achieving full and meaningful implementation of effective models. Recom­ mendations which  are given emphasize that investing in research to evaluate the efficacy of continuing education and its impact on patient outcomes and the healthcare delivery system is inherent in this process.

  13. Lean health care.

    Science.gov (United States)

    Hawthorne, Henry C; Masterson, David J

    2013-01-01

    Principles of Lean management are being adopted more widely in health care as a way of improving quality and safety while controlling costs. The authors, who are chief executive officers of rural North Carolina hospitals, explain how their organizations are using Lean principles to improve quality and safety of health care delivery.

  14. Health care marketing management.

    Science.gov (United States)

    Cooper, P D

    1979-01-01

    Health Care Marketing Management is the process of understanding the needs and the wats of a target market. Its purpose is to provide a viewpoint from which to integrate the analysis, planning, implementation (or organization) and control of the health care delivery system.

  15. Indian Health Service: Find Health Care

    Science.gov (United States)

    ... and Human Services Indian Health Service The Federal Health Program for American Indians and Alaska Natives Feedback ... Forgot Password IHS Home Find Health Care Find Health Care IMPORTANT If you are having a health ...

  16. Health care globalization: a need for virtual leadership.

    Science.gov (United States)

    Holland, J Brian; Malvey, Donna; Fottler, Myron D

    2009-01-01

    As health care organizations expand and move into global markets, they face many leadership challenges, including the difficulty of leading individuals who are geographically dispersed. This article provides global managers with guidelines for leading and motivating individuals or teams from a distance while overcoming the typical challenges that "virtual leaders" and "virtual teams" face: employee isolation, confusion, language barriers, cultural differences, and technological breakdowns. Fortunately, technological advances in communications have provided various methods to accommodate geographically dispersed or "global virtual teams." Health care leaders now have the ability to lead global teams from afar by becoming "virtual leaders" with a responsibility to lead a "virtual team." Three models of globalization presented and discussed are outsourcing of health care services, medical tourism, and telerobotics. These models require global managers to lead virtually, and a positive relationship between the virtual leader and the virtual team member is vital in the success of global health care organizations.

  17. Interprofessional teaching and learning in the health care professions: A qualitative evaluation of the Robert Bosch Foundation's grant program "Operation Team"

    Directory of Open Access Journals (Sweden)

    Nock, Lukas

    2016-04-01

    Full Text Available Aim: Interprofessional teaching and learning is gaining significance in the health professions. At the same time, the development and implementation of such educational courses is demanding. Focusing on factors critical to success, the aim of this paper is to evaluate the experience gathered by eight grant projects in which interprofessional courses were designed. Emphasis is placed on the level of cooperation between the participating educational institutions, course content, the operative implementation of the course units and their permanent integration into curricula.Method: Data was collected in semi-structured, guideline-based interviews with project leaders and team members (n=43. University and vocational students who had attended the evaluated courses were also included in the survey (n=7 as a means to triangulate data. Analysis was carried out based on qualitative content analysis.Results: A participatory, dialogue-centered model of cooperation appears to be most suited for developing and implementing courses. Belonging to the factors critical to success are the time when courses are offered, the conditions for attendance, the different teaching and learning cultures of the professions involved, preparation and deployment of instructors, and the role played by project coordination. Permanently integrating interprofessional units into medical curricula revealed itself to be difficult.Conclusion: While the development and realization of interprofessional courses can be achieved easily enough in projects, curricular integration of the new course units is challenging. In respect to the latter, not only a large amount of staffing resources and time are required, but also the creation of the necessary system-level structures, not just within the educational institutions (organizational development but also in the frameworks governing the professions.

  18. Developing patient-centered teams: The role of sharing stories about patients and patient care.

    Science.gov (United States)

    Bennett, Ariana H; Hassinger, Jane A; Martin, Lisa A; Harris, Lisa H; Gold, Marji

    2015-09-01

    Research indicates that health care teams are good for staff, patients, and organizations. The characteristics that make teams effective include shared objectives, mutual respect, clarity of roles, communication, trust, and collaboration. We were interested in examining how teams develop these positive characteristics. This paper explores the role of sharing stories about patients in developing patient-centered teams. Data for this paper came from 1 primary care clinic as part of a larger Providers Share Workshop study conducted by the University of Michigan. Each workshop included 5 facilitated group sessions in which staff met to talk about their work. This paper analyzes qualitative data from the workshops. Through an iterative process, research team members identified major themes, developed a coding scheme, and coded transcripts for qualitative data analysis. One of the most powerful ways group members connected was through sharing stories about their patients. Sharing clinical cases and stories helped participants bond around their shared mission of patient-centered care, build supportive relationships, enhance compassion for patients, communicate and resolve conflict, better understand workflows and job roles, develop trust, and increase morale. These attributes highlighted by participants correspond to those documented in the literature as important elements of teambuilding and key indicators of team effectiveness. The sharing of stories about patients seems to be a promising tool for positive team development in a primary care clinical setting and should be investigated further. (c) 2015 APA, all rights reserved).

  19. The systematic review team: contributions of the health sciences librarian.

    Science.gov (United States)

    Dudden, Rosalind F; Protzko, Shandra L

    2011-01-01

    While the role of the librarian as an expert searcher in the systematic review process is widely recognized, librarians also can be enlisted to help systematic review teams with other challenges. This article reviews the contributions of librarians to systematic reviews, including communicating methods of the review process, collaboratively formulating the research question and exclusion criteria, formulating the search strategy on a variety of databases, documenting the searches, record keeping, and writing the search methodology. It also discusses challenges encountered such as irregular timelines, providing education, communication, and learning new technologies for record keeping. Rewards include building relationships with researchers, expanding professional expertise, and receiving recognition for contributions to health care outcomes.

  20. Primary care teams in Ireland: a qualitative mapping review of Irish grey and published literature.

    Science.gov (United States)

    O'Sullivan, M; Cullen, W; MacFarlane, A

    2015-03-01

    The Irish government published its primary care strategy, Primary Care: A New Direction in 2001. Progress with the implementation of Primary care teams is modest. The aim of this paper is to map the Irish grey literature and peer-reviewed publications to determine what research has been carried out in relation to primary care teams, the reform process and interdisciplinary working in primary care in Ireland. This scoping review employed three methods: a review of Web of Science, Medline and Embase databases, an email survey of researchers across academic institutions, the HSE and independent researchers and a review of Lenus and the Health Well repository. N = 123 outputs were identified. N = 14 were selected for inclusion. A thematic analysis was undertaken. Common themes identified were resources, GP participation, leadership, clarity regarding roles in primary care teams, skills and knowledge for primary care team working, communication and community. There is evidence of significant problems that disrupt team formation and functioning that warrants more comprehensive research.

  1. Integrating pharmacists into primary care teams: barriers and facilitators.

    Science.gov (United States)

    Jorgenson, Derek; Laubscher, Tessa; Lyons, Barry; Palmer, Rebecca

    2014-08-01

    This study evaluated the barriers and facilitators that were experienced as pharmacists were integrated into 23 existing primary care teams located in urban and rural communities in Saskatchewan, Canada. Qualitative design using data from one-on-one telephone interviews with pharmacists, physicians and nurse practitioners from the 23 teams that integrated a new pharmacist role. Four researchers from varied backgrounds used thematic analysis of the interview transcripts to determine key themes. The research team met on multiple occasions to agree on the key themes and received written feedback from an external auditor and two of the original interviewees. Seven key themes emerged describing the barriers and facilitators that the teams experienced during the pharmacist integration: (1) relationships, trust and respect; (2) pharmacist role definition; (3) orientation and support; (4) pharmacist personality and professional experience; (5) pharmacist presence and visibility; (6) resources and funding; and (7) value of the pharmacist role. Teams from urban and rural communities experienced some of these challenges in unique ways. Primary care teams that integrated a pharmacist experienced several common barriers and facilitators. The negative impact of these barriers can be mitigated with effective planning and support that is individualized for the type of community where the team is located. © 2013 Royal Pharmaceutical Society.

  2. Evaluation of an Interdisciplinary Curriculum Teaching Team-Based Palliative Care Integration in Oncology.

    Science.gov (United States)

    Head, Barbara A; Schapmire, Tara; Earnshaw, Lori; Faul, Anna; Hermann, Carla; Jones, Carol; Martin, Amy; Shaw, Monica Ann; Woggon, Frank; Ziegler, Craig; Pfeiffer, Mark

    2016-06-01

    For students of the health care professions to succeed in today's health care environment, they must be prepared to collaborate with other professionals and practice on interdisciplinary teams. As most will care for patients with cancer, they must also understand the principles of palliative care and its integration into oncology. This article reports the success of one university's effort to design and implement an interdisciplinary curriculum teaching team-based palliative care in oncology which was mandatory for medical, nursing, social work, and chaplaincy students. Quantitative evaluation indicated that students made significant improvements related to palliative care knowledge and skills and readiness for interprofessional education. Qualitative feedback revealed that students appreciated the experiential aspects of the curriculum most, especially the opportunity to observe palliative teams at work and practice team-based skills with other learners. While there exist many obstacles to interprofessional education and hands-on learning, the value of such experiences to the learners justifies efforts to initiate and continue similar programs in the health sciences.

  3. Benchmarking HIV health care

    DEFF Research Database (Denmark)

    Podlekareva, Daria; Reekie, Joanne; Mocroft, Amanda

    2012-01-01

    ABSTRACT: BACKGROUND: State-of-the-art care involving the utilisation of multiple health care interventions is the basis for an optimal long-term clinical prognosis for HIV-patients. We evaluated health care for HIV-patients based on four key indicators. METHODS: Four indicators of health care were...... assessed: Compliance with current guidelines on initiation of 1) combination antiretroviral therapy (cART), 2) chemoprophylaxis, 3) frequency of laboratory monitoring, and 4) virological response to cART (proportion of patients with HIV-RNA 90% of time on cART). RESULTS: 7097 Euro...... to North, patients from other regions had significantly lower odds of virological response; the difference was most pronounced for East and Argentina (adjusted OR 0.16[95%CI 0.11-0.23, p HIV health care utilization...

  4. Development of a standardised pro forma for specialist palliative care multidisciplinary team meetings.

    Science.gov (United States)

    Gallagher, Jennifer; Forman, Margaret Louise

    2012-05-01

    A pro forma of the caseload of the community palliative care clinical nurse specialists in the Central Lancashire Community Specialist Palliative Care Team was devised to provide a brief overview of each patient's plan of care for use in the multidisciplinary team meetings and as a consequence of preparing for the UK Department of Health's peer review process. The pro forma was also designed to be used in everyday clinical practice in Gold Standards Framework meetings in the community. It has been evaluated by the team and found to be helpful for highlighting key issues in clinical practice, such as symptoms, psychological and emotional needs, and Preferred Priorities of Care. Over the past 2 years, it has also complemented the organisation's drive to become 'paperless'. This article looks at how the pro forma was developed, how it has evolved over time, and how it works today. Consideration has also been given to its benefits and limitations.

  5. O trabalho de equipe no programa de saúde da família: reflexões a partir de conceitos do processo grupal e de grupos operativos El trabajo del equipo en el programa de salud de la familia: reflexión a partir de conceptos del proceso grupal y de grupos operativos Team work in a family health care program: the team process concept and operational teams

    Directory of Open Access Journals (Sweden)

    Cinira Magali Fortuna

    2005-04-01

    theoretical revision of team work in a family Health Care Program. We define team work in the health care field as a relationship network among people, power, knowledge, affection, and wishes, when there is a possibility of identifying group processes. We deal with concepts of Operational Group from the Argentinean School, which might help health professionals to get training in team work. We have visible (spoken and invisible (unspoken tasks within teams, which are modified and need to be combined and known. Communication, learning, the feeling of belonging, the atmosphere, the actions' pertinence for the team's purpose and power relations may help the team to get to know and analyze each other and to build a team. External supervision may help the team to turn itself into an operational team, working towards a life care project.

  6. The organization of multidisciplinary care teams: modeling internal and external influences on cancer care quality.

    Science.gov (United States)

    Fennell, Mary L; Das, Irene Prabhu; Clauser, Steven; Petrelli, Nicholas; Salner, Andrew

    2010-01-01

    Quality cancer treatment depends upon careful coordination between multiple treatments and treatment providers, the exchange of technical information, and regular communication between all providers and physician disciplines involved in treatment. This article will examine a particular type of organizational structure purported to regularize and streamline the communication between multiple specialists and support services involved in cancer treatment: the multidisciplinary treatment care (MDC) team. We present a targeted review of what is known about various types of MDC team structures and their impact on the quality of treatment care, and we outline a conceptual model of the connections between team context, structure, process, and performance and their subsequent effects on cancer treatment care processes and patient outcomes. Finally, we will discuss future research directions to understand how MDC teams improve patient outcomes and how characteristics of team structure, culture, leadership, and context (organizational setting and local environment) contribute to optimal multidisciplinary cancer care.

  7. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    Lifestyle Changes and the Risk of Colorectal Cancer among. Immigrants in the United .... food rich in red meat, animal fat, sugars and refined of CRC in Africa .... region to improve health care delivery and secure the is obtainable in the UK, ...

  8. Resilient health care

    DEFF Research Database (Denmark)

    Hollnagel, E.; Braithwaite, J.; Wears, R. L.

    engineering's unique approach emphasises the usefulness of performance variability, and that successes and failures have the same aetiology. This book contains contributions from acknowledged international experts in health care, organisational studies and patient safety, as well as resilience engineering......Health care is everywhere under tremendous pressure with regard to efficiency, safety, and economic viability - to say nothing of having to meet various political agendas - and has responded by eagerly adopting techniques that have been useful in other industries, such as quality management, lean...... production, and high reliability. This has on the whole been met with limited success because health care as a non-trivial and multifaceted system differs significantly from most traditional industries. In order to allow health care systems to perform as expected and required, it is necessary to have...

  9. Managed health care.

    Science.gov (United States)

    Curtiss, F R

    1989-04-01

    The fundamental components of managed-care plans are described; the development of managed-care programs is discussed; and the impact of managed care on pharmacy services and the price, quality, and accessibility of health care are reviewed. Health care can be considered to be managed when at least one of the following fundamental components is present: prospective pricing, "UCR" (usual, customary, and reasonable) pricing of services, peer review, mandatory use review, benefit redesign, capitation payments, channeling, quality criteria, and health promotion. The managed-care industry consists of health maintenance organizations (HMOs), preferred provider organizations (PPOs), and managed fee-for-service plans. Managed-care reimbursement principles involve transferring some or all of the impetus for controlling use of services to the health-care provider. Means by which this is done include prospective pricing, services bundling, price discounts and negotiated fees, and capitation financing and reimbursement. Financial risk-sharing arrangements with providers--including hospitals, physicians, pharmacies, and home-care companies--are necessary for any managed-care plan to attain true control over its service costs. Use-review and use-management services are also fundamental to containing health-care spending. These include retrospective, concurrent, and prospective reviews of the necessity and appropriateness of medical services. Use management, like services bundling and prospective pricing, has been more effective in reducing costs of hospital inpatient services than costs associated with ambulatory care. Per case payments and services bundling have made individual charges for items irrelevant to hospital revenue. This has forced hospital pharmacy managers to become more sensitive to cost management. Drug formularies, improved productivity, and use of prescribing protocols are means by which hospital pharmacies have controlled costs. However, since shorter hospital

  10. Identifying health care quality attributes.

    Science.gov (United States)

    Ramsaran-Fowdar, Roshnee R

    2005-01-01

    Evaluating health care quality is important for consumers, health care providers, and society. Developing a measure of health care service quality is an important precursor to systems and organizations that value health care quality. SERVQUAL has been proposed as a broad-based measure of service quality that may be applicable to health care settings. Results from a study described in this paper verify SERVQUAL dimensions, but demonstrate additional dimensions that are specific to health care settings.

  11. Child Health Booklet: experiences of professionals in primary health care

    Directory of Open Access Journals (Sweden)

    Gisele Nepomuceno de Andrade

    2014-10-01

    Full Text Available Objective: Understanding the experiences of health professionals in primary care with the Child Health Booklet in child health care. Method: A qualitative study with a phenomenological approach, in which participated nurses and doctors from six teams of the Family Health Strategy (FHS in Belo Horizonte, MG. In total, were carried out 12 non-directive interviews, using two guiding questions. Results: A comprehensive analysis of the speeches enabled the construction of three categories that signal the experiences of the professionals with the booklet. The experiments revealed difficulties arising from the limitations of knowledge about the instrument; incomplete filling out of the booklet by many professionals that care for children; the daily confrontations of the process and the organization of work teams; disinterest of families with the instrument. Conclusion: The research points possible and necessary ways to improve the use of booklets as an instrument of full child health surveillance.

  12. Community mental health teams for older people in England: Variations in ways of working.

    Science.gov (United States)

    Verbeek, Hilde; Worden, Angela; Wilberforce, Mark; Brand, Christian; Tucker, Sue; Abendstern, Michele; Challis, David

    2017-08-23

    Integrated community mental health teams (CMHTs) are a key component of specialist old age psychiatry services internationally. However, in England, significant shifts in policy, including a focus on dementia and age inclusive services, have influenced provision. This study portrays teams in 2009 against which subsequent service provision may be compared. A bespoke national postal survey of CMHT managers collected data on teams' structure, composition, organisation, working practices, case management, and liaison activities. A total of 376 CMHTs (88%) responded. Teams comprised a widespread of disciplines. However, just 28% contained the full complement of professionals recommended by government policy. Over 93% of teams had a single point of access, but some GPs bypassed this, and 40% of teams did not accept direct referrals from care homes. Initial assessments were undertaken by multiple disciplines, and 71% of teams used common assessment documentation. Nevertheless, many social workers maintained both NHS and local authority records. In 92% of teams, nominated care coordinators oversaw the support provided by other team members. However, inter-agency care coordination was less prevalent. Few teams offered the range of outreach/liaison activities anticipated in the national dementia strategy. Compared with previous studies, teams had grown and changed, with a clear increase in non-medical practitioners, particularly support workers. Measures to facilitate integrated care within CMHTs (eg, common access and documentation) were widespread, but integration across health and social care/primary and secondary services was less developed. Consideration of barriers to further integration, and the impact of current reforms is potentially fruitful. Copyright © 2017 John Wiley & Sons, Ltd.

  13. Mercury and health care

    Directory of Open Access Journals (Sweden)

    Rustagi Neeti

    2010-01-01

    Full Text Available Mercury is toxic heavy metal. It has many characteristic features. Health care organizations have used mercury in many forms since time immemorial. The main uses of mercury are in dental amalgam, sphygmomanometers, and thermometers. The mercury once released into the environment can remain for a longer period. Both acute and chronic poisoning can be caused by it. Half of the mercury found in the atmosphere is human generated and health care contributes the substantial part to it. The world has awakened to the harmful effects of mercury. The World Health Organization and United Nations Environmental Programme (UNEP have issued guidelines for the countries′ health care sector to become mercury free. UNEP has formed mercury partnerships between governments and other stakeholders as one approach to reducing risks to human health and the environment from the release of mercury and its compounds to the environment. Many hospitals are mercury free now.

  14. Mercury and health care

    Science.gov (United States)

    Rustagi, Neeti; Singh, Ritesh

    2010-01-01

    Mercury is toxic heavy metal. It has many characteristic features. Health care organizations have used mercury in many forms since time immemorial. The main uses of mercury are in dental amalgam, sphygmomanometers, and thermometers. The mercury once released into the environment can remain for a longer period. Both acute and chronic poisoning can be caused by it. Half of the mercury found in the atmosphere is human generated and health care contributes the substantial part to it. The world has awakened to the harmful effects of mercury. The World Health Organization and United Nations Environmental Programme (UNEP) have issued guidelines for the countries’ health care sector to become mercury free. UNEP has formed mercury partnerships between governments and other stakeholders as one approach to reducing risks to human health and the environment from the release of mercury and its compounds to the environment. Many hospitals are mercury free now. PMID:21120080

  15. Mercury and health care.

    Science.gov (United States)

    Rustagi, Neeti; Singh, Ritesh

    2010-08-01

    Mercury is toxic heavy metal. It has many characteristic features. Health care organizations have used mercury in many forms since time immemorial. The main uses of mercury are in dental amalgam, sphygmomanometers, and thermometers. The mercury once released into the environment can remain for a longer period. Both acute and chronic poisoning can be caused by it. Half of the mercury found in the atmosphere is human generated and health care contributes the substantial part to it. The world has awakened to the harmful effects of mercury. The World Health Organization and United Nations Environmental Programme (UNEP) have issued guidelines for the countries' health care sector to become mercury free. UNEP has formed mercury partnerships between governments and other stakeholders as one approach to reducing risks to human health and the environment from the release of mercury and its compounds to the environment. Many hospitals are mercury free now.

  16. Interprofessional Teamwork and Collaboration Between Community Health Workers and Healthcare Teams

    Science.gov (United States)

    Bernhardt, Jean M.; Lopez, Ruth Palan; Long-Middleton, Ellen R.; Davis, Sheila

    2015-01-01

    Objectives: Community Health Workers (CHWs) serve as a means of improving outcomes for underserved populations. However, their relationship within health care teams is not well studied. The purpose of this integrative review was to examine published research reports that demonstrated positive health outcomes as a result of CHW intervention to identify interprofessional teamwork and collaboration between CHWs and health care teams. Methods: A total of 47 studies spanning 33 years were reviewed using an integrative literature review methodology for evidence to support the following assumptions of effective interprofessional teamwork between CHWs and health care teams: (1) shared understanding of roles, norms, values, and goals of the team; (2) egalitarianism; (3) cooperation; (4) interdependence; and(5) synergy. Results: Of the 47 studies, 12 reported at least one assumption of effective interprofessional teamwork. Four studies demonstrated all 5 assumptions of interprofessional teamwork. Conclusions: Four studies identified in this integrative review serve as exemplars for effective interprofessional teamwork between CHWs and health care teams. Further study is needed to describe the nature of interprofessional teamwork and collaboration in relation to patient health outcomes. PMID:28462254

  17. Interprofessional Teamwork and Collaboration Between Community Health Workers and Healthcare Teams: An Integrative Review.

    Science.gov (United States)

    Franklin, Catherine M; Bernhardt, Jean M; Lopez, Ruth Palan; Long-Middleton, Ellen R; Davis, Sheila

    2015-01-01

    Community Health Workers (CHWs) serve as a means of improving outcomes for underserved populations. However, their relationship within health care teams is not well studied. The purpose of this integrative review was to examine published research reports that demonstrated positive health outcomes as a result of CHW intervention to identify interprofessional teamwork and collaboration between CHWs and health care teams. A total of 47 studies spanning 33 years were reviewed using an integrative literature review methodology for evidence to support the following assumptions of effective interprofessional teamwork between CHWs and health care teams: (1) shared understanding of roles, norms, values, and goals of the team; (2) egalitarianism; (3) cooperation; (4) interdependence; and(5) synergy. Of the 47 studies, 12 reported at least one assumption of effective interprofessional teamwork. Four studies demonstrated all 5 assumptions of interprofessional teamwork. Four studies identified in this integrative review serve as exemplars for effective interprofessional teamwork between CHWs and health care teams. Further study is needed to describe the nature of interprofessional teamwork and collaboration in relation to patient health outcomes.

  18. Interprofessional Teamwork and Collaboration Between Community Health Workers and Healthcare Teams

    Directory of Open Access Journals (Sweden)

    Catherine M. Franklin

    2015-03-01

    Full Text Available Objectives: Community Health Workers (CHWs serve as a means of improving outcomes for underserved populations. However, their relationship within health care teams is not well studied. The purpose of this integrative review was to examine published research reports that demonstrated positive health outcomes as a result of CHW intervention to identify interprofessional teamwork and collaboration between CHWs and health care teams. Methods: A total of 47 studies spanning 33 years were reviewed using an integrative literature review methodology for evidence to support the following assumptions of effective interprofessional teamwork between CHWs and health care teams: (1 shared understanding of roles, norms, values, and goals of the team; (2 egalitarianism; (3 cooperation; (4 interdependence; and(5 synergy. Results: Of the 47 studies, 12 reported at least one assumption of effective interprofessional teamwork. Four studies demonstrated all 5 assumptions of interprofessional teamwork. Conclusions: Four studies identified in this integrative review serve as exemplars for effective interprofessional teamwork between CHWs and health care teams. Further study is needed to describe the nature of interprofessional teamwork and collaboration in relation to patient health outcomes.

  19. Interprofessional Teamwork and Collaboration Between Community Health Workers and Healthcare Teams

    Directory of Open Access Journals (Sweden)

    Catherine M. Franklin

    2015-03-01

    Full Text Available Objectives: Community Health Workers (CHWs serve as a means of improving outcomes for underserved populations. However, their relationship within health care teams is not well studied. The purpose of this integrative review was to examine published research reports that demonstrated positive health outcomes as a result of CHW intervention to identify interprofessional teamwork and collaboration between CHWs and health care teams. Methods: A total of 47 studies spanning 33 years were reviewed using an integrative literature review methodology for evidence to support the following assumptions of effective interprofessional teamwork between CHWs and health care teams: (1 shared understanding of roles, norms, values, and goals of the team; (2 egalitarianism; (3 cooperation; (4 interdependence; and(5 synergy. Results: Of the 47 studies, 12 reported at least one assumption of effective interprofessional teamwork. Four studies demonstrated all 5 assumptions of interprofessional teamwork. Conclusions: Four studies identified in this integrative review serve as exemplars for effective interprofessional teamwork between CHWs and health care teams. Further study is needed to describe the nature of interprofessional teamwork and collaboration in relation to patient health outcomes.

  20. [Knowledge and practices in breastfeeding promotion by Family Health teams in Montes Claros, Brazil].

    Science.gov (United States)

    Caldeira, Antônio Prates; Nobre de Aguiar, Gabriel; Cavalcanti Magalhães, Weslane Almeida; Fagundes, Gizele Carmem

    2007-08-01

    The Family Health Strategy has been implemented in Brazil with the aim of reorganizing the health care system with an emphasis on promotion and prevention. Thus, encouragement for breastfeeding is one of the most important activities by family health care teams. The objective of this study was to assess knowledge and practices by family health care teams in relation to breastfeeding. In addition to a questionnaire on health professionals' characteristics, a specific knowledge test on breastfeeding was conducted with 41 physicians and nurses and another test on the same subject was given to 152 community health workers. Scores were above 80% on the advantages of breastfeeding in all the teams, but knowledge on practical issues concerning technique and management of the main problems encountered in breastfeeding was not uniform among the health professions. Nurses scored better than physicians, and community health workers had the lowest scores. Practical activities to promote breastfeeding were not developed uniformly among health care professionals. There is a need for systematic and ongoing training in breastfeeding management in the family health teams.

  1. Chronicity and primary care: the role of prison health

    Directory of Open Access Journals (Sweden)

    R. Morral-Parente

    2015-10-01

    Full Text Available The Prison Primary Health Care Teams in Catalonia have been integrated into the Catalan Health Institute. This integration shall facilitate¹ training and updating, while eliminating the existing differences between the health services belonging to prison institutions and those of the Catalan Health Service. It shall enable team work and coordination between Primary Health Care Teams in the community and the PHCTs in prisons within the same geographical area by sharing ongoing training, multi-sector work teams and territory-based relations, thereby facilitating continuance in care and complete and integrated treatment of chronicity. The existing information systems in Primary Health Care and the shared clinical history in Catalonia are key factors for this follow up process. Support tools for clinical decision making shall also be shared, which shall contribute towards an increase in quality and clinical safety. These tools include electronic clinical practice guides, therapeutic guides, prescription alert systems, etc. This shall be an opportunity for Prison Health Care Teams to engage in teaching and research, which in turn shall have an indirect effect on improvements in health care quality and the training of professionals in this sector. The critical factor for success is the fact that a unique chronicity health care model shall be shared, where measures for health promotion prevention can be taken, along with multi-sector monitoring of pathologies and with health care information shared between professionals and levels throughout the patient's life, both in and out of the prison environment.

  2. [Chronicity and primary care: the role of prison health].

    Science.gov (United States)

    Morral-Parente, R

    2015-01-01

    The Prison Primary Health Care Teams in Catalonia have been integrated into the Catalan Health Institute. This integration shall facilitate¹ training and updating, while eliminating the existing differences between the health services belonging to prison institutions and those of the Catalan Health Service. It shall enable team work and coordination between Primary Health Care Teams in the community and the PHCTs in prisons within the same geographical area by sharing ongoing training, multi-sector work teams and territory-based relations, thereby facilitating continuance in care and complete and integrated treatment of chronicity. The existing information systems in Primary Health Care and the shared clinical history in Catalonia are key factors for this follow up process. Support tools for clinical decision making shall also be shared, which shall contribute towards an increase in quality and clinical safety. These tools include electronic clinical practice guides, therapeutic guides, prescription alert systems, etc. This shall be an opportunity for Prison Health Care Teams to engage in teaching and research, which in turn shall have an indirect effect on improvements in health care quality and the training of professionals in this sector. The critical factor for success is the fact that a unique chronicity health care model shall be shared, where measures for health promotion prevention can be taken, along with multi-sector monitoring of pathologies and with health care information shared between professionals and levels throughout the patient's life, both in and out of the prison environment.

  3. [A determined team caring for an elderly detainee].

    Science.gov (United States)

    Sifaoui, Brigitte

    2011-01-01

    The arrival of an elderly person in a remand centre reveals the extent to which the prison system is ill-equipped to deal with this type of detainee. The cooperation between the prison, nursing and social care teams however compensates for the many difficulties his case presents.

  4. Understanding interdisciplinary health care teams: using simulation design processes from the Air Carrier Advanced Qualification Program to identify and train critical teamwork skills.

    Science.gov (United States)

    Hamman, William R; Beaudin-Seiler, Beth M; Beaubien, Jeffrey M

    2010-09-01

    In the report "Five Years After 'To Err is Human' ", it was noted that "the combination of complexity, professional fragmentation, and a tradition of individualism, enhanced by a well-entrenched hierarchical authority structure and diffuse accountability, forms a daunting barrier to creating the habits and beliefs of common purpose, teamwork, and individual accountability for successful interdependence that a safe culture requires". Training physicians, nurses, and other professionals to work in teams is a concept that has been promoted by many patient safety experts. However the model of teamwork in healthcare is diffusely defined, no clear performance metrics have been established, and the use of simulation to train teams has been suboptimal. This paper reports on the first three years of work performed in the Michigan Economic Development Corporation (MEDC) Tri-Corridor life science grant to apply concepts and processes of simulation design that were developed in the air carrier industry to understand and train healthcare teams. This work has been monitored by the American Academy for the Advancement of Science (AAA) and is based on concepts designed in the Advanced Qualification Program (AQP) from the air carrier industry, which trains and assesses teamwork skills in the same manner as technical skills. This grant has formed the foundation for the Center of Excellence for Simulation Education and Research (CESR).

  5. Palliative care team visits. Qualitative study through participant observation

    Directory of Open Access Journals (Sweden)

    María del Mar Alfaya Góngora

    2016-04-01

    Full Text Available Objectives:To describe the clinical encounters that occur when a palliative care team provides patient care and the features that influence these encounters and indicate whether they are favorable or unfavorable depending on the expectations and feelings of the various participants.Methods:A qualitative case study conducted via participant observation. A total of 12 observations of the meetings of palliative care teams with patients and families in different settings (home, hospital and consultation room were performed. The visits were follow-up or first visits, either scheduled or on demand. Content analysis of the observation was performed.Results:The analysis showed the normal follow-up activity of the palliative care unit that was focused on controlling symptoms, sharing information and providing advice on therapeutic regimens and care. The environment appeared to condition the patients' expressions and the type of patient relationship. Favorable clinical encounter conditions included kindness and gratitude. Unfavorable conditions were deterioration caused by approaching death, unrealistic family objectives and limited resources.Conclusion:Home visits from basic palliative care teams play an important role in patient and family well-being. The visits seem to focus on controlling symptoms and are conditioned by available resources.

  6. Leadership models in health care - a case for servant leadership.

    Science.gov (United States)

    Trastek, Victor F; Hamilton, Neil W; Niles, Emily E

    2014-03-01

    Our current health care system is broken and unsustainable. Patients desire the highest quality care, and it needs to cost less. To regain public trust, the health care system must change and adapt to the current needs of patients. The diverse group of stakeholders in the health care system creates challenges for improving the value of care. Health care providers are in the best position to determine effective ways of improving the value of care. To create change, health care providers must learn how to effectively lead patients, those within health care organizations, and other stakeholders. This article presents servant leadership as the best model for health care organizations because it focuses on the strength of the team, developing trust and serving the needs of patients. As servant leaders, health care providers may be best equipped to make changes in the organization and in the provider-patient relationship to improve the value of care for patients.

  7. Team behaviors in emergency care: a qualitative study using behavior analysis of what makes team work

    Directory of Open Access Journals (Sweden)

    Mazzocato Pamela

    2011-11-01

    Full Text Available Abstract Objective Teamwork has been suggested as a promising approach to improving care processes in emergency departments (ED. However, for teamwork to yield expected results, implementation must involve behavior changes. The aim of this study is to use behavior analysis to qualitatively examine how teamwork plays out in practice and to understand eventual discrepancies between planned and actual behaviors. Methods The study was set in a Swedish university hospital ED during the initial phase of implementation of teamwork. The intervention focused on changing the environment and redesigning the work process to enable teamwork. Each team was responsible for entire care episodes, i.e. from patient arrival to discharge from the ED. Data was collected through 3 days of observations structured around an observation scheme. Behavior analysis was used to pinpoint key teamwork behaviors for consistent implementation of teamwork and to analyze the contingencies that decreased or increased the likelihood of these behaviors. Results We found a great discrepancy between the planned and the observed teamwork processes. 60% of the 44 team patients observed were handled solely by the appointed team members. Only 36% of the observed patient care processes started according to the description in the planned teamwork process, that is, with taking patient history together. Beside this behavior, meeting in a defined team room and communicating with team members were shown to be essential for the consistent implementation of teamwork. Factors that decreased the likelihood of these key behaviors included waiting for other team members or having trouble locating each other. Getting work done without delay and having an overview of the patient care process increased team behaviors. Moreover, explicit instructions on when team members should interact and communicate increased adherence to the planned process. Conclusions This study illustrates how behavior analysis

  8. Team behaviors in emergency care: a qualitative study using behavior analysis of what makes team work.

    Science.gov (United States)

    Mazzocato, Pamela; Forsberg, Helena Hvitfeldt; Schwarz, Ulrica von Thiele

    2011-11-15

    Teamwork has been suggested as a promising approach to improving care processes in emergency departments (ED). However, for teamwork to yield expected results, implementation must involve behavior changes. The aim of this study is to use behavior analysis to qualitatively examine how teamwork plays out in practice and to understand eventual discrepancies between planned and actual behaviors. The study was set in a Swedish university hospital ED during the initial phase of implementation of teamwork. The intervention focused on changing the environment and redesigning the work process to enable teamwork. Each team was responsible for entire care episodes, i.e. from patient arrival to discharge from the ED. Data was collected through 3 days of observations structured around an observation scheme. Behavior analysis was used to pinpoint key teamwork behaviors for consistent implementation of teamwork and to analyze the contingencies that decreased or increased the likelihood of these behaviors. We found a great discrepancy between the planned and the observed teamwork processes. 60% of the 44 team patients observed were handled solely by the appointed team members. Only 36% of the observed patient care processes started according to the description in the planned teamwork process, that is, with taking patient history together. Beside this behavior, meeting in a defined team room and communicating with team members were shown to be essential for the consistent implementation of teamwork. Factors that decreased the likelihood of these key behaviors included waiting for other team members or having trouble locating each other. Getting work done without delay and having an overview of the patient care process increased team behaviors. Moreover, explicit instructions on when team members should interact and communicate increased adherence to the planned process. This study illustrates how behavior analysis can be used to understand discrepancies between planned and observed

  9. Interprofessional team building in the palliative home care setting: Use of a conceptual framework to inform a pilot evaluation.

    Science.gov (United States)

    Shaw, James; Kearney, Colleen; Glenns, Brenda; McKay, Sandra

    2016-01-01

    Home-based palliative care is increasingly dependent on interprofessional teams to deliver collaborative care that more adequately meets the needs of clients and families. The purpose of this pilot evaluation was to qualitatively explore the views of an interprofessional group of home care providers (occupational therapists, nurses, personal support work supervisors, community care coordinators, and a team coordinator) regarding a pilot project encouraging teamwork in interprofessional palliative home care services. We used qualitative methods, informed by an interprofessional conceptual framework, to analyse participants' accounts and provide recommendations regarding strategies for interprofessional team building in palliative home health care. Findings suggest that encouraging practitioners to share past experiences and foster common goals for palliative care are important elements of team building in interprofessional palliative care. Also, establishing a team leader who emphasises sharing power among team members and addressing the need for mutual emotional support may help to maximise interprofessional teamwork in palliative home care. These findings may be used to develop and test more comprehensive efforts to promote stronger interprofessional teamwork in palliative home health care delivery.

  10. Improving the delivery of care for patients with diabetes through understanding optimised team work and organisation in primary care

    Directory of Open Access Journals (Sweden)

    Hrisos Susan

    2009-04-01

    Full Text Available Abstract Background Type 2 diabetes is an increasingly prevalent chronic illness and is an important cause of avoidable mortality. Patients are managed by the integrated activities of clinical and non-clinical members of the primary care team. Studies of the quality of care for patients with diabetes suggest less than optimum care in a number of areas. Aim The aim of this study is to improve the quality of care for patients with diabetes cared for in primary care in the UK by identifying individual, team, and organisational factors that predict the implementation of best practice. Design Participants will be clinical and non-clinical staff within 100 general practices sampled from practices who are members of the MRC General Practice Research Framework. Self-completion questionnaires will be developed to measure the attributes of individual health care professionals, primary care teams (including both clinical and non-clinical staff, and their organisation in primary care. Questionnaires will be administered using postal survey methods. A range of validated theories will be used as a framework for the questionnaire instruments. Data relating to a range of dimensions of the organisational structure of primary care will be collected via a telephone interview at each practice using a structured interview schedule. We will also collect data relating to the processes of care, markers of biochemical control, and relevant indicator scores from the quality and outcomes framework (QOF. Process data (as a proxy indicator of clinical behaviours will be collected from practice databases and via a postal questionnaire survey of a random selection of patients from each practice. Levels of biochemical control will be extracted from practice databases. A series of analyses will be conducted to relate the individual, team, and organisational data to the process, control, and QOF data to identify configurations associated with high quality care. Study

  11. Improving the delivery of care for patients with diabetes through understanding optimised team work and organisation in primary care.

    Science.gov (United States)

    Eccles, Martin P; Hawthorne, Gillian; Johnston, Marie; Hunter, Margaret; Steen, Nick; Francis, Jill; Hrisos, Susan; Elovainio, Marko; Grimshaw, Jeremy M

    2009-04-27

    Type 2 diabetes is an increasingly prevalent chronic illness and is an important cause of avoidable mortality. Patients are managed by the integrated activities of clinical and non-clinical members of the primary care team. Studies of the quality of care for patients with diabetes suggest less than optimum care in a number of areas. The aim of this study is to improve the quality of care for patients with diabetes cared for in primary care in the UK by identifying individual, team, and organisational factors that predict the implementation of best practice. Participants will be clinical and non-clinical staff within 100 general practices sampled from practices who are members of the MRC General Practice Research Framework. Self-completion questionnaires will be developed to measure the attributes of individual health care professionals, primary care teams (including both clinical and non-clinical staff), and their organisation in primary care. Questionnaires will be administered using postal survey methods. A range of validated theories will be used as a framework for the questionnaire instruments. Data relating to a range of dimensions of the organisational structure of primary care will be collected via a telephone interview at each practice using a structured interview schedule. We will also collect data relating to the processes of care, markers of biochemical control, and relevant indicator scores from the quality and outcomes framework (QOF). Process data (as a proxy indicator of clinical behaviours) will be collected from practice databases and via a postal questionnaire survey of a random selection of patients from each practice. Levels of biochemical control will be extracted from practice databases. A series of analyses will be conducted to relate the individual, team, and organisational data to the process, control, and QOF data to identify configurations associated with high quality care. UKCRN ref:DRN120 (ICPD).

  12. [Transforming health systems based on primary care].

    Science.gov (United States)

    Durán-Arenas, Luis; Salinas-Escudero, Guillermo; Granados-García, Víctor; Martínez-Valverde, Silvia

    2012-01-01

    Access to health services is a social basic determinant of health in Mexico unlike what happens in developed countries. The demand for health services is focused on primary care, but the design meets only the supply of hospital care services. So it generates a dissonance between the needs and the effective design of health services. In addition, the term affiliation refers to population contributing or in the recruitment process, that has been counted as members of these social security institutions (SS) and Popular Insurance (SP). In the case of Instituto Mexicano del Seguro Social (IMSS) three of four contributors are in contact with health services; while in the SP, this indicator does not exist. Moreover, the access gap between health services is found in the health care packages so that members of the SS and SP do not have same type of coverage. The question is: which model of health care system want the Mexicans? Primary care represents the first choice for increasing the health systems performance, as well as to fulfill their function of social protection: universal access and coverage based on needs, regardless whether it is a public or private health insurance. A central aspect for development of this component is the definition of the first contact with the health system through the creation of a primary health care team, led by a general practitioner as the responsible of a multidisciplinary health team. The process addresses the concepts of primary care nursing, consumption of inputs (mainly medical drugs), maintenance and general services. Adopting a comprehensive strategy that will benefit all Mexicans equally and without discrimination, this primary care system could be financed with a total operating cost of approximately $ 22,809 million by year.

  13. Role expansion on interprofessional primary care teams: Barriers of role self-efficacy among clinical associates.

    Science.gov (United States)

    Giannitrapani, Karleen F; Soban, Lynn; Hamilton, Alison B; Rodriguez, Hector; Huynh, Alexis; Stockdale, Susan; Yano, Elizabeth M; Rubenstein, Lisa V

    2016-12-01

    Interprofessional team-based models of primary care that expand the role of clinical associates (CAs) are increasingly adopted in primary care practices. In this study we query team members of a newly implemented patient centered medical home (PCMH) to identify facilitators and barriers of occupational role self-efficacy, a belief of possessing the capacity to execute their new team based role effectively. 79 key informants, members of primary care teams at six Veterans Health Administration (VA) clinics, were interviewed to assess their experiences with implementing expanded roles for CAs. All sites had implemented Patient Aligned Care Teams, the VA's version of PCMH. Three themes that produced the self-efficacy necessary for successful role expansion of CAs were identified: (1) role training (2) time and resources for roles and (3) cross-disciplinary role agreement. Sub-themes emerged around role challenges. Training sub themes included incomplete or limited training, inconsistencies in trainings within a site, and not receiving training with team members. Insufficient resources sub-themes included limited time for expanded tasks, inadequate space, low staffing, and poor task mix. Cross-disciplinary agreement failed to occur specifically when there was insufficient coordination between medicine and nursing leadership about staff roles, poor primary care provider (PCPs) knowledge of the boundaries of staff roles, and lack of synchronicity between staff roles and what PCPs would like staff roles to include. These identified themes have implications for healthcare professionals working in interprofessional teams in a variety of settings and indicate the need for interdisciplinary leadership based solutions. Clarifying the factors that impact self-efficacy for the role expansion of PACT staff can inform strategies for role transformation for enhanced primary care delivery. Published by Elsevier Inc.

  14. Allied health team management of rheumatoid arthritis patients.

    Science.gov (United States)

    Feinberg, J R; Brandt, K D

    1984-09-01

    The use of a coordinated team of allied health professionals (AHPs) to treat patients with rheumatoid arthritis assigned to experimental groups (EG) and comparison groups (CG) was assessed. The EG patients were evaluated regularly by each AHP team member, whereas CG patients were seen by AHPs only upon referral. Of the 10 EG and 13 CG patients who remained in the study for 2 years, the EG patients initially exhibited somewhat greater disease activity than CG (as reflected by erythrocyte sedimentation rate and duration of morning stiffness). After 2 years, EG patients demonstrated less disease activity than at the outset, whereas CG patients either showed little change in these parameters or deteriorated during the study. Grip strength, which was initially similar in the two groups, improved in EG patients but decreased in CG patients, so that after 2 years a significant difference was noted between the two groups (p less than .05). Tendency to lose hand range of motion was also greater in CG than in EG patients. Some EG patients showed improvement in finger flexion deformities during the study. Furthermore, EG patients showed a greater tendency to acquire positive attitudes regarding themselves and family relationships. These results suggest that ongoing "team care" may be more efficacious than episodic use of AHPs in management of patients with mild rheumatoid arthritis.

  15. Health care technology assessment

    Science.gov (United States)

    Goodman, Clifford

    1994-12-01

    The role of technology in the cost of health care is a primary issue in current debates concerning national health care reform. The broad scope of studies for understanding technological impacts is known as technology assessment. Technology policy makers can improve their decision making by becoming more aware, and taking greater advantage, of key trends in health care technology assessment (HCTA). HCTA is the systematic evaluation of the properties, impacts, and other attributes of health care technologies, including: technical performance; clinical safety and efficacy/effectiveness; cost-effectiveness and other economic attributes; appropriate circumstances/indications for use; and social, legal, ethical, and political impacts. The main purpose of HCTA is to inform technology-related policy making in health care. Among the important trends in HCTA are: (1) proliferation of HCTA groups in the public and private sectors; (2) higher standards for scientific evidence concerning technologies; (3) methodological development in cost analyses, health-related quality of life measurement, and consolidation of available scientific evidence (e.g., meta-analysis); (4) emphasis on improved data on how well technologies work in routine practice and for traditionally under-represented patient groups; (5) development of priority-setting methods; (6) greater reliance on medical informatics to support and disseminate HCTA findings.

  16. Primary health care.

    Science.gov (United States)

    Kitai, A

    1986-07-01

    Development of primary care in Japan in still relatively unorganized and unstructured. As mentioned above, the author describes some strengths and weaknesses of the Japanese primary care system. In addressing the weaknesses the following suggestions are offered for the Japanese primary care delivery system: Increase the number of emergency rooms for all day, especially on holidays and at night. Introduce an appointment system. Introduce an open system of hospitals. Coordinate with public hospitals and primary care clinics. Organize the referral system between private practitioners and community hospitals. Increase the number of paramedical staff. Strengthen group practice among primary care physicians. Increase the establishment of departments of primary care practice with government financial incentives to medical schools and teaching hospitals. Develop a more active and direct teaching role for primary care practice or family practice at undergraduate, graduate, and postgraduate levels. Improve and maintain present health insurance payment method, shifting from quantity of care to quality and continuity of care. Introduce formal continuing education. Introduce formal training programs of primary care and strengthen ambulatory care teaching programs.

  17. Interprofessional team management in pediatric critical care: some challenges and possible solutions

    Science.gov (United States)

    Stocker, Martin; Pilgrim, Sina B; Burmester, Margarita; Allen, Meredith L; Gijselaers, Wim H

    2016-01-01

    Background Aiming for and ensuring effective patient safety is a major priority in the management and culture of every health care organization. The pediatric intensive care unit (PICU) has become a workplace with a high diversity of multidisciplinary physicians and professionals. Therefore, delivery of high-quality care with optimal patient safety in a PICU is dependent on effective interprofessional team management. Nevertheless, ineffective interprofessional teamwork remains ubiquitous. Methods We based our review on the framework for interprofessional teamwork recently published in association with the UK Centre for Advancement of Interprofessional Education. Articles were selected to achieve better understanding and to include and translate new ideas and concepts. Findings The barrier between autonomous nurses and doctors in the PICU within their silos of specialization, the failure of shared mental models, a culture of disrespect, and the lack of empowering parents as team members preclude interprofessional team management and patient safety. A mindset of individual responsibility and accountability embedded in a network of equivalent partners, including the patient and their family members, is required to achieve optimal interprofessional care. Second, working competently as an interprofessional team is a learning process. Working declared as a learning process, psychological safety, and speaking up are pivotal factors to learning in daily practice. Finally, changes in small steps at the level of the microlevel unit are the bases to improve interprofessional team management and patient safety. Once small things with potential impact can be changed in one’s own unit, engagement of health care professionals occurs and projects become accepted. Conclusion Bottom–up patient safety initiatives encouraging participation of every single care provider by learning effective interprofessional team management within daily practice may be an effective way of

  18. Organizing Rural Health Care

    DEFF Research Database (Denmark)

    Bunkenborg, Mikkel

    2012-01-01

    The liberalization of health care in the course of three decades of ‘reform and opening up’ has given people in rural China access to a diverse range of treatment options, but the health care system has also been marred by accusations of price hikes, fake pharmaceuticals, and medical malpractice....... This chapter offers an ethnographic description of health as an issue in a Hebei township and it focuses on a popular and a statist response to the perceived inadequacy of the rural health care system. The revival of religious practices in rural China is obviously motivated by many factors, but in the township...... in question, various forms of healing play a significant role in religious movements and the rising cost of medical services as well as a general distrust of formal medical institutions seem to be part of the reason why people choose to follow spirit mediums and religious movements that offer alternative...

  19. The effect of multidisciplinary team care on cancer management.

    Science.gov (United States)

    Abdulrahman, Ganiy Opeyemi

    2011-01-01

    Over the past 15 years, the multidisciplinary team management of many medical conditions especially cancers has increasingly taken a prominent role in patient management in many hospitals and medical centres in the developed countries. In the United Kingdom, it began to gain prominence following the Calman-Heine report in 1995 which suggested that each Cancer Unit in a hospital should have in place arrangements for non-surgical oncological input into services, with a role for a non-surgical oncologist. The report further suggested that a lead clinician with a well established interest in cancer care should be appointed to organise and coordinate the whole range of cancer services provided within the Cancer Unit. Many people have argued that the multidisciplinary team management of patients has resulted in better care and improved survival. However, there are barriers to the optimal effectiveness of the multidisciplinary team. This paper aims to review various studies on the effectiveness of the multidisciplinary team in the management of cancer patients and also discuss some of the barriers to the multidisciplinary team.

  20. Recovery practice in community mental health teams: national survey.

    Science.gov (United States)

    Leamy, M; Clarke, E; Le Boutillier, C; Bird, V; Choudhury, R; MacPherson, R; Pesola, F; Sabas, K; Williams, J; Williams, P; Slade, M

    2016-10-01

    There is consensus about the importance of 'recovery' in mental health services, but the link between recovery orientation of mental health teams and personal recovery of individuals has been underresearched. To investigate differences in team leader, clinician and service user perspectives of recovery orientation of community adult mental health teams in England. In six English mental health National Health Service (NHS) trusts, randomly chosen community adult mental health teams were surveyed. A random sample of ten patients, one team leader and a convenience sample of five clinicians were surveyed from each team. All respondents rated the recovery orientation of their team using parallel versions of the Recovery Self Assessment (RSA). In addition, service users also rated their own personal recovery using the Questionnaire about Processes of Recovery (QPR). Team leaders (n = 22) rated recovery orientation higher than clinicians (n = 109) or patients (n = 120) (Wald(2) = 7.0, P = 0.03), and both NHS trust and team type influenced RSA ratings. Patient-rated recovery orientation was a predictor of personal recovery (b = 0.58, 95% CI 0.31-0.85, Pservice users have less positive views on recovery orientation. Increasing recovery orientation may support personal recovery. © The Royal College of Psychiatrists 2016.

  1. The Role of Council Health Management Team in the Improvement ...

    African Journals Online (AJOL)

    The Role of Council Health Management Team in the Improvement of Health ... services included the shortage of human resources, poor working equipment, lack ... adequate resources for participatory organs to execute their functions as well ...

  2. Telementoring Primary Care Clinicians to Improve Geriatric Mental Health Care.

    Science.gov (United States)

    Fisher, Elisa; Hasselberg, Michael; Conwell, Yeates; Weiss, Linda; Padrón, Norma A; Tiernan, Erin; Karuza, Jurgis; Donath, Jeremy; Pagán, José A

    2017-01-20

    Health care delivery and payment systems are moving rapidly toward value-based care. To be successful in this new environment, providers must consistently deliver high-quality, evidence-based, and coordinated care to patients. This study assesses whether Project ECHO(®) (Extension for Community Healthcare Outcomes) GEMH (geriatric mental health)-a remote learning and mentoring program-is an effective strategy to address geriatric mental health challenges in rural and underserved communities. Thirty-three teleECHO clinic sessions connecting a team of specialists to 54 primary care and case management spoke sites (approximately 154 participants) were conducted in 10 New York counties from late 2014 to early 2016. The curriculum consisted of case presentations and didactic lessons on best practices related to geriatric mental health care. Twenty-six interviews with program participants were conducted to explore changes in geriatric mental health care knowledge and treatment practices. Health insurance claims data were analyzed to assess changes in health care utilization and costs before and after program implementation. Findings from interviews suggest that the program led to improvements in clinician geriatric mental health care knowledge and treatment practices. Claims data analysis suggests that emergency room costs decreased for patients with mental health diagnoses. Patients without a mental health diagnosis had more outpatient visits and higher prescription and outpatient costs. Telementoring programs such as Project ECHO GEMH may effectively build the capacity of frontline clinicians to deliver high-quality, evidence-based care to older adults with mental health conditions and may contribute to the transformation of health care delivery systems from volume to value.

  3. Health care in the Netherlands.

    NARCIS (Netherlands)

    Weel, C. van; Schers, H.J.; Timmermans, A.

    2012-01-01

    This article analyzes Dutch experiences of health care reform--in particular in primary care--with emphasis on lessons for current United States health care reforms. Recent major innovations were the introduction of private insurance based on the principles of primary care-led health care and

  4. Skill mix, roles and remuneration in the primary care workforce: who are the healthcare professionals in the primary care teams across the world?

    NARCIS (Netherlands)

    Freund, T.; Everett, C.; Griffiths, P.; Hudon, C.; Naccarella, L.; Laurant, M.G.H.

    2015-01-01

    World-wide, shortages of primary care physicians and an increased demand for services have provided the impetus for delivering team-based primary care. The diversity of the primary care workforce is increasing to include a wider range of health professionals such as nurse practitioners, registered

  5. Skill mix, roles and remuneration in the primary care workforce: who are the healthcare professionals in the primary care teams across the world?

    NARCIS (Netherlands)

    Freund, T.; Everett, C.; Griffiths, P.; Hudon, C.; Naccarella, L.; Laurant, M.G.H.

    2015-01-01

    World-wide, shortages of primary care physicians and an increased demand for services have provided the impetus for delivering team-based primary care. The diversity of the primary care workforce is increasing to include a wider range of health professionals such as nurse practitioners, registered n

  6. [Role of primary care teams in hospitalization of children under 2 years of age?].

    Science.gov (United States)

    Pardo Crespo, M R; Pérez Iglesias, R; Llorca, J; Rodrigo Calabia, E; Alvarez Granda, L; Delgado-Rodríguez, M

    2000-10-31

    To determine whether the structure of primary care teams on carrying out the healthy child health programme leads to a drop in the risk of admission to hospital of children under two, in comparison with the traditional clinic or out-clinic health system. Case-reference epidemiological study. 40% of the children under 24 months admitted to paediatric or neonate floors of the Marqués de Valdecilla University Hospital. Reference: 15% of the recently born children alive in this hospital. Information was gathered through face-to-face interview and by examining health cards. The study ran from April 1995 to May 1996. Children under two monitored habitually by a doctor belonging to a primary care team showed a drop in risk of hospital admission for all clinical diagnoses of 0.57 (95% CI, 0.35-0.93), after adjustment due to various confusion factors such as maternal education, social class, ethnic background, mother's age, mother's tobacco consumption, natural breast-feeding at birth, admission at birth. There was a drop of risk of hospital admission for high temperature without apparent cause in those children monitored habitually by a team doctor (adjusted RR = 0.41; 95% CI, 0.19-0.90). The advantages of the paediatric health care reform with the structuring of the primary care teams and the accompanying activities performed lead to a drop in the risk of hospital admission of those children under two years old who are habitually monitored by a doctor belonging to a primary care team.

  7. Integrating pharmacists into diverse diabetes care teams: implementation tactics from Project IMPACT: Diabetes.

    Science.gov (United States)

    Watson, Lindsay L; Bluml, Benjamin M

    2014-01-01

    To describe local implementation tactics used by the 25 Project Diabetes communities and partnering organizations to help patients who are disproportionately affected by diabetes. Care was delivered in 25 communities within 17 states at federally qualified health centers, community pharmacies, free clinics, employer work sites, medical clinics, physician offices, and other settings. In addition to pharmacists, practices included physicians, nurse practitioners, dietitians, physician assistants, social workers, behavioral therapists, and other types of health professionals. Insurance status and the predominant ethnicity of patients differed between communities. Each community had at least one community champion responsible for leading local implementation who was supported by an American Pharmacists Association Foundation community coordinator and Foundation staff. The key innovations within each of the 25 communities were the integration of pharmacists on diabetes care teams, use of the Patient Self-Management Credential for Diabetes at baseline, and collection of a standardized minimum dataset. Communities deployed other practice innovations to support the care model, including group education classes, grocery store tours, joint provider visits, and provision of patient incentives. The specific components of each community's implementation and innovation were aggregated via postproject surveys. Clinical and process measures were also collected and are published separately. Each community is characterized based on the people involved and the care delivered. Aspects of the communities described include health care provider teams, population characteristics, practice settings, care components, data collection methods, incentives provided, and self-reported service sustainability. Pharmacists can be integrated successfully into a diverse array of practice settings and teams to help a wide variety of patients through the provision of team-based, patient-centered care

  8. Recovery practice in community mental health teams: national survey

    Science.gov (United States)

    Leamy, M.; Clarke, E.; Le Boutillier, C.; Bird, V.; Choudhury, R.; MacPherson, R.; Pesola, F.; Sabas, K.; Williams, J.; Williams, P.; Slade, M.

    2016-01-01

    Background There is consensus about the importance of ‘recovery’ in mental health services, but the link between recovery orientation of mental health teams and personal recovery of individuals has been underresearched. Aims To investigate differences in team leader, clinician and service user perspectives of recovery orientation of community adult mental health teams in England. Method In six English mental health National Health Service (NHS) trusts, randomly chosen community adult mental health teams were surveyed. A random sample of ten patients, one team leader and a convenience sample of five clinicians were surveyed from each team. All respondents rated the recovery orientation of their team using parallel versions of the Recovery Self Assessment (RSA). In addition, service users also rated their own personal recovery using the Questionnaire about Processes of Recovery (QPR). Results Team leaders (n = 22) rated recovery orientation higher than clinicians (n = 109) or patients (n = 120) (Wald(2) = 7.0, P = 0.03), and both NHS trust and team type influenced RSA ratings. Patient-rated recovery orientation was a predictor of personal recovery (b = 0.58, 95% CI 0.31–0.85, P<0.001). Team leaders and clinicians with experience of mental illness (39%) or supporting a family member or friend with mental illness (76%) did not differ in their RSA ratings from other team leaders or clinicians. Conclusions Compared with team leaders, frontline clinicians and service users have less positive views on recovery orientation. Increasing recovery orientation may support personal recovery. PMID:27340113

  9. A new quality assurance package for hospital palliative care teams: the Trent Hospice Audit Group model.

    Science.gov (United States)

    Hunt, J; Keeley, V L; Cobb, M; Ahmedzai, S H

    2004-07-19

    Cancer patients in hospitals are increasingly cared for jointly by palliative care teams, as well as oncologists and surgeons. There has been a considerable growth in the number and range of hospital palliative care teams (HPCTs) in the United Kingdom. HPCTs can include specialist doctors and nurses, social workers, chaplains, allied health professionals and pharmacists. Some teams work closely with existing cancer multidisciplinary teams (MDTs) while others are less well integrated. Quality assurance and clinical governance requirements have an impact on the monitoring of such teams, but so far there is no standardised way of measuring the amount and quality of HPCTs' workload. Trent Hospice Audit Group (THAG) is a multiprofessional research group, which has been developing standards and audit tools for palliative care since the 1990s. These follow a format of structure-process-outcome for standards and measures. We describe a collaborative programme of work with HPCTs that has led to a new set of standards and audit tools. Nine HPCTs participated in three rounds of consultation, piloting and modification of standard statements and tools. The final pack of HPCT quality assurance tools covers: policies and documentation; medical notes review; questionnaires for ward-based staff. The tools measure the HPCT workload and casemix; the views of ward-based staff on the supportive role of the HPCT and the effectiveness of HPCT education programmes, particularly in changing practice. The THAG HPCT quality assurance pack is now available for use in cancer peer review.

  10. Health care reforms

    Directory of Open Access Journals (Sweden)

    Marušič Dorjan

    2016-09-01

    Full Text Available In large systems, such as health care, reforms are underway constantly. The article presents a definition of health care reform and factors that influence its success. The factors being discussed range from knowledgeable personnel, the role of involvement of international experts and all stakeholders in the country, the importance of electoral mandate and governmental support, leadership and clear and transparent communication. The goals set need to be clear, and it is helpful to have good data and analytical support in the process. Despite all debates and experiences, it is impossible to clearly define the best approach to tackle health care reform due to a different configuration of governance structure, political will and state of the economy in a country.

  11. Health care reforms.

    Science.gov (United States)

    Marušič, Dorjan; Prevolnik Rupel, Valentina

    2016-09-01

    In large systems, such as health care, reforms are underway constantly. The article presents a definition of health care reform and factors that influence its success. The factors being discussed range from knowledgeable personnel, the role of involvement of international experts and all stakeholders in the country, the importance of electoral mandate and governmental support, leadership and clear and transparent communication. The goals set need to be clear, and it is helpful to have good data and analytical support in the process. Despite all debates and experiences, it is impossible to clearly define the best approach to tackle health care reform due to a different configuration of governance structure, political will and state of the economy in a country.

  12. Resilient health care

    DEFF Research Database (Denmark)

    Hollnagel, E.; Braithwaite, J.; Wears, R. L.

    production, and high reliability. This has on the whole been met with limited success because health care as a non-trivial and multifaceted system differs significantly from most traditional industries. In order to allow health care systems to perform as expected and required, it is necessary to have......Health care is everywhere under tremendous pressure with regard to efficiency, safety, and economic viability - to say nothing of having to meet various political agendas - and has responded by eagerly adopting techniques that have been useful in other industries, such as quality management, lean...... concepts and methods that are able to cope with this complexity. Resilience engineering provides that capacity because its focus is on a system's overall ability to sustain required operations under both expected and unexpected conditions rather than on individual features or qualities. Resilience...

  13. Interprofessional team management in pediatric critical care: some challenges and possible solutions

    Directory of Open Access Journals (Sweden)

    Stocker M

    2016-02-01

    Full Text Available Martin Stocker,1 Sina B Pilgrim,2 Margarita Burmester,3 Meredith L Allen,4 Wim H Gijselaers5 1Neonatal and Pediatric Intensive Care Unit, Children's Hospital Lucerne, Lucerne, 2Pediatric Intensive Care, University Children's Hospital Berne, Berne, Switzerland; 3Pediatric Intensive Care Unit, Royal Brompton Hospital, London, UK; 4Department of Pediatrics, The Royal Children's Hospital, Victoria, Australia; 5Educational Research and Development, School of Business and Economics, Maastricht University, Maastricht, the Netherlands Background: Aiming for and ensuring effective patient safety is a major priority in the management and culture of every health care organization. The pediatric intensive care unit (PICU has become a workplace with a high diversity of multidisciplinary physicians and professionals. Therefore, delivery of high-quality care with optimal patient safety in a PICU is dependent on effective interprofessional team management. Nevertheless, ineffective interprofessional teamwork remains ubiquitous.Methods: We based our review on the framework for interprofessional teamwork recently published in association with the UK Centre for Advancement of Interprofessional Education. Articles were selected to achieve better understanding and to include and translate new ideas and concepts.Findings: The barrier between autonomous nurses and doctors in the PICU within their silos of specialization, the failure of shared mental models, a culture of disrespect, and the lack of empowering parents as team members preclude interprofessional team management and patient safety. A mindset of individual responsibility and accountability embedded in a network of equivalent partners, including the patient and their family members, is required to achieve optimal interprofessional care. Second, working competently as an interprofessional team is a learning process. Working declared as a learning process, psychological safety, and speaking up are pivotal

  14. Joy and challenges in improving chronic illness care: capturing daily experiences of academic primary care teams.

    Science.gov (United States)

    Johnson, Julie K; Woods, Donna M; Stevens, David P; Bowen, Judith L; Provost, Lloyd P; Sixta, Connie S; Wagner, Ed H

    2010-09-01

    Two chronic care collaboratives (The National Collaborative and the California Collaborative) were convened to facilitate implementing the chronic care model (CCM) in academic medical centers and into post-graduate medical education. We developed and implemented an electronic team survey (ETS) to elicit, in real-time, team member's experiences in caring for people with chronic illness and the effect of the Collaborative on teams and teamwork. The ETS is a qualitative survey based on Electronic Event Sampling Methodology. It is designed to collect meaningful information about daily experience and any event that might influence team members' daily work and subsequent outcomes. Forty-one residency programs from 37 teaching hospitals participated in the collaboratives and comprised faculty and resident physicians, nurses, and administrative staff. Each team member participating in the collaboratives received an e-mail with directions to complete the ETS for four weeks during 2006 (the National Collaborative) and 2007 (the California Collaborative). At the team level, the response rate to the ETS was 87% with team members submitting 1,145 narrative entries. Six key themes emerged from the analysis, which were consistent across all sites. Among teams that achieved better clinical outcomes on Collaborative clinical indicators, an additional key theme emerged: professional work satisfaction, or "Joy in Work". In contrast, among teams that performed lower in collaborative measures, two key themes emerged that reflected the effect of providing care in difficult institutional environments-"lack of professional satisfaction" and awareness of "system failures". The ETS provided a unique perspective into team performance and the day-to-day challenges and opportunities in chronic illness care. Further research is needed to explore systematic approaches to integrating the results from this study into the design of improvement efforts for clinical teams.

  15. Integralidade do cuidado: representações sociais das equipes de Saúde da Família do Distrito Federal Comprehensive care: social representations of Family Health teams in Distrito Federal, Brazil

    Directory of Open Access Journals (Sweden)

    Vladimir Andrei Rodrigues Arce

    2013-03-01

    Full Text Available Trata-se de pesquisa qualitativa que analisou as representações sociais dos profissionais da Estratégia Saúde da Família (ESF do Distrito Federal-DF acerca da integralidade do cuidado. A ESF vem sendo implantada no Brasil desde 1994 como uma estratégia política para reordenar o modelo de atenção à saúde, estando atualmente em processo de ampliação no DF. Foram realizados entrevistas individuais semiestruturadas e grupo focal com gestores locais e profissionais das equipes de 11 das 15 regionais de saúde. Utilizou-se o Discurso de Sujeito Coletivo (DSC e a teoria das Representações Sociais para análise, com o objetivo de compreender a sociogênese da forma de pensar a partir de um olhar psicossocial sobre a realidade. Verificou-se que o cuidado é percebido como ato de solidariedade e atributo profissional, apoio às famílias em suas múltiplas necessidades e articulação de ações interdisciplinares de prevenção, promoção e tratamento, visando qualidade de vida. A integralidade do cuidado permeia a noção de autonomia profissional, requer a criação de vínculos de confiança e responsabilização entre profissionais e usuários, a contextualização da família sobre os determinantes e formas de enfrentamento dos problemas e demanda a integração com demais serviços. O estudo demonstrou que o cuidado relaciona-se com diferentes dimensões da integralidade, refletindo potencialidades e desafios do modelo da ESF para o desenvolvimento de práticas ampliadas de saúde. Faz-se necessário que a potencialidade das relações estabelecidas entre diferentes sujeitos no território permita a qualificação das ações de saúde, sobretudo aquelas voltadas para a promoção.This qualitative research analyzed the social representations about comprehensive care of the health professionals who work at the teams of the Family Health Strategy (ESF in Distrito Federal - DF, Brazil. The ESF is being implemented in Brazil since 1994

  16. Assessing the Quality and Comparative Effectiveness of Team-Based Care for Heart Failure: Who, What, Where, When, and How.

    Science.gov (United States)

    Cooper, Lauren B; Hernandez, Adrian F

    2015-07-01

    Team-based or multidisciplinary care may be a potential way to positively impact outcomes for heart failure (HF) patients by improving clinical outcomes, managing patient symptoms, and reducing costs. The multidisciplinary team includes the HF cardiologist, HF nurses, clinical pharmacists, dieticians, exercise specialists, mental health providers, social workers, primary care providers, and additional subspecialty providers. The timing and setting of multidisciplinary care depends on the needs of the patient and the resources available. Multidisciplinary HF teams should be evaluated based on their ability to achieve goals, as well as their potential for sustainability over time.

  17. Evaluation of interprofessional education: lessons learned through the development and implementation of an interprofessional seminar on team communication for undergraduate health care students in Heidelberg - a project report.

    Science.gov (United States)

    Berger, Sarah; Mahler, Cornelia; Krug, Katja; Szecsenyi, Joachim; Schultz, Jobst-Hendrik

    2016-01-01

    Einleitung: Dieser Projektbericht beschreibt die Entwicklung, Pilotierung und Evaluation eines interprofessionellen Seminars zur Team-Kommunikation, das Studierende der Humanmedizin und Studierende des Studiengangs Interprofessionelle Gesundheitsversorgung B.Sc. an der Medizinische Fakultät der Universität Heidelberg zusammengebracht hat.Projektbeschreibung: Ein fünfköpfiges interprofessionelles Team arbeitete zusammen an diesem Projekt. Kolbs Theorie des erfahrungsorientierten Lernens bildete die theoretische Grundlage für das Seminar, in dem drei interprofessionelle Kompetenzdomänen vermittelt wurden: Teamarbeit, Kommunikation und Werte/Ethik. Die Evaluation zum Zwecke der Qualitätssicherung und der zukünftigen curricularen Entwicklung wurde mit zwei quantitativen Instrumenten durchgeführt:deskriptive Analyse eines standardisierten Kurs-Bewertungsinstruments (EvaSys) Varianzanalyse (ANOVA) der deutschen Version des Fragebogens „University of the West of England Interprofessional Questionnaire“ (UWE-IP-D).Ergebnisse: Das Hauptergebnis der standardisierten Kursevaluation war, dass die interprofessionellen Seminare positiver bewertet wurden [MW=2,11 (Bereich: 1 sehr positiv bis 5 sehr negativ), SD=1, n=27] als die monoprofessionellen Seminare [MW=2,55, SD=0,98, n=90]. Der Vergleich der Vorher-/Nachher-Ergebnisse in der UWE-IP-D Befragung der interprofessionellen (IP) (n=40) und monoprofessionellen (MP) Gruppen (n=34) zeigte signifikante positive Veränderungen der Mittelwerte für beide Gruppen hinsichtlich Kommunikation, Teamarbeit und interprofessionellem Lernen. Schlussfolgerungen: Erkenntnisgewinne aus dem Projekt: a) Nutzen einer pragmatischen Vorgehensweise bei der Einführung interprofessioneller Ausbildungssequenzen, die es ermöglichte, dass verschiedene Barrieren bzgl. Logistik sowie Einstellung/Haltung überwunden werden konnten; b) eine quantitative Evaluation allein konnte die positiven Rückmeldungen des interprofessionellen Settings nicht

  18. Health care need

    DEFF Research Database (Denmark)

    Hasman, Andreas; Hope, Tony; Østerdal, Lars Peter

    2006-01-01

    The argument that scarce health care resources should be distributed so that patients in 'need' are given priority for treatment is rarely contested. In this paper, we argue that if need is to play a significant role in distributive decisions it is crucial that what is meant by need can...... be precisely articulated. Following a discussion of the general features of health care need, we propose three principal interpretations of need, each of which focuses on separate intuitions. Although this account may not be a completely exhaustive reflection of what people mean when they refer to need...

  19. Burnout and health care utilization.

    Science.gov (United States)

    Jackson, C N; Manning, M R

    1995-01-01

    This study explores the relationship between burnout and health care utilization of 238 employed adults. Burnout was measured by the Maslach Burnout Inventory and health care utilization by insurance company records regarding these employees' health care costs and number of times they accessed health care services over a one year period. ANOVAs were conducted using Golembiewski and Munzenrider's approach to define the burnout phase. Significant differences in health care costs were found.

  20. Transdisciplinarity in Health Care: A Concept Analysis.

    Science.gov (United States)

    Van Bewer, Vanessa

    2017-05-26

    To analyze the concept of transdisciplinarity and provide an enhanced definition of transdisciplinarity in health care. The term transdisciplinarity is increasingly prevalent in health care research and has been identified as important to improving the effectiveness and efficiency in health care. However, the term continues to be misappropriated and poorly understood by researchers and clinicians alike which hinders its potential use and impact. Walker and Avant's (2005) method of concept analysis was used as a framework for the study of the concept. The databases PubMed, CINAHL, Academic Search Premier, PsycInfo and ERIC were used searching the terms transdisciplinarity, transdisciplinary, interdisciplinary and interdisciplinarity. Transdisciplinarity in health care involves transcending of disciplinary boundaries, a sharing of knowledge, skills and decision-making, a focus on real-world problems and the inclusion of multiple stakeholders including patients, their families and their communities. An enhanced definition of transdisciplinarity in health care emerged from this concept analysis that may provide clarity and direction for health care providers. Nurses, and other health care providers, can look to this definition to understand transdisciplinary health care teams as opposed to multidisciplinary, and interdisciplinary ones. © 2017 Wiley Periodicals, Inc.

  1. Multidisciplinary care team for cancer patients and its implementation in several Middle Eastern countries.

    Science.gov (United States)

    Silbermann, M; Pitsillides, B; Al-Alfi, N; Omran, S; Al-Jabri, K; Elshamy, K; Ghrayeb, I; Livneh, J; Daher, M; Charalambous, H; Jafferri, A; Fink, R; El-Shamy, M

    2013-10-01

    This article introduces palliative care to cancer patients in Middle Eastern countries. It considers the importance of the multidisciplinary team in providing an adequate service to the patient and his/her family. It provides views of professionals from the various countries with regard to the role of the nurse in such teams; whereby the three elements of palliative care nursing entail: 1. Working directly with patients and families; 2. Working with other health and social care professionals to network and co-ordinate services; and 3. working at an organizational level to plan, develop and manage service provision in local, regional and national settings. This article also details the challenges that nurses face in the Middle East and outlines the preferable ways to overcome such challenges. The latter include more focused educational activities at the undergraduate and graduate levels and continuous clinical training throughout their work as palliative care nurse specialists.

  2. Primary care team- and clinic level factors affecting HPV vaccine uptake.

    Science.gov (United States)

    Chuang, Emmeline; Cabrera, Claudia; Mak, Selene; Glenn, Beth; Hochman, Michael; Bastani, Roshan

    2017-08-16

    This study examined patient-, care team- and clinic-level factors associated with human papillomavirus (HPV) vaccine initiation and completion. HPV vaccine initiation and completion rates among adolescents aged 9-18years were assessed using administrative data (n=38,277) from a large federally qualified health center serving predominantly Latino patients. Four clinics with particularly high and low adolescent HPV vaccine uptake were selected for in-depth case study analyses. Semi-structured interviews with clinic leaders, providers, and support staff in these clinics (n=36) examined multilevel factors perceived as affecting vaccine initiation and completion. On average, less than half (45%) of patients had initiated the HPV vaccine; of these, 52% of patients completed all recommended doses. Vaccine uptake varied significantly across clinics but was higher among patients seen by providers specializing in pediatrics. Qualitative findings confirmed the importance of provider communication strategies but indicated that other health care team structures and processes also play an important role in vaccine uptake. Care team members in higher performing clinics were more likely to describe vaccination as a team effort rather than solely the provider's responsibility. Support staff in higher performing clinics also spent more time reviewing patient preventive care needs and preparing patients for the provider encounter. Clinic-level factors such as performance management systems and the use of immunization champions were described as important for developing an organizational climate supportive of vaccination. Tracking and reminder systems were described as important but insufficient for ensuring vaccine uptake in the absence of other supports. Efforts to improve HPV initiation and completion could benefit from additional attention to factors at the health care team and clinic levels. Interventions that target factors at multiple levels of influence are most likely to

  3. [Palliative care support teams and the commitment of primary care teams to terminally ill patients in their homes].

    Science.gov (United States)

    Rocafort Gil, Javier; Herrera Molina, Emilio; Fernández Bermejo, Félix; Grajera Paredes María, María Eulalia; Redondo Moralo, María José; Díaz Díez, Fátima; Espinosa Rojas, José Armando

    2006-10-15

    To find out if the activity of palliative care support teams (PCST) does not negatively influences the performance of the primary care "care of terminally ill patients" service. Terminally ill patients cared for at home. Multicentre observational study. The observed variable is the increase in the number of registered patients in primary care, and the number of patients covered between the years 2002 and 2003 and the 4 intervention variables are: total visits, joint visits, assessments, and teaching sessions. The number of patients covered in 2002 was 41.19%, increasing to 45.44% in 2003. The activity rate of the PCST for each 100 000 inhabitants was 526 home visits in 2003, 86.15 joint visits, 313.68 professional assessments, and 23.14 teaching sessions. The joint visits and the teaching sessions were strongly associated with an improvement in the coverage of primary care (Pearson correlation of 0.784 and 0.759, respectively). The total visits were moderately associated (0.525) and the assessments were weakly associated (0.245). Joint visits and teaching sessions of a PCST are associated to an increase in the activity of primary care teams. Assessments and total visits did not have a negative influence.

  4. The Preventable Admissions Care Team (PACT): A Social Work-Led Model of Transitional Care.

    Science.gov (United States)

    Basso Lipani, Maria; Holster, Kathleen; Bussey, Sarah

    2015-10-01

    In 2010, the Preventable Admissions Care Team (PACT), a social work-led transitional care model, was developed at Mount Sinai to reduce 30-day readmissions among high-risk patients. PACT begins with a comprehensive bedside assessment to identify the psychosocial drivers of readmission. In partnership with the patient and family, a patient-centered action plan is developed and carried out through phone calls, accompaniments, navigations and home visits, as needed, in the first 30 days following discharge. 620 patients were enrolled during the pilot from September 2010-August 2012. Outcomes demonstrated a 43% reduction in inpatient utilization and a 54% reduction in emergency department visits among enrollees. In addition, 93% of patients had a follow-up appointment within 7-10 days of discharge and 90% of patients attended the appointment. The success of PACT has led to additional funding from the Centers for Medicare and Medicaid Services under the Community-based Care Transitions Program and several managed care companies seeking population health management interventions for high risk members.

  5. Team sponsors in community-based health leadership programs.

    Science.gov (United States)

    Patterson, Tracy Enright; Dinkin, Donna R; Champion, Heather

    2017-05-02

    Purpose The purpose of this article is to share the lessons learned about the role of team sponsors in action-learning teams as part of community-based health leadership development programs. Design/methodology/approach This case study uses program survey results from fellow participants, action learning coaches and team sponsors to understand the value of sponsors to the teams, the roles they most often filled and the challenges they faced as team sponsors. Findings The extent to which the sponsors were perceived as having contributed to the work of the action learning teams varied greatly from team to team. Most sponsors agreed that they were well informed about their role. The roles sponsors most frequently played were to provide the teams with input and support, serve as a liaison to the community and serve as a sounding board, motivator and cheerleader. The most common challenges or barriers team sponsors faced in this role were keeping engaged in the process, adjusting to the role and feeling disconnected from the program. Practical implications This work provides insights for program developers and community foundations who are interested in building the capacity for health leadership by linking community sponsors with emerging leaders engaged in an action learning experience. Originality/value This work begins to fill a gap in the literature. The role of team sponsors has been studied for single organization work teams but there is a void of understanding about the role of sponsors with multi-organizational teams working to improve health while also learning about leadership.

  6. Nursing care community health

    Directory of Open Access Journals (Sweden)

    Diana Acosta-Salazar

    2016-07-01

    Full Text Available Process Nursing Care (PAE is a systematic tool that facilitates the scientificity of care in community practice nurse, the application of scientific method in community practice, allows nursing to provide care in logical, systematic and comprehensive reassessing interventions to achieve the proposed results. It began with the valuation of Marjory Gordon Functional Patterns and then at the stage of diagnosis and planning North American Nursing Diagnosis Association (NANDA, Nursing Interventions Classification (NIC and Nursing Outcomes Classification (NOC is interrelate. It is a descriptive and prospective study. Diagnosis was made by applying the instruments measuring scale of the socio-demographic characteristics, symptom questionnaire for early detection of mental disorders in the community and appreciation for functional patterns. The PAE includes more frequent diagnoses, criteria outcomes, indicators, interventions and activities to manage community issues. alteration was evidenced in patterns: Adaptation and Stress Tolerance, Self-perception-Self-concept-, Role-Relationships, sleep and rest and Perception and Health Management. A standardized NANDA-NIC-NOC can provide inter care holistic care from the perspective of community mental health with a degree of scientific nature that frames the professional work projecting the individual, family and community care.

  7. Information in Health Care.

    Science.gov (United States)

    Mayeda, Tadashi A.

    The report stresses the fact that while there is unity in the continuum of medicine, information in health care is markedly different from information in medical education and research. This difference is described as an anomaly in that it appears to deviate in excess of normal variation from needs common to research and education. In substance,…

  8. What Does Change with Nutrition Team in Intensive Care Unit?

    Directory of Open Access Journals (Sweden)

    Ahmet Fatih Yılmaz

    2016-08-01

    Full Text Available Intrroduction: Clinical nutrition is the nutrition support therapy provided to patients under medical supervision at the hospital or home setting. It is a multidisciplinary task performed under the control of the physician, dietician, pharmacist and nurse. In this study, the changes in the patient admission statistics to the general intensive care unit (GICU, the exitus ratios, decubitus ulcer formation rates, albumin use rates, duration of the hospital stay, Acute Physiology and Chronic Health Evaluation (APACHE II scores, rate of usege of parenteral and enteral products, and the change in expenses per patient within the first year of activity of the nutrition team in comparison to the previous year was presented. Material and Method: In this study a 6-bed GICU was used. The patients who was admitted through retrospective file scanning between 1 January 2012 and 31 December 2012 and between 1 January 2013 and 31 December 2013 were compared. Results: The number of the patients admitted to the GICU was 341 in 2012 and 369 in 2013. The number of the patients who died in 2012 was 86 (25.2%, while it was 106 in 2013 (28.7%. In 2012, 122 patients (35.7% had decubitus ulcers, while this number was 92 (24.7% in 2013. Human albumin usage was reduced by 23% for the 100 mL (225 in 2012, 175 in 2013 and by 33% for the 50 mL doses (122 in 2012, 82 in 2013. Duration of stay in the hospital was 6.3±0.9 vs. 5.8±0.9 (days (p=0.06. The mean APACHE II scores were observed to be 24.7±6.9 vs. 30.5±11.4 (p=0.03. When the distribution of product types were analyzed, it was observed that the ratio of parenteral products: enteral products was 2:1 in 2012, however the ratio of enteral products to parenteral products was 2:1 in 2013. The daily expense of a patient decreased from 100 TL to 55 TL. Conclusion: The nutrition team directly influences the clinical process outcomes of patients under treatment in the ICU. It was thought that using appropriate nutritional

  9. [Comparison of primary care teams in Barcelona according to management formulas].

    Science.gov (United States)

    Guarga, A; Gil, M; Pasarín, M; Manzanera, R; Armengol, R; Sintes, J

    2000-11-30

    The aim of the study is to compare, among socio-economically similar areas, the use of medical services, clinical practice and pharmacy costs depending on the how the primary healthcare teams, that provide these services, are organized according to different managemental formulas. Descriptive study of the evaluation of health care services. The population units (basic health areas) attended by the reformed primary health care services in Barcelona were classified into three levels according to the population's socioeconomic status (high, medium or low). For each level, two primary health care teams were selected representing different primary health care providers: "Institut Catala de la Salut"; and others. The influence of both the provision option and the population characteristics on service use, clinical practice and costs of prescription were compared. The services offered by the two provision options differ. However, the use of medical services is related to the socioeconomic characteristics and not to the option for service provision. Whilst there are no relevant differences in clinical practice between the different options, we observed variations among different primary care teams, notably in referrals to specialists and influenza vaccine coverage. The greater source of variation in prescription costs seems to be related to an external confounding factor. Empirical data have not identified relevant differences in the pattern of use, clinical practice, or costs between the different options for service provision within the model of reformed primary care services. Observed variations seem to be associated mainly with the population's characteristics, its pattern of health service use or other external confounding factors.

  10. Characterizing the Structure of a Patient's Care Team through Electronic Encounter Data Analysis.

    Science.gov (United States)

    He, Shan; Gurr, Greg; Rea, Susan; Thornton, Sidney N

    2015-01-01

    As the field of medicine grows more complicated and doctors become more specialized in a particular field, the number of healthcare providers involved in healing an individual patient increases. This is particularly true of patients with multiple chronic conditions. Establishing effective communications among the care providers becomes critical to facilitate care coordination and more efficient resource use, which will ultimately result in health outcome improvement. The first step for care coordination is to understand who have been involved in a patient's care and their relationships with the patient. The widespread adoption of Electronic Health Records provides us an opportunity to explore solutions to well-coordinated care. This paper presents the concept of a patient's care team and demonstrates the feasibility of identifying relevant healthcare providers for an individual patient by leveraging electronic patient encounter data. Combined with network analysis techniques, we further visualize the care team structure with quantified strength of patient-provider relationships. Our work is foundational to the larger goal of patient-centered, coordinated care in the digital age of healthcare.

  11. Development of a team performance scale to assess undergraduate health professionals.

    Science.gov (United States)

    Sigalet, Elaine; Donnon, Tyrone; Cheng, Adam; Cooke, Suzette; Robinson, Traci; Bissett, Wendy; Grant, Vincent

    2013-07-01

    Interprofessional simulation-based team training is strongly endorsed as a potential solution for improving teamwork in health care delivery. Unfortunately, there are few teamwork evaluation instruments. The present study developed and tested the psychometric characteristics of the newly developed KidSIM Team Performance Scale checklist. A quasi-experimental research design engaging a convenience sample of 196 undergraduate medical, nursing, and respiratory therapy students was completed in the 2010-2011 academic year. Multidisciplinary student teams participated in a simulation-based curriculum that included the completion of two acute illness management scenarios, resulting in 282 independent reviews by evaluators from medicine, nursing, and respiratory therapy. The authors investigated the underlying factors of the performance checklist and examined the performance scores of an experimental and a control team-training-curriculum group. Participation in the supplemental team training curriculum was related to higher team performance scores (P teams at Time 2 achieved higher scores than at Time 1 (P performance scale was α = 0.90. Factor analysis supported a three-factor solution (accounting for 67.9% of the variance) with an emphasis on roles and responsibilities (five items) and communication (six items) subscale factors. When simulation is used in acute illness management training, the KidSIM Team Performance Scale provides reliable, valid score interpretation of undergraduates' team process based on communication effectiveness and identification of roles and responsibilities. Implementation of a supplementary team training curriculum significantly enhances students' performance in multidisciplinary simulation-based scenarios at the undergraduate level.

  12. Flourishing in health care

    OpenAIRE

    Edgar, Andrew Robert; Pattison, Stephen

    2016-01-01

    The purpose of this paper is to offer an account of ‘flourishing’ that is relevant to health care provision, both in terms of the flourishing of the individual patient and carer, and in terms of the flourishing of the caring institution. It is argued that, unlike related concepts such as ‘happiness’, ‘well-being’ or ‘quality of life’, ‘flourishing’ uniquely has the power to capture the importance of the vulnerability of human being. Drawing on the likes of Heidegger and Nussbaum, it is argued...

  13. Mental Health promotion of a hospital through the nurse in the liaison psychiatry team

    Directory of Open Access Journals (Sweden)

    Natalia Cámara Conde

    2008-09-01

    Full Text Available We show a proposal to increase the quality of nursing cares, improving mental health care of hospitalized patients by creating the figure of the liaison nurse within the liaison psychiatry team. This nurse would not only be a reference to support the nursing staff at the level of patient care, but also the psycho-emotional self-care professional.Objectives: Justifying the need to include the figure of the specialist mental health team liaison psychiatry nurse. Method: The rotation as residents, for a month, with the interconsultation team psychiatric hospital Gregorio Marañón and literature review. Results: There have been partially unmet needs, these could be covered with the existence of a nurse specialist in mental health consultation in this hospital. Discussion: Possibly it poses difficulties in defining the roles of various liaison team professionals, which we expect can be defined at the start implementing the new member.The hospital itself has an own field defined, articulated through the NANDA, NIC, NOC methodology, which covers aspects that so far have not being made, there is not a nurse figure into the psychiatric consultation liaison team.

  14. Children's rights to health care.

    Science.gov (United States)

    Brock, D W

    2001-04-01

    This paper will explore the application of an account of justice in health and health care to the special case of children. It is tempting to hold that children require no special treatment in an account of just health care; justice requires guaranteeing access to at least basic health care services to all persons, whatever their age group, within the constraints of a society's resources. However, I will argue that for a number of reasons we need to address what justice requires specifically for children from the health care system, even if the answer must be embedded within a general account of justice in health and health care.

  15. Facilitating care of patients with HIV infection by hospital and primary care teams.

    Science.gov (United States)

    Smits, A; Mansfield, S; Singh, S

    1990-01-01

    To complement the role of primary care teams working with patients with HIV disease and AIDS within greater London and to ease the load on the special hospital units a home support team was developed. It comprises six specialist nurses, a general practitioner trained medical officer, and a receptionist and is funded from regional and district sources and charities. A nurse is available for out of hours and emergency weekend calls, with support from the patient's general practitioner or the attached medical officer. During the first 18 months 249 patients were seen; the mean duration of care was five months. Nearly a third (18/50, 30%) of patients who were terminally ill died at home. The team's activities included practical nursing care, emotional support for carers and patients, and advice and guidance to primary care teams. Problems in providing care in patients' homes included issues relating to confidentiality and 24 hour cover. With the increasing incidence of HIV infection the home support team may be a useful model for care of large numbers of patients with symptomatic HIV disease, especially in large urban areas. PMID:2106936

  16. Community care in practice: social work in primary health care.

    Science.gov (United States)

    Lymbery, M; Millward, A

    2001-01-01

    This paper examines the establishment of social work within primary health care settings in Great Britain, following the passage of the National Health Service and Community Care Act in 1990. Although the improvement of relationships between social workers and primary health care teams has been promoted for a number of years, the advent of formal policies for community care has made this a priority for both social services and health. This paper presents interim findings from the evaluation of three pilot projects in Nottinghamshire, Great Britain. These findings are analysed from three linked perspectives. The first is the extent to which structures and organisations have worked effectively together to promote the location of social workers within health care settings. The second is the impact of professional and cultural factors on the work of the social worker in these settings. The third is the effect of interpersonal relationships on the success of the project. The paper will conclude that there is significant learning from each of these perspectives which can be applied to the future location of social workers to primary health care.

  17. Applying the guidelines for pharmacists integrating into primary care teams.

    Science.gov (United States)

    Barry, Arden R; Pammett, Robert T

    2016-07-01

    In 2013, Jorgenson et al. published guidelines for pharmacists integrating into primary care teams. These guidelines outlined 10 evidence-based recommendations designed to support pharmacists in successfully establishing practices in primary care environments. The aim of this review is to provide a detailed, practical approach to implementing these recommendations in real life, thereby aiding to validate their effectiveness. Both authors reviewed the guidelines independently and ranked the importance of each recommendation respective to their practice. Each author then provided feedback for each recommendation regarding the successes and challenges they encountered through implementation. This feedback was then consolidated into agreed upon statements for each recommendation. Focusing on building relationships (with an emphasis on face time) and demonstrating value to both primary care providers and patients were identified as key aspects in developing these new roles. Ensuring that the environment supports the practice, along with strategic positioning within the clinic, improves uptake and can maximize the usefulness of a pharmacist in primary care. Demonstrating consistent and competent clinical and documentation skills builds on the foundation of the other recommendations to allow for the effective provision of clinical pharmacy services. Additional recommendations include developing efficient ways (potentially provider specific) to communicate with primary care providers and addressing potential preconceived notions about the role of the pharmacist in primary care. We believe these guidelines hold up to real-life integration and emphatically recommend their use for new and existing primary care pharmacists.

  18. Escalas de satisfação com o atendimento às doenças cardiovasculares: CARDIOSATIS usuário e equipe Satisfaction scales with health care to cardiovascular diseases: CARDIOSATIS patient and team

    Directory of Open Access Journals (Sweden)

    Clareci Silva Cardoso

    2011-01-01

    Full Text Available A satisfação é uma importante medida da qualidade da atenção, da adesão ao tratamento e uso adequado dos serviços de saúde. O objetivo foi construir as escalas para avaliar a satisfação da equipe médica e de usuários com o atendimento às emergências cardiovasculares oferecido por um projeto de telemedicina. A construção das escalas seguiu os padrões internacionais para criação de instrumentos incluindo a definição operacional do construto satisfação e sua dimensionalidade; a operacionalização dos itens; a realização de pré-teste e o estudo piloto. A revisão de literatura, os grupos focais e discussão com especialistas delimitaram as áreas a serem incluídas nas escalas e a elaboração das questões. A escala CARDIOSATIS-Equipe é composta por quinze itens e a escala CARDIOSATIS-Usuário, por onze, pontuados em escala tipo Likert de cinco pontos, incluindo questões abertas. Englobam informações sobre satisfação com a estrutura física, recursos humanos, capacidade de resolutividade, atenção e cuidados oferecidos pelo serviço, além da satisfação com o atendimento recebido/prestado. As escalas CARDIOSATIS têm mostrado fácil compreensão e aceitação pela equipe médica e pacientes. Resultados preliminares mostraram boas características de validade e confiabilidade dos instrumentos.Satisfaction is an important measure of quality care, of adherence to the treatment and adequate use of health services. The objective here is to build two scales which evaluates team' and patients' satisfaction with cardiovascular disease treatment provided through a distance telecardiology project. The procedure followed international standards for development of measure instruments, including operational definition of satisfaction contents and its area for evaluation; item definition; pre-test and pilot study. The literature review, focal groups and discussion with specialists had delimited the domains to be included in

  19. [Social isolation and loneliness: What can we do as Primary Care teams?

    Science.gov (United States)

    Gené-Badia, Joan; Ruiz-Sánchez, Marina; Obiols-Masó, Núria; Oliveras Puig, Laura; Lagarda Jiménez, Elena

    2016-11-01

    Loneliness and social isolation are emerging health conditions in the elderly population, in particular widows, high frequency users of health services and those with chronic problems and depression. Loneliness is the subjective feeling of having less affection and closeness than that desired in the intimate or relational field. Social isolation is an objective situation of having minimal contact with other people. Its contribution to increased morbidity and mortality is comparable to other well known risk factors that we deal with daily as Primary Care teams. Strategies to identify these problems in our patients and to perform scientific evidence based studies at individual and community level in cooperation with other community resources and interventions are discussed. The Primary Care team must promote the autonomy of these patients, facilitating their sociability, and act on their social maladaptive thoughts that hinder their social integration. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  20. Attitudes of primary care team to diagnosing dementia.

    Science.gov (United States)

    Thomas, Hywel

    2010-04-01

    Healthcare professionals in primary care are gatekeepers to specialist services and are important in terms of ensuring access to community support and appropriate referral for the sizable number of older people with mental health problems. This literature review explores the role of primary care professionals, particularly GPs and practice nurses, in diagnosing and managing patients with dementia. It recommends that education and training are required to raise awareness of the importance of accurate diagnosis and management in primary care.

  1. Building the occupational health team: keys to successful interdisciplinary collaboration.

    Science.gov (United States)

    Wachs, Joy E

    2005-04-01

    Teamwork among occupational health and safety professionals, management, and employees is vital to solving today's complex problems cost-effectively. No single discipline can meet all the needs of workers and the workplace. However, teamwork can be time-consuming and difficult if attention is not given to the role of the team leader, the necessary skills of team members, and the importance of a supportive environment. Bringing team members together regularly to foster positive relationships and infuse them with the philosophy of strength in diversity is essential for teams to be sustained and work to be accomplished. By working in tandem, occupational health and safety professionals can become the model team in business and industry delivering on their promise of a safe and healthy workplace for America's work force.

  2. The importance of multidisciplinary teamwork and team climate for relational coordination among teams delivering care to older patients.

    Science.gov (United States)

    Hartgerink, J M; Cramm, J M; Bakker, T J E M; van Eijsden, A M; Mackenbach, J P; Nieboer, A P

    2014-04-01

    To identify predictors of relational coordination among professionals delivering care to older patients. Relational coordination is known to enhance quality of care in hospitals. The underlying mechanisms, however, remain poorly understood. This cross-sectional study was part of a larger evaluation study examining the opportunity to prevent loss of function in older patients due to hospitalization in the Netherlands. This study was performed in spring 2010 among team members delivering care to older hospitalized patients (192 respondents; 44% response rate) in one hospital. Relational coordination was measured by the Relational Coordination survey; team climate by the Team Climate Inventory and questions were asked about participation in multidisciplinary team meetings and disciplines represented in these meetings. To account for the hierarchical structure, a multilevel analysis was performed. Correlation analysis revealed a positive relationship among being female, being a nurse and relational coordination; medical specialists showed a negative relationship. The number of disciplines represented during multidisciplinary team meetings and team climate were positively related with relational coordination. The multilevel analysis showed a positive relationship between the number of disciplines represented during multidisciplinary team meetings and team climate with relational coordination. The enhancement of team climate and attendance of diverse professionals during multidisciplinary team meetings are expected to improve relational coordination. Furthermore, this study underscores the importance of enhancing relational coordination between medical specialists and other professionals. © 2013 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.

  3. Collaboration and entanglement: An actor-network theory analysis of team-based intraprofessional care for patients with advanced heart failure.

    Science.gov (United States)

    McDougall, A; Goldszmidt, M; Kinsella, E A; Smith, S; Lingard, L

    2016-09-01

    Despite calls for more interprofessional and intraprofessional team-based approaches in healthcare, we lack sufficient understanding of how this happens in the context of patient care teams. This multi-perspective, team-based interview study examined how medical teams negotiated collaborative tensions. From 2011 to 2013, 50 patients across five sites in three Canadian provinces were interviewed about their care experiences and were asked to identify members of their health care teams. Patient-identified team members were subsequently interviewed to form 50 "Team Sampling Units" (TSUs), consisting of 209 interviews with patients, caregivers and healthcare providers. Results are gathered from a focused analysis of 13 TSUs where intraprofessional collaborative tensions involved treating fluid overload, or edema, a common HF symptom. Drawing on actor-network theory (ANT), the analysis focused on intraprofessional collaboration between specialty care teams in cardiology and nephrology. The study found that despite a shared narrative of common purpose between cardiology teams and nephrology teams, fluid management tools and techniques formed sites of collaborative tension. In particular, care activities involved asynchronous clinical interpretations, geographically distributed specialist care, fragmented forms of communication, and uncertainty due to clinical complexity. Teams 'disentangled' fluid in order to focus on its physiological function and mobilisation. Teams also used distinct 'framings' of fluid management that created perceived collaborative tensions. This study advances collaborative entanglement as a conceptual framework for understanding, teaching, and potentially ameliorating some of the tensions that manifest during intraprofessional care for patients with complex, chronic disease.

  4. Effects of team-based learning on perceived teamwork and academic performance in a health assessment subject.

    Science.gov (United States)

    Park, Hyung-Ran; Kim, Chun-Ja; Park, Jee-Won; Park, Eunyoung

    2015-01-01

    The purpose of this study was to examine the effectiveness of team-based learning (a well-recognized learning and teaching strategy), applied in a health assessment subject, on nursing students' perceived teamwork (team-efficacy and team skills) and academic performance (individual and team readiness assurance tests, and examination scores). A prospective, one-group, pre- and post-test design enrolled a convenience sample of 74 second-year nursing students at a university in Suwon, Korea. Team-based learning was applied in a 2-credit health assessment subject over a 16-week semester. All students received written material one week before each class for readiness preparation. After administering individual- and team-readiness assurance tests consecutively, the subject instructor gave immediate feedback and delivered a mini-lecture to the students. Finally, students carried out skill based application exercises. The findings showed significant improvements in the mean scores of students' perceived teamwork after the introduction of team-based learning. In addition, team-efficacy was associated with team-adaptability skills and team-interpersonal skills. Regarding academic performance, team readiness assurance tests were significantly higher than individual readiness assurance tests over time. Individual readiness assurance tests were significantly related with examination scores, while team readiness assurance tests were correlated with team-efficacy and team-interpersonal skills. The application of team-based learning in a health assessment subject can enhance students' perceived teamwork and academic performance. This finding suggests that team-based learning may be an effective learning and teaching strategy for improving team-work of nursing students, who need to collaborate and effectively communicate with health care providers to improve patients' health.

  5. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    Email- aagobir@yahoo.co.uk ... households do not use any method for malaria prevention. ... study was conducted to assess the barriers to obtained from Ahmadu Bello University Teaching ..... Environmental Study Team (NEST).2007; p 1-57.

  6. Building an Interdisciplinary Faculty Team for Allied Health Gerontology Education.

    Science.gov (United States)

    Glista, Sandra; Petersons, Maija

    2003-01-01

    An interdisciplinary team from various college allied health departments implemented Project AGE: Alliance for Gerontology Education to develop content to infuse in courses on the themes of age and culture, assistive technology, collaboration, and consumer health education. One goal was to foster interaction among allied health students to prepare…

  7. [Primary health care product defined by health professionals and users].

    Science.gov (United States)

    Pujol Ribera, Enriqueta; Gené Badia, Joan; Sans Corrales, Mireia; Sampietro-Colom, Laura; Pasarín Rua, María Isabel; Iglesias-Pérez, Begoña; Casajuana-Brunet, Josep; Escaramis-Babiano, Georgia

    2006-01-01

    To identify the components of the primary health care (PHC) product defined by health professionals and users in order to establish indicators for evaluation. Qualitative methodology was used with group techniques: a nominal group (health professionals) and focus groups (users). The study was performed in PHC centers in Catalonia (Spain). There were 7 groups: a) family physicians and pediatricians; b) nurses and social workers; c) staff from admissions units and customer services; d) other medical specialists; e) users; f) managers, pharmacists, pharmacologists, and technicians. Participants responded to the question: "Which features should be evaluated in the services that should be provided by PHC?". A content analysis was performed. Textual data were broken down into units and then grouped into categories, following analogy criteria. The interpretative context of the research team was taken into account. Health professionals and users identified 4 dimensions of the PHC product, coinciding with its basic attributes: a) access to services; b) coordination and continuity of the PHC teams with other levels of healthcare; c) relationship between health professionals and users, and d) scientific-technical quality of the PHC teams and the portfolio of services. Equity, satisfaction and efficiency appeared as keystones in all the components of the product identified. There was broad agreement in the product definition among health professionals and users. The relationship between health professionals and patients was a key element in all groups. The four dimensions should be included in the evaluation of PHC teams.

  8. Enhancing the primary care team to provide redesigned care: the roles of practice facilitators and care managers.

    Science.gov (United States)

    Taylor, Erin Fries; Machta, Rachel M; Meyers, David S; Genevro, Janice; Peikes, Deborah N

    2013-01-01

    Efforts to redesign primary care require multiple supports. Two potential members of the primary care team-practice facilitator and care manager-can play important but distinct roles in redesigning and improving care delivery. Facilitators, also known as quality improvement coaches, assist practices with coordinating their quality improvement activities and help build capacity for those activities-reflecting a systems-level approach to improving quality, safety, and implementation of evidence-based practices. Care managers provide direct patient care by coordinating care and helping patients navigate the system, improving access for patients, and communicating across the care team. These complementary roles aim to help primary care practices deliver coordinated, accessible, comprehensive, and patient-centered care.

  9. [Neonatal palliative care at home: Contribution of the regional pediatric palliative care team].

    Science.gov (United States)

    Cojean, N; Strub, C; Kuhn, P; Calvel, L

    2017-02-01

    The "patients' rights and end-of-life care" act, known as the Leonetti law, has allowed implementation of palliative care in neonatology as an alternative to unreasonable therapeutic interventions. A palliative care project can be offered to newborns suffering from intractable diseases. It must be focused on the newborn's quality of life and comfort and on family support. Palliative care for newborns can be provided in the delivery room, in the neonatal unit, and also at home. Going home is possible but requires medical support. Here we describe the potential benefits of the intervention of a regional team of pediatric palliative care for newborns, both in the hospital and at home. Two clinical situations of palliative care at home started in the neonatal period and the neonatal unit are presented. They are completed by a retrospective national survey focusing on the type of support to newborns in palliative care in 2014, which was conducted in 22 French regional pediatric palliative care teams. It shows that 26 newborns benefited from this support at home in 2014. Sixteen infants were born after a pregnancy with a palliative care birth plan and ten entered palliative care after a decision to limit life-sustaining treatments. Twelve of them returned home before the 20th day of life. Sixteen infants died, six of them at home. The regional pediatric palliative care team first receives in-hospital interventions: providing support for ethical reflection in the development of the infant's life project, meeting with the child and its family, helping organize the care pathway to return home. When the child is at home, the regional pediatric palliative care team can support the caregiver involved, provide home visits to continue the clinical monitoring of the infant, and accompany the family. The follow-up of the bereavement and the analysis of the practices with caregivers are also part of its tasks.

  10. Transitions: A Guide to Teens Getting Older and Changing Health Care Providers

    Science.gov (United States)

    ... have By age 17 or 18, you should: Work on managing your health care Learn about your health insurance ... health care to in an adult setting Actively work with your health care team to ensure that you receive optimal care Update ...

  11. 'Shared-rhythm cooperation' in cooperative team meetings in acute psychiatric inpatient care.

    Science.gov (United States)

    Vuokila-Oikkonen, P; Janhonen, S; Vaisanen, L

    2004-04-01

    The cooperative team meeting is one of the most important interventions in psychiatric care. The purpose of this study was to describe the participation of patients and significant others in cooperative team meetings in terms of unspoken stories. The narrative approach focused on storytelling. The data consisted of videotaped cooperative team meetings (n = 11) in two acute closed psychiatric wards. The QRS NVivo computer program and the Holistic Content Reading method were used. During the process of analysis, the spoken and unspoken stories were analysed at the same time. According to the results, while there was some evident shared-rhythm cooperation (the topics of discussion were shared and the participants had eye contact), there were many instances where the interaction was controlled and defined by health care professionals. This lack of shared rhythm in cooperation, as defined in terms of storytelling, was manifested as monologue and the following practices: the health care professionals controlled the storytelling by sticking to their opinions, by giving the floor or by pointing with a finger and visually scanning the participants, by interrupting the speaker or by allowing the other experts to sit passively. Implications for mental health nursing practice are discussed.

  12. Creating and supporting a mixed methods health services research team.

    Science.gov (United States)

    Bowers, Barbara; Cohen, Lauren W; Elliot, Amy E; Grabowski, David C; Fishman, Nancy W; Sharkey, Siobhan S; Zimmerman, Sheryl; Horn, Susan D; Kemper, Peter

    2013-12-01

    To use the experience from a health services research evaluation to provide guidance in team development for mixed methods research. The Research Initiative Valuing Eldercare (THRIVE) team was organized by the Robert Wood Johnson Foundation to evaluate The Green House nursing home culture change program. This article describes the development of the research team and provides insights into how funders might engage with mixed methods research teams to maximize the value of the team. Like many mixed methods collaborations, the THRIVE team consisted of researchers from diverse disciplines, embracing diverse methodologies, and operating under a framework of nonhierarchical, shared leadership that required new collaborations, engagement, and commitment in the context of finite resources. Strategies to overcome these potential obstacles and achieve success included implementation of a Coordinating Center, dedicated time for planning and collaborating across researchers and methodologies, funded support for in-person meetings, and creative optimization of resources. Challenges are inevitably present in the formation and operation of effective mixed methods research teams. However, funders and research teams can implement strategies to promote success. © Health Research and Educational Trust.

  13. Practice improvement, part II: collaborative practice and team-based care.

    Science.gov (United States)

    Roett, Michelle A; Coleman, Mary Thoesen

    2013-11-01

    The Institute of Medicine recommends interprofessional teams to address patients' complex needs. Team care should be structured in a way that uses the highest training levels of its members. Team communication is enhanced through regular meetings (eg, team huddles), and office efficiency is improved through identifying and solving underlying system-level issues (ie, second-order problem solving). Inclusive leadership principles are used to strengthen team practices and meet chronic care model goals. Setting clear goals with measurable outcomes, creating clinical and administrative systems, establishing a clear division of labor among team members who have occupational diversity, and providing ongoing training all facilitate team building. Increasing opportunities for team members to work together, such as with group visits, and providing interprofessional education are ways to encourage adoption of interprofessional practice. Reimbursement for team care includes per member per month payments for such services as care management, pay-for-performance benchmark payments, and payment for non-face-to-face services.

  14. Utilization of registered nurses in primary care teams: A systematic review.

    Science.gov (United States)

    Norful, Allison; Martsolf, Grant; de Jacq, Krystyna; Poghosyan, Lusine

    2017-05-20

    Registered nurses are increasingly becoming embedded in primary care teams yet there is a wide variability in nursing roles and responsibilities across organizations. Policy makers are calling for a closer look at how to best utilize registered nurses in primary care teams. Lack of knowledge about effective primary care nursing roles and responsibilities challenges policy makers' abilities to develop recommendations to effectively deploy registered nurses in primary care needed to assure efficient, evidence-based, and quality health care. To synthesize international evidence about primary care RN roles and responsibilities to make recommendations for maximizing the contributions of RNs in team-based primary care models. Systematic review. The Meta-Analysis and Systematic Reviews of Observational Studies framework guided the conduct of this review. Five electronic databases (OVID Medline, CINAHL, EMBASE, PubMed and Cochrane Library) were searched using MeSH terms: primary care, roles, and responsibilities. The term "nurs*" was truncated to identify all literature relevant to nursing. The initial search yielded 2243. Abstracts and titles were screened for relevance and seventy-one full text reviews were completed by two researchers. Inclusion criteria included: (1) registered nurses practicing in interprofessional teams; (2) description of registered nursing roles and responsibilities; (3) primary care setting. All eligible studies underwent quality appraisal using the Integrative Quality Criteria for Review of Multiple Study Designs tool. Eighteen studies met eligibility across six countries: Australia, United States, Spain, Canada, New Zealand, and South Africa. Registered nurses play a large role in chronic disease management, patient education, medication management, and often can shift between clinical and administrative responsibilities. There are a limited number of registered nurses that participate in primary care policy making and research. Integrating

  15. The effect of transforming care at the bedside initiative on healthcare teams' work environments.

    Science.gov (United States)

    Lavoie-Tremblay, Mélanie; O'Conner, Patricia; Harripaul, Anastasia; Biron, Alain; Ritchie, Judith; Lavigne, Genevieve L; Baillargeon, Sophie; Ringer, Justin; Macgibbon, Brenda; Taylor-Ducharme, Sharon; Sourdif, Jacynthe

    2014-02-01

    Different initiatives have been implemented in healthcare organizations to improve efficiency, such as transforming care at the bedside (TCAB). However, there are important gaps in understanding the effect of TCAB on healthcare teams' work environments. The specific aim of the study is to describe findings regarding the TCAB initiative effects on healthcare teams' work environments. A pretest and posttest study design was used for this study. The TCAB initiative was implemented in fall 2010 in a university health center in Montreal, Canada. The sample consisted of healthcare workers from four different care units. Statistically significant improvement was observed with the communicating specific information subscale from the measure of processes of care variable, and a significant difference was found between the support from colleagues variable, which was higher at baseline than postprogram. The differences for psychological demand, decisional latitude, and effort-reward were not significant. TCAB is an intervention that allows healthcare teams to implement change to improve patients' and families' outcomes. Ongoing energy should focus on how to improve communication among all members of the team and ensure their support. © 2013 Sigma Theta Tau International.

  16. Do primary care professionals agree about progress with implementation of primary care teams: results from a cross sectional study.

    Science.gov (United States)

    Tierney, E; O'Sullivan, M; Hickey, L; Hannigan, A; May, C; Cullen, W; Kennedy, N; Kineen, L; MacFarlane, A

    2016-11-22

    Primary care is the cornerstone of healthcare reform with policies across jurisdictions promoting interdisciplinary team working. The effective implementation of such health policies requires understanding the perspectives of all actors. However, there is a lack of research about health professionals' views of this process. This study compares Primary Healthcare Professionals' perceptions of the effectiveness of the Primary Care Strategy and Primary Care Team (PCT) implementation in Ireland. Design and Setting: e-survey of (1) General Practitioners (GPs) associated with a Graduate Medical School (N = 100) and (2) Primary Care Professionals in 3 of 4 Health Service Executive (HSE) regions (N = 2309). After piloting, snowball sampling was used to administer the survey. Descriptive analysis was carried out using SPSS. Ratings across groups were compared using non-parametric tests. There were 569 responses. Response rates varied across disciplines (71 % for GPs, 22 % for other Primary Healthcare Professionals (PCPs). Respondents across all disciplines viewed interdisciplinary working as important. Respondents agreed on lack of progress of implementation of formal PCTs (median rating of 2, where 1 is no progress at all and 5 is complete implementation). GPs were more negative about the effectiveness of the Strategy to promote different disciplines to work together (median rating of 2 compared to 3 for clinical therapists and 3.5 for nurses, P = 0.001). Respondents identified resources and GP participation as most important for effective team working. Protected time for meetings and capacity to manage workload for meetings were rated as very important factors for effective team working by GPs, clinical therapists and nurses. A building for co-location of teams was rated as an important factor by nurses and clinical therapists though GPs rated it as less important. Payment to attend meetings and contractual arrangements were considered important factors by

  17. Organizational culture, team climate and diabetes care in small office-based practices

    Directory of Open Access Journals (Sweden)

    van der Weijden Trudy

    2008-08-01

    Full Text Available Abstract Background Redesigning care has been proposed as a lever for improving chronic illness care. Within primary care, diabetes care is the most widespread example of restructured integrated care. Our goal was to assess to what extent important aspects of restructured care such as multidisciplinary teamwork and different types of organizational culture are associated with high quality diabetes care in small office-based general practices. Methods We conducted cross-sectional analyses of data from 83 health care professionals involved in diabetes care from 30 primary care practices in the Netherlands, with a total of 752 diabetes mellitus type II patients participating in an improvement study. We used self-reported measures of team climate (Team Climate Inventory and organizational culture (Competing Values Framework, and measures of quality of diabetes care and clinical patient characteristics from medical records and self-report. We conducted multivariate analyses of the relationship between culture, climate and HbA1c, total cholesterol, systolic blood pressure and a sum score on process indicators for the quality of diabetes care, adjusting for potential patient- and practice level confounders and practice-level clustering. Results A strong group culture was negatively associated to the quality of diabetes care provided to patients (β = -0.04; p = 0.04, whereas a more 'balanced culture' was positively associated to diabetes care quality (β = 5.97; p = 0.03. No associations were found between organizational culture, team climate and clinical patient outcomes. Conclusion Although some significant associations were found between high quality diabetes care in general practice and different organizational cultures, relations were rather marginal. Variation in clinical patient outcomes could not be attributed to organizational culture or teamwork. This study therefore contributes to the discussion about the legitimacy of the widespread idea

  18. Implementation of quality improvement skills by primary care teams: case study of a large academic practice.

    Science.gov (United States)

    Watts, Brook; Lawrence, Renée H; Singh, Simran; Wagner, Carol; Augustine, Sarah; Singh, Mamta K

    2014-04-01

    Continuous quality improvement (QI) is important to primary care in general, and is emphasized as a key tenet of the primary care patient-centered medical home (PCMH) model. While team-based QI activities within the PCMH model are expected, concerns exist as to how successful efforts have been at implementing team-driven QI projects. To (a) identify opportunities and challenges to QI efforts in a large primary care practice in order to (b) develop action plans to facilitate QI work into primary care teams. We obtained qualitative and quantitative information about existing primary care team QI initiatives. Eleven interdisciplinary primary care teams and 4 facilitators/coaches. We conducted unstructured interviews and gathered documentation from primary care team members about QI efforts to (a) characterize team-based QI progress and (b) identify barriers and facilitators. In the 18 months since local leadership prioritized conducting team-based QI projects, team members described multiple exposures to QI training, coaching resources, and data/analysis support. No team developed a formal aim statement. Six of the 11 teams completed any steps beyond the initial team discussion. Four teams attempted to apply an intervention. Challenges included team time and competing demands/priorities; 3 of the 4 teams attempting to implement a project credited a data/informatics facilitator for their progress. In this large academic primary care clinic setting, interdisciplinary team training in QI, support for data collection, and dedicated coaching resources produced few sustainable continuous QI initiatives. Several potentially modifiable barriers to initiation, completion, and sustainability of QI initiatives by primary care teams were identified.

  19. Commentary: educating the present and future health care workforce to provide care to populations.

    Science.gov (United States)

    Garr, David R; Margalit, Ruth; Jameton, Andrew; Cerra, Frank B

    2012-09-01

    The crisis of the rising cost of health care in the United States is stimulating major changes in the way care is being delivered. New models such as patient-centered medical homes and accountable care organizations are being developed with the expectation that health care professionals will address and improve the health of populations. Electronic health records and interprofessional teams will be critical to achieving the goal of better health. It is now time to bring together educators and clinicians at academic health centers, public health educators and practitioners, along with researchers, representatives from the health care delivery and financing systems, and community partners to reengineer health professions education to prepare health professions students for the health care system of the future.

  20. [Satisfaction of principal caregivers of patients followed-up by palliative care teams].

    Science.gov (United States)

    Fernández-Isla, L E; Conde-Valvis-Fraga, S; Fernández-Ruíz, J S

    2016-10-01

    To determine the satisfaction of main caregivers of deceased patients followed-up by palliative care teams. Web research on electronic data bases: PubMed and MEDES, using "Palliative Care" and "Patient Satisfaction" as main descriptors, and "Family", "Professional-Family Relations", "Quality of Health Care" and "Quality Assurance, Health Care" as secondary descriptors. Studies written in Spanish and English were included. Profile of principal caregiver: a woman between her mid-forties and her mid-fifties, usually related with the patient as a daughter, and of primary educational level. The items that the main caregivers valued the most were: a kind manner, feeling free to ask questions about problems during the process, tactful explanations, receiving information, pain management, time for answering questions, interest for emotional problems, and information about treatment. The worse valued items were: symptoms control, lack of psychological support after death, preparation for a death of a relative, keeping in touch after death, help to resolve outstanding issues, and help during grief. In general, a great majority of palliative care teams achieved excellent results. In spite of the good results obtained in satisfaction surveys from caregivers with regard to palliative care teams, it is essential to improve the quality of scientific-technical training (both from the medical and the psychological point of view), as well as to improve communicational skills among palliative care staff. Copyright © 2016 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  1. Informações em saúde: o uso do SIAB pelos profissionais das Equipes de Saúde da Família Información en salud: el uso del SIAB por los profesionales de los Equipos de Salud de la Familia Information in health care: the use of SIAB by the professional teams of family health

    Directory of Open Access Journals (Sweden)

    Janaína de Souza Marcolino

    2010-06-01

    complex organization of basic health care. So, in 1998, the Basic Health Care Information System (SIAB was founded. This research aimed at investigating the use of SIAB by the professional teams of the Family Health Care. A questionnaire was applied to 75 professionals belonging to 10 teams. Besides, of these teams were observed, one week each. It showed as evidence that the Family Health Care teams that participated in this research have not used the available information for planning or assessing their health care services, and so, they have missed the opportunity of using the available information for health care local needs.

  2. Betting against health care.

    Science.gov (United States)

    Appleby, C

    1996-06-20

    Health care firms of all types helped fuel the biggest short-selling frenzy in the New York Stock Exchange's history, recently hitting a record 2.2 billion shares. While some analysts say this means nothing, the fact is that many investors are "shorting" the stock; in other words, they're betting against it. What appears as a lack of confidence may be nothing more than a simple quirk of Wall Street. Good, bad or indifferent, selling short is no tall tale.

  3. Health care engineering

    CERN Document Server

    Frize, Monique

    2013-01-01

    Part II of Health Care Engineering begins with statistics on the occurrence of medical errors and adverse events, and includes some technological solutions. A chapter on electronic medical records follows. The knowledge management process divided into four steps is described; this includes a discussion on data acquisition, storage, and retrieval. The next two chapters discuss the other three steps of the knowledge management process (knowledge discovery, knowledge translation, knowledge integration and sharing). The last chapter briefly discusses usability studies and clinical trials.This two-

  4. Primary care emergency team training in situ means learning in real context

    Science.gov (United States)

    Brandstorp, Helen; Halvorsen, Peder A.; Sterud, Birgitte; Haugland, Bjørgun; Kirkengen, Anna Luise

    2016-01-01

    Objective The purpose of our study was to explore the local learning processes and to improve in situ team training in the primary care emergency teams with a focus on interaction. Design, setting and subjects As participating observers, we investigated locally organised trainings of teams constituted ad hoc, involving nurses, paramedics and general practitioners, in rural Norway. Subsequently, we facilitated focus discussions with local participants. We investigated what kinds of issues the participants chose to elaborate in these learning situations, why they did so, and whether and how local conditions improved during the course of three and a half years. In addition, we applied learning theories to explore and challenge our own and the local participants’ understanding of team training. Results In situ team training was experienced as challenging, engaging, and enabling. In the training sessions and later focus groups, the participants discussed a wide range of topics constitutive for learning in a sociocultural perspective, and topics constitutive for patient safety culture. The participants expanded the types of training sites, themes and the structures for participation, improved their understanding of communication and developed local procedures. The flexible structure of the model mirrors the complexity of medicine and provides space for the participants’ own sense of responsibility. Conclusion Challenging, monthly in situ team trainings organised by local health personnel facilitate many types of learning. The flexible training model provides space for the participants’ own sense of responsibility and priorities. Outcomes involve social and structural improvements, including a sustainable culture of patient safety. Key Points Challenging, monthly in situ team trainings, organised by local health personnel, facilitate many types of learning.The flexible structure of the training model mirrors the complexity of medicine and the realism of the

  5. FastStats: Home Health Care

    Science.gov (United States)

    ... Day Services Centers Home Health Care Hospice Care Nursing Home Care Residential Care Communities Screenings Mammography Pap Tests Disability ... Care National Study of Long-Term Care Providers Nursing Home Care Residential Care Communities Centers for Medicare and Medicaid ...

  6. The role of the surgical care practitioner within the surgical team.

    Science.gov (United States)

    Quick, Julie

    Changes to the surgical workforce and the continued development of health policy have perpetuated the requirement for innovative perioperative roles. The surgical care practitioner is a nurse or allied health professional who works within a surgical team and has advanced perioperative skills, including the ability to undertake surgical interventions.With only limited literature evaluating this role, any benefits of their inclusion to a surgical team are largely anecdotal. This article presents the findings of an autoethnographic inquiry that explored the experiences of surgical team members who worked with the nurse researcher in her role as surgical care practitioner. Surgeons identified the provision of a knowledgeable, competent assistant and operator who enhanced patient care, helped maintain surgical services and supported the training of junior doctors. The professional, ethical and legal obligations of advanced perioperative practice were upheld. Interprofessional collaboration was improved, as was service provision. This further enhanced the patient experience. The traditional viewpoint that nurses who undertake tasks previously associated with medicine should be working to the standard of a doctor is challenged but requires further examination.

  7. Sale of drugs and health care utilization in a health care district in Zaire.

    Science.gov (United States)

    Courtois, X; Dumoulin, J

    1995-06-01

    Health centres of Idjwi district (Zaire) have been self-financed through the selling of drugs since 1985. Medical care is expensive and its use is low (24 visits per year per 100 inhabitants). In 1989 the medical team tried to reduce the cost of visits by changing the prices of drugs and prescriptions. A limited control was set up to assess this intervention. The study showed that although prescribed drug costs were stabilized compared to inflation, there was no increase in the use of medical care. Moreover, the reduction of drug profit margins for health centres seriously affected the health care institution by causing a drop in income. Six months after the intervention the monthly accounts showed a deficit in 6 centres out of 8. The need for health care centres to be self-financing is a major limiting factor in the use of health care in Idjwi district. There are no easy solutions for health centre managers that satisfy both low-cost access to care and health care self-financing. Some minimal financial participation from the state is required. Only then can the concept of financing health care through the selling of drugs be operational.

  8. Communication between the elderly person and the Family Health Team: is there integrality?

    Directory of Open Access Journals (Sweden)

    Rita Tereza de Almeida

    2013-07-01

    Full Text Available OBJECTIVE: to verify the forms of communication used in four Primary Health Units with Family Health Program teams in Porto Feliz, São Paulo, and how they impact in the care and control of the health of elderly people. METHOD: this qualitative study sought to capture the communication between elderly people and healthcare professionals. Interviews were conducted with 20 elderly people of both sexes. RESULTS: from the discourses and observations, assertive communication and blocked communication emerged as the central analysis themes, the verbal and nonverbal elements of which, unveiled subjectivity of the communication process, of the local culture and of the psychosocial factors positively and negatively contributing to the healthcare for elderly people. The nursing teams of the Family Health Strategy showed forms of communication that favored the adherence of the elderly people to the care and control of their health. Negatives aspects did not have completely prejudicial consequences, however, should be avoided, in order to facilitate integral care to elderly people. CONCLUSION: it is worth reinforcing the need for improvement of the nursing team and other healthcare professionals regarding health communication as an innovative technology, bringing credibility to the health promotion and prevention programs with elderly users.

  9. Balancing professional and team boundaries in mental health services: pursuing the holy grail in Somerset.

    Science.gov (United States)

    Gulliver, Pauline; Peck, Edward; Towell, David

    2002-11-01

    The overcoming of professional boundaries to collaboration in patient care has become one of the goals of mental health service policy in England over the past 25 years, predominantly through the creation of community mental health teams. However, research has shown that these boundaries have been slow to come down, and some commentators have pointed to the benefits of appropriate boundaries. This paper introduces a theoretical framework, which seeks to categorise boundary activity in organisations and then examines the boundary activity of professional groups and community teams during the integration of mental health and social care service provision in one locality in the southwest of England. The paper identifies the ways in which this integration impacted on boundary activity and draws out the messages for mental health policy and practice that emerge.

  10. Can a community health worker and a trained traditional birth attendant work as a team to deliver child health interventions in rural Zambia?

    Science.gov (United States)

    Yeboah-Antwi, Kojo; Hamer, Davidson H; Semrau, Katherine; Waltensperger, Karen Z; Snetro-Plewman, Gail; Kambikambi, Chilobe; Sakala, Amon; Filumba, Stephen; Sichamba, Bias; Marsh, David R

    2014-10-27

    Teaming is an accepted approach in health care settings but rarely practiced at the community level in developing countries. Save the Children trained and deployed teams of volunteer community health workers (CHWs) and trained traditional birth attendants (TBAs) to provide essential newborn and curative care for children aged 0-59 months in rural Zambia. This paper assessed whether CHWs and trained TBAs can work as teams to deliver interventions and ensure a continuum of care for all children under-five, including newborns. We trained CHW-TBA teams in teaming concepts and assessed their level of teaming prospectively every six months for two years. The overall score was a function of both teamwork and taskwork. We also assessed personal, community and service factors likely to influence the level of teaming. We created forty-seven teams of predominantly younger, male CHWs and older, female trained TBAs. After two years of deployment, twenty-one teams scored "high", twelve scored "low," and fourteen were inactive. Teamwork was high for mutual trust, team cohesion, comprehension of team goals and objectives, and communication, but not for decision making/planning. Taskwork was high for joint behavior change communication and outreach services with local health workers, but not for intra-team referral. Teams with members residing within one hour's walking distance were more likely to score high. It is feasible for a CHW and a trained TBA to work as a team. This may be an approach to provide a continuum of care for children under-five including newborns.

  11. Collaboration in the provision of mental health care services

    DEFF Research Database (Denmark)

    Jaruseviciene, L.; Valius, L.; Lazarus, J.V.

    2012-01-01

    Background. General practitioners (GPs) often become the first point of care for mental health issues. Improved collaboration between GPs and mental health teams can make a GP's mental health services more efficient. Objective. The aim of this study was to assess the collaboration between GPs and...

  12. Burnout in nurses working in Portuguese palliative care teams: a mixed methods study.

    Science.gov (United States)

    Fonseca, Antonio; Pereira, Sandra; Carvalho, Ana Sofia

    2012-08-01

    Repeat contact with suffering, dying, and death is considered to be a risk factor for burnout among health professionals, particularly nurses working in palliative care. A mixed methods study was conducted to identify burnout levels, risk and protective factors, prevention strategies, and the emotional impact of working in palliative care among nurses in Portugal. A quantitative questionnaire was completed by nursing members of nine different palliative care teams and was supported by interviews and observation. Although the participants were exposed to risk factors, such as work overload, disorganisation, difficult relationships within the team and with patients' relatives, they showed a low risk of burnout. These results appear to be related both to the protective factors identified-namely the ethic of care in the relationship the nurses establish with patients, families, and within their teams-and to the preventive strategies they actively adopt for burnout prevention. The positive aspects of the nurses' roles help them to build a positive view of their work, which also promotes their own personal and professional development.

  13. Collaboration between physicians and a hospital-based palliative care team in a general acute-care hospital in Japan

    Directory of Open Access Journals (Sweden)

    Nishikitani Mariko

    2010-06-01

    Full Text Available Abstract Background Continual collaboration between physicians and hospital-based palliative care teams represents a very important contributor to focusing on patients' symptoms and maintaining their quality of life during all stages of their illness. However, the traditionally late introduction of palliative care has caused misconceptions about hospital-based palliative care teams (PCTs among patients and general physicians in Japan. The objective of this study is to identify the factors related to physicians' attitudes toward continual collaboration with hospital-based PCTs. Methods This cross-sectional anonymous questionnaire-based survey was conducted to clarify physicians' attitudes toward continual collaboration with PCTs and to describe the factors that contribute to such attitudes. We surveyed 339 full-time physicians, including interns, employed in a general acute-care hospital in an urban area in Japan; the response rate was 53% (N = 155. We assessed the basic characteristics, experience, knowledge, and education of respondents. Multiple logistic regression analysis was used to determine the main factors affecting the physicians' attitudes toward PCTs. Results We found that the physicians who were aware of the World Health Organization (WHO analgesic ladder were 6.7 times (OR = 6.7, 95% CI = 1.98-25.79 more likely to want to treat and care for their patients in collaboration with the hospital-based PCTs than were those physicians without such awareness. Conclusion Basic knowledge of palliative care is important in promoting physicians' positive attitudes toward collaboration with hospital-based PCTs.

  14. The Effects of the Transforming Care at the Bedside Program on Perceived Team Effectiveness and Patient Outcomes.

    Science.gov (United States)

    Lavoie-Tremblay, Mélanie; O'Connor, Patricia; Biron, Alain; Lavigne, Geneviéve L; Fréchette, Julie; Briand, Anaïck

    The objective of the study was to document the impact of Transforming Care at the Bedside (TCAB) program on health care team's effectiveness, patient safety, and patient experience. A pretest and posttest (team effectiveness) and a time-series study design (patient experience and safety) were used. The intervention (the TCAB program) was implemented in 8 units in a multihospital academic health science center in Montreal, Quebec, Canada. The impact of TCAB interventions was measured using the Team Effectiveness (TCAB teams, n = 50), and Clostridium difficile-associated diarrhea and vancomycin-resistant Enterobacter rates (patient safety) and Hospital Consumer Assessment of Healthcare Providers and Systems (patient experience; n = 551 patients). The intervention was composed of 4 learning modules, each lasting 12 to 15 weeks of workshops held at the start of each module, combined with hands-on learning 1 day per week. Transforming Care at the Bedside teams also selected 1 key safety indicator to improve throughout the initiative. Pretest and posttest differences indicate improvement on the 5 team effectiveness subscales. Improvement in vancomycin-resistant Enterococcus rate was also detected. No significant improvement was detected for patient experience. These findings call to attention the need to support ongoing quality improvement competency development among frontline teams.

  15. Personal Care in Learning Health Care Systems.

    Science.gov (United States)

    Miller, Franklin G; Kim, Scott Y H

    2015-12-01

    The idea of a "learning health care system"--one that systematically integrates clinical research with medical care--has received considerable attention recently. Some commentators argue that under certain conditions pragmatic comparative effectiveness randomized trials can be conducted ethically within the context of a learning health care system without the informed consent of patients for research participation. In this article, we challenge this perspective and contend that conducting randomized trials of individual treatment options without consent is neither necessary nor desirable to promote and sustain learning health care systems. Our argument draws on the normative conception of personal care developed by Charles Fried in a landmark 1974 book on the ethics of randomized controlled trials.

  16. Teamwork methods for accountable care: relational coordination and TeamSTEPPS®.

    Science.gov (United States)

    Gittell, Jody Hoffer; Beswick, Joanne; Goldmann, Don; Wallack, Stanley S

    2015-01-01

    To deliver greater value in the accountable care context, the Institute of Medicine argues for a culture of teamwork at multiple levels--across professional and organizational siloes and with patients and their families and communities. The logic of performance improvement is that data are needed to target interventions and to assess their impact. We argue that efforts to build teamwork will benefit from teamwork measures that provide diagnostic information regarding the current state and teamwork interventions that can respond to the opportunities identified in the current state. We identify teamwork measures and teamwork interventions that are validated and that can work across multiple levels of teamwork. We propose specific ways to combine them for optimal effectiveness. We review measures of teamwork documented by Valentine, Nembhard, and Edmondson and select those that they identified as satisfying the four criteria for psychometric validation and as being unbounded and therefore able to measure teamwork across multiple levels. We then consider teamwork interventions that are widely used in the U.S. health care context, are well validated based on their association with outcomes, and are capable of working at multiple levels of teamwork. We select the top candidate in each category and propose ways to combine them for optimal effectiveness. We find relational coordination is a validated multilevel teamwork measure and TeamSTEPPS® is a validated multilevel teamwork intervention and propose specific ways for the relational coordination measure to enhance the TeamSTEPPS intervention. Health care systems and change agents seeking to respond to the challenges of accountable care can use TeamSTEPPS as a validated multilevel teamwork intervention methodology, enhanced by relational coordination as a validated multilevel teamwork measure with diagnostic capacity to pinpoint opportunities for improving teamwork along specific dimensions (e.g., shared knowledge

  17. Reforming the health care system: implications for health care marketers.

    Science.gov (United States)

    Petrochuk, M A; Javalgi, R G

    1996-01-01

    Health care reform has become the dominant domestic policy issue in the United States. President Clinton, and the Democratic leaders in the House and Senate have all proposed legislation to reform the system. Regardless of the plan which is ultimately enacted, health care delivery will be radically changed. Health care marketers, given their perspective, have a unique opportunity to ensure their own institutions' success. Organizational, managerial, and marketing strategies can be employed to deal with the changes which will occur. Marketers can utilize personal strategies to remain proactive and successful during an era of health care reform. As outlined in this article, responding to the health care reform changes requires strategic urgency and action. However, the strategies proposed are practical regardless of the version of health care reform legislation which is ultimately enacted.

  18. Investments and costs of oral health care for Family Health Care

    Science.gov (United States)

    Macêdo, Márcia Stefânia Ribeiro; Chaves, Sônia Cristina Lima; Fernandes, Antônio Luis de Carvalho

    2016-01-01

    ABSTRACT OBJECTIVE To estimate the investments to implement and operational costs of a type I Oral Health Care Team in the Family Health Care Strategy. METHODS This is an economic assessment study, for analyzing the investments and operational costs of an oral health care team in the city of Salvador, BA, Northeastern Brazil. The amount worth of investments for its implementation was obtained by summing up the investments in civil projects and shared facilities, in equipments, furniture, and instruments. Regarding the operational costs, the 2009-2012 time series was analyzed and the month of December 2012 was adopted for assessing the monetary values in effect. The costs were classified as direct variable costs (consumables) and direct fixed costs (salaries, maintenance, equipment depreciation, instruments, furniture, and facilities), besides the indirect fixed costs (cleaning, security, energy, and water). The Ministry of Health’s share in funding was also calculated, and the factors that influence cost behavior were described. RESULTS The investment to implement a type I Oral Health Care Team was R$29,864.00 (US$15,236.76). The operational costs of a type I Oral Health Care Team were around R$95,434.00 (US$48,690.82) a year. The Ministry of Health’s financial incentives for investments accounted for 41.8% of the implementation investments, whereas the municipality contributed with a 59.2% share of the total. Regarding operational costs, the Ministry of Health contributed with 33.1% of the total, whereas the municipality, with 66.9%. Concerning the operational costs, the element of heaviest weight was salaries, which accounted for 84.7%. CONCLUSIONS Problems with the regularity in the supply of inputs and maintenance of equipment greatly influence the composition of costs, besides reducing the supply of services to the target population, which results in the service probably being inefficient. States are suggested to partake in funding, especially to cover the

  19. Investments and costs of oral health care for Family Health Care

    Directory of Open Access Journals (Sweden)

    Márcia Stefânia Ribeiro Macêdo

    2016-01-01

    Full Text Available ABSTRACT OBJECTIVE To estimate the investments to implement and operational costs of a type I Oral Health Care Team in the Family Health Care Strategy. METHODS This is an economic assessment study, for analyzing the investments and operational costs of an oral health care team in the city of Salvador, BA, Northeastern Brazil. The amount worth of investments for its implementation was obtained by summing up the investments in civil projects and shared facilities, in equipments, furniture, and instruments. Regarding the operational costs, the 2009-2012 time series was analyzed and the month of December 2012 was adopted for assessing the monetary values in effect. The costs were classified as direct variable costs (consumables and direct fixed costs (salaries, maintenance, equipment depreciation, instruments, furniture, and facilities, besides the indirect fixed costs (cleaning, security, energy, and water. The Ministry of Health’s share in funding was also calculated, and the factors that influence cost behavior were described. RESULTS The investment to implement a type I Oral Health Care Team was R$29,864.00 (US$15,236.76. The operational costs of a type I Oral Health Care Team were around R$95,434.00 (US$48,690.82 a year. The Ministry of Health’s financial incentives for investments accounted for 41.8% of the implementation investments, whereas the municipality contributed with a 59.2% share of the total. Regarding operational costs, the Ministry of Health contributed with 33.1% of the total, whereas the municipality, with 66.9%. Concerning the operational costs, the element of heaviest weight was salaries, which accounted for 84.7%. CONCLUSIONS Problems with the regularity in the supply of inputs and maintenance of equipment greatly influence the composition of costs, besides reducing the supply of services to the target population, which results in the service probably being inefficient. States are suggested to partake in funding

  20. Opportunities in interdisciplinary care team adoption of electronic point-of-care documentation systems.

    Science.gov (United States)

    Sockolow, Paulina S; Bowles, Kathryn H; Rogers, Michelle; Adelsberger, Marguerite C; Chittams, Jesse L; Liao, Cindy

    2014-01-01

    We conducted three evaluation studies in community and hospital settings to examine point-of-care documentation system adoption among interdisciplinary care team clinicians. In the community settings, quantitative methods included documentation time-to-completion and a clinician satisfaction survey. Qualitative methods included observations and follow-up interviews. Qualitative data and quantitative data were merged comparing findings along themes. In the hospitals, qualitative scenario testing results indicated clinician system adoption was universal, though not always timely. At all sites, mismatch between system functionality and workflow was a barrier to clinician system access during patient care and reduced clinician efficiency. Clinicians at all settings were satisfied with their ability to access other clinicians' notes, without increased interdisciplinary team communication. Clinicians did not identify any systems impact on patient outcomes. To facilitate adoption, clinicians should see the value of using the system as intended by receiving system data feedback that shows improvement of patient care and patient safety.

  1. Community health workers in primary care practice: redesigning health care delivery systems to extend and improve diabetes care in underserved populations.

    Science.gov (United States)

    Collinsworth, Ashley; Vulimiri, Madhulika; Snead, Christine; Walton, James

    2014-11-01

    New, comprehensive, approaches for chronic disease management are needed to ensure that patients, particularly those more likely to experience health disparities, have access to the clinical care, self-management resources, and support necessary for the prevention and control of diabetes. Community health workers (CHWs) have worked in community settings to reduce health care disparities and are currently being deployed in some clinical settings as a means of improving access to and quality of care. Guided by the chronic care model, Baylor Health Care System embedded CHWs within clinical teams in community clinics with the goal of reducing observed disparities in diabetes care and outcomes. This study examines findings from interviews with patients, CHWs, and primary care providers (PCPs) to understand how health care delivery systems can be redesigned to effectively incorporate CHWs and how embedding CHWs in primary care teams can produce informed, activated patients and prepared, proactive practice teams who can work together to achieve improved patient outcomes. Respondents indicated that the PCPs continued to provide clinical exams and manage patient care, but the roles of diabetes education, nutritional counseling, and patient activation were shifted to the CHWs. CHWs also provided patients with social support and connection to community resources. Integration of CHWs into clinical care teams improved patient knowledge and activation levels, the ability of PCPs to identify and proactively address specific patient needs, and patient outcomes.

  2. Presentations by ambulance under the NSW Mental Health Act to an emergency department with a 24-hour mental health team.

    Science.gov (United States)

    Skopek, Michaela A; Francis, Jeryl Lynn

    2016-10-01

    The objective of this study was to examine the presentations of patients by ambulance, under Section 20 of the NSW Mental Health Act of 2007, to a hospital emergency department (ED) with a 24-hour Mental Health Team. Patient records between December 2013 and December 2014 were audited and analysed in Excel. There were 47 such presentations: 51% required a mental health admission. Patients required management for up to six of the nine identified mental health and physical problems. As the number of clinical problems in these patients increased, the length of their stay and the likelihood of discharge to home increased. The need for psychiatric admission did not appear to prolong their length of stay, though chemical sedation did. The availability of an ED mental health team did assist in achieving a length of stay that was in keeping with Australian National Emergency Access Target guidelines. A 24-hour ED mental health team provided specialised assessment and management for patients, alongside the necessary emergency medical intervention. This team assisted in easing the increasing pressure on the ED and minimising the patients' length of stay. The team redirected patients requiring admission, facilitated timely discharge of others and revoked Section 20 when less restrictive care was appropriate. © The Royal Australian and New Zealand College of Psychiatrists 2016.

  3. Occupational Health for Health Care Providers

    Science.gov (United States)

    Health care workers are exposed to many job hazards. These can include Infections Needle injuries Back injuries ... prevention practices. They can reduce your risk of health problems. Use protective equipment, follow infection control guidelines, ...

  4. Diabetes Connect: Developing a Mobile Health Intervention to Link Diabetes Community Health Workers with Primary Care

    OpenAIRE

    Cherrington, Andrea L.; Agne, April A; Lampkin, Yolanda; Birl, Annie; Shelton, Tanya C.; Guzman,Alfredo; Willig, James H.

    2015-01-01

    Community Health Worker (CHW) interventions can help improve diabetes self-management and health outcomes. There is limited evidence on how to effectively integrate CHW programs with primary care efforts. Mobile health technology (mHealth) can connect CHWs to members of the healthcare team and enhance care. We tested a model for the integration of a CHW delivered mHealth intervention to improve diabetes self-management. Seventy-two African American patients with diabetes were followed using t...

  5. The German health care system and health care reform.

    Science.gov (United States)

    Kamke, K

    1998-02-01

    This article presents a structured survey of the German health care and health insurance system, and analyzes major developments of current German health policy. The German statutory health insurance system has been known as a system that provides all citizens with ready access to comprehensive high quality medical care at a cost the country considered socially acceptable. However, an increasing concern for rapidly rising health care expenditure led to a number of cost-containment measures since 1977. The aim was to bring the growth of health care expenditure in line with the growth of wages and salaries of the sickness fund members. The recent health care reforms of 1989 and 1993 yielded only short-term reductions of health care expenditure, with increases in the subsequent years. 'Stability of the contribution rate' is the uppermost political objective of current health care reform initiatives. Options under discussion include reductions in the benefit package and increases of patients' co-payments. The article concludes with the possible consequences of the 1997 health care reform of which the major part became effective 1 July 1997.

  6. [Information system in primary health care].

    Science.gov (United States)

    Stevanović, Ranko; Stanić, Arsen; Varga, Sinisa

    2005-01-01

    The Croatian Ministry of Health started a health care system computerization project aimed at strengthening the collaboration among health care institutions, expert groups and individual health care providers. A tender for informatic system for Primary Health Care (PHC) general practice, pediatrics and gynecology, a vital prerequisite for project realization, has now been closed. Some important reasons for undertaking the project include rationalization of drug utilization, savings through a reduced use of specialists, consultants and hospitalization, then achievement of better cooperation, work distribution, result linking, data quality improvement (by standardization), and ensuring proper information-based decision making. Keeping non-standardized and thus difficult to process data takes too much time of the PHC team time. Since, however, a vast amount of data are collected on only a few indicators, some important information may remain uncovered. Although decisions made by health authorities should rely on evidence and processed information, the authorities spend most of the time working with raw data from which their decisions ultimately derive. The Informatic Technology (IT) in PHC is expected to enable a different approach. PHC teams should be relieved from the tedious task of data gathering and the authorities enabled to work with the information rather than data. The Informatics Communication Technology (ICT) system consists of three parts: hardware (5000 personal computers for work over the Internet), operative system with basic software (editor, etc.), and PHC software for PHC teams. At the national level (National Public Health Informatics System), a software platform will be built for data collection, analysis and distribution. This data collection will be based on the International Classification of Primary Care (ICPC-2) standard to ensure the utilization of medical records and quality assessment. The system permits bi-directional data exchange between

  7. Organizational culture, team climate and diabetes care in small office-based practices

    NARCIS (Netherlands)

    Bosch, M.; Dijkstra, R.F.; Wensing, M.J.P.; Weijden, T.T. van der; Grol, R.P.T.M.

    2008-01-01

    BACKGROUND: Redesigning care has been proposed as a lever for improving chronic illness care. Within primary care, diabetes care is the most widespread example of restructured integrated care. Our goal was to assess to what extent important aspects of restructured care such as multidisciplinary team

  8. Accountability in Health Care

    DEFF Research Database (Denmark)

    Vrangbæk, Karsten; Byrkjeflot, Haldor

    2016-01-01

    The debate on accountability within the public sector has been lively in the past decade. Significant progress has been made in developing conceptual frameworks and typologies for characterizing different features and functions of accountability. However, there is a lack of sector specific...... adjustment of such frameworks. In this article we present a framework for analyzing accountability within health care. The paper makes use of the concept of "accountability regime" to signify the combination of different accountability forms, directions and functions at any given point in time. We show...... that reforms can introduce new forms of accountability, change existing accountability relations or change the relative importance of different accountability forms. They may also change the dominant direction and shift the balance between different functions of accountability. We further suggest...

  9. Federalism and Health Care

    Directory of Open Access Journals (Sweden)

    G. Alan Tarr

    2011-10-01

    Full Text Available President Barack Obama proposed a major overhaul of the American healthsystem, and in 2010 the U.S. Congress enacted his proposal, the PatientProtection and Affordable Care Act. Opponents of the Act challenged itsconstitutionality in federal court, claiming that it exceeds the powers grantedto the federal government under the Commerce Clause and the NecessaryProper Clause of the federal Constitution. Some courts have upheldthe law, but others have agreed with the critics, in particular ruling thatthe provision requiring citizens to buy health insurance is unconstitutional.Eventually the U.S. Supreme Court will rule on the issue. This article tracesthe controversy, surveys the interpretation of pertinent constitutional provisionsin past cases, analyzes the constitutional arguments presented byproponents and opponents of the Act, and concludes that the Act is constitutional.

  10. Mental health collaborative care and its role in primary care settings.

    Science.gov (United States)

    Goodrich, David E; Kilbourne, Amy M; Nord, Kristina M; Bauer, Mark S

    2013-08-01

    Collaborative care models (CCMs) provide a pragmatic strategy to deliver integrated mental health and medical care for persons with mental health conditions served in primary care settings. CCMs are team-based intervention to enact system-level redesign by improving patient care through organizational leadership support, provider decision support, and clinical information systems, as well as engaging patients in their care through self-management support and linkages to community resources. The model is also a cost-efficient strategy for primary care practices to improve outcomes for a range of mental health conditions across populations and settings. CCMs can help achieve integrated care aims underhealth care reform yet organizational and financial issues may affect adoption into routine primary care. Notably, successful implementation of CCMs in routine care will require alignment of financial incentives to support systems redesign investments, reimbursements for mental health providers, and adaptation across different practice settings and infrastructure to offer all CCM components.

  11. Health and Disability: Partnerships in Health Care

    Science.gov (United States)

    Tracy, Jane; McDonald, Rachael

    2015-01-01

    Background: Despite awareness of the health inequalities experienced by people with intellectual disability, their health status remains poor. Inequalities in health outcomes are manifest in higher morbidity and rates of premature death. Contributing factors include the barriers encountered in accessing and receiving high-quality health care.…

  12. Health and Disability: Partnerships in Health Care

    Science.gov (United States)

    Tracy, Jane; McDonald, Rachael

    2015-01-01

    Background: Despite awareness of the health inequalities experienced by people with intellectual disability, their health status remains poor. Inequalities in health outcomes are manifest in higher morbidity and rates of premature death. Contributing factors include the barriers encountered in accessing and receiving high-quality health care.…

  13. Flourishing in Health Care.

    Science.gov (United States)

    Edgar, Andrew; Pattison, Stephen

    2016-06-01

    The purpose of this paper is to offer an account of 'flourishing' that is relevant to health care provision, both in terms of the flourishing of the individual patient and carer, and in terms of the flourishing of the caring institution. It is argued that, unlike related concepts such as 'happiness', 'well-being' or 'quality of life', 'flourishing' uniquely has the power to capture the importance of the vulnerability of human being. Drawing on the likes of Heidegger and Nussbaum, it is argued that humans are at once beings who are autonomous and thereby capable of making sense of their lives, but also subject to the contingencies of their bodies and environments. To flourish requires that one engages, imaginatively and creatively, with those contingencies. The experience of illness, highlighting the vulnerability of the human being, thereby becomes an important experience, stimulating reflection in order to make sense of one's life as a narrative. To flourish, it is argued, is to tell a story of one's life, realistically engaging with vulnerability and suffering, and thus creating a framework through which one can meaningful and constructively go on with one's life.

  14. Team Investment and Longitudinal Relationships: An Innovative Global Health Education Model.

    Science.gov (United States)

    Myers, Kimberly R; Fredrick, N Benjamin

    2017-06-27

    Increasing student interest in global health has resulted in medical schools offering more global health opportunities. However, concerns have been raised, particularly about one-time, short-term experiences, including lack of follow-through for students and perpetuation of unintentional messages of global health heroism, neocolonialism, and disregard for existing systems and communities of care. Medical schools must develop global health programs that address these issues. The Global Health Scholars Program (GHSP) was created in 2008-2009 at Penn State College of Medicine. This four-year program is based on values of team investment and longitudinal relationships and uses the service-learning framework of preparation, service, and reflection. Teams of approximately five students, with faculty oversight, participate in two separate monthlong trips abroad to the same host community in years 1 and 4, and in campus- and Web-based activities in years 2 and 3. As of December 2016, 191 students have been accepted into the GHSP. Since inception, applications have grown by 475% and program sites have expanded from one to seven sites on four continents. The response from students has been positive, but logistical challenges persist in sustaining team investment and maintaining longitudinal relationships between student teams and host communities. Formal methods of assessment should be used to compare the GHSP model with more traditional approaches to global health education. Other medical schools with similar aims can adapt the GHSP model to expand their global health programming.

  15. Interdisciplinary geriatric and palliative care team narratives: collaboration practices and barriers.

    Science.gov (United States)

    Goldsmith, Joy; Wittenberg-Lyles, Elaine; Rodriguez, Dariela; Sanchez-Reilly, Sandra

    2010-01-01

    Despite the development and implementation of team training models in geriatrics and palliative care, little attention has been paid to the nature and process of teamwork. Geriatrics and palliative care in the clinical setting offer an interdisciplinary approach structured to meet the comprehensive needs of a patient and his or her family. Fellowship members of an interdisciplinary geriatric and palliative care team participated in semistructured interviews. Team members represented social work, chaplaincy, psychology, nursing, and medicine. A functional narrative analysis revealed four themes: voice of the lifeworld, caregiver teamwork, alone on a team, and storying disciplinary communication. The content-ordering function of narratives revealed a divergence in team members' conceptualization of teamwork and team effectiveness, and group ordering of narratives documented the collaborative nature of teams. The study findings demonstrate the potential for narratives as a pedagogical tool in team training, highlighting the benefits of reflective practice for improving teamwork and sustainability.

  16. Sampling considerations for health care improvement.

    Science.gov (United States)

    Perla, Rocco J; Provost, Lloyd P; Murray, Sandra K

    2014-01-01

    Sampling in improvement work can pose challenges. How is it different from the sampling strategies many use with research, clinical trials, or regulatory programs? What should improvement teams consider when determining a useful approach to sampling and a useful sample size? The aim of this article is to introduce some of the concepts related to sampling for improvement. We give specific guidance related to determining a useful sample size to a wider health care audience so that it can be applied to improvement projects in hospitals and health systems.

  17. The entrepreneurial revolution in health care delivery.

    Science.gov (United States)

    Silver, A D

    1987-06-01

    The rapid changes in the health marketplace have opened the door for entrepreneurs. The author shows how entrepreneurs seek previously unthought of solutions to problems and through a team effort increase corporate value. According to the author, there is a specific profile of the successful entrepreneur. The qualities of the entrepreneur and the managers that work with them, therefore, are discussed in detail. Finally, several examples of problems in health care that present entrepreneurial opportunities are presented. The author includes scenarios for taking advantage of these opportunities.

  18. Education and multidisciplinary team care concepts for pediatric and adolescent diabetes mellitus.

    Science.gov (United States)

    Brink, Stuart J; Miller, Marilyn; Moltz, Kathleen C

    2002-01-01

    The DCCT scientifically established the basis for optimizing blood glucose control in type 1 diabetes mellitus around the world using a multidisciplinary team approach and patient-centered adjustments of food and insulin based upon blood glucose data generated by the patient. Pediatric diabetologists no longer believe that it is prudent to allow higher blood glucose levels in prepubertal children but much educational emphasis must be placed upon minimizing serious episodes of hypoglycemia. Individualized treatment should be determined by a close working relationship between highly trained diabetes nurses, educators and dieticians with the patient as the focus of self-care decisions, and a pediatric diabetologist ideally setting the philosophical and medical goals. Rather than the diabetes health care team being the only ones to initiate treatment, patient and parents should be empowered to analyze their own data, identify patterns, solve problems with food and activity, and do so based upon actual blood glucose results. This empowerment paradigm helps decrease care frustrations and improve treatment outcomes. Survival education followed by in-depth problem solving education and organized follow-up education are all needed steps for successful diabetes management. Identification of psychosocial barriers and energy diverting behavioral and family issues just as knowledge about learning styles play key roles in this process. Dogma should be avoided. More physiological utilization of insulin analogs, greater insulin dosing flexibility with a multidose insulin regimen coupled with adaptation of insulin to food and activity, should allow maximum benefit. Four major types of learning styles are reviewed: concrete sequential learners, abstract sequential learners, abstract random learners and concrete random learners. Health Belief Models, Locus of Control constructs, and Self-Efficacy models all provide sophisticated ways to help identify and overcome learning and self-care

  19. Spiritual Care Education of Health Care Professionals

    Directory of Open Access Journals (Sweden)

    Donia Baldacchino

    2015-05-01

    Full Text Available Nurses and health care professionals should have an active role in meeting the spiritual needs of patients in collaboration with the family and the chaplain. Literature criticizes the impaired holistic care because the spiritual dimension is often overlooked by health care professionals. This could be due to feelings of incompetence due to lack of education on spiritual care; lack of inter-professional education (IPE; work overload; lack of time; different cultures; lack of attention to personal spirituality; ethical issues and unwillingness to deliver spiritual care. Literature defines spiritual care as recognizing, respecting, and meeting patients’ spiritual needs; facilitating participation in religious rituals; communicating through listening and talking with clients; being with the patient by caring, supporting, and showing empathy; promoting a sense of well-being by helping them to find meaning and purpose in their illness and overall life; and referring them to other professionals, including the chaplain/pastor. This paper outlines the systematic mode of intra-professional theoretical education on spiritual care and its integration into their clinical practice; supported by role modeling. Examples will be given from the author’s creative and innovative ways of teaching spiritual care to undergraduate and post-graduate students. The essence of spiritual care is being in doing whereby personal spirituality and therapeutic use of self contribute towards effective holistic care. While taking into consideration the factors that may inhibit and enhance the delivery of spiritual care, recommendations are proposed to the education, clinical, and management sectors for further research and personal spirituality to ameliorate patient holistic care.

  20. The Occupational Therapy in adult Intensive Care Unit (ICU and team perceptions

    Directory of Open Access Journals (Sweden)

    Tatiana Barbieri Bombarda

    2016-10-01

    Full Text Available Introduction: The National Health Surveillance Agency (ANVISA, on 24 February 2010, adopted resolution number 7, which makes mandatory the presence of an occupational therapist as an active member of the Intensive Care Unit professional team. It is believed that the ICU scope is a small professional practice in Occupational Therapy due to the small number of publications in the literature. Objective: To describe the experience and actions developed by occupational therapy in an adult ICU and report the staff awareness reagrding this practice at a state hospital, located in the state of São Paulo. Method: This is an experience report in which we conducted document analysis to obtain data regarding actions taken by occupational therapy, as well as the application of a questionnaire with the team to understand the professionals perceptions regarding the care provided. The data obtained was processed through thematic content analysis. Results: We identified that the occupational therapy intervention transited by functional aspects and support for coping, with the recognition of these actions by the team. Conclusion: The described action consists of practices derived from the occupational therapy insertion process in an adult ICU and meets the desire to encourage the research development in this area for the promotion of debates to promote technical improvement of the profession in the care of critically ill patients.

  1. Communication in Cancer Care (PDQ®)—Health Professional Version

    Science.gov (United States)

    Effective cancer communication between the health care team, cancer patients, and their family is important. Learn about communication skills that support a patient-centered practice and how to talk with adults and children about their diagnosis, prognosis, and transition to end-of-life care in this expert-reviewed summary.

  2. [Health care insurance for Africa].

    Science.gov (United States)

    Schellekens, O P; Lindner, M E; van Esch, J P L; van Vugt, M; Rinke de Wit, T F

    2007-12-01

    Long-term substantial development aid has not prevented many African countries from being caught in a vicious circle in health care: the demand for care is high, but the overburdened public supply of low quality care is not aligned with this demand. The majority of Africans therefore pay for health care in cash, an expensive and least solidarity-based option. This article describes an innovative approach whereby supply and demand of health care can be better aligned, health care can be seen as a value chain and health insurance serves as the overarching mechanism. Providing premium subsidies for patients who seek health care through private, collective African health insurance schemes stimulates the demand side. The supply of care improves by investing in medical knowledge, administrative systems and health care infrastructure. This initiative comes from the Health Insurance Fund, a unique collaboration of public and private sectors. In 2006 the Fund received Euro 100 million from the Dutch Ministry of Foreign Affairs to implement insurance programmes in Africa. PharmAccess Foundation is the Fund's implementing partner and presents its first experiences in Africa.

  3. Child Poverty and the Health Care System.

    Science.gov (United States)

    Racine, Andrew D

    2016-04-01

    The persistence of child poverty in the United States and the pervasive health consequences it engenders present unique challenges to the health care system. Human capital theory and empirical observation suggest that the increased disease burden experienced by poor children originates from social conditions that provide suboptimal educational, nutritional, environmental, and parental inputs to good health. Faced with the resultant excess rates of pediatric morbidity, the US health care system has developed a variety of compensatory strategies. In the first instance, Medicaid, the federal-state governmental finance system designed to assure health insurance coverage for poor children, has increased its eligibility thresholds and expanded its benefits to allow greater access to health services for this vulnerable population. A second arm of response involves a gradual reengineering of health care delivery at the practice level, including the dissemination of patient-centered medical homes, the use of team-based approaches to care, and the expansion of care management beyond the practice to reach deep into the community. Third is a series of recent experiments involving the federal government and state Medicaid programs that includes payment reforms of various kinds, enhanced reporting, concentration on high-risk populations, and intensive case management. Fourth, pediatric practices have begun to make use of specific tools that permit the identification and referral of children facing social stresses arising from poverty. Finally, constituencies within the health care system participate in enhanced advocacy efforts to raise awareness of poverty as a distinct threat to child health and to press for public policy responses such as minimum wage increases, expansion of tax credits, paid family leave, universal preschool education, and other priorities focused on child poverty.

  4. Experiences of security and continuity of care: Patients' and families' narratives about the work of specialized palliative home care teams.

    Science.gov (United States)

    Klarare, Anna; Rasmussen, Birgit H; Fossum, Bjöörn; Fürst, Carl Johan; Hansson, Johan; Hagelin, Carina Lundh

    2017-04-01

    Those who are seriously ill and facing death are often living with physical, emotional, social, and spiritual suffering. Teamwork is considered to be necessary to holistically meet the diverse needs of patients in palliative care. Reviews of studies regarding palliative care team outcomes have concluded that teams provide benefits, especially regarding pain and symptom management. Much of the research concerning palliative care teams has been performed from the perspective of the service providers and has less often focused on patients' and families' experiences of care. Our aim was to investigate how the team's work is manifested in care episodes narrated by patients and families in specialized palliative home care (SPHC). A total of 13 interviews were conducted with patients and families receiving specialized home care. Six patients and seven family members were recruited through SPHC team leaders. Interviews were transcribed verbatim and the transcripts qualitatively analyzed into themes. Two themes were constructed through thematic analysis: (1) security ("They are always available," "I get the help I need quickly"); and (2) continuity of care ("They know me/us, our whole situation and they really care"). Of the 74 care episodes, 50 were descriptions of regularly scheduled visits, while 24 related to acute care visits and/or interventions. Patients' and family members' descriptions of the work of SPHC teams are conceptualized through experiences of security and continuity of care. Experiences of security are fostered through the 24/7 availability of the team, sensitivity and flexibility in meeting patients' and families' needs, and practical adjustments to enable care at home. Experiences of continuity of care are fostered through the team's collective approach, where the individual team member knows the patients and family members, including their whole situation, and cares about the little things in life as well as caring for the family unit.

  5. Perceptions of team workers in youth care of what makes teamwork effective.

    Science.gov (United States)

    Buljac-Samardzic, M; van Wijngaarden, J D H; van Wijk, K P; van Exel, N J A

    2011-05-01

    In youth care, little is known about what makes teamwork effective. What is known mostly reflects the view of managers in care organisations, as objective outcome measures are lacking. The objective of this article was to explore the views of youth care workers in different types of teams on the relative importance of characteristics of teamwork for its effectiveness. Q methodology was used. Fifty-one respondents rank-order 34 opinion statements regarding characteristics of teamwork. Individual Q sorts were analysed using by-person factor analysis. The resulting factors, which represented team workers' views of what is important for effective teamwork, were interpreted and described using composite rankings of the statements for each factor and corresponding team workers' explanations. We found three views of what makes teamwork effective. One view emphasised interaction between team members as most important for team effectiveness. A second view pointed to team characteristics that help sustain communication within teams as being most important. In the third view, the team characteristics that facilitate individuals to perform as a team member were put forward as most important for teamwork to be effective. In conclusion, different views exist on what makes a team effective in youth care. These views correspond with the different types of teams active in youth care as well as in other social care settings.

  6. Exploring the leadership role of the clinical nurse specialist on an inpatient palliative care consulting team.

    Science.gov (United States)

    Stilos, Kalli; Daines, Pat

    2013-03-01

    Demand for palliative care services in Canada will increase owing to an aging population and the evolving role of palliative care in non-malignant illness. Increasing healthcare demands continue to shape the clinical nurse specialist (CNS) role, especially in the area of palliative care. Clinical nurse specialists bring specialized knowledge, skills and leadership to the clinical setting to enhance patient and family care. This paper highlights the clinical leadership role of the CNS as triage leader for a hospital-based palliative care consulting team. Changes to the team's referral and triage processes are emphasized as key improvements to team efficiency and timely access to care for patients and families.

  7. Variables associated with work performance in multidisciplinary mental health teams

    Science.gov (United States)

    Fleury, Marie-Josée; Grenier, Guy; Bamvita, Jean-Marie; Chiocchio, François

    2017-01-01

    Objectives: This study investigates work performance among 79 mental health teams in Quebec (Canada). We hypothesized that work performance was positively associated with the use of standardized clinical tools and clinical approaches, integration strategies, “clan culture,” and mental health funding per capita. Methods: Work performance was measured using an adapted version of the Work Role Questionnaire. Variables were organized into four key areas: (1) team attributes, (2) organizational culture, (3) inter-organizational interactions, and (4) external environment. Results: Work performance was associated with two types of organizational culture (clan and hierarchy) and with two team attributes (use of standardized clinical tools and approaches). Discussion and conclusion: This study was innovative in identifying associations between work performance and best practices, justifying their implementation. Recommendations are provided to develop organizational cultures promoting a greater focus on the external environment and integration strategies that strengthen external focus, service effectiveness, and innovation. PMID:28839935

  8. Desafios para a ação interdisciplinar na atenção básica: implicações relativas à composição das equipes de saúde da família Challenges to an interdisciplinary action in basic care: implications related to composition of family health teams

    Directory of Open Access Journals (Sweden)

    Gecioni Loch-Neckel

    2009-10-01

    Full Text Available O Programa Saúde da Família (PSF surge como uma nova estratégia de atenção à saúde e de reorientação do modelo de assistência. Partindo desses pressupostos, o presente artigo tem como objetivo refletir sobre a relação entre integralidade na atenção básica e a composição das equipes de saúde da família, na perspectiva dos integrantes da equipe mínima do PSF, caracterizando as possibilidades de atuação e contribuições de outros profissionais de saúde no PSF. Participaram da pesquisa profissionais com curso superior, membros de equipes de PSF de um município no sul do Brasil. A qualidade da experiência profissional ou pessoal acerca da atuação desses profissionais contribuiu para o conhecimento sobre suas possibilidades de intervenção. A investigação permitiu também analisar como a estratégia de saúde da família tem atingido os integrantes que constituem as equipes mínimas no contexto local. Além disso, evidenciou de que maneira a integralidade e a interdisciplinaridade têm sido entendidas pelos que compõem tais equipes, e as relações entre a composição das equipes e as (impossibilidades de concretizá-la.The Family Health Program emerges as a new strategy of health care as well as a reorientation of the assistance model. Based on these presuppositions, this article reflects on the relationship between integrality in basic care and the composition of family health teams, in the view of the Family Health Program minimum team members, characterizing the possible fields of action and the contributions of other health professionals in the Family Health Program. Undergraduates and members of a Family Health Program team from a certain city in the south of Brazil participated in this research. The quality of personal or professional expertise of these professionals contributed to a better understanding of their intervention possibilities. The investigation also allowed the analysis of how the family health

  9. Integrated Primary Care Teams (IPCT) pilot project in Quebec: a protocol paper.

    Science.gov (United States)

    Contandriopoulos, Damien; Duhoux, Arnaud; Roy, Bernard; Amar, Maxime; Bonin, Jean-Pierre; Borges Da Silva, Roxane; Brault, Isabelle; Dallaire, Clémence; Dubois, Carl-Ardy; Girard, Francine; Jean, Emmanuelle; Larue, Caroline; Lessard, Lily; Mathieu, Luc; Pépin, Jacinthe; Perroux, Mélanie; Cockenpot, Aurore

    2015-12-23

    The overall aim of this project is to help develop knowledge about primary care delivery models likely to improve the accessibility, quality and efficiency of care. Operationally, this objective will be achieved through supporting and evaluating 8 primary care team pilot sites that rely on an expanded nursing role within a more intensive team-based, interdisciplinary setting. The first research component is aimed at supporting the development and implementation of the pilot projects, and is divided into 2 parts. The first part is a logical analysis based on interpreting available scientific data to understand the causal processes by which the objectives of the intervention being studied may be achieved. The second part is a developmental evaluation to support teams in the field in a participatory manner and thereby learn from experience. Operationally, the developmental evaluation phase mainly involves semistructured interviews. The second component of the project design focuses on evaluating pilot project results and assessing their costs. This component is in turn made up of 2 parts. Part 1 is a pre-and-post survey of patients receiving the intervention care to analyse their care experience. In part 2, each patient enrolled in part 1 (around 4000 patients) will be matched with 2 patients followed within a traditional primary care model, so that a comparative analysis of the accessibility, quality and efficiency of the intervention can be performed. The cohorts formed in this way will be followed longitudinally for 4 years. The project, as well as all consent forms and research tools, have been accepted by 2 health sciences research ethics committees. The procedures used will conform to best practices regarding the anonymity of patients. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  10. A team approach to improving colorectal cancer services using administrative health data

    Directory of Open Access Journals (Sweden)

    Porter Geoffrey

    2012-01-01

    Full Text Available Abstract Background Colorectal cancer (CRC is the third most commonly diagnosed cancer in Canada and accounts for 11.9% of all cancer-related mortality. Fortunately, previous studies have provided evidence of improved outcomes from access to timely and appropriate health services along the disease trajectory in CRC. As a result, the CIHR/CCNS Team in Access to Colorectal Cancer Services in Nova Scotia (Team ACCESS was created to build colorectal cancer (CRC research capacity in Nova Scotia (NS and to study access to and quality of CRC services along the entire continuum of cancer care. Objectives The objectives of this paper are to: 1 provide a detailed description of the methodologies employed across the various studies being conducted by Team ACCESS; 2 demonstrate how administrative health data can be used to evaluate access and quality in CRC services; and 3 provide an example of an interdisciplinary team approach to addressing health service delivery issues. Methods All patients diagnosed with CRC in NS between 2001 and 2005 were identified through the Nova Scotia Cancer Registry (NSCR and staged using the Collaborative Stage Data Collection System. Using administrative databases that were linked at the patient level, Team ACCESS created a retrospective longitudinal cohort with comprehensive demographic, clinical, and healthcare utilization data. These data were used to examine access to and quality of CRC services in NS, as well as factors affecting access to and quality of care, at various transition points along the continuum of care. Team ACCESS has also implemented integrated knowledge translation strategies targeting policy- and decision- makers. Discussion The development of Team ACCESS represents a unique approach to CRC research. We anticipate that the skills, tools, and knowledge generated from our work will also advance the study of other cancer disease sites in NS. Given the increasing prevalence of cancer, and with national and

  11. Mental health nurses' contributions to community mental health care: An Australian study.

    Science.gov (United States)

    Heslop, Brett; Wynaden, Dianne; Tohotoa, Jenny; Heslop, Karen

    2016-10-01

    Australian mental health policy is focused on providing mental health care in the community setting and community mental health teams provide services to clients in a shared model with primary care. The historical literature reports that community mental health nurses' experience high levels of stress and are often allocated the most complex and challenging clients managed by the team. Yet information on their specific roles remains limited. This paper reports on research conducted at one Australian public mental health service to identify the components of the community mental health nursing role and to quantify the time nurses spent in each component during the study period. Six focus groups were conducted with community mental health nurses to identify their perceived role within the team. Data analysis identified 18 components of which 10 were related to direct clinical contact with clients and eight covered administrative and care coordination activities. A data collection tool based on the findings of the focus groups was designed and nurses recorded workload data on the tool in 15-min intervals over a 4-week period. Seventeen nurses collected 1528 hours of data. Internal coordination of care was identified as the top workload item followed by clinical documentation and national data collection responsibilities supporting the complexity of the community mental health nursing role. The high rating attached to the internal coordination of care role demonstrates an important contribution that community mental health nurses make to the functioning of the team and the delivery of quality mental health care.

  12. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    2Department of Health Policy and Management, Faculty of Public Health, College of Medicine and University ... 86 (21%) had primary school education, 210 (51.3%) were married, and 357 (87.3%) were employed. ...... patient satisfaction and behavioral intentions in. 5. .... Psychological Assessment 1995; 7 (3):309-319.

  13. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    user

    2Department of Community Health, University of Benin, Benin City, Nigeria. ... public health problem that can lead to a great burden of disability in the community. ..... women. Equally worthy of note, is the fact that a higher proportion of females ...

  14. Radiology as the Point of Cancer Patient and Care Team Engagement: Applying the 4R Model at a Patient's Breast Cancer Care Initiation.

    Science.gov (United States)

    Weldon, Christine B; Friedewald, Sarah M; Kulkarni, Swati A; Simon, Melissa A; Carlos, Ruth C; Strauss, Jonathan B; Bunce, Mikele M; Small, Art; Trosman, Julia R

    2016-12-01

    Radiologists aspire to improve patient experience and engagement, as part of the Triple Aim of health reform. Patient engagement requires active partnerships among health providers and patients, and rigorous teamwork provides a mechanism for this. Patient and care team engagement are crucial at the time of cancer diagnosis and care initiation but are complicated by the necessity to orchestrate many interdependent consultations and care events in a short time. Radiology often serves as the patient entry point into the cancer care system, especially for breast cancer. It is uniquely positioned to play the value-adding role of facilitating patient and team engagement during cancer care initiation. The 4R approach (Right Information and Right Care to the Right Patient at the Right Time), previously proposed for optimizing teamwork and care delivery during cancer treatment, could be applied at the time of diagnosis. The 4R approach considers care for every patient with cancer as a project, using project management to plan and manage care interdependencies, assign clear responsibilities, and designate a quarterback function. The authors propose that radiology assume the quarterback function during breast cancer care initiation, developing the care initiation sequence, as a project care plan for newly diagnosed patients, and engaging patients and their care teams in timely, coordinated activities. After initial consultations and treatment plan development, the quarterback function is transitioned to surgery or medical oncology. This model provides radiologists with opportunities to offer value-added services and solidifies radiology's relevance in the evolving health care environment. To implement 4R at cancer care initiation, it will be necessary to change the radiology practice model to incorporate patient interaction and teamwork, develop 4R content and local adaption approaches, and enrich radiology training with relevant clinical knowledge, patient interaction

  15. Sustainable care improvement programs supported by undergraduate health care education

    NARCIS (Netherlands)

    C.H.M. Smits (Carolien); A. Harps (Annelies); A.M.V. Stoopendaal (Annemiek); A.M. Kamper (Ad); M.M.H. Strating (Mathilde); R.A. Bal (Roland)

    2017-01-01

    markdownabstractBackground: The Care for Better Region program was developed to achieve sustainable care improvement focusing onfall prevention. Key ingredients involved improvement teams developing and implementing a falls reduction plan, PracticeDevelopment; facilitation of

  16. Negotiating the equivocality of palliative care: a grounded theory of team communicative processes in inpatient medicine.

    Science.gov (United States)

    Ledford, Christy J W; Canzona, Mollie Rose; Cafferty, Lauren A; Kalish, Virginia B

    2016-01-01

    In the majority of U.S. hospitals, inpatient medicine teams make palliative care decisions in the absence of a formalized palliative system. Using a grounded theory approach, interviews with inpatient team members were systematically analyzed to uncover how participants conceptualize palliative care and how they regard the communicative structures that underlie its delivery. During analysis, Weick's model of organizing emerged as a framework that fit the data. The 39 participant inpatient team members discussed palliative care as primarily a communicative process. Themes describing the meaning of palliative care emerged around the concepts of receiver of care, timeline of care, and location of care. The emerging model included four stages in the communicative processes of inpatient palliative care: (a) interpret the need, (b) initiate the conversation, (c) integrate the processes, and (d) identify what works. In contrast to stable, focused palliative care teams or hospice care teams, which have prescribed patient populations and processes, the inpatient medicine team faces the equivocality of providing palliative care within a broader practice. This research offers a four-phase model to show how these inpatient teams communicate within this context. Implications for the provision of palliative care are discussed.

  17. How do interprofessional student teams interact in a primary care clinic? A qualitative analysis using activity theory.

    Science.gov (United States)

    Kent, Fiona; Francis-Cracknell, Alison; McDonald, Rachael; Newton, Jennifer M; Keating, Jennifer L; Dodic, Miodrag

    2016-10-01

    Practice based interprofessional education opportunities are proposed as a mechanism for health professionals to learn teamwork skills and gain an understanding of the roles of others. Primary care is an area of practice that offers a promising option for interprofessional student learning. In this study, we investigated what and how students from differing professions learn together. Our findings inform the design of future interprofessional education initiatives. Using activity theory, we conducted an ethnographic investigation of interprofessional education in primary care. During a 5 months period, we observed 14 clinic sessions involving mixed discipline student teams who interviewed people with chronic disease. Teams were comprised of senior medicine, nursing, occupational therapy, pharmacy and physiotherapy entry level students. Semi-structured interviews were also conducted with seven clinical educators. Data were analysed to ascertain the objectives, tools, rules and division of labour. Two integrated activity systems were identified: (1) student teams gathering information to determine patients' health care needs and (2) patients either as health consumers or student educators. Unwritten rules regarding 'shared contribution', 'patient as key information source' and 'time constraints' were identified. Both the significance of software literacy on team leadership, and a pre-determined structure of enquiry, highlighted the importance of careful consideration of the tools used in interprofessional education, and the way they can influence practice. The systems of practice identified provide evidence of differing priorities and values, and multiple perspectives of how to manage health. The work reinforced the value of the patients' voice in clinical and education processes.

  18. Health promotion innovation in primary health care

    OpenAIRE

    Alexandra McManus

    2013-01-01

    Previously, the main focus of primary health care practices was to diagnose and treat patients. The identification of risk factors for disease and the prevention of chronic conditions have become a part of everyday practice. This paper provides an argument for training primary health care (PHC) practitioners in health promotion, while encouraging them to embrace innovation within their practice to streamline the treatment process and improve patient outcomes. Electronic modes of communication...

  19. Using Learning Teams for Reflective Adaptation (ULTRA): insights from a team-based change management strategy in primary care.

    Science.gov (United States)

    Balasubramanian, Bijal A; Chase, Sabrina M; Nutting, Paul A; Cohen, Deborah J; Strickland, Pamela A Ohman; Crosson, Jesse C; Miller, William L; Crabtree, Benjamin F

    2010-01-01

    The Using Learning Teams for Reflective Adaptation (ULTRA) study used facilitated reflective adaptive process (RAP) teams to enhance communication and decision making in hopes of improving adherence to multiple clinical guidelines; however, the study failed to show significant clinical improvements. The purpose of this study was to examine qualitative data from 25 intervention practices to understand how they engaged in a team-based collaborative change management strategy and the types of issues they addressed. We analyzed field notes and interviews from a multimethod practice assessment, as well as field notes and audio-taped recordings from RAP meetings, using an iterative group process and an immersion-crystallization approach. Despite a history of not meeting regularly, 18 of 25 practices successfully convened improvement teams. There was evidence of improved practice-wide communication in 12 of these practices. At follow-up, 8 practices continued RAP meetings and found the process valuable in problem solving and decision making. Seven practices failed to engage in RAP primarily because of key leaders dominating the meeting agenda or staff members hesitating to speak up in meetings. Although the number of improvement targets varied considerably, most RAP teams targeted patient care-related issues or practice-level organizational improvement issues. Not a single practice focused on adherence to clinical care guidelines. Primary care practices can successfully engage in facilitated team meetings; however, leaders must be engaged in the process. Additional strategies are needed to engage practice leaders, particularly physicians, and to target issues related to guideline adherence.

  20. The Oral Health Care Manager in a Patient-Centered Health Facility.

    Science.gov (United States)

    Theile, Cheryl Westphal; Strauss, Shiela M; Northridge, Mary Evelyn; Birenz, Shirley

    2016-06-01

    The dental hygienist team member has an opportunity to coordinate care within an interprofessional practice as an oral health care manager. Although dental hygienists are currently practicing within interprofessional teams in settings such as pediatric offices, hospitals, nursing homes, schools, and federally qualified health centers, they often still assume traditional responsibilities rather than practicing to the full extent of their training and licenses. This article explains the opportunity for the dental hygiene professional to embrace patient-centered care as an oral health care manager who can facilitate integration of oral and primary care in a variety of health care settings. Based on an innovative model of collaboration between a college of dentistry and a college of nursing, an idea emerged among several faculty members for a new management method for realizing continuity and coordination of comprehensive patient care. Involved faculty members began working on the development of an approach to interprofessional practice with the dental hygienist serving as an oral health care manager who would address both oral health care and a patient's related primary care issues through appropriate referrals and follow-up. This approach is explained in this article, along with the results of several pilot studies that begin to evaluate the feasibility of a dental hygienist as an oral health care manager. A health care provider with management skills and leadership qualities is required to coordinate the interprofessional provision of comprehensive health care. The dental hygienist has the opportunity to lead closer integration of oral and primary care as an oral health care manager, by coordinating the team of providers needed to implement comprehensive, patient-centered care. Copyright © 2016 Elsevier Inc. All rights reserved.