Mirjam Körner

Interprofessional teamwork in medical rehabilitation: a comparison of multidisciplinary and interdisciplinary team approach

Objective: To compare multi- and interdisciplinary team approaches concerning team process (teamwork) and team effectiveness (team performance and staff satisfaction) in German medical rehabilitation clinics. Design: A cross-sectional study with a descriptive—explorative design. Setting: Eighteen medical rehabilitation clinics divided into two groups (somatic and psychosomatic indication fields). Subjects: The 18 head physicians or psychotherapists in the clinics and their complete rehabilitation teams (n = 824). Main measures: An interview guide was designed to determine the team approach in a telephone interview. A staff questionnaire for team members measured teamwork and team effectiveness with psychometrically validated questionnaires and self-administered items. Results: All 18 head physicians took part in the telephone interview. The response rate of the employee attitude survey averaged 46% (n = 378). Eight teams were categorized as multidisciplinary and seven teams as interdisciplinary. In three cases the results were ambiguous. These teams were not considered in the further study. As expected, the interdisciplinary team approach showed significantly better results for nearly all aspects of teamwork and team effectiveness in comparison with the multidisciplinary team approach. The differences between multi- and interdisciplinary approach concerning teamwork and team effectiveness were higher in the somatic (8 teams, n = 183) than in the psychosomatic indication fields (7 teams, n = 195). Conclusions: Teamwork and team effectiveness are higher in teams working with the interdisciplinary team approach. Therefore the interdisciplinary approach can be recommended, particularly for clinics in the somatic indication field. Team development can help to move from the multidisciplinary to the interdisciplinary approach.

Interprofessional teamwork and team interventions in chronic care: A systematic review

ABSTRACT To identify key features of teamwork and interventions for enhancing interprofessional teamwork (IPT) in chronic care and to develop a framework for further research, we conducted a systematic literature review of IPT in chronic care for the years 2002–2014. Database searches yielded 3217 abstracts, 21 of which fulfilled inclusion criteria. We identified two more studies on the topic by scanning the reference lists of included articles, which resulted in a final total of 23 included studies. The key features identified in the articles (e.g., team member characteristics, common task, communication, cooperation, coordination, responsibility, participation, staff satisfaction, patient satisfaction, and efficiency) were structured in line with the input–process–output model, and evaluated interventions, such as tools, workshops, and changes in team structure, were added to the model. The most frequently evaluated team interventions were complex intervention programs. All but one of the 14 evaluation studies resulted in enhancement of teamwork and/or staff-related, patient-related, and organization-related outcome criteria. To date, there is no consensus about the main features of IPT and the most effective team interventions in chronic care. However, the findings may be used to standardize the implementation and evaluation of IPT and team interventions in practice and for further research.

Designing an interprofessional training program for shared decision making

For implementation of patient-centered treatment in interprofessional health care units, such as rehabilitation teams, external participation (interaction between patient and health care professionals) and internal participation (communication, coordination and cooperation in the interprofessional team) need to be considered. The aim of this study is to identify the preferences of patients and health care professionals concerning internal and external participation in rehabilitation clinics, in order to develop an interprofessional shared decision-making (SDM) training program for health care professionals to enhance both types of participation. Therefore, a cross-sectional mixed-methods study was implemented in four rehabilitation clinics. The study consists of two parts: focus groups with patients and a survey of experts (senior health care professionals from medicine, psychotherapy, physical therapy and nursing). More time, more respect from the health care professionals and the desire for more participation in decision-making processes were mentioned most frequently by patients (n = 36) in the focus groups. The health care professionals (n = 32) saw most deficits in internal participation, e.g. management of feedback, talking with difficult team members and moderate conflict discussion. The results of both assessments have been used to develop an interprofessional SDM training program for implementing internal and external participation in interprofessional teams in medical rehabilitation.

Knowledge integration, teamwork and performance in health care.

PURPOSE Knowledge integration is the process of building shared mental models. The integration of the diverse knowledge of the health professions in shared mental models is a precondition for effective teamwork and team performance. As it is known that different groups of health care professionals often tend to work in isolation, the authors compared the perceptions of knowledge integration. It can be expected that based on this isolation, knowledge integration is assessed differently. The purpose of this paper is to test these differences in the perception of knowledge integration between the professional groups and to identify to what extent knowledge integration predicts perceptions of teamwork and team performance and to determine if teamwork has a mediating effect. DESIGN/METHODOLOGY/APPROACH The study is a multi-center cross-sectional study with a descriptive-explorative design. Data were collected by means of a staff questionnaire for all health care professionals working in the rehabilitation clinics. FINDINGS The results showed that there are significant differences in knowledge integration within interprofessional health care teams. Furthermore, it could be shown that knowledge integration is significantly related to patient-centered teamwork as well as to team performance. Mediation analysis revealed partial mediation of the effect of knowledge integration on team performance through teamwork. PRACTICAL/IMPLICATIONS: In practice, the results of the study provide a valuable starting point for team development interventions. ORIGINALITY/VALUE This is the first study that explored knowledge integration in medical rehabilitation teams and its relation to patient-centered teamwork and team performance.

Development and psychometric properties of a scale for measuring internal participation from a patient and health care professional perspective

BackgroundEffective patient-centred health care requires internal participation, which is defined as interprofessional patient-centred teamwork. Many scales are designed for measuring teamwork from the perspective of one type of health care professional (e.g. physician or nurse), rather than for the use for all health care professionals as well as patients. Hence, this paper’s purpose is to develop a scale for measuring internal participation from all relevant perspectives and to check its psychometric properties.MethodsIn a multicentre cross-sectional study, a 6-item Internal Participation Scale (IPS) was developed and administered to 661 health care professionals (staff) and 1419 patients in 15 rehabilitation clinics to test item characteristics, acceptance, reliability (internal consistency) and construct validity. Additionally, we performed an exploratory factor analysis (EFA) to determine the factorial structure and explained variance. Confirmatory factor analysis (CFA) was used to verify the theoretically assumed one-dimensional factorial structure.ResultsA total of 275 health care professionals and 662 patients participated, and the complete data sets of 272 staff members and 536 patients were included in the final analysis. The discrimination index was above .4 for all items in both samples. Internal consistency was very good, with Cronbach’s alpha equalling .87 for the staff and .88 for the patient sample. EFA supported a one-dimensional structure of the instrument (explained variance: 61.1% (staff) and 62.3% (patients)). CFA verified the factorial structure, with the factor loadings exceeding .4 for five of six items in both samples. Global goodness-of-fit indices indicated a good model fit, with a Tucker-Lewis index (TLI) of .974 (staff) and .976 (patients) and a comparative fit index (CFI) of .988 (staff) and .989 (patients). The root mean square error of approximation (RMSEA) amounted to .068 for the patient sample and .069 for the staff sample. There is evidence of construct validity for both populations.ConclusionsThe analysis of the scale’s psychometric properties resulted in good values. The scale is a promising instrument to assess internal participation from the perspective of both patients and staff. Further research should investigate the scale’s psychometric properties in other interprofessional health care settings to examine its generalizability as well as its sensitivity to change.

Die Bedeutung der internen und externen Partizipation für die Patientenzufriedenheit

AIM OF THE STUDY Patient satisfaction is an essential quality and outcome criteria for patient-centered treatment of chronic diseases. For successful implementation of integrated patient-centered care it is important to take the needs and expectations of the patients into consideration in the treatment process and to involve them in decision-making (external participation), as well as establishing patient-centered collaboration within the team and organization (internal participation). This study examines in what respect patient satisfaction can be predicted through parameters that focus on the personal needs of the individual or internal and external participation. METHODS To this end we used a multicenter cross-sectional study to collect evaluations from N=329 patients with different chronic diseases in 11 rehabilitation clinics. Patient satisfaction (ZUF-8) served as the criterion, and the predictors were external participation (PEF-FB-9), satisfaction with decision-making (Man-Son-Hing Scale) and internal participation (Internal Participation Scale), socio-demographic factors and rehabilitation status (IRES-24). The data were analyzed statistically using multiple linear regression. RESULTS A high degree of variance of patient satisfaction could be explained by the parameters applied (Goodness-of-fit: R²corrected=47.3%). The strongest predictors of satisfaction were internal participation (Beta=0.44, p<0.001) and satisfaction with the decision-making (Beta=0.36, p<0.001). CONCLUSION The study provides initial indications of the positive effects of internal and external participation. Further studies are necessary to substantiate the connection between internal and external participation and patient satisfaction.

Patient-centeredness and its impact on patient satisfaction and treatment outcomes in medical rehabilitation.

OBJECTIVE To examine the impact of patient-centeredness for patient satisfaction and treatment outcomes. METHOD A multicenter cross-sectional survey study with patients (n=1033) in nine medical rehabilitation centers in Germany was conducted. Data was analyzed with multiple linear regression. Predictors were patient-centeredness (CCRQ-15) and patient́s age, employment and therapeutic indication; outcomes were patient satisfaction and treatment outcomes (changes in living conditions and health status). RESULTS The regression model could explain 54% of variance in patient satisfaction. The strongest predictor was decision-making/communication (β=0.34). In treatment outcome, 19% of variance of changes in living conditions and 21% of variance of changes in state of health could be explained. The strongest predictor in both variables was self-management/empowerment (β=0.40 and 0.32, respectively). CONCLUSION The results emphasize the relevance of patient-centered treatments for patient satisfaction and treatment results. The evidence is provided for the first time in medical rehabilitation. PRACTICE IMPLICATIONS Further studies should consider multilevel modeling and diverse survey methods. Continued implementation and evaluation of patient-centeredness in the medical rehabilitation treatment are recommended measures. Promoting shared decision-making, effective clinician-patient communication, and increased patient empowerment are essential, e.g. by patient education programs or staff training in shared decision-making.

[Team Development in Medical Rehabilitation: Concept and Evaluation of a Team Intervention].

AIM OF THE STUDY Interprofessional collaboration is a main precondition of successful treatment in rehabilitation. In order to improve interprofessional collaboration, a clinic-specific, goal- and solution-oriented and systemic team development approach was designed. The aim of the study is the evaluation of this approach. METHODS A multi-centre cluster-randomized controlled study with staff questionnaires. RESULTS The team development could be implemented successfully in 4 of 5 clinics and led to significant improvements in team organisation, willingness to accept responsibility and knowledge integration. The effects are small and are caused by the opposed development of intervention and control group. CONCLUSIONS The team development approach can be recommended for rehabilitation practice. A train-the-trainer approach will be developed and further studies are planned in order to disseminate the approach and to investigate the conditions of implementation.

Healthcare professionals’ evaluation of interprofessional teamwork and job satisfaction / Evaluation der Teamarbeit und der Arbeitszufriedenheit von Gesundheitsfachberufen

Abstract Interprofessional teamwork among healthcare professionals in healthcare organizations is a key factor for both their job satisfaction and patients’ effective and efficient treatment. One precondition for successful interprofessional teamwork is a shared mental model (a common cognitive frame of reference and knowledge) of working together as a team. However, there often exist subcultures, and each of these has its own mental model of teamwork. Hence, it can be assumed that different healthcare professional groups do not share the evaluation of their interprofessional teamwork and job satisfaction (Hypothesis 1). Additionally, based on the input-process-output model of team effectiveness, it can be expected that interprofessional teamwork determines job satisfaction (Hypothesis 2). These hypotheses were tested in a survey of 272 employees in 15 rehabilitation clinics in Germany. Results showed that healthcare professionals’ evaluation of their interprofessional teamwork (F(3, 203) = 9.118, p < 0.001, η2 = 0.119) as well as their job satisfaction (F(3, 210) = 3.357, p = 0.02, η2 = 0.046) differed significantly. Physicians reported the highest level of interprofessional teamwork and job satisfaction compared with other groups. Perceptions of interprofessional teamwork explain approximately 20% of the variance in job satisfaction. Thus, both hypotheses were confirmed. Interprofessional interventions in education and practice are recommended to establish a shared mental model, which could improve teamwork and subsequently job satisfaction.

Psychometric evaluation of the Client-Centered Rehabilitation Questionnaire (CCRQ) in a large sample of German rehabilitation patients

Objective: Structural analysis of the German translation of the “Client-Centered Rehabilitation Questionnaire” (CCRQ). Design: Cross-sectional multicenter study. Setting: Ten inpatient rehabilitation centers in Germany. Subjects: The CCRQ was completed by patients in the ten rehabilitation centers. Main measures: The psychometric analysis of the CCRQ was conducted using exploratory and confirmatory factor analysis. Results: The CCRQ was completed by 496 patients (average age: 59 years; 59.7% women). The CCRQ’s 7-factor structure could not be confirmed. Factor analysis showed that the three latent constructs “decision-making/communication”, “self-management/empowerment”, and “psychosocial well-being” (60.73% variance explained) adequately represent patient-centeredness in medical rehabilitation assessed by the CCRQ. The scales possess good reliability (Cronbach’s α = .83 to .87) and convergent criterion validity (r = 0.48 to 0.68). The three-factorial model exhibited good local and global data fit (RMSEA: 0.063, CFI 0.962, TLI 0.954) and proved to have a better data fit than concurring models (e.g. a model assuming an underlying factor). Conclusions: A validated short form of the Client-Centered Rehabilitation Questionnaire, CCRQ-15, could be identified. Three scales based on 15 items allow assessing the key aspects of patient-centeredness in German medical rehabilitation.