The contract contains detailed specifications from the purchaser and outcome control requires detailed reporting by the provider [11, 12]. Craven, MA and Bland, R (). Journal of Interprofessional Care (Suppl 1): 116–31, DOI: Inter-professional collaboration on patients is personally and professionally demanding, takes time, and presupposes that health care professions both know and trust each other. People refer to all software with a social component (chat, messaging, document sharing, etc.) Reframing the challenges to integrated care: a complex-adaptive systems perspective. Most of patients had an IP, but they still experienced discontinuity in service delivery. We used meta-ethnography as a method to synthesize the results across our eight articles focusing on how key barriers to collaboration can impact on clinical practice from the perspective of patients and providers. The likely result is a hodgepodge promotion that lacks focus and a clear target. The nurses in the intermediate unit collaborated appropriately and the patient felt well cared for. The second analytic stage included identifying meaning units related to each of these three topics. The GP as a collaborative actor in municipal care. Romøren, TI, Torjesen, DO and Landmark, B (2011). The overall aim of this article is to explore how challenges of collaboration impact on clinical work in healthcare services in Norway across four different healthcare contexts: (i) intermediate unit for older people, (ii) mental health care services (iii) home-based rehabilitation, and (iv) GPs’ collaboration in municipal care. Bjerkan, J, Richter, M, Grimsmo, A, Hellesø, R and Brender, J (2011). The increasing professional differentiation and sub-division of healthcare services in Norway has been allied with attempts to improve collaboration and coordination between health care services. This is impeded by time pressures and lack of places to meet on a face to face basis. According to Lauren McAdams, career advisor and hiring manager at, the most successful method for creating excellent intra-team relations were instilling a sense of teamwork early on in the onboarding process. It requires clinical work to be broken down into smaller, measurable units. Different professional groups disagreed as to what rehabilitation is and had different foci in the rehabilitation process. This leads to initial assumptions about relations between studies. Ahgren, B (2014). Insufficient inter-disciplinary collaboration seemed to hamper work with patients. Degeling, PJ, Maxwell, S, Iedema, R and Hunter, DJ (2004). DOI:, Steihaug, S., et al.. “Challenges in Achieving Collaboration in Clinical Practice: The Case of Norwegian Health Care”. The study’s new and original contribution to knowledge in this field is that our findings reveal how challenges to collaboration are intimately connected to a range of organizational factors across the four contexts under study. On the other hand, if national policies are lacking, the collaboration arrangements in healthcare could develop in different ways with accordingly various effect for patients involved. The four researchers coming from different professions and perspectives performed the data analyses according to the meta-ethnography methods. Poor teamwork can lead to grave mistakes. For example, instead of working toward a … Hospitals are financed by a combination of block grants and activity based financing, with hospital employees paid on the basis of a fixed salary. clinical medical activity provided by various groups of healthcare professionals. The significance of good relationships between providers and having sufficient time and resources for ongoing relationship-building has been well rehearsed in the literature [3]. Several reported about how they “were admitted” and “were discharged” without being consulted. Thanks to the researchers Hilde Lurås, Anne Werner, and Jan Lippestad for valuable contributions in the half-yearly research workshops where the analysis and emerging findings were discussed and debated. Dag Olaf Torjesen, Associate Professor, Ph.d., Dep. European Societies 8(3): 403–22, DOI:, Vabø, M (2012). In four separate but inter-linked empirical projects we explored the professional and organizational challenges to achieving collaboration in different health care settings in the Norwegian health system from the perspective of both providers and patients. Both in the intermediate unit [15] and the municipalities [18, 19, 20] physicians, nurses and physiotherapists revealed different understandings of their own and others’ roles and tasks. This method was developed for synthesizing published literature and involves taking relevant empirical studies to be synthesized, reading them repeatedly and noting down key concepts. The results are summarised in one article: Paulsen: Playing a key role, GPs share their treatment of patients with many collaborative partners. The municipality was committed to receiving patients ready to be discharged. For instance were different symptoms treated in different departments in specialist services without collaboration between providers in the different departments. “We cannot always wait for that”, a GP related. The synthesis of these key concepts is achieved via a translation. The lack of collaboration resulted in inadequate rehabilitation services and lengthened the institutional stay for older patients. [8] recently addressed the concept of patient-centeredness in the provision of integrated care. There are written rules about how to define a patient who is ready to be discharged, but they don’t necessarily work in practice”. Just about every job will require teamwork and collaboration. When you think of collaboration, the first thing that comes to mind likely … Even though the authors knew all the sub-projects fairly well we read all the eight articles thoroughly at the start of the process of analysis. Improve network security. Phase 1: Getting started – identifying an intellectual interest that qualitative research might inform. Norwegian municipalities are required to offer social, psychosocial, or medical rehabilitation to all inhabitants requiring such services and to establish a coordinating unit for rehabilitation. As a medical specialty, the field of psychiatry is based on a medical logic in which mental disorders are classified into stable, universal categories - diagnoses - where one diagnosis is associated with specific treatment methods with predicted effects [26, 27]. The key is to limit the number of tools by finding a fe… Holum, LC (2012). Despite the fact that municipalities are required by law to provide rehabilitation, patients were rarely rehabilitated in their own home [18]. Example: Cisco leverages a collaboration environment to crowd source issues and requests; these enables them yo find the best and fastest solution which makes for a … Steihaug, S., Johannessen, A.-K., Ådnanes, M., Paulsen, B. and Mannion, R., 2016. The nurse-led unit had 15 beds, was located near a university hospital, and constituted collaboration between the hospital and four municipalities. Fragmented healthcare services require effective collaboration. Ådnanes: Article II. Signs of Weak Leadership in the Business Place, Traits & Qualities Exhibited by a Bad Leader. A strength of the study is that four different contexts were studied and a wide spectrum of professionals interviewed but a study limitation was that there were relatively few participants in some of the studies. In collaboration between GPs and specialists in mental health, GPs seem to feel inferior; they want to be regarded as competent colleagues by the specialists and to be accorded the same level of respect that specialists show each other [32]. 2016;16(3):3. Good patient-provider relationships required, according to the patients “good chemistry,” trust, and continuity. Policies and programmes to achieve this aim are among other initiatives which established intermediate units between the two governmental levels, and the introduction of a daily penalty fee when municipalities are not able to receive those patients that are ready for discharge from hospital. In the municipalities, nurses on the managerial level placed less emphasis on home based rehabilitation than nurses on the clinical level [18, 19]. Differences in positional and economic power may also lead to significant barriers to inter-professional collaboration. Health Technol Assess 15(43): 1–164, DOI: When studies are about similar issues, they can be synthesised as reciprocal translations. The whole group met at half-yearly workshops throughout the period of research and openly debated and discussed the analysis, emerging findings and their interpretation. Many described the negative effects of this uncertainty and unpredictability. Vabø, M (2006). The findings from the study are summarised in eight articles, outlined below: Sub-project I explored an intermediate unit recently established to improve the clinical pathway from hospital to home for patients aged 60 and over. DOI:, Steihaug S, Johannessen A-K, Ådnanes M, Paulsen B, Mannion R. Challenges in Achieving Collaboration in Clinical Practice: The Case of Norwegian Health Care. A risk with knowing the projects so well could be that the researchers held common biases or took things for granted. DOI: Are about similar issues, they encounter confused and misinformed staff coin general... 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